http://tc.bmj.com/ Latest from TC en-us http://bmjopen.bmj.com/cgi/content/full/3/6/e002907?rss=1 ObjectiveTo test the specificity of the association between tobacco advertising and youth smoking initiation. DesignLongitudinal survey with a 30 month interval. Setting21 public schools in three German states. ParticipantsA total of 1320 sixth-to-eighth grade students who were never-smokers at baseline (age range at baseline, 10-15 years; mean, 12.3 years). ExposuresExposure to tobacco and non-tobacco advertisements was measured at baseline with images of six tobacco and eight non-tobacco advertisements; students indicated the number of times they had seen each ad and the sum score over all advertisements was used to represent inter-individual differences in the amount of advertising exposure. Primary and secondary outcome measuresEstablished smoking, defined as smoked >100 cigarettes during the observational period, and daily smoking at follow-up. Secondary outcome measures were any smoking and smoking in the last 30 days. ResultsDuring the observation period, 5% of the never-smokers at baseline smoked more than 100 cigarettes and 4.4% were classified as daily smokers. After controlling for age, gender, socioeconomic status, school performance, television screen time, personality characteristics and smoking status of peers and parents, each additional 10 tobacco advertising contacts increased the adjusted relative risk for established smoking by 38% (95% CI 16% to 63%; p<0.001) and for daily smoking by 30% (95% CI 3% to 64%; p<0.05). No significant association was found for non-tobacco advertising contact. ConclusionsThe study confirms a content-specific association between tobacco advertising and smoking behaviour and underlines that tobacco advertising exposure is not simply a marker for adolescents who are generally more receptive or attentive towards marketing. http://bmjopen.bmj.com/cgi/content/full/3/6/e002907?rss=1 Mon, 17 Jun 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://bmjopen.bmj.com/cgi/content/full/3/6/e002916?rss=1 ObjectiveTo examine the effect of an outdoor smokefree law in parks and on beaches on observed smoking in selected venues. MethodsThe study involved repeated observations in selected parks and beaches in Vancouver, British Columbia, Canada. The main outcome measure was changes in observed smoking rates in selected venues from prelaw to 12 months postlaw. ResultsNo venue was 100% smokefree at the 12-month postlaw observation time point. There was a significant decrease in observed smoking rates in all venues from prelaw to 12-month postlaw (prelaw mean smoking rate=20.5 vs 12-month mean smoking rate=4.7, p=0.04). In stratified analysis by venue, the differences between the prelaw and 12-month smoking rates decreased significantly in parks (prelaw mean smoking rate=37.1 vs 12-month mean smoking rate=6.5, p=0.01) but not in beaches (prelaw mean smoking rate=2.9 vs 12-month mean smoking rate=1.0, p=0.1). ConclusionsSmokefree policies in outdoor recreational venues have the potential to decrease smoking in these venues. The effectiveness of such policies may differ by the type and usage of the venue; for instance, compliance may be better in venues that are used more often and have enforcement. Future studies may further explore factors that limit and foster the enforcement of such policies in parks and beaches. http://bmjopen.bmj.com/cgi/content/full/3/6/e002916?rss=1 Mon, 17 Jun 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050841v1?rss=1 ObjectiveEvidence shows that smoking tobacco using a waterpipe is significantly associated with diseases. Despite this, waterpipe use seems to be increasing worldwide, though nationally representative data are not widely available. The Global Adult Tobacco Survey (GATS) provides an opportunity to measure various indicators of waterpipe use from nationally representative surveys. MethodsData were obtained for adults 15 years of age or older from 13 countries (Bangladesh, Brazil, China, Egypt, India, Mexico, Philippines, Russia, Thailand, Turkey, Ukraine, Uruguay and Vietnam) who completed GATS from 2008-2010. The GATS questionnaire collected data on current waterpipe use, including daily/less than daily prevalence and number of sessions per day/week. An optional waterpipe module measured former use, age of initiation, and level of consumption during a session. ResultsGATS was successful in producing nationally representative data on waterpipe use from 13 countries, many of which for the first time. The prevalence of waterpipe use among men was highest in Vietnam (13.0%) and Egypt (6.2%); among women, waterpipe use was highest in Russia (3.2%) and Ukraine (1.1%). While over 90% of adults in Ukraine thought smoking tobacco causes serious illness, only 31.4% thought smoking tobacco using a waterpipe causes serious illness. ConclusionsGATS data provide the ability to analyse waterpipe use within a country and across countries. Monitoring of waterpipe use at a national level will better enable countries to target tobacco control interventions such as education campaigns about the negative health effects of waterpipe use. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050841v1?rss=1 Tue, 11 Jun 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050890v1?rss=1 ObjectiveTo develop an approach for rapid assessment of tobacco control interventions in China. We examined the correlation between components of the Strength of Tobacco Control (SOTC) index and a proposed rapid evaluation indicator, the Policy Performance Indicator (PPI), which is based on protection of non-smokers from secondhand smoke (SHS). The PPI was used to assess the implementation of policies related to SHS at the provincial/municipal level in China. MethodsStratified random sampling was used to select five types of organisational and household respondents in two municipalities and five provinces in China (Shanghai and Tianjin, Heilongjiang, Henan, Guangdong, Zhejiang and Jiangxi, respectively). Data collection methods included key informant interviews, observation and intercept surveys (organisations), and a modified Global Adult Tobacco Survey (GATS) questionnaire (households). SOTC scores (SHS policy, capacity and efforts), PPI (no smoking in designated smoke-free places) and mid-term to long-term impact (knowledge, attitude and reduced exposure to SHS) were measured, and correlations among them were calculated. ResultsThe PPI varied across the seven locations. Shanghai led in the component indicators (at 56.5% for indoor workplaces and 49.1% for indoor public places, respectively), followed by Guangdong, Tianjin and Zhejiang (at 30-35% for these two indicators), and finally, Henan and Jiangxi (at 20-25%). Smoke-free policies were more effectively implemented at indoor workplaces than indoor public places. The PPI correlated well with certain components of the SOTC but not with the long-term indicators. ConclusionsThe PPI is useful for evaluating implementation of smoke-free policies. As tobacco control programmes are implemented, the PPI offers an indicator to track success and change strategies, without collecting data for a full SOTC index. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050890v1?rss=1 Tue, 11 Jun 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050849v3?rss=1 IntroductionThe increasingly inequitable impacts of tobacco use highlight the importance of ensuring developing countries' ongoing participation in global tobacco control. The WHO Framework Convention on Tobacco Control (FCTC) has been widely regarded as reflecting the high engagement and effective influence of developing countries. MethodsWe examined participation in FCTC governance based on records from the first four meetings of the Conference of the Parties (COP), comparing representation and delegate diversity across income levels and WHO regions. ResultsWhile attendance at the COP sessions is high, there are substantial disparities in the relative representation of different income levels and regions, with lower middle and low income countries contributing only 18% and 10% of total meeting delegates, respectively. In regional terms, Europe provided the single largest share of delegates at all except the Durban (2008) meeting. Thirty-nine percent of low income countries and 27% of those from Africa were only ever represented by a single person delegation compared with 10% for high income countries and 11% for Europe. Rotation of the COP meeting location outside of Europe is associated with better representation of other regions and a stronger presence of delegates from national ministries of health and focal points for tobacco control. ConclusionsDeveloping countries face particular barriers to participating in the COP process, and their engagement in global tobacco control is likely to diminish in the absence of specific measures to support their effective participation. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050849v3?rss=1 Mon, 10 Jun 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://bmjopen.bmj.com/cgi/content/full/3/5/e002299?rss=1 ObjectiveTo resolve uncertainty as to the risk of Sudden Infant Death Syndrome (SIDS) associated with sleeping in bed with your baby if neither parent smokes and the baby is breastfed. DesignBed sharing was defined as sleeping with a baby in the parents' bed; room sharing as baby sleeping in the parents' room. Frequency of bed sharing during last sleep was compared between babies who died of SIDS and living control infants. Five large SIDS case-control datasets were combined. Missing data were imputed. Random effects logistic regression controlled for confounding factors. SettingHome sleeping arrangements of infants in 19 studies across the UK, Europe and Australasia. Participants1472 SIDS cases, and 4679 controls. Each study effectively included all cases, by standard criteria. Controls were randomly selected normal infants of similar age, time and place. ResultsIn the combined dataset, 22.2% of cases and 9.6% of controls were bed sharing, adjusted OR (AOR) for all ages 2.7; 95% CI (1.4 to 5.3). Bed sharing risk decreased with increasing infant age. When neither parent smoked, and the baby was less than 3 months, breastfed and had no other risk factors, the AOR for bed sharing versus room sharing was 5.1 (2.3 to 11.4) and estimated absolute risk for these room sharing infants was very low (0.08 (0.05 to 0.14)/1000 live-births). This increased to 0.23 (0.11 to 0.43)/1000 when bed sharing. Smoking and alcohol use greatly increased bed sharing risk. ConclusionsBed sharing for sleep when the parents do not smoke or take alcohol or drugs increases the risk of SIDS. Risks associated with bed sharing are greatly increased when combined with parental smoking, maternal alcohol consumption and/or drug use. A substantial reduction of SIDS rates could be achieved if parents avoided bed sharing. http://bmjopen.bmj.com/cgi/content/full/3/5/e002299?rss=1 Tue, 28 May 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050924v1?rss=1 ObjectiveTo identify the international philanthropies that have invested in tobacco control in China, describe their role and strategies in changing the social norms of tobacco use, and define the outcomes achieved. MethodsInformation on the international philanthropic donor China projects, including activities and outcomes, was gathered from multiple sources including organisational websites, key informant interviews and emails with project officers, and published research papers and reports. ResultsPhilanthropic donations to China's tobacco control efforts began in 1986. The donors provided funds to national, city, provincial government organisations, non-government organisations, universities, and healthcare organisations throughout China to establish a tobacco control workforce and effective programmes to reduce the burden of tobacco use. ConclusionsInternational engagement has been an important dimension of tobacco control in China. Recognising the large burden of illness and capitalising on proven effective control measures, philanthropic organisations understandably seized the opportunity to achieve major health gains. Much of the international philanthropic investment has been directed at public information, policy change and building the Chinese research knowledge base. Documenting research and evaluation findings will continue to be important to ensure that promising practices and lessons learned are identified and shared with the China tobacco control practitioners. The ultimate question is whether foreign philanthropy is making a difference in tobacco control and changing social norms in China? The answer is plainly and simply that we do not know; the evidence is not yet available. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050924v1?rss=1 Sat, 25 May 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050816v1?rss=1 BackgroundLarge-scale international events such as World Expos and Olympic Games have the potential to strengthen smoke-free norms globally. The Shanghai 2010 World Expo was one of the first large-scale events to implement and evaluate the adoption of strict tobacco control policies. ObjectiveTo evaluate implementation of tobacco control policies at the 2010 World Expo in Shanghai, China. MethodsThis mixed methods evaluation was conducted from July to October 2010. Observations were conducted in all 155 pavilions and outdoor queuing areas, all 45 souvenir shops, a random sample of restaurants (51 of 119) and selected outdoor non-smoking areas in all sections of the Expo. In addition, intercept surveys were completed with 3022 visitors over a 4-month period. ResultsAll pavilions and souvenir shops were smoke-free. Restaurants were smoke-free, with only 0.1% of customers observed smoking. Smoking was more common in outdoor non-smoking areas, but still relatively rare overall with only 4.5% of visitors observed smoking. Tobacco products were not sold or marketed in any public settings except for three pavilions that had special exemptions from the policy. Overall, 80.3% of visitors were aware of the smoke-free policy at the World Expo, 92.5% of visitors supported the policy and 97.1% of visitors were satisfied with the smoke-free environment. ConclusionsTobacco control policies at the World Expo sites were generally well-enforced and accepted although compliance was not 100%, particularly in outdoor non-smoking areas. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050816v1?rss=1 Sat, 25 May 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050850v1?rss=1 ObjectivesTo examine contextual and individual demographical predictors of smoking and exposure to second-hand smoke (SHS) in a tobacco-cultivating rural area of southwest China. MethodsA cross-sectional survey of 4070 consenting individuals aged 18 years or more was conducted in 2010. Information on demographical characteristics, tobacco smoking status and SHS exposure were obtained by a standard questionnaire. Multilevel logistic regression was used to model the variation in prevalence of smoking and SHS exposure. ResultsIn the study population, the prevalence rates of smoking and exposure to SHS were 63.5% and 74.7% for men, and 0.6% and 71.2% for women, respectively. Men were more likely to use tobacco than women: OR 8.27, 95% CI (4.83 to 10.97). Age was inversely associated with the probability of tobacco use (OR 0.98, 95% CI 0.97 to 0.99), and exposure to SHS (OR 0.97, 95% CI 0.96 to 0.99). Individual educational level was inversely associated with smoking, but showed no association with exposure to SHS. Adults who did not grow tobacco were less likely to consume tobacco (OR 0.75, 95% CI 0.57 to 0.99) and to be exposed to SHS (OR 0.76, 95% CI 0.58 to 0.99). Living in a high-income community was associated with a low rate of current smoking (OR 0.66, 95% CI 0.57 to 0.77) and SHS exposure (OR 0.58, 95% CI 0.52 to 0.65). ConclusionsFuture interventions to reduce smoking and exposure to SHS in China should focus more on tobacco farmers, less-educated individuals and on poor rural communities. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050850v1?rss=1 Sat, 25 May 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2013-051054v1?rss=1 Research has been shown to be a critical component of successful national tobacco control programmes. China currently has a small number of dedicated researchers addressing tobacco use and control. We encourage the growth of tobacco research as an academic and governmental field of inquiry. Such research would include multiple foci: biologic and toxicologic, epidemiologic, economic, health promotion, evaluation, policy and regulatory, and legal. Developing a community of tobacco researchers would elevate the tobacco issue on the public policy agenda, encourage transparency among key stakeholders and better identify strategies of tobacco control that could be effective in the Chinese context. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2013-051054v1?rss=1 Wed, 22 May 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050838v2?rss=1 BackgroundLegal tobacco tax avoidance strategies such as cross-border cigarette purchasing may attenuate the impact of tax increases on tobacco consumption. Little is known about socioeconomic and country variations in cross-border purchasing. ObjectiveTo describe socioeconomic and country variations in cross-border cigarette purchasing in six European countries. MethodsCross-sectional data from adult smokers (n=7873) from the International Tobacco Control (ITC) Surveys in France (2006/2007), Germany (2007), Ireland (2006), The Netherlands (2008), Scotland (2006) and the rest of the UK (2007/2008) were used. Respondents were asked whether they had bought cigarettes outside their country in the last 6 months and how often. FindingsIn French and German provinces/states bordering countries with lower cigarette prices, 24% and 13% of smokers, respectively, reported purchasing cigarettes frequently outside their country. In non-border regions of France and Germany, and in Ireland, Scotland, the rest of the UK and The Netherlands, frequent purchasing of cigarettes outside the country was reported by 2-7% of smokers. Smokers with higher levels of education or income, younger smokers, daily smokers, heavier smokers and smokers not planning to quit smoking were more likely to purchase cigarettes outside their country. ConclusionsCross-border cigarette purchasing is more common in European regions bordering countries with lower cigarette prices and is more often reported by smokers with higher education and income. Increasing taxes in countries with lower cigarette prices, and reducing the number of cigarettes that can be legally imported across borders could help to avoid cross-border purchasing. http://tobaccocontrol.bmj.com/cgi/content/full/tobaccocontrol-2012-050838v2?rss=1 Wed, 8 May 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/22/suppl_1/i1?rss=1 Ritual tobacco use may have an ancient history, but there is nothing natural' about the way that tobacco now is grown, processed, sold and used. Cigarettes have been engineered for addictiveness, and in the process they have become more deadly.1 The tobacco industry has worked for a century to create the impression that tobacco use is inevitable and to shape the social mores that enable addiction. The once near-ubiquity of smoking, and the concomitant epidemic of disease, are human constructs. Tobacco control advocates can, and are, changing them. Considering endgames marks a new phase of tobacco control. Ten years ago such ideas were not on the agenda, advocates perhaps having been intimidated by the spectre of alcohol prohibition and its failures and unintended consequences (a ghost the industry has invoked with alacrity). The very phrase tobacco control' suggests that tobacco is here to stay, and that its goals should be to rest ... http://tobaccocontrol.bmj.com/cgi/content/full/22/suppl_1/i1?rss=1 Wed, 1 May 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://tobaccocontrol.bmj.com/cgi/content/full/22/suppl_1/i3?rss=1 Since its origins in the 1960s, tobacco control has achieved remarkable success against the scourge of tobacco-produced disease and death. Yet tobacco use, especially cigarette smoking, remains the world's leading cause of preventable premature death and is likely to do so for decades to come. Evidence-based policies seem incapable of substantially hastening the demise of smoking. Slowness in the decline of smoking in developed nations, and increasing smoking in many low- and middle-income countries has sparked interest in novel, even radical 'endgame' strategies to eliminate the toll of tobacco. This paper identifies the principal endgame proposals and, with the other papers in this volume, has the goal of expanding and deepening the endgame conversation by engaging the broader tobacco control community. While we struggle today with often widely divergent perspectives and beliefs about what is possible and how it might be achieved, we all share the same vision of the final words to this story: The end'. http://tobaccocontrol.bmj.com/cgi/content/full/22/suppl_1/i3?rss=1 Wed, 1 May 2013 00:00:00 +0000 Tobacco Control Subject Collection: Open access http://bmjopen.bmj.com/cgi/content/full/3/4/e002157?rss=1 ObjectiveTo assess the mediation of smoking-associated postoperative mortality by postoperative complications. DesignObservational cohort study. SettingUsing data from the Veterans Affairs (VA) Surgical Quality Improvement Programme, a quality assurance programme for major surgical procedures in the VA healthcare system, we assessed the association of current smoking at the time of the surgery with 6-month and 1-year mortality. Primary and secondary outcome measuresUsing mediation analyses, we calculated the relative contribution of each smoking-associated complication to smoking-associated postoperative mortality, both unadjusted and adjusted for age, race/ethnicity, work relative value unit of the operation, surgeon specialty, American Society of Anesthesiologists class and year of surgery. Smoking-associated complications included surgical site infection (SSI), cardiovascular complications (myocardial infarction, cardiac arrest and/or stroke) and pulmonary complications (pneumonia, failure to wean and/or reintubation). ResultsThere were 186 632 never smokers and 135 741 current smokers. The association of smoking and mortality was mediated by smoking-related complications with varying effects. In unadjusted analyses, the proportions of mediation of smoking to 6-month mortality explained by the complications were as follows: SSIs 22%, cardiovascular complications 12% and pulmonary complications 89%. In adjusted analyses, the per cents mediated by each complication were as follows: SSIs 2%, cardiovascular complications 4% and pulmonary complications 22%. In adjusted analyses for 1-year mortality, respective per cents mediated were 2%, 3% and 16%. ConclusionsPulmonary complications, followed by cardiovascular complications and SSIs were mediators of smoking-associated 6-month and 1-year mortality. Interventions targeting smoking cessation and prevention and early treatment of pulmonary complications has the likelihood of reducing postoperative mortality after elective surgery. http://bmjopen.bmj.com/cgi/content/full/3/4/e002157?rss=1 Thu, 18 Apr 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://bmjopen.bmj.com/cgi/content/full/3/4/e002100?rss=1 ObjectiveIn view of the high-smoking rate among university students in Lebanon and the known adverse effects of second-hand smoking, the American University of Beirut (AUB) decided to implement a non-smoking policy on campus. This study sought to examine the students' compliance and attitudes following the ban. DesignCross-sectional study. SettingA private university in Lebanon. Participants545 randomly selected students were approached. A stratified cluster sample of classes offered in the spring semester of the 2008/2009 academic year was selected. Students completed a self-administered paper and pencil survey during class time. Primary and secondary outcome measuresThe main outcomes were compliance with and attitudes towards the ban. Other secondary outcomes were the perception of barriers to implementation of the ban and attitudes towards tobacco control in general. Results535 students participated in the study. Smokers were generally compliant with the ban (72.7%) and for some (20%) it led to a decrease in their smoking. Students' attitude towards the ban and the enforcement of a non-smoking policy in public places across Lebanon varied according to their smoking status whereby non-smokers possessed a more favourable attitude and strongly supported such policies compared with smokers; overall, the largest proportions of students were satisfied to a large extent with the ban and considered it justified (58.6% and 57.2%, respectively). While much smaller percentages reported that the ban would help in reducing smoking to a large extent (16.7%) or it would help smokers quit (7.4%). Perceived barriers to implementation of the non-smoking policy in AUB included the lack of compliance with and strict enforcement of the policy as well as the small number and crowdedness of the smoking areas. ConclusionsAn education campaign, smoking cessation services and strict enforcement of the policy might be necessary to boost its effect in further reducing students' cigarette use. http://bmjopen.bmj.com/cgi/content/full/3/4/e002100?rss=1 Thu, 11 Apr 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://bmjopen.bmj.com/cgi/content/full/3/4/e002486?rss=1 ObjectiveTo study the temporal relationship of smoking with electrophysiological changes. DesignProspective observational study. SettingTertiary cardiac center. ParticipantsMale smokers with atypical chest pain were screened with a treadmill exercise test (TMT). A total of 31 such patients aged 49.8{+/-}10.5 years, in whom TMT was either negative or mildly positive were included. Heart rate variability (HRV) parameters of smokers were compared to those of 15 healthy non-smoking participants. InterventionsAll patients underwent a 24 h Holter monitoring to assess ECG changes during smoking periods. ResultsHeart rate increased acutely during smoking. Mean heart rate increased from 83.8{+/-}13.7 bpm 10 min before smoking, to 90.5{+/-}16.4 bpm during smoking, (p<0.0001) and returned to baseline after 30 min. Smoking was also associated with increased ectopic beats (mean of 5.3/h prior to smoking to 9.8/h during smoking to 11.3/h during the hour after smoking; p<0.001). Three patients (9.7%) had significant ST-T changes after smoking. HRV index significantly decreased in smokers (15.2{+/-}5.3) as compared to non-smoking controls participants (19.4{+/-}3.6; p=0.02), but the other spectral HRV parameters were comparable. ConclusionsHeart rate and ectopic beats increase acutely following smoking. Ischaemic ST-T changes were also detected during smoking. Spectral parameters of HRV analysis of smokers remained in normal limits, but more importantly geometrical parameter--HRV index--showed significant abnormality. http://bmjopen.bmj.com/cgi/content/full/3/4/e002486?rss=1 Fri, 5 Apr 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://bmjopen.bmj.com/cgi/content/full/3/3/e002402?rss=1 ObjectivesTo explore young adult women smokers' cognitive and emotional response to using dark brown plain' cigarette packs in natural settings and whether plain packaging is associated with any short-term change in smoking behaviour. DesignA naturalistic approach. Participants used plain cigarette packs provided to them for 1 week and for 1 week their own fully branded packs, but otherwise smoked and socialised as normal. Participants completed questionnaires twice a week. SettingThe six most populated cities and towns in Scotland. Participants301 young women smokers were recruited, with a final sample of 187 (62.1%). To meet the inclusion criteria women had to be between the ages of 18 and 35, daily cigarette smokers and provide a breath sample to confirm smoking status. Primary and secondary outcome measuresPack perceptions and feelings, feelings about smoking, salience and perceptions of health warnings and avoidant and cessation behaviours. ResultsIn comparison to fully branded packaging, plain packaging was associated with more negative perceptions and feelings about the pack and about smoking (p<0.001). No significant overall differences in salience, seriousness or believability of health warnings were found between the pack types, but participants reported looking more closely at the warnings on plain packs and also thinking more about what the warnings were telling them (p<0.001). Participants reported being more likely to engage in avoidant behaviours, such as hiding or covering the pack (p<0.001), and cessation behaviours, such as foregoing cigarettes (p<0.05), smoking less around others (p<0.001), thinking about quitting (p<0.001) and reduced consumption (p<0.05), while using the plain packs. Results did not differ by dependence level or socioeconomic status. ConclusionsNo research design can capture the true impacts of plain packaging prior to its introduction, but this study suggests that plain packaging may help reduce cigarette consumption and encourage cessation in the short term. http://bmjopen.bmj.com/cgi/content/full/3/3/e002402?rss=1 Mon, 18 Mar 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://bmjopen.bmj.com/cgi/content/full/3/2/e002178?rss=1 IntroductionChronic obstructive pulmonary disease (COPD) is a heterogeneous disease with pulmonary and extra-pulmonary manifestations. Although COPD is a complex disease, diagnosis and staging are still based on simple spirometry measurements. Different COPD phenotypes exist based on clinical, physiological, immunological and radiological observations. Cigarette smoking is the most important risk factor for COPD, but only 15-20% of smokers develop the disease, suggesting a genetic predisposition. Unfortunately, little is known about the pathogenesis of COPD, and even less on the very first steps that are associated with an aberrant response to smoke exposure. This study aims to investigate the underlying local and systemic inflammation of different clinical COPD phenotypes, and acute effects of cigarette smoke exposure in individuals susceptible and non-susceptible for the development of COPD. Furthermore, we will investigate mechanisms associated with corticosteroid insensitivity. Our study will provide valuable information regarding the pathogenetic mechanisms underlying the natural course of COPD. Methods and analysisThis cross-sectional study will include young and old individuals susceptible or non-susceptible to develop COPD. At a young age (18-40 years) 60 party smokers' will be included who are called susceptible or non-susceptible based on COPD prevalence in smoking family members. In addition, 30 healthy smokers (age 40-75 years) and 110 COPD patients will be included. Measurements will include questionnaires, pulmonary function, low-dose CT scanning of the lung, body composition, 6 min walking distance and biomarkers in peripheral blood, sputum, urine, exhaled breath condensate, epithelial lining fluid, bronchial brushes and biopsies. Non-biased approaches such as proteomics will be performed in blood and epithelial lining fluid. Ethics and disseminationThis multicentre study was approved by the medical ethical committees of UMC Groningen and Utrecht, the Netherlands. The study findings will be presented at conferences and will be reported in peer-reviewed journals. Trial registrationClinicalTrials.gov, NCT00807469 (study 1) and NCT00850863 (study 2). http://bmjopen.bmj.com/cgi/content/full/3/2/e002178?rss=1 Fri, 22 Feb 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://bmjopen.bmj.com/cgi/content/full/3/2/e002340?rss=1 ObjectiveTo evaluate the content of school textbooks as a tool to prevent tobacco use in developing countries. DesignContent analysis was used to evaluate if the textbooks incorporated the following five core components recommended by the WHO: (1) consequences of tobacco use; (2) social norms; (3) reasons to use tobacco; (4) social influences and (5) resistance and life skills. SettingNine developing countries: Bangladesh, Cambodia, Laos, Nepal, Sri Lanka, Benin, Ghana, Niger and Zambia. Textbooks analysedOf 474 textbooks for primary and junior secondary schools in nine developing countries, 41 were selected which contained descriptions about tobacco use prevention. ResultsOf the 41 textbooks, the consequences of tobacco use component was covered in 30 textbooks (73.2%) and the social norms component was covered in 19 (46.3%). The other three components were described in less than 20% of the textbooks. ConclusionsA rather limited number of school textbooks in developing countries contained descriptions of prevention of tobacco use, but they did not fully cover the core components for tobacco use prevention. The chance of tobacco prevention education should be seized by improving the content of school textbooks. http://bmjopen.bmj.com/cgi/content/full/3/2/e002340?rss=1 Thu, 21 Feb 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco http://bmjopen.bmj.com/cgi/content/full/3/2/e002123?rss=1 IntroductionThe tobacco use among the youth, in both smoking and smokeless forms, is quite high in the South East Asian region. Tobacco use is a major proven risk factor and contributes substantially to the rising epidemic of non-communicable diseases. ObjectivesTo estimate the prevalence of tobacco use and determine associated factors among adolescent students of Dharan municipality. DesignCross-sectional study. SettingSecondary and higher secondary schools of Dharan municipality in Sunsari district of Nepal. ParticipantsStudents in middle (14-15 years) and late adolescence (16-19 years) from grades 9, 10, 11 and 12 were included. Primary outcome measureEver tobacco use which was defined as one who had not used any form of tobacco in the past 1 month but had tried in the past. MethodologySelf-administered questionnaire adapted from Global Youth Tobacco Survey was used to assess tobacco use among the representative sample of 1312 adolescent students selected by stratified random sampling from July 2011 to July 2012. ResultsOut of 1454 students, 1312 students completed the questionnaires with a response rate of 90.23%. Prevalence of ever use of any tobacco product was 19.7% (95% CI 17.7 to 21.6). More than half of the tobacco users (51.9%) consumed tobacco in public places whereas almost a third (75.6%) of the consumers purchased tobacco from shops. Multivariate analysis showed that tobacco use was associated with late adolescence (OR: 1.64; 95% CI 1.17 to 2.28), male gender (OR: 12.20; 95% CI 7.78 to 19.14), type of school (OR=1.72; 95% CI 1.01 to 2.94), Janajati ethnicity (OR: 2.05; 95% CI 1.39 to 3.01) and receiving pocket money [≥]Nepalese rupees 500/month (OR: 1.45; 95% CI 1.04 to 2.03). ConclusionsTobacco-focused interventions are required for school/college going students to promote cessation among users and prevent initiation, focussing on late adolescence, male gender, government schools, Janajati ethnicity and higher amount of pocket money. http://bmjopen.bmj.com/cgi/content/full/3/2/e002123?rss=1 Thu, 14 Feb 2013 00:00:00 +0000 BMJ Open Subject Collection: Smoking and tobacco