This document summarizes a study examining the association between socioeconomic status (SES) and the presence, introduction, and retention of smoke-free policies in homes, worksites, bars, and restaurants. The study used data from the International Tobacco Control Four Country Survey, which included over 8,000 smokers from Canada, the US, the UK, and Australia at Wave 5 and nearly 6,000 of those respondents at Wave 6. The results showed that smokers with high SES had increased odds of having and introducing a total smoking ban in the home compared to low SES smokers. High SES smokers also had decreased odds of removing a home smoking ban. No consistent association was found between SES and smoke-free policies in works
This study examined the association between tobacco control policies and smoking prevalence, denormalization of smoking, and public support for tobacco control across European Union countries. The researchers found that countries with higher scores on the Tobacco Control Scale (measuring implementation of tobacco policies) had more smokers who reported quitting due to concerns about passive smoking harming others. This concern about passive smoking was also strongly correlated with greater public support for tobacco control policies. The results suggest that addressing concerns about passive smoking is important for advancing tobacco control measures and denormalizing tobacco use in Europe.
This document discusses electronic cigarettes (ECs) and whether they are safer than combustible cigarettes. It summarizes that while ECs may expose users to fewer harmful chemicals than smoking, the long-term safety of ECs is still unknown. Studies have found potentially harmful chemicals in EC vapor, but in much lower amounts than in cigarette smoke. The regulation of ECs is also debated, as stricter rules may discourage innovation but make the products less appealing to youth and non-smokers. The evidence that ECs help smokers quit is also limited and inconclusive. More research is still needed to understand the public health impact of ECs.
Editorial: Evidence based policy or policy based evidence? by Michael MarmotJim Bloyd, DrPH, MPH
A simple prescription would be to review the scientific evidence of what would make a difference, formulate policies, and implement them—evidence based policy making. Unfor- tunately this simple prescription, applied to real life, is simplistic. The relation between science and policy is more complicated. Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be.
This document discusses tobacco control and prevention policies recommended by the American College of Physicians. It provides background on the health and economic impacts of tobacco use. Key points include:
- Tobacco use is the leading preventable cause of death in the US. Comprehensive tobacco control programs are needed to reduce smoking rates.
- The FDA was given authority in 2009 to regulate tobacco, but regulation alone is not enough. States must fund tobacco control efforts and increase tobacco taxes.
- Smokeless tobacco and cigars also harm health. Secondhand smoke exposure causes illness and death in nonsmokers.
Dr. Terry F. Pechacek, professor of health management and policy at the School of Public Health at Georgia State University, discusses strategies for tobacco control, including the impact of of e-cigarettes.
This document discusses tobacco harm reduction strategies for engaging healthcare professionals in Nigeria. It defines harm reduction as improving lives without focusing solely on abstinence. Tobacco harm reduction aims to provide safer nicotine delivery alternatives to cigarettes like e-cigarettes and smokeless tobacco. Healthcare professionals can advocate for harm reduction, educate about reduced risk products, and support spiritual and physical wellbeing to help people quit smoking. Embracing harm reduction strategies is key to achieving global smoke-free goals.
This document discusses efforts to develop safer cigarettes through modifying tobacco and reducing tar and toxic compounds. In the 20th century, tobacco companies experimented with adding filters and other additives to cigarettes in attempts to make them less hazardous. One promising attempt involved adding palladium to tobacco, but this "Epic" brand was withheld from the market due to pressure from tobacco control groups and other companies. Later attempts in the 1970s by government and industry to develop "tobacco substitutes" and ultra-low tar cigarettes also failed commercially. Opponents argued safer cigarettes could deter quitting and mask the true risks of smoking. Overall, fully neutralizing the harms of smoking has proved very difficult due to the many toxic compounds produced from
This study examined the association between tobacco control policies and smoking prevalence, denormalization of smoking, and public support for tobacco control across European Union countries. The researchers found that countries with higher scores on the Tobacco Control Scale (measuring implementation of tobacco policies) had more smokers who reported quitting due to concerns about passive smoking harming others. This concern about passive smoking was also strongly correlated with greater public support for tobacco control policies. The results suggest that addressing concerns about passive smoking is important for advancing tobacco control measures and denormalizing tobacco use in Europe.
This document discusses electronic cigarettes (ECs) and whether they are safer than combustible cigarettes. It summarizes that while ECs may expose users to fewer harmful chemicals than smoking, the long-term safety of ECs is still unknown. Studies have found potentially harmful chemicals in EC vapor, but in much lower amounts than in cigarette smoke. The regulation of ECs is also debated, as stricter rules may discourage innovation but make the products less appealing to youth and non-smokers. The evidence that ECs help smokers quit is also limited and inconclusive. More research is still needed to understand the public health impact of ECs.
Editorial: Evidence based policy or policy based evidence? by Michael MarmotJim Bloyd, DrPH, MPH
A simple prescription would be to review the scientific evidence of what would make a difference, formulate policies, and implement them—evidence based policy making. Unfor- tunately this simple prescription, applied to real life, is simplistic. The relation between science and policy is more complicated. Scientific findings do not fall on blank minds that get made up as a result. Science engages with busy minds that have strong views about how things are and ought to be.
This document discusses tobacco control and prevention policies recommended by the American College of Physicians. It provides background on the health and economic impacts of tobacco use. Key points include:
- Tobacco use is the leading preventable cause of death in the US. Comprehensive tobacco control programs are needed to reduce smoking rates.
- The FDA was given authority in 2009 to regulate tobacco, but regulation alone is not enough. States must fund tobacco control efforts and increase tobacco taxes.
- Smokeless tobacco and cigars also harm health. Secondhand smoke exposure causes illness and death in nonsmokers.
Dr. Terry F. Pechacek, professor of health management and policy at the School of Public Health at Georgia State University, discusses strategies for tobacco control, including the impact of of e-cigarettes.
This document discusses tobacco harm reduction strategies for engaging healthcare professionals in Nigeria. It defines harm reduction as improving lives without focusing solely on abstinence. Tobacco harm reduction aims to provide safer nicotine delivery alternatives to cigarettes like e-cigarettes and smokeless tobacco. Healthcare professionals can advocate for harm reduction, educate about reduced risk products, and support spiritual and physical wellbeing to help people quit smoking. Embracing harm reduction strategies is key to achieving global smoke-free goals.
This document discusses efforts to develop safer cigarettes through modifying tobacco and reducing tar and toxic compounds. In the 20th century, tobacco companies experimented with adding filters and other additives to cigarettes in attempts to make them less hazardous. One promising attempt involved adding palladium to tobacco, but this "Epic" brand was withheld from the market due to pressure from tobacco control groups and other companies. Later attempts in the 1970s by government and industry to develop "tobacco substitutes" and ultra-low tar cigarettes also failed commercially. Opponents argued safer cigarettes could deter quitting and mask the true risks of smoking. Overall, fully neutralizing the harms of smoking has proved very difficult due to the many toxic compounds produced from
The role of harm reduction in tobacco controlTobaccoFindings
The document discusses the role of harm reduction in tobacco control. It argues that for current tobacco users who cannot quit, switching to a nicotine product that is markedly less harmful than cigarettes, such as nicotine replacement therapy or low-nitrosamine smokeless tobacco, can significantly reduce health risks compared to continuing smoking. While prevention and smoking cessation efforts are important, harm reduction strategies are also needed to help smokers unable or unwilling to quit nicotine use altogether. Regulating alternative nicotine products to ensure they are much safer than cigarettes can achieve public health benefits as part of a comprehensive approach to tobacco control.
This document provides smoking prevalence and impact data for England from various surveys. Key points include: smoking prevalence among adults was 14.9% in 2017 and was higher for routine workers and those with mental health conditions; 6.7% of 15 year olds smoked regularly in 2016; smoking attributable mortality was 263 per 100,000 people aged 35+ in 2015-17; and there were 1,685 smoking attributable hospital admissions per 100,000 aged 35+ in 2016/17. The document also presents data on smoking quitters, illicit tobacco, and the harms of secondhand smoke.
NYU College of Global Health - E-cigarette seminar - New YorkClive Bates
E-Cigarettes: The Tectonic Shift in Nicotine and Tobacco Consumption: Opportunity or Threat to Saving Lives?
Clive Bates
Friday, October 19, 2018
NYU School of Law, Greenberg Lounge
40 Washington Square South, New York, New York
Li et al china predictors of quitting paper published versionAlexander Li
This research report examines predictors of quitting behaviors among adult smokers in six cities in China using data from the International Tobacco Control (ITC) China Survey. The study followed 4732 smokers surveyed in 2006, with 3863 respondents re-contacted in 2007. The study found that 25.3% of smokers reported making a quit attempt in the follow-up period, with 21.7% of those still abstaining from smoking. Independent predictors of making a quit attempt included higher quitting self-efficacy, previous quit attempts, stronger immediate quitting intentions, longer time to first cigarette upon waking, negative opinions of smoking, and smoking restrictions at home. Independent predictors of staying quit included older age, longer previous abstinence
Vaping and tobacco: six things you need to know about harm reductionClive Bates
1. Smoking has not gone away
2. Technologies to obsolete cigarettes
3. Risks and risk (mis)perceptions
4. The public health mechanism and the pleasure principle
5. The youth vaping epidemic – a harder look
6. Policymaking and perverse consequences
This document provides smoking prevalence and tobacco control data for England. Key facts include that smoking prevalence among adults was 14.9% in 2017, with higher rates for routine workers and those with mental illness. Around 6.7% of 15 year olds regularly smoke. Smoking causes over 1,500 years of life lost per 100,000 people annually and over 1,600 hospital admissions per 100,000 people. Over 300,000 people set a quit date in 2016/17, with around 2,200 successful quitters per 100,000 smokers.
Seven insights into tobacco harm reductionClive Bates
1st Tobacco Harm Reduction Malaysia Scientific Meeting
21 November 2021.
1. The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
Patch 3 smoking prevalence & attributable burdenNimraBhatti6
The document analyzes smoking prevalence and disease burden from 1990-2015 based on a study. It finds that while smoking rates have decreased significantly globally, one in four men and one in twenty women still smoke daily. The top three causes of smoking-attributable diseases are cardiovascular, cancer, and chronic respiratory globally. It recommends stronger implementation of tobacco control policies, improved monitoring of smoking behaviors, and supplementing surveys with biomarkers to better track smoking trends.
Knowledge and awareness of tobacco related health problems: A study from East...EDITOR IJCRCPS
Three million people die every year because of tobacco-related diseases in the world. The present
study was carried out to find out the association between Knowledge and awareness towards tobacco
consumption and to find out association between awareness towards tobacco consumption and
diseases in the last one year among residents of Dhankuta Municipality. The cross-sectional study was
conducted among residents of Dhankuta Municipality where 205 households were taken as subjects.
Pretested semi-structured questionnaire was administered to the study subjects and face to face
interview was conducted. Chi-square test was applied to find out the association between Knowledge
and awareness towards tobacco consumption and association between awareness towards tobacco
consumption and diseases in the last one year among residents of Dhankuta Municipality. The
respondents those thinking that tobacco is injurious to health were significantly more aware (46.9%)
than those not thinking (26.7%) (P<0.05). The respondents those thinking that tobacco can cause oral
problems (51.7%) and respiratory problems (48%) were more aware but the difference were not
significant. The respondent suffered from diseases was high who was not aware of tobacco
consumption (18.2%). The respondent suffered from respiratory problems (12.5%) and oral problems
(10%) was high among those not aware of tobacco consumption but the difference was not significant.
We conclude that people those thinking that tobacco is injurious to health were significantly more
aware. The people who were not aware of tobacco consumption suffered more from diseases but the
difference was not significant.
Innovation for Consumers: E-cigarettes and novel tobacco products - Part of t...Clive Bates
This document discusses e-cigarettes and novel tobacco products. It argues that they are substantially less harmful than combustible cigarettes and have the potential to significantly reduce smoking rates and associated deaths. However, regulations should balance this potential benefit with preventing unintended consequences like perpetuating smoking or increasing youth uptake. The document proposes risk-proportionate regulations and taxes to incentivize switching from cigarettes, along with standards, marketing restrictions, and age limits, while ensuring products remain appealing to smokers trying to quit. The goal is harm reduction for populations according to the WHO framework convention on tobacco control.
Albania National Association of Public health - Harm Reduction ConferenceClive Bates
Seven insights into tobacco harm reduction (20 min version) 20th December 2021.
1.The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
The txt2stop trial assessed the effectiveness of an automated smoking cessation program delivered via mobile phone text messaging. Over 5,800 smokers were randomly assigned to either receive the text messaging intervention providing motivational messages and support or control messages unrelated to quitting. The primary outcome of biochemically verified continuous abstinence at 6 months was significantly higher in the intervention group at 10.7% compared to 4.9% in the control group. The text messaging program significantly improved smoking cessation rates at 6 months and should be considered for inclusion in smoking cessation services.
This document discusses smoking rates and health risks in the United States. It provides statistics showing that while smoking rates have declined, millions still smoke and die from tobacco-related illnesses each year. The document examines factors influencing smoking behaviors like education level, gender, and access to healthcare. It also explores approaches to reducing smoking like healthcare provider education, smoke-free laws, marketing restrictions, and smoking cessation programs.
This document summarizes the results of a survey on substance use, mental health, risky behaviors, and service needs among grade 8-10 learners in Western Cape schools in 2011. Some key findings include:
- Alcohol, tobacco, and cannabis were the most commonly used substances. Two-thirds of learners reported alcohol use, nearly half reported tobacco use, and about a quarter reported cannabis use.
- Males generally reported higher rates of substance use than females. They were more likely to report behaviors like binge drinking, weekly alcohol and tobacco use, and smoking more than 10 cigarettes per day.
- Hard drug use like cocaine, mandrax, ecstasy, heroin, and methamphetamine was relatively low at
Smoking was identified as a major addictive behavior among students at Tula State University in Russia. According to surveys, 75% of Russian citizens associate a healthy lifestyle with smoking cessation. The number of smokers in Russia has increased over the last 20 years, especially among younger people aged 15-19. Among college students, 75% of males and 64% of females smoke. The report identifies predisposing, enabling, and reinforcing factors for smoking among TSU students and recommends addressing these through seminars, presentations, and activities to decrease smoking rates by 30% by June 2014.
Tobacco Harm Reduction - an introductionClive Bates
This document provides an introduction to tobacco harm reduction and alternative nicotine products such as e-cigarettes. It summarizes statements from public health organizations that find e-cigarettes to be much less harmful than combustible cigarettes. Research shows e-cigarettes help smokers quit at the population level and are effective cessation tools. The document argues for risk-proportionate regulation and taxation of nicotine products to incentivize smokers to switch to less harmful options and further reduce smoking rates.
This document summarizes a study examining how socioeconomic status influences the price minimizing behaviors of smokers. The study analyzed data from over 7,000 smokers across 4 countries (Canada, US, UK, Australia) who participated in the International Tobacco Control survey between 2006-2007. The study found that relatively common price avoidance strategies included purchasing discount brands (36%), roll-your-own tobacco (13.5%), cartons of cigarettes (29%), or obtaining cigarettes from low/untaxed sources (8%). Lower socioeconomic smokers were more likely to use discount brands but less likely to purchase from low-tax sources or in cartons. Overall, lower socioeconomic smokers engaged in at least one price avoidance behavior more than higher socioeconomic smokers
This document summarizes a study that examined how socioeconomic status influences the behaviors smokers use to minimize the costs of tobacco products when prices increase. The study analyzed data from over 8,000 smokers across 4 countries. It found that while many smokers engage in cost-cutting behaviors like buying discount brands, in bulk, or from untaxed sources, the specific strategies differed by socioeconomic status. Lower-SES smokers were more likely to use discount brands, while higher-SES smokers were more likely to purchase from low-tax locations or in bulk. Overall, lower-SES smokers were slightly more likely to engage in at least one cost-minimizing behavior. The strategies used by lower-SES smokers, like discount brands, could be more
The role of harm reduction in tobacco controlTobaccoFindings
The document discusses the role of harm reduction in tobacco control. It argues that for current tobacco users who cannot quit, switching to a nicotine product that is markedly less harmful than cigarettes, such as nicotine replacement therapy or low-nitrosamine smokeless tobacco, can significantly reduce health risks compared to continuing smoking. While prevention and smoking cessation efforts are important, harm reduction strategies are also needed to help smokers unable or unwilling to quit nicotine use altogether. Regulating alternative nicotine products to ensure they are much safer than cigarettes can achieve public health benefits as part of a comprehensive approach to tobacco control.
This document provides smoking prevalence and impact data for England from various surveys. Key points include: smoking prevalence among adults was 14.9% in 2017 and was higher for routine workers and those with mental health conditions; 6.7% of 15 year olds smoked regularly in 2016; smoking attributable mortality was 263 per 100,000 people aged 35+ in 2015-17; and there were 1,685 smoking attributable hospital admissions per 100,000 aged 35+ in 2016/17. The document also presents data on smoking quitters, illicit tobacco, and the harms of secondhand smoke.
NYU College of Global Health - E-cigarette seminar - New YorkClive Bates
E-Cigarettes: The Tectonic Shift in Nicotine and Tobacco Consumption: Opportunity or Threat to Saving Lives?
Clive Bates
Friday, October 19, 2018
NYU School of Law, Greenberg Lounge
40 Washington Square South, New York, New York
Li et al china predictors of quitting paper published versionAlexander Li
This research report examines predictors of quitting behaviors among adult smokers in six cities in China using data from the International Tobacco Control (ITC) China Survey. The study followed 4732 smokers surveyed in 2006, with 3863 respondents re-contacted in 2007. The study found that 25.3% of smokers reported making a quit attempt in the follow-up period, with 21.7% of those still abstaining from smoking. Independent predictors of making a quit attempt included higher quitting self-efficacy, previous quit attempts, stronger immediate quitting intentions, longer time to first cigarette upon waking, negative opinions of smoking, and smoking restrictions at home. Independent predictors of staying quit included older age, longer previous abstinence
Vaping and tobacco: six things you need to know about harm reductionClive Bates
1. Smoking has not gone away
2. Technologies to obsolete cigarettes
3. Risks and risk (mis)perceptions
4. The public health mechanism and the pleasure principle
5. The youth vaping epidemic – a harder look
6. Policymaking and perverse consequences
This document provides smoking prevalence and tobacco control data for England. Key facts include that smoking prevalence among adults was 14.9% in 2017, with higher rates for routine workers and those with mental illness. Around 6.7% of 15 year olds regularly smoke. Smoking causes over 1,500 years of life lost per 100,000 people annually and over 1,600 hospital admissions per 100,000 people. Over 300,000 people set a quit date in 2016/17, with around 2,200 successful quitters per 100,000 smokers.
Seven insights into tobacco harm reductionClive Bates
1st Tobacco Harm Reduction Malaysia Scientific Meeting
21 November 2021.
1. The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
Patch 3 smoking prevalence & attributable burdenNimraBhatti6
The document analyzes smoking prevalence and disease burden from 1990-2015 based on a study. It finds that while smoking rates have decreased significantly globally, one in four men and one in twenty women still smoke daily. The top three causes of smoking-attributable diseases are cardiovascular, cancer, and chronic respiratory globally. It recommends stronger implementation of tobacco control policies, improved monitoring of smoking behaviors, and supplementing surveys with biomarkers to better track smoking trends.
Knowledge and awareness of tobacco related health problems: A study from East...EDITOR IJCRCPS
Three million people die every year because of tobacco-related diseases in the world. The present
study was carried out to find out the association between Knowledge and awareness towards tobacco
consumption and to find out association between awareness towards tobacco consumption and
diseases in the last one year among residents of Dhankuta Municipality. The cross-sectional study was
conducted among residents of Dhankuta Municipality where 205 households were taken as subjects.
Pretested semi-structured questionnaire was administered to the study subjects and face to face
interview was conducted. Chi-square test was applied to find out the association between Knowledge
and awareness towards tobacco consumption and association between awareness towards tobacco
consumption and diseases in the last one year among residents of Dhankuta Municipality. The
respondents those thinking that tobacco is injurious to health were significantly more aware (46.9%)
than those not thinking (26.7%) (P<0.05). The respondents those thinking that tobacco can cause oral
problems (51.7%) and respiratory problems (48%) were more aware but the difference were not
significant. The respondent suffered from diseases was high who was not aware of tobacco
consumption (18.2%). The respondent suffered from respiratory problems (12.5%) and oral problems
(10%) was high among those not aware of tobacco consumption but the difference was not significant.
We conclude that people those thinking that tobacco is injurious to health were significantly more
aware. The people who were not aware of tobacco consumption suffered more from diseases but the
difference was not significant.
Innovation for Consumers: E-cigarettes and novel tobacco products - Part of t...Clive Bates
This document discusses e-cigarettes and novel tobacco products. It argues that they are substantially less harmful than combustible cigarettes and have the potential to significantly reduce smoking rates and associated deaths. However, regulations should balance this potential benefit with preventing unintended consequences like perpetuating smoking or increasing youth uptake. The document proposes risk-proportionate regulations and taxes to incentivize switching from cigarettes, along with standards, marketing restrictions, and age limits, while ensuring products remain appealing to smokers trying to quit. The goal is harm reduction for populations according to the WHO framework convention on tobacco control.
Albania National Association of Public health - Harm Reduction ConferenceClive Bates
Seven insights into tobacco harm reduction (20 min version) 20th December 2021.
1.The problem is smoking
2. Smoke-free alternatives
3. Quitting smoking with smoke-free alternatives
4. Health concerns
5. Youth vaping
6. Policy and unintended consequences
7. Innovation (and its enemies)
The txt2stop trial assessed the effectiveness of an automated smoking cessation program delivered via mobile phone text messaging. Over 5,800 smokers were randomly assigned to either receive the text messaging intervention providing motivational messages and support or control messages unrelated to quitting. The primary outcome of biochemically verified continuous abstinence at 6 months was significantly higher in the intervention group at 10.7% compared to 4.9% in the control group. The text messaging program significantly improved smoking cessation rates at 6 months and should be considered for inclusion in smoking cessation services.
This document discusses smoking rates and health risks in the United States. It provides statistics showing that while smoking rates have declined, millions still smoke and die from tobacco-related illnesses each year. The document examines factors influencing smoking behaviors like education level, gender, and access to healthcare. It also explores approaches to reducing smoking like healthcare provider education, smoke-free laws, marketing restrictions, and smoking cessation programs.
This document summarizes the results of a survey on substance use, mental health, risky behaviors, and service needs among grade 8-10 learners in Western Cape schools in 2011. Some key findings include:
- Alcohol, tobacco, and cannabis were the most commonly used substances. Two-thirds of learners reported alcohol use, nearly half reported tobacco use, and about a quarter reported cannabis use.
- Males generally reported higher rates of substance use than females. They were more likely to report behaviors like binge drinking, weekly alcohol and tobacco use, and smoking more than 10 cigarettes per day.
- Hard drug use like cocaine, mandrax, ecstasy, heroin, and methamphetamine was relatively low at
Smoking was identified as a major addictive behavior among students at Tula State University in Russia. According to surveys, 75% of Russian citizens associate a healthy lifestyle with smoking cessation. The number of smokers in Russia has increased over the last 20 years, especially among younger people aged 15-19. Among college students, 75% of males and 64% of females smoke. The report identifies predisposing, enabling, and reinforcing factors for smoking among TSU students and recommends addressing these through seminars, presentations, and activities to decrease smoking rates by 30% by June 2014.
Tobacco Harm Reduction - an introductionClive Bates
This document provides an introduction to tobacco harm reduction and alternative nicotine products such as e-cigarettes. It summarizes statements from public health organizations that find e-cigarettes to be much less harmful than combustible cigarettes. Research shows e-cigarettes help smokers quit at the population level and are effective cessation tools. The document argues for risk-proportionate regulation and taxation of nicotine products to incentivize smokers to switch to less harmful options and further reduce smoking rates.
This document summarizes a study examining how socioeconomic status influences the price minimizing behaviors of smokers. The study analyzed data from over 7,000 smokers across 4 countries (Canada, US, UK, Australia) who participated in the International Tobacco Control survey between 2006-2007. The study found that relatively common price avoidance strategies included purchasing discount brands (36%), roll-your-own tobacco (13.5%), cartons of cigarettes (29%), or obtaining cigarettes from low/untaxed sources (8%). Lower socioeconomic smokers were more likely to use discount brands but less likely to purchase from low-tax sources or in cartons. Overall, lower socioeconomic smokers engaged in at least one price avoidance behavior more than higher socioeconomic smokers
This document summarizes a study that examined how socioeconomic status influences the behaviors smokers use to minimize the costs of tobacco products when prices increase. The study analyzed data from over 8,000 smokers across 4 countries. It found that while many smokers engage in cost-cutting behaviors like buying discount brands, in bulk, or from untaxed sources, the specific strategies differed by socioeconomic status. Lower-SES smokers were more likely to use discount brands, while higher-SES smokers were more likely to purchase from low-tax locations or in bulk. Overall, lower-SES smokers were slightly more likely to engage in at least one cost-minimizing behavior. The strategies used by lower-SES smokers, like discount brands, could be more
Varenicline became available as a prescription stop smoking medication between 2006-2008 in the US, UK, Canada, and Australia. This study uses survey data to examine trends in stop smoking medication use in these countries during this period. The study finds that overall use of stop smoking medications increased significantly in all four countries. Varenicline became the second most used medication behind NRT. Varenicline use increased substantially, from 0.4% to 21.7% in the US and 0% to 14.8% in Canada. Males and non-whites were less likely to use medications while more educated smokers were more likely. The introduction of varenicline appears to have increased overall medication use rather than
Varenicline became available as a prescription stop smoking medication between 2006-2008 in the US, UK, Canada, and Australia. This study uses survey data to examine trends in stop smoking medication use in these countries during this period. The study finds that the use of any stop smoking medication increased significantly over the 3 years in all 4 countries. Varenicline became the second most used medication, behind NRT. Varenicline use increased substantially in each country as it was introduced, from 0.4-21.7% in the US to 0-14.8% in Canada. This suggests varenicline increased overall medication use rather than just gaining market share.
Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Sm.docxtoltonkendal
Efficacy of Nicotine Replacement Therapy (NRT) to Aid Cigarette Smoking Cessation amongst Adults in United Kingdom
Introduction
Tobacco smoking is a major contributor to many serious diseases that eventually lead to death in the United Kingdom (UK). According to Office of National Statistics (ONS) (2017), 7.4 million of United Kingdom’s population are smokers and 19.7 percent of these smokers are adult with age-range of 25 to 34 years. Tobacco cigarettes contain nicotine. Nicotine changes the balance of two chemicals namely noreadrenaline and dopamine which are found in human the brain. The sudden change on the levels of these chemicals after inhalation may result in changes in mood which could result in reduction of stress, anxiety and increase in pleasure (National Health Service (NHS), 2018a). Transmission of nicotine by inhalation of tobacco is the fastest way of distributing nicotine into the bloodstream according to Action on Smoking and Health (ASH) (2019). Therefore, these facts indicate that smoking cigarettes could be profoundly addictive due to the rapid delivery of the desired effects to its users without taking into consideration any adverse effects on the human body and health.
Cigarette smoking harms human health; and stopping has proven hard to do alone. According to Health and Social Care Information Centre (HSCIC) (2017), in 2017 there were 146,234 people who started to try to quit smoking, only 49 percent successfully managed to stay away from using cigarretes and 33 percent of the individuals who successfully managed to stop smoking utilised licensed nicotine containing products. The government came up with tobacco control plan for England to assist its people to stop smoking; the elements of the plan include making tobacco more expensive, restraining tobacco related publicity, efficient control of tobacco products, developing alertness on harm caused by smoking and lowering the instance to be exposed to second-hand smoke (Public Health England, 2015).
Smoking cessation services and interventions are being offered by the NHS. Affirmed by National Institute for Health and Care Excellence (NICE) (2019), there are few evidenced-based interventions for smoking available in the UK for adults which include behavioural support, bupropion, nicotine replacement therapy (NRT), varenicline and very brief advices (VBA). These interventions are available to individuals who seek help through their general practitioner and to those who are being referred to health professionals for assistance; some of the interventions are combined to be able to achieve the desired goal which is to ultimately forgo smoking tobacco.
This paper will discuss the different kinds of NRT available for adults in the United Kingdom. Nicotine replacement therapy (NRT) includes few ways to supplement smoking. It helps to fight the urge to consume or inhale tobacco and also to reduce the effects of withdrawal. In addition, it will help individuals to slowly redu.
This document provides information about secondhand smoke exposure in multi-unit housing. It notes that while homes are private spaces, many non-smokers complain about smoke drifting into their units from neighbors, especially those with babies or feeling trapped. As high-density living increases, smoke drift can be addressed through housing regulations that deal with nuisances as loud noise or barking dogs. The guide aims to raise awareness of health, legal and financial benefits of smokefree multi-unit housing and empower various stakeholders to address this issue.
The document discusses the health promotion activity of encouraging smoking cessation. It assesses the health needs, outlines the target group as smokers, and chooses an educational approach to provide information about the benefits of quitting smoking. The aims are to increase awareness of benefits, diseases caused by smoking, and where to get help. Process evaluation determined the information provided addressed different learning styles and was effective at engaging the target group.
This study examined oral mucosal lesions in 45 former smokers and 45 electronic cigarette consumers. Oral examinations found lesions in 55 total patients, with 36 lesions in electronic cigarette consumers and 19 in former smokers. Nicotine stomatitis, hairy tongue, and hyperplastic candidiasis were significantly more common among electronic cigarette consumers. The study aims to evaluate differences in oral mucosal lesions between the groups but found no statistically significant difference in total prevalence of lesions.
Reducing Tobacco Use Among Adolescents Using Social Cognitive Theory and Soci...Shauna Ayres, MPH, CHES
This document discusses reducing tobacco use among adolescents using Social Cognitive Theory (SCT) and Social Network Theory (SNT). It summarizes key aspects of SCT, including its focus on personal, behavioral, and environmental factors that influence health behaviors. Studies discussed found targeting self-efficacy, normative beliefs, and intentions through programs and policies were effective in preventing or reducing tobacco use. The document suggests using a multi-strategy approach incorporating several SCT constructs is most effective for interventions.
This document discusses cigarette smoking and lung cancer. It provides an overview of the link between smoking and lung cancer, noting that rates vary by race and location. Two key social determinants that influence smoking and cancer are then examined: adolescent age and level of education. The socio-ecological model is applied to understand the multiple factors that influence health behaviors like smoking. Intervention strategies are proposed that target different levels of influence, including social support from family/peers and policies to restrict tobacco use and exposure.
Review Paper - Addiction of Cigarette Smoking.pdfRAlphabet18
This review paper investigates cigarette smoking addiction, covering its physical and mental mechanisms, societal influences on smoking habits, health risks, quitting difficulties, and cessation interventions.
The use of cessation assistance among smokers from china findings from the ...Julia Purpera
This study examined smoking cessation behavior and use of cessation assistance among Chinese smokers. The key findings were:
1) Approximately 26% of smokers reported attempting to quit smoking between the first and second waves of the survey, while only 6% were abstinent at 18-month follow-up.
2) Visiting a doctor or health professional was associated with greater attempts to quit smoking and higher abstinence rates compared to those who did not visit.
3) Only 5.8% of smokers who attempted to quit reported using nicotine replacement therapy (NRT). Contrary to findings in other countries, NRT use in China was associated with lower abstinence rates.
4) The
This study examined smoking cessation behavior and use of cessation assistance among Chinese smokers. The key findings were:
1) Approximately 26% of smokers attempted to quit between waves of the survey (18 months apart), while 6% were abstinent at follow-up.
2) Only 5.8% of those attempting to quit reported using nicotine replacement therapy (NRT) and NRT was associated with lower odds of abstinence.
3) Visiting a doctor/health professional was associated with greater attempts to quit smoking and higher abstinence rates compared to those who did not visit a professional.
4) The use of formal cessation assistance remains low in China despite some evidence that
The document is the proceedings from the Australian Smoking Cessation Conference in 2013. It includes:
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1. Int. J. Environ. Res. Public Health 2011, 8, 411-434; doi:10.3390/ijerph8020411
O P E N A C C ESS
International Journal of
E nvironmental Research and
Public H ealth
ISSN 1660-4601
www.mdpi.com/journal/ijerph
Article
Socioeconomic V ariation in the Prevalence, Introduction,
Retention, and Removal of Smoke-F ree Policies among Smokers:
F indings from the International Tobacco Control (I T C) Four
Country Survey
Brian A. K ing 1, Andrew J. H yland 1,*, Ron Borland 2, A nn McNeill 3 and K . M ichael C ummings 1
1
Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo,
NY 14263, USA; E-Mails: brian.alexander.king@gmail.com (B.A.K.);
michael.cummings@roswellpark.org (K.M.C.)
2
Vic Health Center for Tobacco Control, The Cancer Council Victoria, Carlton, VIC 3053,
Australia; E-Mail: ron.borland@cancervic.org.au
3
UK Centre for Tobacco Control Studies, Division of Epidemiology & Public Health, University of
Nottingham, Nottingham NG51PB, UK; E-Mail: ann.mcneill@nottingham.ac.uk
* Author to whom correspondence should be addressed; E-Mail: andrew.hyland@roswellpark.org;
Tel.: +1-716-845-8391; Fax: +1-716-845-1265.
Received: 15 December 2010; in revised form : 10 January 2011 / Accepted: 25 January 2011 /
Published: 31 January 2011
A bstract: Introduction: Exposure to secondhand smoke causes premature death and
disease in non-smokers and indoor smoke-free policies have become increasingly prevalent
worldwide. Although socioeconomic disparities have been documented in tobacco use and
cessation, the association between socioeconomic status (SES) and smoke-free policies is
less well studied. Methods: Data were obtained from the 2006 and 2007 Waves of the
International Tobacco Control Four Country Survey (ITC-4), a prospective study of
nationally representative samples of smokers in Canada, the United States, the United
Kingdom, and Australia. Telephone interviews were administered to 8,245 current and
former adult smokers from October 2006 to February 2007. Between September 2007 and
February 2008, 5,866 respondents were re-interviewed. Self-reported education and annual
household income were used to create SES tertiles. Outcomes included the presence,
introduction, and removal of smoke-free policies in homes, worksites, bars, and restaurants.
Results: Smokers with high SES had increased odds of both having [OR: 1.54, 95% CI:
2. Int. J. Environ. Res. Public Health 2011, 8 412
1.27–2.87] and introducing [OR: 1.49, 95% CI: 1.04–2.13] a total ban on smoking in the
home compared to low SES smokers. Continuing smokers with high SES also had
decreased odds of removing a total ban [OR: 0.44, 95% CI: 0.26–0.73]. No consistent
association was observed between SES and the presence or introduction of bans in
worksites, bars, or restaurants. Conclusions: The presence, introduction, and retention of
smoke-free homes increases with increasing SES, but no consistent socioeconomic
variation exists in the presence or introduction of total smoking bans in worksites, bars, or
restaurants. Opportunities exist to reduce SES disparities in smoke-free homes, while the
lack of socioeconomic differences in public workplace, bar, and restaurant smoke-free
policies suggest these measures are now equitably distributed in these four countries.
K eywords: tobacco smoke pollution; smoking; public policy; socioeconomic factors;
United States, Canada; Australia; United Kingdom
1. Introduction
Exposure to secondhand smoke (SHS) causes significant morbidity and mortality among both adults
and children who do not smoke [1,2]. SHS is responsible for an estimated 600,000 premature deaths
per year worldwide, 31% of which occur among children [3]. Accordingly, Article 8 of the World
Health Organization Framework Convention on Tobacco Control requires ratifying nations to pass
measures that provide universal protection from tobacco smoke in indoor environments, including
public places, worksites, and public transport [3].
Global estimates indicate that one-third of adults are exposed to SHS on a regular basis and
approximately 700 million children (40%) are exposed in the home [3]. Fortunately, restrictions on
smoking in indoor public places are becoming increasingly normative in many countries [4,5]. The
implementation of such policies significantly reduces SHS exposure [6] and can have an immediate
and sustained impact on smoking-related health outcomes, including the reduced incidence of heart
attacks in the general population [7]. There is also evidence to suggest that public smoking restrictions
stimulate the adoption of voluntary smoke-free policies in the home [8], both of which have been
shown to have a beneficial impact on smoking behavior change [9-11].
Socioeconomic status (SES) is strongly associated with smoking related knowledge, consumption,
and cessation [12-15] and socioeconomic disparities in smoking prevalence have continued to widen
over time in many Western countries [16-18]. Substantial socioeconomic differences in adult mortality
have also been linked to the effects of smoking [19-21]. Commonly cited hypotheses for the
underlying processes that produce these social inequalities include variations in educational attainment,
propensity and self-efficacy toward quitting, and deprivation [22]. In contrast, few studies have
assessed the association between SES and population-level strategies to reduce tobacco use and SHS
exposure, such as the implementation of indoor smoking restrictions. The limited number of
population-based studies of smoke-free worksites indicate that overall exposure and policy
non-compliance are disproportionately higher among individuals with lower SES [23-27]. Similarly,
assessments of smoking restrictions in homes have found smoke-free policy prevalence is positively
3. Int. J. Environ. Res. Public Health 2011, 8 413
associated with increasing SES [8,26,28]. Socioeconomic disparities have also been observed in
receptivity toward such policies, with individuals of lower SES being less likely to support restrictions
in indoor public places and worksites [29]. There is also evidence to suggest that the benefits of
smoke-free policies may be irrespective of socioeconomic status; one recent study found that
comprehensive policies prohibiting smoking in all worksites, restaurants, and bars are independently
associated with reduced smoking participation and consumption, regardless of education and
income [30].
Given the magnitude and persistence of the association between SES and tobacco use, the reduction
of social inequalities in smoking-related indicators has become an important public health priority for
many national governments and policymakers [31]. A key strategy used to achieve this goal has been
the implementation and intensification of smoking restrictions in indoor environments [3]. However,
there has been limited research on the extent to which these restrictions vary among socioeconomic
groups both across and within countries. More specifically, it is of particular importance to determine
whether the recent worldwide proliferation of smoke-free policies [4,5] has been uniform across
socioeconomic groups.
The primary objective of this study was to utilize population data from Canada, the United States
(US), the United Kingdom (UK), and Australia to assess socioeconomic and national variations in the
prevalence, introduction, retention, and removal of smoke-free policies in various indoor environments,
including homes, worksites, bars, and restaurants. The assessment of policy change was of particular
interest in the UK, where national legislation prohibiting smoking in worksites, bars, and restaurants
was implemented among most respondents between data collection Waves. A secondary objective was
to identify sociodemographic predictors of these policy-related indicators by environment type.
Understanding sociodemographic disparities in access to smoke-free environments may help mitigate
such disparities in tobacco use.
2. M ethods
This study reports data from Waves 5 and 6 of the International Tobacco Control Four Country
Survey (ITC-4), a prospective cohort study to monitor the impact of national level tobacco control
policies in four countries: Canada, the US, the UK, and Australia. The ITC-4 was initiated in 2002
with over 2,000 adult smokers recruited by probability sampling methods in each of the four countries.
In subsequent follow-up surveys of the cohort, recruited samples are replenished after attrition to
ensure a sample size of at least 2,000 per country at each Wave. A detailed description of the design
features, data collection methods, and analytic strategies of the ITC-4 study have been previously
reported elsewhere [32].
Participants were identified using stratified random digit dialing and interviews were conducted
using computer assisted telephone interview (CATI) software by multiple research firms. The
interviews were conducted in either English or French (francophone areas of Canada), but strict
protocols were followed to ensure methodological congruity across firms and between the two
languages [32]. The study protocol received ethical review and clearance from the Institutional Review
Boards or Research Ethics Boards at the University of Waterloo (Canada), Roswell Park Cancer
4. Int. J. Environ. Res. Public Health 2011, 8 414
Institute (USA), the University of Illinois at Chicago (USA), the University of Stirling (UK), the
University of Nottingham (UK), and the Cancer Council Victoria (Australia).
2.1. Participants
Selected participants included 8,245 current and former adult smokers who were interviewed as part
of Wave 5 of the ITC-4 survey between October 2006 and February 2007 (Canada, n = 2,023; the US,
n = 2,034; the UK, n = 2,019; and Australia, n = 2,169). Between September 2007 and February 2008,
a total of 5,866 of these participants (71.1%) were successfully re-interviewed in Wave 6 (Canada,
n = 1,459, 72.1%; the US, n = 1,291, 63.5%; the UK, n = 1,484, 73.5%; and Australia, n = 1,632,
75.2%). In addition, another 2,329 individuals were recruited as part of the Wave 6 replenishment
sample (Canada, n = 556; the US, n = 711; the UK, n = 523; and Australia, n = 539).
2.2. Measures
2.2.1. Socioeconomic status
Questions related to respondent education and annual household income were used to create
previously utilized indices of self-reported socioeconomic status [14,15]. Respondents were
categorized into three levels of educational attainment: low (less than high school diploma), moderate
(high school diploma), and high (some university training or a university degree). Similarly,
respondents from the US, Canada, and Australia were categorized into three levels of annual
household income: low ($29,999 or less), moderate ($30,000 to $59,999), and high ($60,000 or more).
In an effort to account for variation in currency values, respondents from the UK were categorized into
annual household income categories using a modified rubric: low (£15,000 or less), moderate (£15,001
to £30,000), and high (£30,001 or more). These education and income categories were then combined
to create a previously utilized composite measure for SES [33] as follows: low (low education and low
income), moderate (low income and moderate education, low income and high education, moderate
income and low education, and high income and low education), and high (moderate income and
moderate education, moderate income and high education, high income and moderate education, and
high income and high education). Respondents who did not report either income (5.7%) or education
(0.3%) were excluded from the analysis. The aforementioned categorization methods resulted in a
similar distribution across countries and tertile divisions.
2.2.2. Smoke-Free policy presence, introduction, retention, and removal
The presence of a smoke-free home policy was assessed using the question, ‘Which of the
following best describes smoking in your home?’, with the following response options: ‘smoking is
allowed anywhere in your home’, ‘smoking is never allowed anywhere in your home’, or ‘something
in between’. A respondent was considered to be covered by a total ban in their home if they answered
‘smoking is never allowed anywhere in your home’ and a partial ban if they answered ‘something
in between’.
The presence of a smoke-free bar policy was assessed using the question, ‘Which of the following
best describes the rules about smoking in drinking establishments, bars, and pubs where you live?’,
5. Int. J. Environ. Res. Public Health 2011, 8 415
with the following response options: ‘smoking is not allowed in any indoor area’, ‘smoking is allowed
in some indoor areas’, or ‘no rule or restrictions’. A respondent was considered to be covered by a total
ban in local bars if they answered ‘smoking is not allowed in any indoor area’ and a partial ban if they
answered ‘smoking is allowed in some indoor areas’.
The presence of a smoke-free restaurant policy was assessed using the question, ‘Which of the
following best describes the rules about smoking in restaurants and cafes where you live?’, with the
following response options: ‘smoking is not allowed in any indoor area’, ‘smoking is allowed in some
indoor areas’, ‘smoking is allowed in all indoor areas’, or ‘every restaurant, café has its own rules’. A
respondent was considered to be covered by a total ban in local restaurants if they answered ‘smoking
is not allowed in any indoor area’ and a partial ban if they answered ‘smoking is allowed in some
indoor areas’.
The presence of a smoke-free worksite policy was assessed among individuals employed outside
the home using the question, ‘Which of the following best describes the smoking policy where you
work?’, with the following response options: ‘smoking is not allowed in any indoor area’, ‘smoking is
allowed only in some indoor areas’, or ‘smoking is allowed in any indoor areas’. A respondent was
considered to be covered by a total ban in their worksite if they answered ‘smoking is not allowed in
any indoor area’ and a partial ban if they answered ‘smoking is allowed only in some indoor areas’.
The presence of a smoke-free home, bar, restaurant, or worksite policy was defined as being
covered by a total ban at Wave 5, whereas the introduction of a smoke-free policy was defined as
being covered by no ban or a partial ban at Wave 5 and a total ban at Wave 6. Retention of a
smoke-free policy was defined as being covered by a total ban at both Waves, while retention of
smoking was defined as being covered by either no ban or a partial ban at both Waves. Given the
non-voluntary nature of smoking restrictions in public areas, removal of a smoke-free policy was only
assessed among those with smoke-free homes and was defined as being covered by a total ban at
Wave 5 and either no ban or a partial ban at Wave 6 [8,34].
2.2.3. Smoking status
Smoking status was determined at Wave 5 using answers to questions related to respondents’ daily,
weekly, or monthly smoking rates and whether they had quit smoking between study recruitment and
the Wave 5 survey [32]. At Wave 6, respondents were asked whether they were still smoking or not,
and whether any quit attempts were made to arrive at their current smoking or quitting status. A
‘current smoker’ was defined as any respondent who reported smoking daily, weekly, or monthly at
the time of survey. In contrast, a ‘former smoker’ was defined as any respondent who either remained
quit since the time of last survey Wave completion or who made an attempt to stop smoking since the
time of last survey Wave completion and was also quit for a month or more at the time of current
survey Wave.
2.2.4. Covariates
Covariates included: age at Wave 5 (18–24, 25–39, 40–54, or 55+ years), gender (male or female),
minority status (mainstream/non-identified minority or identified minority), country of residence
(Canada, US, UK, or Australia), children less than 18 years old in the household (yes or no),
6. Int. J. Environ. Res. Public Health 2011, 8 416
non-smoking adults in the household (yes or no), Heaviness of Smoking Index (HSI) (range from
0 to 6) [35], smoke-free home policy (partial/no ban or total ban), smoke-free bar policy (partial/no
ban or total ban), smoke-free restaurant policy (partial/no ban or total ban), and smoke-free worksite
policy (partial/no ban, total ban, or not employed outside the home). Support for smoking bans in
worksites, bars, and restaurants were also assessed using a five level index in which a value of ‘1’
represented the belief that smoking should be allowed in all four of the aforementioned venues types, a
value of ‘5’ represented the belief that smoking should be prohibited in all four venue types, and
intermediate values representing the belief that smoking should be prohibited in one, two, or three of
the venue types.
2.3. Data Analysis
Data analyses were conducted using SPSS version 14.0 (SPSS Inc., Chicago, IL). All bivariate
analyses were restricted to participants with complete data for the indicator of interest and stratified by
both participant smoking status and country of residence. Cross-sectional data were weighted by age,
gender, and region [32] to provide representative population estimates for the following four outcomes:
total smoking ban in the home, worksite, bars, or restaurants. Bivariate analyses pertaining to cohort
data were unweighted and included the following four outcomes: introduction of a smoke-free policy,
retention of no total ban, removal of total ban, or retention of a smoke-free policy. For each of the
aforementioned bivariate analyses, a chi-square test was used to determine statistically significant
differences across subgroups (α = 0.05). A binary logistic regression model was also constructed to
identify significant predictors of policy prevalence (total ban vs. partial/no ban at Wave 5),
introduction (introduction vs. no introduction at Wave 6 among those with no ban at Wave 5), and
removal (removal vs. no removal at Wave 6 among those with a total ban at Wave 5) among current
and continuing smokers, while simultaneously adjusting for the effects of the following covariates:
SES, age, gender, minority status, country of residence, children less than 18 years of age in the
household, non-smoking adults in the household, HSI, attitudes toward smoke-free policies in public
places, and the presence of current total smoking bans in local bars, restaurants, and worksites. To
verify whether the effects of SES were consistent across countries, a separate model was also
constructed that included the aforementioned covariates and a statistical interaction term for SES and
country. Due to limited sample size, it was not possible to construct any regression models among
former smokers.
3. Results
3.1. Smoke-F ree Home Policies
Table 1 presents the prevalence, introduction, retention, and removal of smoke-free home policies
by SES and country of residence. Overall, the proportion of current smokers who reported that
smoking was never allowed anywhere in their home (total ban) was greatest among respondents from
Australia (Wave 5: 46.4%; Wave 6: 50.1%) and lowest among those from the UK (Wave 5: 23.9%;
Wave 6: 29.4%) at both Waves. Among former smokers, respondents from Australia had the highest
proportion of total bans at both Waves (Wave 5: 69.4%; Wave 6: 74.9%), while those from the UK
7. Int. J. Environ. Res. Public Health 2011, 8 417
(53.4%) and Canada (60.9%) had the lowest proportions in Waves 5 and 6, respectively. Following
stratification by SES, the proportion of current smokers with a total ban increased with increasing SES
at both Waves, regardless of country of residence. A similar trend was observed across SES levels
among former smokers in Canada, while a significant lack of trend was observed in Australia. With the
exception of the US and Australia, both the introduction and retention of a total ban in the home
among continuing smokers also increased with increasing SES.
Table 2 presents the findings of a binary logistic regression analysis to identify predictors of the
presence, introduction, and removal of a total ban on smoking in the home. Among current and
continuing smokers from all four countries combined, those with either ‘moderate’ [Odds Ratio (OR):
1.31, 95% Confidence Interval (CI): 1.10–1.55] or ‘high’ [OR: 1.54, 95% CI: 1.27–2.87] SES had an
increased odds of having a total ban in Wave 5, as well as a decreased odds of removal of a ban by
Wave 6 [‘Moderate’ OR: 0.52, 95% CI: 0.34–0.80; ‘High’ OR: 0.44, 95% CI: 0.26–0.73]. Additional
predictors of increased odds of a policy in Wave 5 were male gender, the presence of children in the
home, the presence of an adult non-smoker in the home, greater support for smoking bans in public
venues, and residence in the US or Australia. Predictors of increased odds of removal of a total ban
were higher Heaviness of Smoking Index (HSI) and residence in the UK, while predictors of decreased
odds included greater support for smoking bans in public venues, presence of an adult non-smoker in
the home, and residence in Australia. Among continuing smokers with no total ban in Wave 5, those
with ‘high’ SES had an increased odds of adopting a total ban by Wave 6 [OR: 1.49, 95%
CI: 1.04–2.13]. Additional predictors of increased odds of total ban introduction were greater support
for smoking bans in public venues, the presence of a non-smoking adult in the home, and residence in
the UK or Australia, while predictors of decreased odds were older age and higher HSI. There was no
significant interaction observed between SES and country in any of the regression models, and thus the
findings are not presented here.
8. Int. J. Environ. Res. Public Health 2011, 8 418
T able 1. Prevalence and introduction of smoke-free homes by socioeconomic status and country.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
a
Wave 5
Current Smokers
Total ban 21.2 30.9 42.9 32.6 24.0 33.8 50.5 36.0 14.5 26.5 27.4 23.9 34.1 49.6 49.1 46.4
Partial 29.5 31.9 33.3 31.9 31.1 28.8 23.9 28.0 50.7 47.7 51.5 49.3 31.8 29.5 31.4 30.4
None 49.3 37.2 23.8 35.5 44.9 37.4 25.6 36.0 34.8 25.8 21.1 26.8 34.1 20.9 19.5 23.2
n 298 845 468 1,611 * 346 911 430 1,687 * 406 809 323 1,538* 369 950 360 1,679 *
Former Smokers
Total ban 43.5 57.1 69.2 60.6 52.6 62.0 74.5 65.5 51.8 51.0 58.8 53.4 66.6 73.3 63.2 69.4
Partial 21.7 31.3 24.3 27.8 26.3 25.0 18.1 22.4 32.1 37.3 35.0 35.6 16.7 20.3 32.1 23.4
None 34.8 11.6 6.5 11.6 21.1 13.0 7.4 12.1 16.1 11.7 6.2 11.0 16.7 6.4 4.7 7.2
n 26 138 99 263 * 46 105 82 233 64 147 75 286 50 191 104 345 *
Wave 6 a
Current Smokers
Total ban 21.2 29.5 45.0 35.7 24.3 29.2 46.2 35.5 17.5 32.4 32.9 29.4 36.8 52.5 53.3 50.1
Partial 36.9 34.7 28.5 32.1 31.9 30.5 28.0 29.7 45.7 37.7 42.8 41.2 30.9 28.9 28.7 29.2
None 41.9 35.8 26.5 32.2 43.8 40.3 25.8 34.8 36.8 29.9 24.3 29.4 32.3 18.6 18.0 20.7
n 255 603 721 1,579 * 332 635 674 1,641 * 366 634 466 1,466 * 341 811 529 1,681 *
Former Smokers
Total ban 47.4 56.3 68.3 60.9 60.0 67.0 74.5 70.6 63.3 64.0 67.2 65.0 74.0 72.9 77.2 74.9
Partial 31.6 30.3 21.4 26.2 32.0 18.2 20.7 20.9 24.0 25.4 24.8 24.9 13.0 18.3 18.5 17.7
None 21.0 13.4 10.3 12.9 8.0 14.8 4.8 8.5 12.7 10.6 8.0 10.1 13.0 8.8 4.3 7.4
n 40 104 141 285 31 89 124 244 86 135 112 333 50 155 154 359
9. Int. J. Environ. Res. Public Health 2011, 8 419
T able 1. Cont.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
Between Waves among
Continuing Smokers
Introduce smoke-free 4.7 5.9 10.7 7.1 7.7 8.4 4.9 7.3 9.6 10.8 13.8 11.1 9.7 8.9 13.3 10.0
Retain smoke-free 13.5 23.4 36.2 25.7 15.5 23.3 35.6 25.1 6.2 16.4 20.2 14.6 27.8 40.1 42.5 37.8
Retain smoking 75.4 66.1 47.8 62.1 71.1 63.8 54.9 62.9 78.1 66.2 62.8 68.6 55.6 46.5 38.8 46.9
Remove smoke-free 6.4 4.6 5.3 5.1 5.7 4.5 4.6 4.7 6.1 6.6 3.2 5.7 6.9 4.5 5.4 5.3
n 171 563 318 1,052* 194 514 164 972 * 260 518 218 996 * 259 628 240 1,127 *
a
Percentages are based on weighted data.
b
A national policy prohibiting smoking in all worksites, restaurants, and bars was implemented between Waves 5 and 6 in three of the four countries that comprise the
United Kingdom. The fourth country, Scotland, implemented such a policy prior to Wave 5.
* Statistically significant variation across groups (χ2, p < 0.05).
T able 2. Predictors of presence, introduction, and removal of smoke-free policies among smokers, binary logistic regression.
O dds Ratio [95% Confidence Interval]
Homes Bars Restaurant Wor ksites d
Presencea Introduction b Removal c Presence a Introduction b Presence a Introduction b Presence a Introduction b
(n = 5,991) (n = 2,634) (n = 1,216) (n = 5,991) (n = 1,926) (n = 5,991) (n = 1,244) (n = 3,807) (n = 344)
Predictors
Socioeconomic Status
Low 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Moderate 1.31 [1.10–1.55] 1.06 [0.77–1.46] 0.52 [0.34–0.80] 0.93 [0.77–1.10] 1.14 [0.81–1.60] 1.18 [0.97–1.44] 0.94 [0.61–1.45] 1.38 [1.06–1.82] 0.48 [0.22–1.03]
High 1.54 [1.27–2.87] 1.49 [1.04–2.13] 0.44 [0.26–0.73] 0.93 [0.75–1.14] 1.06 [0.71–1.57] 1.21 [0.96–1.54] 0.98 [0.59–1.63] 2.23 [1.63–3.04] 0.55 [0.23–1.34]
Age (years)
18–24 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
25–39 1.02 [0.81–1.30] 0.65 [0.40–1.07] 0.37 [0.20–0.69] 1.15 [0.87–1.52] 0.73 [0.41–1.31] 1.28 [0.94–1.74] 0.82 [0.38–1.78] 1.00 [0.70–1.43] 2.16 [0.75–6.23]
40–54 0.69 [0.55–0.87] 0.45 [0.28–0.73] 0.65 [0.36–1.15] 1.31 [1.00–1.71] 0.72 [0.42–1.26] 1.55 [1.15–2.10] 0.81 [0.39–1.69] 1.20 [0.85–1.69] 1.47 [0.54–3.99]
55+ 0.69 [0.53–0.89] 0.43 [0.26–0.73] 0.59 [0.31–1.13] 1.43 [1.06–1.91] 0.56 [0.31–1.02] 1.63 [1.18–2.26] 0.73 [0.34–1.60] 0.98 [0.66–1.47] 1.08 [0.34–3.40]
10. Int. J. Environ. Res. Public Health 2011, 8 420
T able 2. Cont.
O dds Ratio [95% Confidence Interval]
Homes Bars Restaurant Wor ksites d
Presencea Introduction b Removal c Presence a Introduction b Presence a Introduction b Presence a Introduction b
(n = 5,991) (n = 2,634) (n = 1,216) (n = 5,991) (n = 1,926) (n = 5,991) (n = 1,244) (n = 3,807) (n = 344)
Predictors
Gender
Female 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Male 1.42 [1.25–1.61] 1.09 [0.86–1.39] 1.23 [0.87–1.73] 0.91 [0.79–1.04] 0.96 [0.74–1.24] 1.04 [0.89–1.21] 1.01 [0.72–1.41] 0.41 [0.34–0.50] 0.68 [0.39–1.18]
Minority Status
Mainstream/Non–Minority 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Minority 0.96 [0.79–1.17] 1.08 [0.72–1.62] 1.56 [0.97–2.50] 1.19 [0.96–1.48] 1.17 [0.78–1.75] 0.70 [0.55–0.89] 1.01 [0.62–1.65] 0.87 [0.65–1.17] 0.63 [0.29–1.38]
Country
Canada 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
United States 1.44 [1.20–1.73] 1.19 [0.80–1.76] 0.76 [0.45–1.28] 0.24 [0.20–0.29] 0.55 [0.37–0.82] 0.17 [0.13–0.22] 0.24 [0.13–0.45] 0.78 [0.57–1.06] 0.84 [0.37–1.89]
United Kingdom 0.67 [0.54–0.83] 1.50 [1.02–2.21] 1.90 [1.08–3.33] 0.15 [0.12–0.19] 42.6 [24.8–73.3] 0.08 [0.06–0.10] 11.7 [5.74–23.9] 0.74 [0.54–1.03] 14.2 [5.26–38.5]
Australia 1.75 [1.47–2.08] 1.89 [1.34–2.68] 0.62 [0.39–0.99] 0.12 [0.09–0.14] 4.41 [2.98–6.54] 1.02 [0.77–1.36] 1.66 [0.80–3.47] 0.78 [0.58–1.05] 2.00 [0.92–4.36]
Children in Home
No 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00 1.00
Yes 2.08 [1.83–2.37] 1.08 [0.83–1.41] 0.71 [0.49–1.01] 1.01 [0.87–1.17] 0.83 [0.62–1.10] 1.01 [0.85–1.20] 1.11 [0.76–1.61] 1..06 [0.87–1.29] 1.33 [0.76–2.33]
Non–Smoking Adults in
Home 1.00 1.00 1.00 NI NI NI NI NI NI
No 2.17 [1.92–2.45] 1.51 [1.19–1.91] 0.55 [0.39–0.77]
Yes
Smoke–Free Home Policy
Partial/None NI NI NI 1.00 1.00 1.00 1.00 1.00 1.00
Total Ban 0.96 [0.83–1.12] 0.95 [0.72–1.27] 1.11 [0.93–1.32] 1.07 [0.73–1.57] 1.00 [0.81–1.24] 1.08 [0.59–1.97]
Smoke–Free Bar Policy
Partial/None 1.00 1.00 1.00 NI NI 1.00 1.00 1.00 1.00
Total Ban 0.95 [0.82–1.10] 0.95 [0.71–1.27] 1.05 [0.70–1.59] 14.0 [11.7–16.8] 1.32 [0.74–2.34] 1.33 [1.04–1.70] 0.61 [0.31–1.20]
11. Int. J. Environ. Res. Public Health 2011, 8 421
T able 2. Cont.
O dds Ratio [95% Confidence Interval]
Homes Bars Restaurant Wor ksites d
Presencea Introduction b Removal c Presence a Introduction b Presence a Introduction b Presence a Introduction b
(n = 5,991) (n = 2,634) (n = 1,216) (n = 5,991) (n = 1,926) (n = 5,991) (n = 1,244) (n = 3,807) (n = 344)
Predictors
Smoke–Free Restaurant
Partial/None 1.00 1.00 1.00 1.00 1.00 NI NI 1.00 1.00
Total Ban 1.10 [0.93–1.30] 1.03 [0.75–1.43] 1.12 [0.69–1.80] 13.9 [11.6–16.6] 1.45 [1.08–1.95] 1.61 [1.25–2.06] 0.78 [0.38–1.63]
Smoke–Free Worksite
Partial/None 1.00 1.00 1.00 1.00 1.00 1.00 1.00 NI NI
Total Ban 0.99 [0.80–1.22] 1.14 [0.75–1.74] 0.89 [0.51–1.55] 1.23 [0.97–1.57] 0.98 [0.65–1.49] 1.58 [1.23–2.02] 1.09 [0.67–1.77] NI NI
Not employed outside home 0.93 [0.74–1.17] 1.03 [0.66–1.62] 1.29 [0.72–2.30] 1.31 [1.02–1.70] 1.08 [0.70–1.66] 1.46 [1.13–1.89] 0.83 [0.51–1.37] NI NI
Heaviness of Smoking Index 0.74 [0.71–0.77] 0.87 [0.80–0.94] 1.32 [1.18–1.48] 1.01 [0.97–1.06] 1.02 [0.93–1.11] 1.01 [0.96–1.07] 1.08 [0.97–1.20] 0.90 [0.84–0.96] 0.87 [0.74–1.03]
Public Smoking Ban Support 1.34 [1.27–1.42] 1.24 [1.12–1.38] 0.85 [0.73–0.98] 1.33 [1.26–1.41] 1.20 [1.06–1.35] 1.32 [1.23–1.41] 1.22 [1.04–1.42] 1.59 [1.46–1.73] 1.23 [0.96–1.57]
Note: NI= Not included in model. Statistically significant odds ratios are noted in bold.
a
Presence of total smoking ban among current smokers at Wave 5.
b
Implementation of a total smoking ban between Wave 5 and Wave 6 among continuing smokers.
c
Removal of total smoking ban between Wave 5 and Wave 6 among continuing smokers.
d
Among individuals employed for wages outside the home.
12. Int. J. Environ. Res. Public Health 2011, 8 422
3.2. Smoke-F ree Bar Policies
Table 3 presents the prevalence and introduction of smoke-free bar policies by SES and country of
residence. Overall, the proportion of both current and former smokers who reported that smoking was
not allowed in any indoor area of local bars (total ban) was greatest among respondents from Canada
in Wave 5 (current: 83.6%; former: 83.0%) and those from the UK, where a national ban on smoking
in indoor public places was implemented between Waves, in Wave 6 (current: 97.1%; former: 95.3%).
Between Waves 5 and 6, relative increases of 79.7% and 50.6% were observed in the proportion of
current smokers with a total ban in the UK and Australia, respectively. Similar increases were also
observed among former smokers in these two countries (UK: 81.1%; Australia: 45.3%). Following
stratification by SES, no consistent association was observed across countries with regard to SES and
either the presence or introduction of a total smoking ban in bars.
Table 2 presents the findings of a binary logistic regression analysis to identify predictors of the
presence and introduction of total bans on smoking in local bars. There were no SES differences
observed; however, predictors of increased odds of a total ban in Wave 5 were older age, not being
employed outside the home, the presence of a total ban in restaurants, and greater support for smoking
bans in public venues. In contrast, predictors of decreased odds of a total ban in Wave 5 were
residence in the US, UK, or Australia. Predictors of increased odds of introducing a total ban between
Waves were the presence of a total ban in restaurants, greater support for smoking bans in public
venues, and residence in either the UK or Australia, while a predictor of decreased odds was residence
in the US. There was no significant interaction observed between SES and country in either regression
model, and thus the findings are not presented here.
3.3. Smoke-F ree Restaurant Policies
Table 4 presents the prevalence and introduction of smoke-free restaurant policies by country of
residence. Overall, the proportion of both current and former smokers who reported that smoking was
not allowed in any indoor area of local restaurants (total ban) was greatest among respondents from
Canada in Wave 5 (current: 91.5%; former: 92.7%) and the UK, where a national ban on smoking in
indoor public places was implemented between Waves, in Wave 6 (current: 97.1%; former: 98.2%). In
contrast, the proportion of respondents with such a policy was lowest among those from the UK in
Wave 5 (current: 27.5%; former: 32.0%) and the US in Wave 6 (current: 65.0%; former: 60.9%).
Between Waves 5 and 6, relative increases of 71.7% and 67.4% were observed among current and
former smokers in the UK, respectively. Following stratification by SES, no consistent association was
observed across countries with regard to SES and either the presence or introduction of a total smoking
ban in local restaurants.
Table 2 presents the findings of a binary logistic regression analysis to identify predictors of the
presence and introduction of total bans on smoking in local restaurants. No SES differences were
observed with respect to smoke-free restaurant policy implementation. Among all current smokers,
predictors of increased odds of a total ban in Wave 5 were older age, the presence of a total ban in bars,
greater support for smoking bans in public venues, and having either a total ban in the worksite or not
being employed outside of the home. In contrast, predictors of decreased odds were minority status
13. Int. J. Environ. Res. Public Health 2011, 8 423
and residence in either the US or UK. Predictors of increased odds of introducing a total ban between
Waves among continuing smokers were greater support for smoking bans in public venues and
residence in the UK, while a predictor of decreased odds was residence in the US. There was no
significant interaction observed between SES and country in either regression model, and thus the
findings are not presented here.
3.4. Smoke-F ree Worksite Policies
Table 5 presents the prevalence and introduction of smoke-free worksite policies by country of
residence among those employed for wages at the time of interview. Overall, the proportion of current
smokers who reported that smoking was not allowed in any indoor area of their worksite (total ban)
was greatest among respondents from Canada in Wave 5 (88.2%) and those from the UK, where a
national ban on smoking in indoor public areas was implemented between Waves, in Wave 6 (96.1%).
The US had the lowest proportion at both Waves (Wave 5: 76.8%; Wave 6: 75.9%). Among former
smokers, the proportion of respondents with such a policy in Wave 5 was the greatest in the US
(92.7%), but lowest in Wave 6 (83.0%). Following stratification by SES, the proportion of current
smokers with a total smoking ban in the worksite increased with increasing SES in Canada and the U.S.
in Wave 5, but no significant trends were apparent in Wave 6. In the UK, the proportion of former
smokers with a total smoking ban in the worksite increased with increasing SES in Wave 5. Between
Waves, the introduction of a total ban among continuing smokers significantly decreased with
increasing SES in Canada, the U.S. and the U.K.
Table 2 presents the findings of a binary logistic regression analysis to identify predictors of the
presence and introduction of total bans on smoking in the worksite. Among all current smokers
combined, both those with ‘moderate’ [OR: 1.38, 95% CI: 1.06–1.82] and ‘high’ [OR: 2.23, 95%
CI: 1.63–3.04] SES had an increased odds of having a total ban on smoking in the worksite in Wave 5;
however, rates of smoke-free policy introduction were comparable by SES with lower point estimates
among those with the highest SES compared to those with low SES. Among current smokers from all
four countries combined, predictors of increased odds of a total ban in Wave 5 were the presence of a
total ban in local bars or restaurants and greater support for smoking bans in public venues, while
predictors of decreased odds were male gender and higher HSI. No multivariate association was
observed between socioeconomic status and the introduction of a total ban in Wave 6. The only
predictor of increased odds of introducing a total ban between Waves among continuing smokers was
residence in the UK. There was no significant interaction observed between SES and country in either
regression model, and thus the findings are not presented here.
14. Int. J. Environ. Res. Public Health 2011, 8 424
T able 3. Prevalence and introduction of smoke-free bars by socioeconomic status and country.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
a
Wave 5
Current Smokers
Total ban 82.7 82.3 86.4 83.6 37.6 36.9 44.9 39.1 27.7 18.4 15.5 19.7 41.2 44.9 41.6 43.4
Partial 15.2 15.3 12.3 14.4 44.2 47.9 42.9 45.9 51.7 57.3 65.9 58.2 53.9 52.1 56.4 53.4
None 2.1 2.4 1.3 2.0 18.2 15.2 12.2 15.0 20.6 24.3 18.6 22.1 4.9 3.0 2.0 3.2
n 293 823 462 1,578 311 853 416 1,580 * 365 785 314 1,464 * 350 916 344 1,610
Former Smokers
Total ban 87.0 87.0 76.6 83.0 54.3 46.3 59.1 52.9 20.0 13.5 25.0 18.0 50.0 48.7 46.1 48.1
Partial 8.7 12.3 23.4 16.3 20.0 34.7 31.2 30.9 64.0 66.7 59.2 64.0 50.0 48.7 52.0 49.8
None 4.3 0.7 0.0 0.7 25.7 19.0 9.7 16.2 16.0 19.8 15.8 18.0 0.0 2.6 1.9 2.1
n 25 136 99 260 * 42 101 81 224 58 142 73 273 46 188 99 333
Wave 6 a
Current Smokers
Total ban 85.3 86.2 90.3 88.0 51.2 53.2 50.9 51.9 95.1 97.8 97.6 97.1 88.7 86.3 89.5 87.8
Partial 12.7 13.6 9.1 11.3 38.3 31.8 39.5 36.3 3.1 1.7 2.1 2.2 10.4 13.0 10.0 11.5
None 2.0 0.2 0.6 0.7 10.5 15.0 9.6 11.8 1.8 0.5 0.3 0.7 0.9 0.7 0.5 0.7
n 251 596 713 1,560 * 297 595 649 1,541 356 627 463 1,446 324 786 521 1,631
Former Smokers
Total ban 87.5 88.8 91.5 90.0 47.6 49.3 51.8 50.5 91.3 96.2 97.0 95.3 83.7 83.6 93.9 87.9
Partial 12.5 11.2 7.7 9.7 47.6 38.4 40.0 40.2 7.2 2.3 3.0 3.7 16.3 13.9 6.1 10.9
None 0.0 0.0 0.8 0.3 4.8 12.3 8.2 9.3 1.5 1.5 0.0 1.0 0.0 2.5 0.0 1.2
n 39 100 141 280 28 85 116 229 85 132 111 328 44 150 152 346 *
15. Int. J. Environ. Res. Public Health 2011, 8 425
T able 3. Cont.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
Between Waves among
Continuing Smokers
Introduce smoke-free 7.8 8.2 4.5 7.1 14.5 16.9 14.9 15.9 64.3 78.1 79.3 74.9 42.2 40.9 48.2 42.8
Retain smoke-free 79.5 81.4 83.9 81.8 36.1 34.6 38.1 35.9 30.3 19.5 17.3 21.7 46.0 46.5 41.1 45.2
Retain smoking 7.2 7.5 10.0 8.2 45.2 45.7 43.5 44.9 4.6 1.8 3.4 2.9 10.5 11.4 9.8 10.9
Remove smoke-free 5.5 2.9 1.6 2.9 4.2 2.8 3.5 3.3 0.8 0.6 0.0 0.5 1.3 1.2 0.9 1.1
n 166 547 310 1,023 166 462 255 883 238 497 208 943 * 239 596 224 1,059
a
Percentages are based on weighted data.
b
A national policy prohibiting smoking in all worksites, restaurants, and bars was implemented between Waves 5 and 6 in three of the four countries that comprise the
United Kingdom. The fourth country, Scotland, implemented such a policy prior to Wave 5.
* Statistically significant variation across groups (χ2, p < 0.05).
T able 4. Prevalence and introduction of smoke-free restaurants by socioeconomic status and country.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
a
Wave 5
Current Smokers
Total ban 90.8 90.0 94.6 91.5 50.9 53.2 58.8 54.2 34.3 26.4 24.0 27.5 81.5 86.3 82.5 84.5
Partial 6.7 7.0 4.6 6.3 27.8 26.8 24.5 26.4 33.4 36.2 36.8 35.7 9.1 7.3 12.2 8.8
None 2.5 3.0 0.8 2.2 21.3 20.0 16.7 19.4 32.3 37.4 39.2 36.8 9.4 6.4 6.3 6.7
n 294 842 467 1,603 337 906 429 1,672 380 800 320 1,500* 363 940 358 1,661
16. Int. J. Environ. Res. Public Health 2011, 8 426
T able 4. Cont.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
Former Smokers
Total ban 96.2 91.2 93.9 92.7 60.5 56.0 64.2 60.1 36.4 33.3 26.3 32.0 85.7 92.1 86.7 89.7
Partial 0.0 6.1 5.6 5.4 23.6 25.0 22.3 23.7 30.4 25.9 39.5 30.5 11.6 4.5 8.6 6.6
None 3.8 2.7 0.5 1.9 15.9 19.0 13.5 16.2 33.2 40.8 34.2 37.5 2.7 3.4 4.7 3.7
n 26 137 99 262 46 105 82 233 63 144 73 280 49 192 103 344
Wave 6 a
Current Smokers
Total ban 96.0 93.8 95.7 95.0 69.9 64.1 63.8 65.0 95.2 97.5 97.8 97.1 90.7 94.0 94.7 93.7
Partial 2.3 4.6 3.5 3.7 16.1 18.4 17.7 17.7 2.3 1.7 1.9 1.9 2.9 3.0 2.8 2.9
None 1.7 1.6 0.8 1.3 14.0 17.5 18.5 17.3 2.5 0.8 0.3 1.0 6.4 3.0 2.5 3.4
n 254 604 721 1,579 323 628 674 1,625 360 632 466 1,458* 332 802 527 1,661
Former Smokers
Total ban 91.9 93.3 95.9 94.4 58.3 60.7 61.4 60.9 95.9 100 97.3 98.2 93.3 94.0 97.5 95.5
Partial 0.0 5.8 4.1 4.3 28.0 15.5 20.7 19.7 1.4 0.0 1.8 0.9 4.4 2.4 1.9 2.4
None 8.1 0.9 0.0 2.3 13.7 23.8 17.9 19.4 2.7 0.0 0.9 0.9 2.3 3.6 0.6 2.1
n 40 104 141 285 31 88 122 241 87 134 112 333 48 153 154 355
Between Waves among
Continuing Smokers
Introduce smoke-free 3.5 4.4 2.2 3.6 18.5 14.9 14.0 15.3 57.2 69.0 69.0 66.0 11.0 9.8 13.9 11.0
Retain smoke-free 92.9 91.5 93.4 92.3 47.8 48.7 51.9 49.4 38.7 28.1 27.8 30.7 81.8 84.8 83.6 83.9
Retain smoking 1.8 2.1 1.6 1.9 31.5 32.1 31.1 31.7 2.9 2.5 2.3 2.6 3.6 2.6 0.8 2.4
Remove smoke-free 1.8 2.0 2.8 2.2 2.2 4.3 3.0 3.6 1.2 0.4 0.9 0.7 3.6 2.8 1.7 2.7
n 169 563 317 1,049 184 505 264 953 243 513 216 972 253 620 238 1,111
a
Percentages are based on weighted data.
b
A national policy prohibiting smoking in all worksites, restaurants, and bars was implemented between Waves 5 and 6 in three of the four countries that comprise the
United Kingdom. The fourth country, Scotland, implemented such a policy prior to Wave 5.
* Statistically significant variation across groups (χ2, p < 0.05).
17. Int. J. Environ. Res. Public Health 2011, 8 427
T able 5. Prevalence and introduction of smoke-free worksites by socioeconomic status and country.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
a
Wave 5
Current Smokers
Total ban 85.8 86.4 91.8 88.2 67.5 75.7 83.2 76.8 74.2 75.8 80.3 77.0 88.0 83.7 91.6 86.3
Partial 12.0 9.8 7.2 9.1 21.2 17.4 13.4 16.7 16.5 19.1 16.4 18.0 11.1 12.6 4.5 10.2
None 2.2 3.8 1.0 2.7 11.3 6.9 3.4 6.5 9.3 5.1 3.3 5.0 0.9 3.7 3.9 3.5
n 131 566 373 1,070 * 130 500 298 928* 108 532 256 896 123 646 293 1,062 *
Former Smokers
Total ban 100 84.8 91.9 88.5 82.4 87.7 98.7 92.7 68.2 77.6 90.0 80.9 93.3 90.6 94.7 92.2
Partial 0.0 6.7 7.0 6.5 5.9 3.5 0.0 2.0 18.2 18.7 7.1 14.6 6.7 5.6 3.2 4.8
None 0.0 8.5 1.1 5.0 11.7 8.8 1.3 5.3 13.6 3.7 2.9 4.5 0.0 3.8 2.1 3.0
n 10 96 78 184 13 53 62 128 22 100 65 187* 19 149 90 258
a
Wave 6
Current Smokers
Total ban 88.6 85.1 87.0 86.4 73.9 72.4 79.3 75.9 94.9 95.4 97.4 96.1 84.5 84.9 89.0 86.5
Partial 10.0 8.9 11.1 10.1 18.5 19.4 16.9 18.1 5.1 4.3 1.5 3.3 8.5 9.1 5.2 7.5
None 1.4 6.0 1.9 3.5 7.6 8.2 3.8 6.0 0.0 0.3 1.1 0.6 7.0 6.0 5.8 6.0
n 71 271 320 662 94 235 313 642 70 310 235 615 77 358 295 730
Former Smokers
Total ban 90.0 86.8 84.8 86.4 100 71.4 92.6 83.0 66.7 97.5 89.6 90.0 100 83.7 89.2 87.5
Partial 10.0 13.2 6.1 9.9 0.0 21.4 7.4 13.6 25.0 0.0 10.4 8.0 0.0 9.3 5.4 6.7
None 0.0 0.0 9.1 3.7 0.0 7.2 0.0 3.4 8.3 2.5 0.0 2.0 0.0 7.0 5.4 5.8
n 9 28 33 70 2 26 29 57 12 39 43 94* 5 47 40 92
18. Int. J. Environ. Res. Public Health 2011, 8 428
T able 5. Cont.
Socioeconomic Status
V ariables C anada United States United K ingdom b A ustralia
Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll Low Mod. H igh A ll
Between Waves among
Continuing Smokers
Introduce smoke-free 16.7 8.1 4.6 8.1 25.0 12.6 12.5 14.8 50.0 36.2 29.8 35.8 21.1 14.3 10.2 14.0
Retain smoke-free 83.3 73.8 80.5 77.0 43.8 61.5 70.0 60.8 40.0 61.1 64.3 59.9 71.0 70.9 79.5 73.3
Retain smoking 0.0 14.0 13.8 12.2 31.2 25.9 16.2 24.0 10.0 2.7 1.2 3.0 7.9 13.8 8.0 11.5
Remove smoke-free 0.0 4.1 1.1 2.7 0.0 0.0 1.3 0.4 0.0 0.0 4.7 1.3 0.0 1.0 2.3 1.2
n 36 172 87 295 * 48 135 80 263 * 30 185 84 299 * 38 196 88 322
a
Percentages are based on weighted data.
b
A national policy prohibiting smoking in all worksites, restaurants, and bars was implemented between Waves 5 and 6 in three of the four countries that comprise the
United Kingdom. The fourth country, Scotland, implemented such a policy prior to Wave 5.
* Statistically significant variation across groups (χ2, p < 0.05).
19. Int. J. Environ. Res. Public Health 2011, 8 429
4. Discussion
This study used nationally representative samples of current and former smokers from Canada, the
US, the UK, and Australia to examine socioeconomic and national variations in the prevalence,
introduction, retention, and removal of smoke-free policies in indoor environments, including private
homes, worksites, and local bars and restaurants. The data indicate that smokers with higher SES are
more likely to have, introduce, and retain total smoking bans in the home. Current smokers with higher
SES were also more likely to have a total smoking ban in the workplace; however, the rate of
smoke-free policy adoption in the workplace was comparable by SES group. No consistent association
was observed between SES and any smoke-free policies among former smokers, or in bar and
restaurants policies among current smokers. The implications of these findings are two-fold. First, the
impact of recent efforts to expand the proliferation of smoke-free policies in bars and restaurants in
these four countries has been seemingly uniform across those serving different socioeconomic groups;
although smoke-free workplaces have previously been more common in high SES occupations, this
disparity appears to have disappeared. On balance, the evidence indicates that smoke-free policies in
public places are not being implemented differentially by the socioeconomic status of smokers.
Among continuing smokers, multivariate analyses indicate a clear and consistent relationship
between higher SES and both the presence and introduction of smoking bans in the home. Given the
potentially central role that smokers have in determining the smoke-free status of their home, this
suggests some reluctance by lower SES smokers to be subjected to home smoking bans. This finding
may be a consequence of having a higher likelihood of smokers in their social circle, limited access to
outdoor smoking areas, and/or greater overall deprivation [22]. The present findings also indicate that
nicotine dependence and attitudes toward smoke-free public environments are strong predictors of
policy presence, introduction, and removal among continuing smokers, irrespective of SES. These
findings are consistent with that of Borland et al. [8] and provide an evidence base for ongoing and
future efforts to promote smoke-free homes, which have previously been shown to substantially reduce
secondhand smoke exposure [2] and to have a beneficial impact on smoking behavior [9-11]. More
specifically, strategies to enhance smoke-free home adoption should concentrate on the provision of
cessation services and initiatives to further denormalize tobacco. The implementation of such
strategies would be particularly beneficial in the UK, which had the lowest proportion of smoke-free
home prevalence and retention; however, this finding was not surprising considering that the UK has
traditionally lagged behind Canada, the US, and Australia in smoke-free policy implementation and
support [8,34,36]. Nonetheless, it is important to note that the UK had the highest rate of smoke-free
home policy introduction among continuing smokers between Waves.
While this study used parallel methods to explore predictors of smoke-free policies in various
environments, care needs to be taken in interpreting the results. Although smokers are likely to have a
significant role in determining the smoke-free status of their home, the same is not true for public
environments. Smokers can choose to avoid environments with restrictions they dislike; therefore,
sociodemographic predictors may reflect selective choice of venue for worksites, restaurants, and bars
rather than, or as well as, the propensity of proprietors to differentially impose bans based upon their
clientele. Nonetheless, the finding that SES is not such a factor among smokers is reassuring.
20. Int. J. Environ. Res. Public Health 2011, 8 430
No consistent relationship was observed across countries with regard to SES and the introduction of
smoke-free worksites. Continuing smokers with higher SES were at increased odds of having a total
ban on smoking in the worksite at Wave 5, which may be a consequence of the propensity of lower
SES individuals to work blue collar or service professions in environments that have not been
traditionally covered by smoke-free policies [37]. However, this disparity appeared to attenuate by
Wave 6. The rate of introduction of smoke-free worksite policies was comparable by SES, and the
point estimates, while not statistically significant, indicate that introduction may now be greater in
lower SES smokers. These findings suggest that worksites are now catching up in the adoption of
smoke-free policies.
National variations in smoke-free policy introduction were also observed. More specifically,
respondents in the UK had increased odds of reporting the introduction of bar, restaurant, and worksite
policies between Waves. This finding can be attributed to the comprehensive national smoke-free
legislation that was implemented between survey Waves in three of the four countries that comprise
the UK; the fourth country, Scotland, had previously implemented such legislation prior to Wave 5 [38].
This increase in policy introduction is encouraging, as it confirms that most UK smokers are both
aware of, and seemingly compliant with, the new smoking restrictions in these environments.
Increased odds of smoke-free bar introduction was also observed in Australia, where several states,
including the most populated state of New South Wales, either implemented or strengthened
smoke-free policies in such establishments between Waves. In addition, an increased odds of
smoke-free home introduction was observed in both the UK and Australia. This increase may be partly
a result of the aforementioned public smoke-free policy implementation, which has previously been
shown to be an independent predictor of smoke-free home adoption [8].
Limitations to the study include: (1) the data were obtained using respondent-reported measures of
smoke-free policy presence. However, previous studies of indoor smoke-free policies and SHS have
found that respondent reports are significantly correlated with established ordinances and biological
measures, thereby confirming the validity of respondent-reported indicators [34,39]; and
(2) respondents with missing education or income data were excluded from the analysis. However, the
proportion of respondents with missing education or income data was less than 6%.
In conclusion, the findings of this study demonstrate that the presence, introduction, and retention
of smoke-free homes are greater among individuals with higher SES, but no consistent socioeconomic
variation exists in the presence or introduction of total smoking bans in worksites, bars, or restaurants.
This indicates that opportunities exist to reduce socioeconomic disparities in smoke-free homes, while
the lack of SES differences in public workplace, bar, and restaurant policies suggests these measures
are now equitably distributed in these four countries.
A cknowledgements
This research was support by grants from the National Cancer Institute of the United States (R01
CA100362 and P50 CA111236: Roswell Park Transdisciplinary Tobacco Use Research Center),
Canadian Institutes of Health Research (57897 and 79551), Robert Wood Johnson Foundation
(045734), National Health and Medical Research Council of Australia (265903), Cancer Research
United Kingdom (C312/A3726), Canadian Tobacco Control Research Initiative (014578), and the
21. Int. J. Environ. Res. Public Health 2011, 8 431
Centre for Behavioral Research and Program Evaluation of the National Cancer Institute of
Canada/Canadian Cancer Society.
References
1. International Agency for Research on Cancer. Tobacco Smoke and Involuntary Smoking:
Summary of Data Reported and Evaluation. In IARC Monographs on the Evaluation of
Carcinogenic Risks to Humans; World Health Organization: Geneva, Switzerland, 2004;
Volume 83.
2. U.S. Department of Health & Human Services. The Health Consequences of Involuntary
Exposure to Tobacco Smoke: A Report of the Surgeon General ; U.S. Department of Health and
Human Services, Centers for Disease Control and Prevention, Coordinating Center for Health
Promotion, National Center for Chronic Disease Prevention & Health Promotion, Office on
Smoking and Health: Atlanta, GA, USA, 2006.
3. WH O Report on the Global Tobacco Epidemic, 2009: Implementing Smoke-F ree Environments;
WHO Press: Geneva, Switzerland, 2009.
4. Koh, H.K.; Joossens, L.X.; Connolly, G.N. Making smoking history worldwide. N Engl. J. Med.
2007, 356, 1496-1498.
5. Griffith, G.; Welch, C.; Cardone, A.; Valdemoro, A.; Jo, C. The global momentum for smoke-free
public places: Best practice in current and forthcoming smoke-free policies. Salud publica de
Mexico 2008, 50, S299-S308.
6. Haw, S.J.; Gruer, L. Changes in exposure of adult nonsmokers to secondhand smoke after
implementation of smoke-free legislation in Scotland: national cross sectional survey. Brit. Med. J.
2007, 335, 549.
7. Lightwood, J.M.; Glantz, S.A. Declines in acute myocardial infarction after smoke-free laws and
individual risk attributable to secondhand smoke. Circulation 2009, 120, 1373-1379.
8. Borland, R.; Yong, H.H.; Cummings, K.M.; Hyland, A.; Anderson, S.; Fong, G.T. Determinants
and consequences of smoke-free homes: findings from the international tobacco control (ITC)
Four Country Survey. Tob. Control 2006, 15, iii42-iii50.
9. Fichtenberg, C.M.; Glantz, S.A. Effect of smoke-free workplaces on smoking behaviour:
Systematic review. Brit. Med. J. 2002, 325, 188.
10. Hyland, A.; Higbee, C.; Travers, M.J.; Van Deusen, A.; Bansal-Travers, M.; King, B.A.;
Cummings, K.M. Smoke-free homes and smoking cessation and relapse in a longitudinal
population of adults. Nicotine Tob. Res. 2009, 11, 614-618.
11. Mills, A.; Messer, K.; Gilpin, E.; Pierce, J. The effect of smoke-free homes on adult smoking
behavior: A review. Nicotine Tob. Res. 2009, 11, 1131-1141.
12. Hymowitz, N.; Cummings, K.M.; Hyland, A.; Lynn, W.R.; Pechacek, T.F.; Hartwell, T.D.
Predictors of smoking cessation in a cohort of adult smokers followed for five years. Tob. Control
1997, 6, S57-S62.
13. Siahpush, M. Socioeconomic status and tobacco expenditure among Australians household:
Results from the 1998–99 Household Expenditure Survey. J. Epidemiol. Community Health 2003,
57, 798-801.
22. Int. J. Environ. Res. Public Health 2011, 8 432
14. Siahpush, M.; McNeill, A.; Hammond, D.; Fong, G.T. Socioeconomic and country variations in
knowledge of health risks of tobacco smoking and toxic constituents of smoke: Results from the
2002 International Tobacco Control (ITC) Four Country Survey. Tob. Control 2006, 15,
iii65-iii70.
15. Siahpush, M.; McNeill, A.; Borland, R.; Fong, G.T. Socioeconomic variations in nicotine
dependence, self-efficacy, and intention to quit across four countries: findings from the
International Tobacco Control (ITC) Four Country Survey. Tob. Control 2006, 15, iii71-iii75.
16. Marsh, A.; McKay, S. Poor Smokers; Policy Studies Institute: London, UK, 1994.
17. Nelson, D.E.; Emont, S.L.; Brackbill, R.M.; Cameron, L.L.; Peddicord, J.; Fiore, M.C. Cigarette
smoking prevalence by occupation in the United States. A comparison between 1978 to 1980 and
1987 to 1990. J. Occup. Med. 1994, 36, 516-525.
18. White, V.; Hill, D.; Siahpush, M.; Bobevski, I. How has the prevalence of cigarette smoking
changed among Australian adults? Trends in smoking prevalence between 1980 and 2001. Tob.
Control 2003, 12, 67-74.
19. Hart, C.L.; Hole, D.J.; Gillis, C.R.; Smith, G.D.; Watt, G.C.; Hawthorne, V.M. Social class
differences in lung cancer mortality: Risk factor explanations using two Scottish cohort studies.
Int. J. Epidemiol. 2001, 30, 268-274.
20. Jha, P.; Peto, R.; Zatonski, W.; Boreham, J.; Jarvis, M.J.; Lopez, A.D. Social inequalities in male
mortality, and in male mortality from smoking: Indirect estimation from national death rates in
England and Wales, Poland, and North America. Lancet 2006, 368, 367-370.
21. Mackenbach, J.P.; Stirbu, I.; Roskam, A.J.; Schaap, M.M.; Menvielle, G.; Leinsalu, M.;
Kunst, A.E. Socioeconomic inequalities in health in 22 European countries. N Engl. J. Med. 2008,
358, 2468-2481.
22. Layte, R.; Whelan, C.T. Explaining social class inequalities in smoking: The role of education,
self-efficacy, and deprivation. Eur. Sociol. Rev. 2009, 25, 399-410.
23. Moussa, K.; Lindström, M.; Ostergren, P.O. Socioeconomic and demographic differences in
exposure to environmental tobacco smoke at work: The Scania Public Health Survey 2000. Scand.
J. Public Health 2004, 32, 194-202.
24. Edwards, R.; Hasselholdt, C.P.; Hargreaves, K.; Probert, C.; Holford, R.; Hart, J.;
van Tongeren, M.; Watson, A.F. Levels of second hand smoke in pubs and bars by deprivation
and food-serving status: a cross-sectional study from North West England. BMC Public Health
2006, 6, 42.
25. Moore, R.S.; Lee, J.P.; Antin, T.M.; Martin, S.E. Tobacco free workplace policies and low
socioeconomic status female bartenders in San Francisco. J. Epidemiol. Community Health 2006,
60, ii51-ii56.
26. Shavers, V.L.; Fagan, P.; Alexander, L.A.; Clayton, R.; Doucet, J.; Baezconde-Garbanati, L.
Workplace and home smoking restrictions and racial/ethnic variation in the prevalence and
intensity of current cigarette smoking among women by poverty status, TUS-CPS 1998–1999 and
2001–2002. J. Epidemiol. Community Health 2006, 60, 34-43.
27. Eadie, D.; Heim, D.; MacAskill, S.; Ross, A.; Hastings, G.A. A qualitative analysis of compliance
with smoke-free legislation in community bars in Scotland; implications for public health.
Addiction 2008, 103, 1019-1026.
23. Int. J. Environ. Res. Public Health 2011, 8 433
28. Shopland, D.R.; Anderson, C.M.; Burns, D.M. Association between home smoking restrictions
and changes in smoking behaviour among employed women. J. Epidemiol. Community Health
2006, 60, 44-50.
29. Osypuk, T.L.; Acevedo-Garcia, D. Support for smoke-free policies: A nationwide analysis of
immigrants, US-born, and other demographic groups, 1995–2002. Amer. J. Public Health 2010,
100, 171-181.
30. Dinno, A.; Glantz, S. Tobacco control policies are egalitarian: A vulnerabilities perspective on
clean indoor air laws, cigarettes prices, and tobacco use disparities. Soc. Sci. Med. 2009, 68,
1439-1447.
31. Ogilvie, D.; Petticrew, M. Reducing social inequalities in smoking: Can evidence inform policy?
A pilot study. Tob. Control 2004, 13, 129-131.
32. Thompson, M.E.; Fong, G.T.; Hammond, D.; Boudreau, C.; Driezen, P.; Hyland, A.; Borland, R.;
Cummings, K.M.; Hastings, G.B.; Siahpush, M.; Mackintosh, A.M.; Laux, F.L. Methods of the
International Tobacco Control (ITC) Four Country Survey. Tob. Control 2006, 15,
iii12-iii18.
33. Hyland, A.; Hassan, L.M.; Higbee, C.; Boudreau, C.; Fong, G.T.; Borland, R.; Cummings, K.M.;
Yan, M.; Thompson, M.E.; Hastings, G. The impact of smoke-free legislation in Scotland: results
from the Scottish ITC: Scotland/UK longitudinal surveys. Eur. J. Public Health 2009, 19,
198-205.
34. Borland, R.; Yong, H.H.; Siahpush, M.; Hyland, A.; Campbell, S.; Hastings, G.; Cummings, K.M.;
Fong, G.T. Support for and reported compliance with smoke-free restaurants and bars by smokers
in four countries: Findings from the International Tobacco Control (ITC) Four Country Survey.
Tob. Control 2006, 15, iii34-iii41.
35. Heatherton, T.F.; Kozlowski, L.T.; Frecker, R.C.; Rickert, W.; Robinson, J. Measuring the
heaviness of smoking: Using self-reported time to the first cigarette of the day and number of
cigarettes smoked per day. Brit. J. Addict. 1989, 84, 791-799.
36. Hyland, A.; Higbee, C.; Borland, R.; Travers, M.; Hastings, G.; Fong, G.T.; Cummings, K.M.
Attitudes and beliefs about secondhand smoke and smoke-free policies in four countries: Findings
from the International Tobacco Control Four Country Survey. Nicotine Tob. Res. 2009, 11,
642-649.
37. Shopland, D.R.; Anderson, C.M.; Burns, D.M.; Gerlach, K.K. Disparities in smoke-free
workplace policies among food service workers. J. Occup. Environ. Med. 2004, 46, 347-356.
38. HM Government. A Smoke-F ree Future: A Comprehensive Tobacco Control Strategy for England;
Department of Health: London, UK, 1 February 2010. Available online: http://www.dh.gov.uk/en/
Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_111749 (accessed on
5 May 2010).