Briefly Noted

Vaping and nicotine replacement therapy (NRT) were equally effective at decreasing craving and withdrawal symptoms for smokers discharged from smoke‐free residential treatment for substance use disorder, a pilot study has found. The study, a randomized controlled trial to be published in Nicotine & Tobacco Research on behalf of the Society for Research on Nicotine and Tobacco in Australia, also found that retention was greater for the vaping group (96% at 12 weeks) than the NRT group (68%). For the study, 100 patients received telephone Quitline support and a 12‐week supply of either NRT or a vaping device. At 12 weeks, 14% of the vaping group and 18% of the NRT group report not smoking at all in the last seven days. The researchers concluded that their criteria for retention might have been too strict, and that “some leeway and looking at eventual success over the period people continue to engage with the aids would give a better picture of their long‐term potential.” There is a big movement to legalize vaping in Australia. A key point, however, is that patients readily engaged with smoking cessation after treatment when given the chance. “QuitNic: A pilot randomised controlled trial comparing nicotine vaping products with nicotine replacement therapy for smoking cessation following residential detoxification” by Billie Bonevski and colleagues is available open access, go to https://academic.oup.com/ntr/advance‐article/doi/10.1093/ntr/ntaa143/5889985 .     

Do fines for violating possession-use-purchase laws reduce youth tobacco use?

The present brief report followed children exposed to consequences for violating Purchase, Use, and Possession (PUP) laws over time to assess changes in their smoking status. Youth in 24 towns were surveyed once a year for 3 years, and rates of tobacco use for those fined for PUP law violations were assessed. Of those who were given a ticket for a PUP law violation, 35 (39%) reported not smoking during year 1. Students in grade 7 were more likely to have quit smoking (84%) than those in grade 8 (35%), grade 9 (32%), or grade 10 (21%). For the two follow-up years, 45% and 41% reported not smoking. Assuming those who attrited were smokers, it is possible that about 15% to 24% of the original sample of children cited actually quit smoking over the follow-up period. The implications of these findings are discussed.     

Socioeconomic status, smoking, and health: a test of competing theories of cumulative advantage

Although both low socioeconomic status and cigarette smoking increase health problems and mortality, their possible combined or interactive influence is less clear On one hand, the health of low status groups may be harmed least by unhealthy behavior such as smoking because, given the substantial health risks produced by limited resources, they have less to lose from damaging lifestyles. On the other hand, the health of low status groups may be harmed most by smoking because lifestyle choices exacerbate the health problems created by deprived material conditions. Alternatively, the harm of low status and smoking may accumulate additively rather than multiplicatively. We test these arguments with data from the 1990 U.S. National Health Interview Survey, and with measures of morbidity and mortality. For ascribed statuses such as gender, race, and ethnicity, and for the outcome measure of mortality, the results favor the additive argument, whereas for achieved status and morbidity, the results support the vulnerability hypothesis--that smoking inflicts greater harm among disadvantaged groups.     

WHY UNDERSTANDING SMOKING BANS IS IMPORTANT FOR ESTIMATING THEIR EFFECTS: CALIFORNIA'S RESTAURANT SMOKING BANS AND RESTAURANT SALES

A large literature has sought to determine whether smoking bans help or hinder restaurants. Much of the literature improperly specifies its econometric equations and thus mistakenly infers causality. Examining the relationship between restaurant smoking bans and restaurant revenues in 267 California communities, we reach two main conclusions. First, California's municipal restaurant smoking bans are endogenous in a critical way—restaurant sales growth (or something correlated with restaurant sales growth) appears to cause restaurant bans, not vice versa. Consequently, failure to control properly for trends can produce spurious "evidence" of causation. Second, ban heterogeneity (e.g., state versus local) can be exploited to sort out—or rule out—causal effects. In other words, pooling data and treating smoking bans implemented at different levels as homogenous (as many studies do) ignores an important source of information and is likely to lead to erroneous conclusions. Our analysis holds lessons for the many studies that have examined the arguably more important question of how smoking bans affect smoking rates. ( JEL L51)     

Smoking education and prevention: a developmental model.

A developmental approach to smoking education and prevention for children and adolescents is proposed. Literature is reviewed concerning the most appropriate agent, content, and presentation, of anti-smoking education for each of three age groups: children to age ten, pre/early adolescents eleven to fifteen, and adolescents fifteen to eighteen. For children to age ten, it is suggested that parents are the best agents of education, with teachers, peers, and the mass media, also playing some role. For pre/early adolescents, peers are suggested as the best agents of education, building onto the earlier and ongoing work of the agents mentioned above. For adolescents, the role of the media hero-figure is discussed. It is emphasized that sources of influence may function additively in affecting the child or adolescent's decisions about smoking, and that education in each stage must build on the stage before.     

Smoking Prevalence and Antismoking Regulations in Transition Countries

As a number of new nations emerged in the early nineties, there has been a spurt in regulatory initiatives in transition countries toward nation building and socio-economic reforms. A key prerequisite to policy changes is an understanding of the related patterns and policies. This paper provides an overview of the smoking trends in transition nations, broken by gender and age, and the antismoking policies in place. In particular, four different types of non-price policies are studied. Comparisons with the rest of the world show that transition countries do not fare badly in terms of implementing antismoking policies and are, in fact, better in some cases than other countries. However, greater smoking prevalence for some population subgroups in transition nations suggests that either some other socio-economic factors influencing smoking prevalence might be at play or there might be some enforcement issues with the policies in place.     

Does Telephone Audio Computer-Assisted Self-Interviewing Improve the Accuracy of Prevalence Estimates of Youth Smoking? Evidence from the UMass Tobacco Study

Despite their advantage for obtaining representative samplesof adolescents, telephone surveys have been regarded as an inferiormethod for collecting data on youth tobacco use because theyyield lower estimates than school-based, self-administered surveys.Although no gold standard for smoking estimates exists, thelower estimates in telephone surveys have been attributed tounderreporting due to youths’ concern that parents orothers may overhear their responses. Telephone audio computer-assistedself-interviewing (T-ACASI) is a cost-effective method for obtaininga representative sample of youths and provides increased privacyfor the respondent. We hypothesize that using T-ACASI wouldencourage youths to report more fully smoking behavior comparedto traditional interviewer-administered telephone methods. Ouranalysis further assesses whether respondent age, gender, race/ethnicity,and parental attitude toward smoking moderated the relationshipbetween survey mode and smoking reports. Using data from a statewidetobacco use survey that randomly assigned youth respondentsto either T-ACASI or interviewer-administered modes, we findthat youths were more likely to report smoking behaviors inT-ACASI mode and that this was especially true for girls, particularlythose who believed their parents would disapprove strongly oftheir smoking. The findings suggest that traditional telephonesurveys may underestimate smoking prevalence in most girls bya factor of two, and that a technique for ensuring privacy forthese respondents is an important component of effective telephonesurvey methodology.     

A critique of progress in adolescent smoking prevention

Researchers have developed a number of programs for preventing adolescent smoking. This critique evaluated a cross-section of 12 of these programs. The majority demonstrated short-term effectiveness in reducing the onset of smoking. The studies stressed three common themes: information about smoking's physiological and social effects, skills to cope with peer and advertising pressures, and the modification of attitudes. Despite many positive outcomes in reducing smoking, the studies did not clearly establish whether the interventions did so by imparting coping skills or by modifying attitudes. This leaves in doubt the exact processes that influence smoking behavior. Carbon monoxide and thiocyanate analyses have not been established as alternatives to self-report, as these methods prove unreliable with adolescent populations. Due to the lack of longitudinal studies, the long-term effectiveness of these interventions remains undetermined.     

Canadian Campus Smoking Policies: Investigating the Gap Between Intent and Outcome From a Student Perspective

Abstract

Background: Young adults remain the earliest legal target for the tobacco industry. Against this, the existence of smoking policies would appear to offer some protection to students on campus. However, little research has been conducted into the outcomes of such policies from a student perspective. Methods: The authors conducted 8 focus groups at 4 selected Canadian undergraduate campuses to investigate student perceptions and behaviors resulting from campus smoking policies. Results: Results indicated that student smoking behaviors are minimally impacted by campus smoking policies due to seriously compromised implementation and enforcement. Conclusions: These findings imply that the presence of campus smoking policies and claims of “smoke-free” campuses should not be misinterpreted as achievement and without renewed focus and adequate tobacco control infrastructure, it will remain possible for young adults to initiate and maintain tobacco smoking on campus.     

Social influences on sorority and fraternity member smoking

Objective: To understand how the Greek system uniquely influences smoking attitudes, beliefs, and behaviors among college students who belong to a social sorority or fraternity. Participants: Active members of sororities (n = 16) and fraternities (n = 17) were interviewed between February 2013 and October 2015. Methods: In-depth interviews were conducted examining the social influences of the Greek system on member smoking. Transcribed interviews were coded and analyzed for themes. Results: Sorority and fraternity members experienced different social influences on smoking. Sorority stigmatization of smoking outside bars or parties caused sorority members to hide their smoking. Fraternity members had no social penalties for smoking and allowed smoking at the fraternity house. Fraternity members influenced both fraternity members and sorority members to smoke by sharing cigarettes and smoking at parties. Conclusions: Sororities and fraternities have created social environments that both promote smoking and stigmatize it, presenting unique challenges in college student smoking prevention and cessation efforts.     

SOCIAL LEARNING THEORY AND ALCOHOL BEHAVIOR AMONG THE ELDERLY

Research directly testing Akers's social learning theory has been thus far confined to teenage drug, drinking, and smoking behavior. This study extends the application of social learning theory to older adults' alcohol behavior. Data were gathered through face-to-face interviews of 1,410 people sixty years of age or over living in New Jersey and Florida in either retirement (age homogeneous) or age-integrated communities. A social learning model of differential association, differential reinforcement, and definitions is supported by findings on elderly drinking behavior. As is true for younger age groups, drinking among the elderly is related to the norms and behavior of one's primary groups, one's own attitudes toward (definitions of) alcohol, and the balance of reinforcement for drinking.     

Effects of prenatal care on maternal postpartum behaviors

Most research on the effectiveness of prenatal care has focused on birth outcomes and has found small or no effects. It is possible, however, that prenatal care is “too little too late” to improve pregnancy outcomes in the aggregate, but that it increases the use of pediatric health care or improves maternal health-related parenting practices and, ultimately, child health. We use data from the Fragile Families and Child Wellbeing birth cohort study that have been augmented with hospital medical record data to estimate effects of prenatal care timing on pediatric health care utilization and health-related parenting behaviors during the first year of the child’s life. We focus on maternal postpartum smoking, preventive health care visits for the child, and breastfeeding. We use a multi-pronged approach to address the potential endogeneity of the timing of prenatal care. We find that first trimester prenatal care appears to decrease maternal postpartum smoking by about 5 percentage points and increase the likelihood of 4 or more well-baby visits by about 1 percentage point, and that it may also have a positive effect on breastfeeding. These findings suggest that there are benefits to standard prenatal care that are generally not considered in evaluations of prenatal care programs and interventions.     

The politics of health: the case of smoking control

The policy of the United Kingdom government towards the control of smoking has been characterized by a non-interventionist approach such as persuasion and industrial self-regulation, as opposed to more direct intervention through fiscal policy or control over tobacco production and sales. The effectiveness of the policies adopted by the UK government is difficult to assess, although there has been a reduction over the last ten years in the proportion of smokers in the population. However, evidence from other countries shows that a more comprehensive programme including direct legislation controlling tobacco advertising has a much stronger impact on tobacco consumption. The determinants of the UK government's policy position are analysed and the evidence suggests that this policy position is determined in part by the power of the vested interests in the maintenance of tobacco production, as well as the confusion of interests within the government itself.     

Age and Gender Differerences In a Social Process Model of Adolescent Cigarette Use*

This study examines how age and gender influence the ability of social process theory to explain adolescent cigarette use. Differences in the causal effects of social process variables for three age periods for male and female adolescents are examined. Longitudinal data from a sample of midwestern adolescents are analyzed using path analyses procedures. Findings from these analyses indicate that social process theory is better able to account for cigarette use among older females than any other age and gender group. For females, commitment to education and school activities were better predictors of cigarette smoking at a later age than an earlier age, whereas the opposite was found for belief in conventional societal rules. For males, previous smoking was the major variable in all three age groups to directly affect subsequent smoking. These findings are discussed in terms of previous age and gender research.     

A quit smoking group. Pilot study

1. While the rate of smoking is extremely high among persons with mental illness, there have been efforts to assist this population to quit. A 10-week smoking cessation program was provided for 10 highly nicotine dependent persons with persistent mental illness. 2. No significant differences were found in psychiatric symptoms or drug side effects prior to and after smoking cessation efforts. Four months later, for the 7 subjects who completed the program, 14% were abstinent, 43% maintained reduced tobacco intake, and 43% had resumed previous smoking patterns. 3. Specific barriers to quitting include a lack of nonsmoking coping skills, long-term identity as a smoker, ready access to tobacco products, nicotine addiction, and limited nonsmoking social support.     

Resisting Smoking When a Best Friend Smokes: Do Intrapersonal and Contextual Factors Matter?

This longitudinal study examines individual differences in the tendency to initiate (N = 4,612) and escalate (N = 2,837) smoking when adolescents gain a best friend who smokes. Potential moderating factors include self-esteem, depression, problem behavior, school and family bonds, and household access to cigarettes. In addition to acquiring a smoking best friend, initiation was predicted by trouble at school, household access, poorer grades and delinquency, whereas escalation was predicted by depressive symptoms. There was little evidence that the examined individual difference factors moderate the association between gaining a smoking best friend and increased adolescent smoking. Results point to the challenges of identifying factors that may lead adolescents to be more or less susceptible to the influence of pro-smoking friends.