Serving Substance Abuse Professionals Since 1993

Last Update: 11.03.09

C O R K O N L I N E

powerpoint presentations
CORK database search
resource materials
bibliographies
clinical tools
user services
newsletters
about cork
home

CORK Bibliography: Drug Control Policy

76 citations. March 2008 to present

Prepared: March 2009

Adams ML; Jason LA; Pokorny S; Hunt Y. The relationship between school policies and youth tobacco use. Journal of School Health 79(1): 17-23, 2009. (39 refs.)

The school setting is frequently used both to educate youth about risks involved in tobacco use and to implement tobacco prevention and cessation programs. Given that school-based programs have resulted in limited success, it is necessary to identify other setting-level intervention strategies. School tobacco policies represent a type of universal intervention that might have some promise for preventing or reducing tobacco use. Hierarchical linear modeling was used to assess whether school tobacco policies were related to observations of tobacco use and current smoking among 16,561 seventh through twelfth graders attending 40 middle and high schools in Illinois. Results indicated that the enforcement of school tobacco policies, but not the comprehensiveness of those policies, was associated with fewer observations of tobacco use by minors on school grounds as well as lower rates of current smoking among students. The school setting is a key system to impact youth tobacco use. Findings underscore the need to train school personnel to enforce school tobacco policy.

Alback E. Holy smoke? No more? Tobacco control in Denmark. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 190-218. (114 refs.)

It is noted at the outset that at first glance, particularly in relation to public smoking, it would appear that Denmark is very lax in respect to tobacco control. This is not in fact the full story. This chapter reviews the history of tobacco use and control efforts, which rely upon tax policy, restriction of advertising, health education, and most recently protecting nonsmokers.

Antonanzas F; Rodriguez R. Tobacco policies in the European Union: A need for state and continental harmonisation? European Journal of Health Economics 8(4): 301-304, 2007. (8 refs.)

A reduction in tobacco consumption has been targeted as a major public health policy by the European Union (EU). Since 1987, there have been several directives and other legal texts concerning this issue. Despite this, the consumption of tobacco, mainly cigarettes, remains unchanged or continues its upward trend (depending on the country studied) and public health goals are not being met. Smoking is still the leading cause of avoidable death in Europe despite the measures taken to control tobacco consumption. Currently it is estimated that more than half a million people die every year in the EU as a direct or indirect consequence of smoking. The preferred reduction in tobacco consumption is from complete cessation. This requires coordination and collaboration at multiple levels. The WHO has recognized that the most efficient strategies to fight tobacco consumption are population-wide. The different types of policies and programs are reviewed. These include informative and educational policies, fiscal policies, ban policies, an subsidies and incentives (particularly to replace the tobacco-growing subsidies.)

Arvey SR; Malone RE. Advance and retreat: Tobacco control policy in the US military. Military Medicine 173(10): 985-991, 2008. (57 refs.)

This archival study explored why military tobacco control initiatives have thus far largely failed to meet their goals. We analyzed more than 5,000 previously undisclosed internal tobacco industry documents made public via an online database and additional documents obtained from the U.S. military. In four case studies, we illustrate how pressures exerted by multiple political actors resulted in weakening or rescinding military tobacco control policy initiatives. Our findings suggest that lowering military smoking rates will require health policymakers to better anticipate and counter political opponents. The findings also suggest that effective tobacco control policies may require strong, explicit implementation instructions and high-level Department of Defense Support. Finally, policy designers should also consider ways to reduce or eliminate existing perverse incentives to increase tobacco consumption, such as allowing exchange store tobacco sales to fund recreation, and welfare programs.

Baillie LE; Lovato CY; Taylor E; Rutherford MB; Smith M. The pit and the pendulum: The impact on teen smokers of including a designated smoking area in school tobacco control policy. Health Education Research 23(6): 1008-1015, 2008. (31 refs.)

Thirty per cent of school districts in British Columbia do not ban smoking outright on school grounds, and in several instances, smoking is permitted in smoking pits, regardless of school district policy. While there is evidence to suggest that enforcing a tobacco-free environment for students does reduce adolescent smoking rates, the concomitant safety and discipline problems it creates for school staff and administration are demanding and complex, and may override concerns regarding student smoking. This study uses a qualitative approach to explore the meanings that students place on tobacco control policy and the impact that these meanings have on their own smoking behaviours. We found that students were surprised and concerned that smoking was permitted on school property and that it negatively impacted their own tobacco prevention/control/cessation attempts.

Ballard J. The politics of tobacco control in Australia: International template? IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 89-113. (75 refs.)

In its early history Australia the supply and marketing, as well as control efforts were closely linked to the U.S. and Britain. However, in the 1960s Australia became a site of innovation. Earlier than elsewhere smoking was defined as a health problem. Of possible relevance is that the culture of smoking in Australia was marked by a preference for pipes and roll-your-own cigarettes through the first half of the 20th century. This chapter charts the evolution of limits on advertising, the adoption of health warnings, and the restriction of smoking in public places, initiated in the early 1970s, as well as the initiation of "Quit" campaigns.

Berridge V. Militants, manufacturers, and governments: Postwar smoking policy in the United Kingdom. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 114-137. (72 refs.)

This chapter focuses upon the smoking culture within Britain and how it influenced the adoption of control efforts. It describes smoking practices within the UK, and the initiatives undertaken to change smoking patterns. This discussion highlights the role of the tobacco industry, and the process of medicalization of smoking and its discussion within the rubric of public health.

Blanke DD; Cork K. Tobacco Law Symposium. Exploring the limits of smoking regulation. William Mitchell Law Review 34: 1587-1593, 2008. (8 legal refs.)

Summary: ... Whether some recent proposals for smoke-free regulation have crossed this line was the subject of a thought-provoking symposium convened by the Tobacco Control Legal Consortium at William Mitchell College of Law on October 23, 2007. ... In 2007, recognizing that these new initiatives were beginning to spark debate around the world, the Tobacco Control Legal Consortium, headquartered at William Mitchell College of Law, organized a forum for leaders in tobacco control policy to exchange views on this issue in a structured format to identify the key points of consensus and disagreement. ... Symposium participants included approximately fifty nationally-recognized experts in tobacco control policy, public health lawyers, academics, and leading professionals from national public health organizations. ... "If we want to prohibit smoking in all indoor public areas, workplaces, and multi-unit housing complexes, we actually hurt our cause by passing laws that prohibit smoking in cars and outdoor areas because we look fanatical." . ... Sweanor's concern about the risk of excessive or unwise regulation is shared by Simon Chapman, a leading figure in tobacco control and Professor of Public Health at the University of Sydney, Australia, who takes up the issue of outdoor smoking policies. ... They discuss the increased healthcare and productivity costs of smoking employees; legal measures, such as insurance surcharges, that employers can take to regulate smoking; and the overall need for tobacco control advocates to work with business to support private-sector initiatives such as tobacco-free workforce policies.

Borland R; Fong GT; Yong HH; Cummings KM; Hammond D; King B et al. What happened to smokers' beliefs about light cigarettes when "light/mild" brand descriptors were banned in the UK? Findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control 17(4): 256-262, 2008. (20 refs.)

Aim: This paper examines how beliefs of smokers in the UK were affected by the removal of "light" and "mild" brand descriptors, which came into effect on 30 September 2003 for Member States of the European Union (EU). Participants: The data come from the first four waves (2002-2005) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, USA, UK and Australia (15 450 individual cases). Design: The UK ban on misleading descriptors occurred around the second wave of data collection in the ITC survey, permitting us to compare beliefs about light cigarettes among adult smokers in the UK before and after the ban, with beliefs in the three other ITC countries unaffected by the ban. Results: There was a substantial decline in reported beliefs about the benefits of light cigarettes in the UK following the policy change and an associated public information campaign, but by 2005 (ie, wave 4), these beliefs rebounded slightly and the change in beliefs was no greater than in the USA, where there was no policy change. Conclusions: The findings reveal that high levels of misperceptions about light cigarettes existed among smokers in all four countries before and after the EU ban took effect. We cannot conclude that the policy of removing some aspects of misleading labels has been effective in changing beliefs about light cigarettes. Efforts to correct decades of consumer misperceptions about light cigarettes must extend beyond simply removing "light'' and "mild'' brand descriptors.

Brandt AM. Difference and diffusion: Cross-cultural perspectives on the rise of anti-tobacco policies. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 255-274. (76 refs.)

This chapter deals with the norm and mores related to tobacco use. It begins with a discussion of cigarette "manners" in the U.S, and the dramatic divide between smokers and non-smokers. In some instances, control policy are being predicated not on health grounds but as a public nuisance, e.g. smoking in public places. The impact of US smoking restrictions is most evident in the smoking ban on airlines, which has had an international impact. The inherent contradiction internationally is noted in the US's proselytizing against smoking, while at the same time aggressively marketing its products throughout the world.

Burns DM; Dybing E; Gray N; Hecht S; Anderson C; Sanner T et al. Mandated lowering of toxicants in cigarette smoke: A description of the World Health Organization TobReg proposal. Tobacco Control 17(2): 132-141, 2008. (16 refs.)

Preventing the initiation of tobacco product use, promoting cessation of tobacco use, and protecting the public from exposure to secondhand smoke are recognized by the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) and by the WHO Study Group on Tobacco Product Regulation (TobReg) as the most effective approaches to reducing tobacco related morbidity and morality. However, the FCTC also recognizes the need for tobacco product regulation in articles 9 and 10 of the treaty In order to inform that process TobReg has developed a series of reports that begin to provide a scientific foundation for tobacco product regulation. This paper summarizes a proposal and the considerations that led to it, developed by a joint International Agency for Research on Cancer (IARC) and WHO working group and approved by TobReg, which present performance standards for cigarettes and a strategy to use them to mandate a reduction in the toxicant yields for cigarette smoke.

Cantrell J; Hung D; Fahs MC; Shelley D. Purchasing patterns and smoking behaviors after a large tobacco tax increase: A study of Chinese Americans living in New York City. Public Health Reports 123(2): 135-146, 2008. (53 refs.)

Objectives. Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens the public health benefits of higher-priced cigarettes. Few studies examine responses to cigarette tax policies, particularly among high-risk minority populations. This study examined the prevalence and correlates of tax avoidance and changes in smoking behaviors among Chinese American smokers in New York City after a large tax increase. Methods. We conducted a cross-sectional study with data for 614 male smokers from in-person and telephone interviews using a comprehensive household-based survey of 2,537 adults aged 18-74 years. Interviews were conducted in multiple Chinese dialects. Results. A total of 54.7% of respondents reported engaging in at least one low- or no-tax strategy after the New York City and New York State tax increases. The more common strategies for tax avoidance were purchasing cigarettes from a private supplier/importer and purchasing duty free/overseas. Higher consumption, younger age, and number of years in the U.S. were consistently associated with engaging in tax avoidance. Younger and heavier continuing smokers were less likely to make a change in smoking behavior in response to the tax increase. Despite high levels of tax avoidance and varying prices, nearly half of continuing smokers made a positive change in smoking behavior after the tax increase. Conclusions. Expanded legislation and enforcement must be directed toward minimizing the availability of legal and illegal low- or no-tax cigarette outlets. Public education and cessation assistance customized for the Chinese American community is key to maximizing the effectiveness of tobacco tax policies in this population.

Chaloupka FJ. Smoking, food insecurity, and tobacco control. (editorial). Archives of Pediatrics & Adolescent Medicine 162(11): 1096-1098, 2008. (14 refs.)

Chapman S. International tobacco control should repudiate Jekyll and Hyde health philanthropy. (editorial). Tobacco Control 17(1): 1-1, 2008. (5 refs.)

Chapman S; Freeman B. Markers of the denormalisation of smoking and the tobacco industry. Tobacco Control 17(1): 25-31, 2008. (64 refs.)

Background: In nations with histories of declining smoking prevalence and comprehensive tobacco control policies, smoking-positive cultures have been severely eroded. Smoking, smokers and the tobacco industry are today routinely depicted in everyday discourse and media representations in a variety of overwhelmingly negative ways. Several authors have invoked Erving Goffman's notions of stigmatisation to describe the process and impact of this radical transformation, which importantly includes motivating smoking cessation. Efforts to describe nations' progress toward comprehensive tobacco control have hitherto taken little account of the role of cultural change to the meaning of smoking and the many ways in which it has become denormalised. Methods: This paper identifies a diversity of generally undocumented yet pervasive markers of the "spoiled identity'' of smoking, smokers and the tobacco industry, illustrated with examples from Australia, a nation with advanced tobacco control. Results: We caution about some important negative consequences arising from the stigmatisation of smokers. Conclusions: We recommend that schemes rating the comprehensiveness of national tobacco control should be supplemented by documentation of markers of this denormalisation.

Commission of the European Communities. Green Paper. Towards a Europee free from tobacco smoke: Policy options at EU level. Brussels: Commission of the European Communitites, 2007. (91 refs.)

Background: Environmental tobacco smoke,also known as "second-hand smoke" or "passive smoking," is a known cause of illness and death in the European Union. The promotion of smoke-free places within Europe began with concern for health and safety at work and has now progressed to country-wide bans on smoking in public places in several countries. Smoking bans have currently been introduced in Scotland, Ireland, Italy, Malta, Belgium, Sweden and most recently in France. However, the national legislation differs according to each country. The Green Paper ooks at justifications for having smoke-free policies in Europe, taking into consideration the health burden of passive smoking, as well as economic and social considerations. An awareness of the dangers of passive smoking and a smoke-free environment is expected to help reduce the number of people who smoke, by "denormalising" the behaviour of smoking within society. The paper outlines the current status of smoke-free regulations at national and EU level. Section 4 then considers the advantages and disadvantages of various forms of regulation: comprehensive smoke-free regulation, versus, smoke-free regulation with exemptions. These exemptions include a choice of: exemption for the licensed hospitality sector; exemption for pubs and bars not serving food; or enclosed, separately ventilated smoking rooms. Section 5 looks at possible policy options. These include a number of self-regulatory options or binding legislation: 1. No change from the status quo: regulatory developments would be the responsibility of national governments and the WHO Framework Convention on Tobacco Control (FCTC). 2. Voluntary measures: encouraging stakeholders (industry) to adopt common voluntary guidelines at European level. 3. Open Method of Coordination: encouraging Member States to link their smoke-free laws. 4. Commission or Council Recommendations: this would still require Member States to voluntarily adopt smoke-free legislation, but simply with the guidance of the Commission or Council. 5. Binding legislation: this would involve enforceable laws throughout Europe.

Danishevski K; Gilmore A; McKee M. Public attitudes towards smoking and tobacco control policy in Russia. Tobacco Control 17(4): 276-283, 2008. (32 refs.)

Background: Since the political transition in 1991, Russia has been targeted intensively by the transnational tobacco industry. Already high smoking rates among men have increased further; traditionally low rates among women have more than doubled. The tobacco companies have so far faced little opposition as they shape the discourse on smoking in Russia. This paper asks what ordinary Russians really think about possible actions to reduce smoking. Methods: A representative sample of the Russian population (1600 respondents) was interviewed face to face in November 2007. Results: Only 14% of respondents considered tobacco control in Russia adequate, while 37% thought that nothing was being done at all. There was support for prices keeping pace with or even exceeding inflation. Over 70% of all respondents favoured a ban on sales from street kiosks, while 56% believed that existing health warnings (currently 4% of front and back of packs) were inadequate. The current policy of designating a few tables in bars and restaurants as non-smoking was supported by less than 10% of respondents, while almost a third supported a total ban, with 44% supporting provision of equal space for smokers and non-smokers. Older age, non-smoking status and living in a smaller town all emerged as significantly associated with the propensity to support antismoking measures. The tobacco companies were generally viewed as behaving like most other companies in Russia, with three-quarters of respondents believing that these companies definitely or maybe bribe politicians. Knowledge of impact of smoking on health was limited with significant underestimation of dangers and addictive qualities of tobacco. A third believed that light cigarettes are safer than normal cigarettes. Conclusion: The majority of the Russian population would support considerable strengthening of tobacco control policies but there is also a need for effective public education campaigns.

Dorotheo EU. Marginalising tobacco control advocates. (editorial). Tobacco Control 18(1): 5-5, 2009. (0 refs.)

Edwards R; Thomson G; Wilson N; Waa A; Bullen C; O'Dea D; Gifford H; Glover M; Laugesen M; Woodward A. After the smoke has cleared: Evaluation of the impact of a new national smoke-free law in New Zealand. Tobacco Control 17(1): e-article 2, 2008. (37 refs.)

Background: The New Zealand 2003 Smoke-free Environments Amendment Act (SEAA) extended existing restrictions on smoking in office and retail workplaces by introducing smoking bans in bars, casinos, members' clubs, restaurants and nearly all other workplaces from 10 December 2004. Objective: To evaluate the implementation and outcomes of aspects of the SEAA relating to smoke-free indoor workplaces and public places, excluding schools and early learning centres. Methods: Data were gathered on public and stakeholder attitudes and support for smoke-free policies; dissemination of information, enforcement activities and compliance; exposure to secondhand smoke (SHS) in the workplace; changes in health outcomes linked to SHS exposure; exposure to SHS in homes; smoking prevalence and smoking related behaviours; and economic impacts. Results: Surveys suggested growing majority support for the SEAA and its underlying principles among the public and bar managers. There was evidence of high compliance in bars and pubs, where most enforcement problems were expected. Self reported data suggested that SHS exposure in the workplace, the primary objective of the SEAA, decreased significantly from around 20% in 2003, to 8% in 2006. Air quality improved greatly in hospitality venues. Reported SHS exposure in homes also reduced significantly. There was no clear evidence of a short term effect on health or on adult smoking prevalence, although calls to the smoking cessation quitline increased despite reduced expenditure on smoking cessation advertising. Available data suggested a broadly neutral economic impact, including in the tourist and hospitality sectors. Conclusion: The effects of the legislation change were favourable from a public health perspective. Areas for further investigation and possible regulation were identified such as SHS related pollution in semi-enclosed outdoor areas. The study adds to a growing body of literature documenting the positive impact of comprehensive smoke-free legislation. The scientific and public health case for introducing comprehensive smoke-free legislation that covers all indoor public places and workplaces is now overwhelming, and should be a public health priority for legislators across the world as part of the globalisation of effective public health policy to control the tobacco epidemic.

Farrelly MC; Pechacek TF; Thomas KY; Nelson D. The impact of tobacco control programs on adult smoking. American Journal of Public Health 98(2): 304-309, 2008. (41 refs.)

Objectives. We examined whether state tobacco control programs are effective in reducing the prevalence of adult smoking. Methods. We used state survey data on smoking from 1985 to 2003 in a quasi-experimental design to examine the association between cumulative state antitobacco program expenditures and changes in adult smoking prevalence, after we controlled for confounding. Results. From 1985 to 2003, national adult smoking prevalence declined from 29.5% to 18.6% (P<.001). Increases in state per capita tobacco control program expenditures were independently associated with declines in prevalence. Program expenditures were more effective in reducing smoking prevalence among adults aged 25 or older than for adults aged 18 to 24 years, whereas cigarette prices had a stronger effect on adults aged 18 to 24 years. If, starting in 1995, all states had funded their tobacco control programs at the minimum or optimal levels recommended by the Centers for Disease Control and Prevention, there would have been 2.2 million to 7.1 million fewer smokers by 2003. Conclusions. State tobacco control program expenditures are independently associated with overall reductions in adult smoking prevalence.

Feldman EA. The limits of tolerance: Cigarettes, politics and society in Japan. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 38-67. (147 refs.)

In contrast to other countries, tobacco control policy in Japan is poorly articulated and little discussed. This has been attributed to many by the state financial interests � the government has the tobacco monopoly -- taking precedent over public health. Official rhetoric typically says that control is inappropriate as it steps on individual rights. This chapter reviews the history of tobacco use in Japan, the prevalence of smoking and related health problems, and reviews the government monopoly, which was restructured in the 1980s, and control efforts in modern Japan, with consideration of taxation, advertising, vending machine sales, and environmental smoke.

Flanagan CA; Stout M; Gallay LS. It's my body and none of your business: Developmental changes in adolescents' perceptions of rights concerning health. Journal of Social Issues 64(4): 815-834, 2008. (29 refs.)

We examined developmental changes in adolescents' perceptions of an individual's right to engage in risky behaviors that could pose harm to health. The views of 563 early, 506 middle, and 467 late adolescents concerning the degree to which individuals have a right to engage in smoking, drinking, and drug use (private health beliefs) or whether the government has a right to impose constraints on individuals (public health beliefs) were surveyed over 3 years. Endorsements of individual rights increased between early and middle adolescence and remained stable into late adolescence. Endorsements of public health beliefs showed a curvilinear trend with middle adolescents less likely than early or late adolescents to endorse the government's right to constrain individual choices. Regardless of age, endorsements of public health were positively and individual rights were negatively related to an adolescent's belief that s/he had a right to intervene in a friend's risky choices.

Frankenberg G. Between paternalism and volunteerism: Tobacco consumption and tobacco control in Germany. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 161-189. (100 refs.)

This chapter outlines the history of tobacco use, noting that after its introduction in the 1600s, beyond its being viewed as a pharmaceutical, tobacco rapidly became a sign of social status. Tobacco has long been a source of state revenue, and any discussion of control is seen as inevitably linked to financial issues. The chapter outlines the development of the tobacco industry and traces its development. There is also an overview of the patterns of current use and associated morbidity and mortality. The remainder of the chapter addresses central issues related to tobacco control and mechanisms used. It is noted that the public voices evident in promoting policies in other countries, the primary spokespeople for control policies have been government officials and experts.

Gartner CE; Hall WD. Should Australia lift its ban on low nitrosamine smokeless tobacco products? Medical Journal of Australia 188(1): 44-46, 2008. (26 refs.)

In Australia, 2.9 million people continue to smoke daily, and tobacco still accounts for 8% of disease burden. Tobacco harm-reduction strategies, such as the use of Swedish snus, have been suggested as a way to further reduce this disease burden. In Australia, the most dangerous tobacco products (cigarettes) are the least regulated, while oral tobacco products, including snus, cannot be sold legally. Recent epidemiological modelling indicates that there are only small differences in life expectancy between smokers who quit and those who switch to snus. There is a case on public health and ethical grounds for allowing inveterate smokers who want to reduce their health risks to access snus. At a minimum, the recent increase in tax on smokeless tobacco should be reversed, and the ban on the commercial importation and supply of low nitrosamine smokeless tobacco should be reconsidered in light of the epidemiological evidence on its potential to reduce tobacco-related disease in smokers.

Gilmore A; McKee M. Tobacco-control policy in the European Union. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 219-254. (195 refs.)

As independent from individual counties, this chapter reviews tobacco control policy in the European Union. It discusses the history of the EU in tobacco control, and also discusses the apparent contradiction inasmuch as the EU also provides subsidies to farmers' growing tobacco in the form of agriculture subsidies. The chapter also addresses tax policy, product labeling and regulation, and environmental smoke.

Goel RK. Unemployment, insurance and smoking. Applied Economics 40(20): 2593-2599, 2008. (16 refs.)

Using recent state-level data from the United States, this article examines new influences on cigarette demand. In particular, we uniquely focus on the effects of unemployment and health insurance coverage on smoking. Results: show that higher cigarette prices, a lack of health insurance and restrictions on smoking at home, all lead to reduced smoking. On the other hand, literacy, income, unemployment, workplace smoking restrictions, smokeless tobacco taxes and tobacco-producing states do not seem to have an appreciable impact. The magnitude of the price elasticity of demand is greater than that found in the pre-MSA era. Policy implications are discussed.

Green MA; Hawranik PG. Smoke-free policies in the psychiatric population on the ward and beyond: A discussion paper. International Journal of Nursing Studies 45(10): 1543-1549, 2008. (46 refs.)

Healthcare facilities from a number of countries have or are in the process of implementing smoke-free policies as part of their public health agenda and tobacco control strategy. Their main intent is to prevent the harmful effects of environmental tobacco smoke on employees and patients. However, these protection policies are often implemented before taking into account the specific needs of patients in psychiatric facilities and are clouded by a lack of knowledge, myths and misconceptions held by a variety of stakeholders. Consequently, the implementation of smoke-free policies tends to result in unintended and unfavourable consequences for this aggregate. Patients are forced to abstain from tobacco use during their hospitalization but have few options to address their dependence upon discharge. The development and implementation of such policies should not occur in isolation. It requires thoughtful consideration of the needs of the affected population. Recommendations are presented on the role of nurses in lobbying for policy changes. As well as strategies for policy makers and administrators that should accompany such a policy in psychiatry.

Hall WD; Gartner CE; Carter A. The genetics of nicotine addiction liability: Ethical and social policy implications. (review). Addiction 103(3): 350-359, 2008. (123 refs.)

Aim: To assess the promise and risks of technological applications of genetic research on liability to develop nicotine dependence. Methods We reviewed (i) the evidence on the genetics of nicotine dependence; (ii) the technical feasibility of using genetic information to reduce smoking uptake and increase cessation; and (iii) policy and ethical issues raised by the uses of genetic information on addiction liability. Results (i) Despite evidence from twin studies that genes contribute to addiction susceptibility, research to date has not identified commonly occurring alleles that are strongly predictive of developing nicotine addiction. Nicotine addiction is likely to involve multiple alleles of small effect that interact with each other and with the environment. (ii) Population screening for susceptibility alleles is unlikely to be effective or cost-effective. Tailoring of smoking cessation treatments with genetic information is more plausible but results to date have been disappointing. Population health strategies such as increased taxation and reduced opportunities to smoke are more efficient in reducing cigarette smoking. Tobacco harm reduction policies applied to populations may also play a role in reducing tobacco-related harm. (iii) Future uses of genomic information on addiction risk will need to assess the risks of medicalising addiction (e.g. pessimism about capacity to quit) and community concerns about genetic privacy. Conclusions: Nicotine genomics is a very new and underdeveloped field. On the evidence to date, its advocates would be wise to avoid extravagant claims about its preventive applications.

Hanewinkel R. Tobacco control policy. (German). Suchttherapie 9(3): 93-102, 2008. (77 refs.)

A comprehensive tobacco control policy covers 10 fields of activities, which aim to reduce demand and supply of tobacco. The following measures are designed to reduce demand: 1. comprehensive smoke-free policies on public places and workplaces, 2. a high real price for tobacco products, 3. public education (school education on tobacco and mass media campaigns), 4. a total ban of advertising and promotion, 5. comprehensive consumer information, and 6. easy access to evidence-based smoking cessation. Measures to reduce supply include: 7. strict control of the product, 8. sales and distribution regulations, 9. measures to combat smuggling, and 10. protection of the environment in regard to tobacco cultivation and manufacture. Studies for all tobacco control fields are presented and discussed. The current status of the implementation and future activities in Germany are described.

Helakorpi SA; Martelin TP; Torppa JO; Patja KM; Kiiskinen UA; Vartiainen EA et al. Did the Tobacco Control Act amendment in 1995 affect daily smoking in Finland? Effects of a restrictive workplace smoking policy. Journal of Public Health 30(4): 407-414, 2008. (40 refs.)

This study examined changes in adult daily smoking in 1981-2005 in Finland, in order to evaluate the impact of the 1995 Tobacco Control Act Amendment (TCAA) and accompanying measures on the proportion of daily smokers. The main focus of the TCAA was to prohibit smoking at workplaces (designated rooms excluded) in order to protect workers from environmental tobacco smoke. The study was based on data from annual postal surveys among 15- to 64-year-olds in 1981-2005 (average response rate 73%). The data set for this study comprised men and women aged 25-64 years (n = 73 471). Logistic models were used to test the effect of the 1995 TCAA across employment status while controlling for the effect of changes in the real price of tobacco and in gross domestic product per capita, and adjusting for age, education, secular trend and prevalence of ever-smokers in each birth cohort. Controlling for confounding factors, the odds ratio (OR) for daily smoking after 1995 among employed men was 0.83 (95% CI 0.73-0.94) compared with the OR (1.0) for the period ending 1994. The corresponding figure for employed women was 0.78 (95% CI 0.68-0.91). The results can be interpreted as a positive effect of the 1995 TCAA on employees' daily smoking. Moreover, a similar decrease in daily smoking was not seen among those not targeted by the TCAA (including farmers, students, housewives, pensioners and the unemployed). Smoking behaviour was and can be influenced by national tobacco policy measures.

Helakorpi S; Martelin T; Torppa J; Vartiainen E; Uutela A; Patja K. Impact of the 1976 Tobacco Control Act in Finland on the proportion of ever daily smokers by socioeconomic status. Preventive Medicine 46(4): 340-345, 2008. (31 refs.)

Objective. To assess the impact of the 1976 Tobacco Control Act (TCA) on smoking initiation across socioeconomic groups. Methods. Nationwide data from independent annual cross-sectional postal surveys in 1978-2002 in Finland. Subjects were 25-64-year-old men and women born 1926-1975 (n = 68 071). Socioeconomic status was derived individually from population census data. Logistic regression was applied to assess the impact of the 1976 TCA on the prevalence of ever daily smoking in birth cohorts and socioeconomic groups. Results. Clear socioeconomic differences in ever daily smoking among men and women were found. In all socioeconomic groups a declining cohort trend was observed among men whereas women showed an increasing trend in early cohorts and a declining one thereafter. A statistically significant decline in the proportion of ever daily smokers compatible with the impact of the TCA was found in all socioeconomic groups except farmers. Among women the decline was roughly similar in each socioeconomic group, while among men it varied and was most pronounced among white collar employees. Conclusions. The impact of the 1976 TCA was less pronounced among male lower socioeconomic groups. In spite of the even impact of the TCA on female smoking across socioeconomic groups, large socioeconomic disparities remain. Tobacco control policy measures specifically directed at lower socioeconomic groups are needed.

Holdsworth C; Robinson JE. 'I've never ever let anyone hold the kids while they've got ciggies': moral tales of maternal smoking practices. Sociology of Health & Illness 30(7): 1086-1100, 2008. (42 refs.)

Smoking in the home is, potentially, the next frontier in tobacco control in the developed world. As smoking regulations in public space are extended, attention is turning to private spaces and the contribution of parental, particularly maternal, smoking to children's health and socio-economic inequalities in family health. Yet relatively little is known about mothers' smoking practices within the home and the social meanings of smoking that are constructed by these practices. In this paper we explore how mothers who smoke construct moralities of their smoking behaviour, particularly in relation to where and with whom they smoke. Drawing on in-depth Biographic Narrative Interpretative Method, in interviews with 12 smoking mothers, and their partners, we consider how these moral tales involve comparisons with other smokers and the importance of community endorsement of smoking practices, particularly around children. We also consider the role of children in the home and how children are actively involved in the regulation of smoking behaviours. Finally, we consider the implications of these moral tales for interventions around smoke-free homes.

Jimenez-Ruiz JA; de Miera BS; Reynales-Shigematsu LM; Waters HR; Hernandez-Avila M. The impact of taxation on tobacco consumption in Mexico. Tobacco Control 17(2): 105-110, 2008. (26 refs.)

Background: The price of cigarettes to consumers in Mexico, and Latin America in general, remains low in comparison with other regions of the world. In Mexico, taxes represented 59% of the total price of cigarettes in 2006, compared to 75% or more in many high-income countries. The feasibility of raising taxes on cigarettes in Mexico-to both discourage consumption and increase revenues - is an important policy question. Methods: Using household survey data, we undertake a pooled cross-sectional analysis of the demand for cigarettes in Mexico. We use a two-part model to estimate the price elasticity of cigarettes. This model controls for the selection effect that arises from the fact that the impact of price on the decision to smoke or not is estimated using all households in the dataset. Results: The results indicate that price is a significant factor in household decisions concerning smoking and the number of cigarettes smoked. Holding other factors constant, our simulations show that a 10% increase in the cigarette tax in Mexico - calculated as a percentage of the price - yields a 12.4% increase in the price to the consumer, a 6.4% decrease in consumption of cigarettes and a 15.7% increase in the revenue yielded by the tax. Conclusion: In Mexico, there are strong arguments for increasing cigarette taxes. Revenue raised could be used to further prevent tobacco consumption and to finance current funding shortages for the treatment of diseases related to smoking.

Kauffman RM; Ferketich AK; Wewers ME. Tobacco policy in American prisons, 2007. Tobacco Control 17(5): 357-360, 2008. (27 refs.)

Objective: To examine current tobacco policy in US prisons and explore changes in prison tobacco policies over time. Data source: Telephone survey of the 52 US departments of correction. Main outcome measures: Current tobacco policy; distribution of free tobacco; availability of smoking cessation programming and cessation aids. Participants: Complete responses were received from 51 of 52 (98%) departments, while one provided partial information. Results: The majority of correctional systems (60%) reported total tobacco bans on prison grounds, with most remaining facilities (27%) having an indoor ban on tobacco use. No prisons distributed free tobacco. No major violence was reported relating to the implementation of stricter tobacco policies; however many respondents noted that tobacco became a major contraband item following the implementation of a total ban. While most prison systems with an indoor tobacco ban (86%) reported having tobacco cessation programmes, few of those with total bans (39%) continued such programmes after the initial transition period. Conclusion: Total tobacco bans have often been accompanied by the termination of tobacco cessation programmes. Such actions undermine efforts to promote long-term cessation resulting in a missed public health opportunity.

Kisely S. Applying the lessons of tobacco and alcohol control to cannabis. (editorial). Canadian Journal of Psychiatry 53(12): 799-799, 2008. (5 refs.)

Kisely S. The case for policy reform in cannabis control. (editorial). Canadian Journal of Psychiatry 53(12): 795-797, 2008. (16 refs.)

Kozlowski LT. The proposed tobacco regulation: The triumph of hope over experience? (editorial). Tobacco Control 17(2): 74-75, 2008. (10 refs.)

Levy DT; Benjakul S; Ross H; Ritthiphakdee B. The role of tobacco control policies in reducing smoking and deaths in a middle income nation: Results from the Thailand SimSmoke simulation model. Tobacco Control 17(1): 53-59, 2008. (60 refs.)

Objectives: With the male smoking prevalence near 60% in 1991, Thailand was one of the first Asian nations to implement strict tobacco control policies. However, the success of their efforts has not been well documented. Methods: The role of tobacco control policies are examined using the "SimSmoke'' tobacco control model. We first validated the model against survey data on smoking prevalence. We then distinguished the effect of policies implemented between 1991 and 2006 from long-term trends in smoking rates. We also estimated smoking attributable deaths and lives saved as a result of the policies. Results: The model validates well against survey data. The model shows that by the year 2006, policies implemented between 1991 and 2006 had already decreased smoking prevalence by 25% compared to what it would have been in the absence of the policies. Tax increases on cigarettes and advertising bans had the largest impact, followed by media anti-smoking campaigns, clean air laws and health warnings. The model estimates that the policies saved 31 867 lives by 2006 and will have saved 319 456 lives by 2026. Conclusions: The results document the success of Thailand in reducing smoking prevalence and reducing the number of lives lost to smoking, thereby showing the potential of tobacco control policies specifically in a middle-income country. Additional improvements can be realised through higher taxes, stronger clean air policies, comprehensive cessation treatment policies, and targeted media campaigns.

Ma SJ; Hoang MA; Samet JM; Wang JF; Mei CZ; Xu XF et al. Myths and attitudes that sustain smoking in China. Journal of Health Communication 13(7): 654-666, 2008. (41 refs.)

China is a particularly critical country for global tobacco control. It has the world's largest number of smokers and is a prize target for the multinational tobacco companies. This article presents results from 80 focus groups and 30 in-depth interviews on the salient myths and misconceptions concerning active and passive smoking for the purpose of developing appropriate tobacco control policies and intervention strategies to reduce tobacco consumption and secondhand smoke exposure. All participants resided in three counties in Jiangxi, Henan, and Sichuan provinces and were from hospitals, schools, and rural and urban communities. The myths and misconceptions included the identification of smoking as a symbol of personal freedom, the importance of tobacco in social and cultural interactions, the ability to control the health effects of smoking through reasonable and measured use, and the importance of tobacco to the economy. These myths were found in nonsmokers and smokers alike, in both rural and urban areas, and across the key professional groups. For China to curb its current smoking epidemic, tobacco control efforts will have to persuasively address and counter prevailing misconceptions and social norms surrounding smoking. This article discusses the implications of misconceptions and prosmoking attitudes for tobacco control efforts in China.

Main C; Thomas S; Ogilvie D; Stirk L; Petticrew M; Whitehead M et al. Population tobacco control interventions and their effects on social inequalities in smoking: Placing an equity lens on existing systematic reviews. BMC Public Health 8(e-article 178), 2008. (47 refs.)

Background: With smoking increasingly confined to lower socio-economic groups, the tobacco control community has been urged to identify which population-level tobacco control interventions work in order to help tackle smoking-related health inequalities. Systematic reviews have a crucial role to play in this task. This overview was therefore carried out in order to (i) summarise the evidence from existing systematic reviews of population-level tobacco control interventions, and (ii) assess the need for a new systematic review of primary studies, with the aim of assessing the differential effects of such interventions. Methods: Systematic review methods were used to evaluate existing systematic reviews that assessed a population-level tobacco control intervention and which reported characteristics of included participants in terms of at least one socio-demographic or socio-economic factor. Results: Nineteen systematic reviews were included. Four reviews assessed interventions aimed at the population level alone, whilst fifteen included at least one primary study that examined this type of intervention. Four reviews assessed youth access restrictions, one assessed the effects of increasing the unit price of tobacco, and six assessed smoking bans or restrictions. Of the eight remaining reviews, six assessed multi-component community based interventions, in which the population-level interventions were part of a wider tobacco control programme, and two assessed the impact of smoking bans or restrictions in reducing exposure to environmental tobacco smoke. We found tentative evidence that the effect of increasing the unit price of tobacco products may vary between ethnic and socio-economic groups, and between males and females. However, differences in the context and the results of different reviews made it difficult to draw any firm conclusions. Few identified reviews explicitly attempted to examine differences in intervention effects between socio-demographic groups. Therefore on the basis of these reviews the potential for smoking bans, and youth access restrictions to decrease social inequalities in smoking remains unknown. Conclusion: There is preliminary evidence that increases in the unit price of tobacco may have the potential to reduce smoking related health inequalities. There is a need for equity effects to be explicitly evaluated in future systematic reviews and in primary research assessing the effects of population tobacco control interventions.

Mamudu HM; Hammond R; Glantz S. Tobacco industry attempts to counter the World Bank report curbing the epidemic and obstruct the WHO framework convention on tobacco control. Social Science & Medicine 67(11): 1690-1699, 2008. (68 refs.)

In 1999 the World Bank published a landmark study on the economics of tobacco control, Curbing the Epidemic: Governments and the Economics of Tobacco Control (CTE), which concluded that tobacco control brings unprecedented health benefits without harming economies, threatening the transnational tobacco companies' ability to use economic arguments to dissuade governments from enacting tobacco control policies and supporting the WHO Framework Convention on Tobacco Control (FCTC). We used tobacco industry documents to analyze how tobacco companies worked to discredit CTE. They hired public relations firms, had academics critique CTE, hired consultants to produce "independent" estimates of the importance of tobacco to national economies, and worked through front groups, particularly the International Tobacco Growers' Association, to question CTEs findings. These efforts failed, and the report remains an authoritative economic analysis of global tobacco control during the ongoing FCTC negotiations. The industry's failure suggests that the World Bank should continue their analytic work on the economics of tobacco control and make tobacco control part of its development agenda.

Manfredi CP; Maiona A. Rights and public health in the balance: Tobacco control in Canada. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 68-88. (56 refs.)

This chapter charts how Canada, although a late-comer to tobacco regulation, in the span of a decade became the word leader in restricting tobacco marketing, in deterring use through taxation, and directly regulating tobacco use. This chapter focuses upon laws and taxation enacted and the process of enacting these, as well as the role of court cases in sparking political action. It reviews the patterns of use, associated morbidity, and also considers the factors and external events that have shaped current efforts.

Marlow ML. Determinants of state tobacco-control expenditures. Applied Economics 40(7): 831-839, 2008. (25 refs.)

While Centers for Disease Control and Prevention believe that most state governments under-fund tobacco-control programs, little is known about why large variation in spending exists between state governments. This study explores reasons for spending variation through an econometric model of per capita spending on tobacco-control programs that explores the effects of smoking prevalence while holding constant tobacco settlement funds, state budget deficits, and other factors that might also be expected to influence spending variation. Empirical evidence indicates no support for the hypothesis that states with high smoking prevalence spend more on tobacco-control than other states. This finding may be quite surprising to those working in areas of public health and clearly leads to many important policy questions regarding why the data indicate that funding does not appear to bear any relation to perceived public health problems as would be predicted if policymakers were following a 'rational needs' approach to funding.

Marmor TR; Lieberman ES. Tobacco control in comparative perspective: Eight nations in search of an explanation. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 275-308. (42 refs.)

This chapter examines tobacco control policy from a cross-cultural perspective, drawing upon the experiences describe for different countries. Among the themes examined are the way in which while science has provided useful data, at the same time, cultural and political factors have been significant. It is also suggested that identifying a vulnerable population in need of protection has been instrumental in the adoption of control efforts. It is also noted that while significant , public policy alone can not account for the dramatic changes in tobacco use. Finally, smoking has been dramatically transformed from a behavior which had no bounds. Smokin/nonsmoking has become a significant class distinction.

Mcketin R. The Holy Grail of supply control: Have we found the evidence? Addiction 104(3): 455-456, 2009. (7 refs.)

This commentary addresses an article by Cunningham et al. that show that precursor regulations have an impact on the retail market for drugs. It addresses the unintended consequences of such regulation

Meyers DG; Neuberger JS. Cardiovascular effect of bans on smoking in public places. (editorial). American Journal of Cardiology 102(10): 1421-1424, 2008. (22 refs.)

Nathanson CA. Liberte, egalite, fumee: Smoking and tobacco control in France. IN: Feldman EA; Bayer R, eds. Unfiltered: Conflicts over Tobacco Policy and Public Health. Cambridge MA: Harvard University Press, 2004. pp. 138-160. (93 refs.)

This chapter begins with a brief review of the history of tobacco use. Despite the stereotypic image of a left-bank intellectual with a Gauloise hanging from his mouth, it was only after WWI that cigarettes became the dominant form of tobacco used. This chapter following an introduction of current use patterns, discusses the relationship of the state and tobacco, examining the history of the French tobacco monopoly, tobacco control legislation, the nature of the anti-tobacco lobby, and finally, the ideological conflicts that underpin the ambivalence between smokers and nonsmokers.

Niederdeppe J; Farrelly MC; Hersey JC; Davis KC. Consequences of dramatic reductions in state tobacco control funds: Florida, 1998-2000. Tobacco Control 17(3): 205-210, 2008. (32 refs.)

Objective: This study assessed whether dramatic funding reductions to the Florida Tobacco Control Program (FTCP) influenced trends in recall of the Florida "truth'' anti-smoking media campaign, anti-industry attitudes and non-smoking intentions among Florida teens. Methods: We used an interrupted time series technique to test for differences in the rates of change in Florida "truth'' recall, anti-industry beliefs and non-smoking intentions before and after the FTCP budget cuts using the Florida Anti-tobacco Media Evaluation ( FAME) survey, a repeated cross-sectional telephone survey of Florida teens. Results: Recall of the Florida "truth'' anti-smoking campaign, anti-industry attitudes, and non-smoking intentions increased dramatically between April 1998 and May 1999. Florida "truth'' recall declined after FTCP budget cuts in June 1999. Anti-industry beliefs and nonsmoking intentions plateaued or began to decline after the budget cuts. The launch of the national "truth'' campaign in February 2000 may have offset otherwise deleterious effects of the budget cuts on anti-industry beliefs, but not smoking intentions. Conclusion: Reductions in tobacco control funding have immediate effects on programme exposure and cognitive precursors to smoking initiation. There is a critical need to maintain and enhance funding for state tobacco control programmes to continue nationwide progress in preventing youth from initiating cigarette smoking.

Pennock PE. Advertising Sin and Sickness. The Politics of Alcohol and Tobacco Marketing, 1950-90. DeKalb IL: Northern Illinois University Press, 2007

This book is organized into three parts. Part I deals with the alcohol industry and the efforts, between 1947 and 1958, to ban alcohol advertising. It addresses attitudes toward temperance in the larger society and the alcohol industry's efforts to resist regulation. Part II focuses upon the tobacco industry. The highlights of these efforts, occurring in the context of the emerging antismoking movement, were the battle to regulate tobacco marketing in the 1960s, followed by the debates over warning labels, and efforts to restrict advertising. Part III considers the alcohol marketing restrictions introduced in the 1970s and 1980s, and what the author describes as a new temperance movement. The intertwining of political, legal and scientific research threads of the debate are presented. The concluding chapter deals with the elusive quest for restraints.

Pichini S; Pacifici R; Rossi S; Martucci L; Zuccaro P; Mastrobattista L. Tobacco smoking, legislation and smoking cessation in Italy: A national portrait. Multidisciplinary Respiratory Medicine 2(4): 110-113, 2007. (2 refs.)

This report presents a national "portrait" of tobacco smoking in Italy during the year 2005, current Italian legislation, and the smoking cessation programs organized by the Observatory on Tobacco Smoking, Drugs and Alcohol. Regarding tobacco consumption in 2005, 12,570,000 individuals (corresponding to 25.6% of the adult population) were current smokers; 9,150,000 (18.6%) were ex smokers and 27,400,000 (55.8%) were non smokers, the prevalence of smokers being highest in the group aged 25-44 years. Since 1975, tobacco smoking has been prohibited in hospitals, on public transport and in cinemas. The prohibition of tobacco smoking was extended to work-places of Public Administration and Public Companies in 1995, and since 2003 smoking has been banned in all closed places of employment (including bars, restaurants, pubs) open to the public with the exception of those places which have rooms reserved for smokers. The majority of Italian smoking cessation centers listed on the website of the Observatory on Tobacco Smoking, Drugs and Alcohol of the Istituto Superiore di Sanita participated in a longitudinal study aimed at evaluating the efficacy of different interventions for smoking cessation. At 12 months follow up, the proportion of those abstaining from smoking, though the use of different cessation treatments, was around 40% of the initial participants.

Polednak AP. Tobacco control indicators and lung cancer rates in young adults by state in the United States. Tobacco Control 17(1): 66-69, 2008. (20 refs.)

Objective: To determine the association between a tobacco control index (TCI) for 1992-93 for each US state and lung and bronchus cancer mortality and incidence rates by state for younger adults, as the best indicator of the effects of recent progress in tobacco control on lung cancer control. Design: For all 51 US areas (50 states and the District of Columbia), correlation coefficients between the state's TCI and lung cancer rate were analysed. Multiple linear regression models (MLR) predicting cancer rates included sociodemographic variables by state (from the 2000 census). In addition, the 51 areas also were divided into tertiles, from highest to lowest TCI, and means for lung cancer rates were compared. Subjects and settings: All areas with available data on lung cancer mortality and incidence rates. Main outcome measures: Age-standardised mortality rates were available for all 51 areas (50 states and the District of Columbia) for 1989-93, 1994-98 and 1999-2003 for lung cancer at age 15-44 years. Lung cancer incidence rates for 1999-2002 were available for age 20-44 years for 44 states. Results: The correlation between the TCI and lung cancer mortality rate increased in magnitude from 1989-93 to 1999-2003, and the association was statistically significant in MLR models for 1994-98 and 1999 - 2003 (but not 1989-93). The TCI was statistically significantly correlated with the lung cancer incidence rate in 1999 - 2002 by state, and the association persisted in an MLR model. Conclusions: Within the limitations of ecologic analyses, findings are consistent with effects of state tobacco control efforts on reducing state-wide lung cancer rates in younger adults.

Pyles MK; Hahn EJ. Smoke-free legislation and charitable gaming in Kentucky. Tobacco Control 18(1): 60-62, 2009. (30 refs.)

Objective: To determine the effect of municipal smoke-free laws in Kentucky on gross and/or net revenues from charitable gaming activities. Between January 2000 and June 2007, 13 Kentucky communities implemented smoke-free legislation; only three specifically exempted charitable gaming facilities and compliance in several communities was not consistent. Kentucky is a tobacco-growing state that has the highest smoking rate in the United States. Design: A fixed-effects time series design to estimate the impact of municipal smoke-free laws on charitable gaming. Setting: 13 Kentucky counties that implemented smoke-free laws during the study period of January 2000 through June 2007. Subjects: All charitable gaming facilities in 13 counties in which a smoke-free ordinance was enacted during the study period. Main outcome measures: Gross and net revenues from charitable gaming activities in each county for each quarter of the study period, obtained from the Kentucky Department of Charitable Gaming. Results: When controlling for economic variables, county-specific effects and time trends using a robust statistical framework, there was no significant relation between smoke-free laws and charitable gaming revenues. Municipal smoke-free legislation had no effect on charitable gaming revenues. Conclusions: No significant harm to charitable gaming revenues was associated with the smoke-free legislation during the 7.5-year study period, despite the fact that Kentucky is a tobacco-producing state with higher-than-average smoking rates.

Ratschen E; Britton J; McNeill A. Smoke-free hospitals. The English experience: results from a survey, interviews, and site visits. BMC Health Services Research 8(e-article 41), 2008. (20 refs.)

Background: According to the provisions of the Health Act 2006, NHS acute Trusts had to become smoke-free by July 2007. Mental health Trusts were granted a further year before all indoor smoking areas have to be removed. This study was carried out to determine the extent of smoke-free policy implementation in English NHS acute and mental health Trusts, and to explore challenges and impacts related to policy implementation. Methods: Questionnaire-based survey of all English NHS acute and mental health hospital settings, supplemented by semi-structured telephone interviews with 22 respondents and direct observation at a sample of 15 Trusts ( 22 different sites). Human Resources Directors of all 245 English NHS Trusts providing acute and/or mental health inpatient care were identified as potential study participants. Main outcome measures comprised the proportions of Trusts reporting smoke-free policy implementation; whether these relate to buildings only or to whole premises including grounds; most frequently reported exemptions; reported and observed frequencies of policy breaches. Results: Smoke-free policies were reported to be implemented in all mental health and 98% of acute settings studied. They applied to whole premises including grounds in 84% of acute, and 64% of mental health settings. However, exemptions were granted by 50% of acute and 78% of mental health settings, typically for bereaved relatives or psychiatric patients, in sheltered outdoor areas and smoking rooms. Reported challenges included policy enforcement and related risks of abuse, and litter on premises and adjacent public grounds. Nearly two thirds of acute and over a third of mental health trusts reported that policy infringements occurred on a daily basis. Indeed, patients and visitors were observed smoking at 94% of acute sites visited and staff smoking at 35% of them. Conclusion: NHS hospitals should play an exemplary role in making a smoke-free environment the norm. Although smoke-free policies have been implemented in nearly all English NHS hospitals, exemptions are frequently granted and policy breaches appear to be commonplace.

Reinarman C. Cannabis policies and user practices: Market separation, price, potency, and accessibility in Amsterdam and San Francisco. International Journal of Drug Policy 20(1): 28-37, 2009. (35 refs.)

Background: This paper explores user perceptions and practices in contrasting legal-policy mileux-Amsterdarn (de facto decriminalization) and San Francisco (de jure criminalization) on four policy issues: sources of cannabis and separation of markets for it and other drugs; user perceptions of effects of price on consumption; effects of potency on consumption; and perceived risk of arrest and accessibility of cannabis. Methods: Questions on these issues were added to Surveys on career use patterns amongst representative samples of experienced cannabis users using comparable methods. Results: Most San Francisco respondents obtained cannabis through friends who knew dealers, whereas most Amsterdam respondents obtained it from regulated shops. Only one in seven Amsterdam respondents but half the San Francisco respondents could obtain other drugs from their cannabis Sources. Majorities under both systems had never found cannabis "too expensive." Amsterdam respondents preferred milder cannabis whilst San Francisco respondents preferred stronger; majorities in both cities reported self-titrating with potent cannabis. Risk and fear of arrest were higher in San Francisco, but most in both cities perceived arrest as unlikely. Estimated search times were somewhat longer in San Francisco, but a majority reported being able to access it within half a day. Conclusions: There is substantial separation of markets in the Dutch system. Policies designed to increase cannabis prices appear unlikely to impact consumption. Decriminalization was associated with a preference for milder cannabis, but under both policy regimes most respondents self-titrated when using more potent strains. Criminalization was associated with somewhat higher risk and fear of arrest and somewhat longer search times, but these did not appear to significantly impede access for most respondents.

Repace JL. Tobacco Law Symposium. Benefits of smoke-free regulations in outdoor settings: Beaches, golf courses, parks, patios, and motor vehicles. William Mitchell Law Review 34: 1621+, 2008. (87 legal refs.)

Summary: ... The law of conservation of mass dictates that this must be true whether tobacco smoke is inhaled in the act of smoking, or inhaled by nonsmokers out of the air indoors or outdoors, known as secondhand smoke (SHS). ... They concluded that these extremely high particle concentrations constitute a serious health risk for adults and children who are passengers in a car with a smoker. ... As Figure 2 shows, these levels are exceeded even at distances 3 or 4 meters (10 to 13 feet) downwind of a smoker in a sidewalk cafe, posing an irritation and annoyance problem even for healthy nonsmokers. ... Speer divided the nonsmokers into 2 groups: 191 nonsmokers with allergic diseases such as nasal allergy, asthma, and allergic headache, and a control group of 250 non-allergic nonsmokers without such diseases. ... Savel concluded that an allergy to cigarette smoke might produce clinically distressing upper respiratory tract symptoms in nonsmokers with allergic backgrounds, exert a depressant effect on the antibacterial defense mechanisms of the lung, exert a toxic effect on lymphocytes, and play a role in the pathogenesis of pulmonary distress. ... The proximity effect was studied in a controlled experiment involving 10 college student smokers placed in rings of increasing diameter around 2 air quality monitors so that no matter which way the wind blew, the monitors were always downwind of 1 smoker. ... Health Risks from Exposure to SHS and OTS Repeated exposure to a carcinogen, such as air pollution from SHS and OTS, over a lifetime increases the risk of cancer.

Sandberg S; Pedersen W. "A magnet for curious adolescents": The perceived dangers of an open drug scene. International Journal of Drug Policy 19(6): 459-466, 2008. (41 refs.)

During the summer of 2004 the police closed Plata, an open drug scene in the midst of Oslo. The most important argument for the closure was that the drug scene made it easier for curious, city-dwelling adolescents to start using drugs. This research sought to assess this assumption. Ethnographic research methods including twenty 2-hr field observations and qualitative semi-structures interviews were employed. Interviews were conducted with 30 adolescents in the centre of Oslo, as well as with 10 former drug users, three police officers and three field workers. We were also given access to police statistics and authorised to do Our own analysis of the material. The most important result was that adolescents seemed rather to avoid than to be attracted to this open drug scene in Oslo. Based on the presentation of qualitative data we suggest that this was due to the social definition of the drug scene. Because they experienced a great social distance between themselves and the regulars at the open drug scene, adolescents seemed to avoid Plata. Moreover, the scene was symbolically associated with heroin and injection as the route of administration, which had low prestige among the adolescents. Despite these findings, adolescents' recruitment to drug use was the key issue in the political debate following the closure. We point to the shared rhetorical interest among important institutional actors in framing the issue in this way. The argument was also embedded in widely shared public representations of adolescents and drug users as passive and irrational.

Schaap MM; Kunst AE; Leinsalu M; Regidor E; Ekholm O; Dzurova D et al. Effect of nationwide tobacco control policies on smoking cessation in high and low educated groups in 18 European countries. Tobacco Control 17(4): 248-255, 2008. (37 refs.)

Background: Recently a scale was introduced to quantify the implementation of tobacco control policies at country level. Our study used this scale to examine the potential impact of these policies on quit ratios in European countries. Special attention was given to smoking cessation among lower educational groups. Methods: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale (TCS). Results: Quit ratios were especially high (> 45%) in Sweden, England, The Netherlands, Belgium and France and relatively low (< 30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low education. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban. Conclusion: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nationwide tobacco control policies.

Schneider NK; Glantz SA. "Nicotine Nazis strike again": A brief analysis of the use of Nazi rhetoric in attacking tobacco control advocacy. (editorial). Tobacco Control 17(5): 291-296, 2008. (89 refs.)

Selvanathan S; Selvanathan EA, eds. The Demand for Alcohol, Tobacco and Marijuana: International Evidence. London: Ashgate Publishing, 2005

Using a diverse database with statistics from some 30 developed and developing countries, the authors present a detailed statistical portrait of the consumption of food, soft drinks, tobacco, alcohol, and marijuana around the world. This data is then used to a model developed by the authors for determining the effect of consumer income and the prices of goods on consumption behavior. The model and data are also used to assess the alcohol and tobacco control policies of a number of countries. Data is summarized in over 100 tables and figures.

Shipley M; Allcock R. Achieving a smoke-free hospital: Reported enforcement of smoke-free regulations by NHS health care staff. Journal of Public Health 30(1): 2-7, 2008. (12 refs.)

Background In December 2006, all UK NHS trusts introduced smoke-free regulations prohibiting smoking on all NHS sites. These rules are to be enforced by all NHS trust staff. We have investigated the implementation of these regulations by health care workers when they encounter smokers on a NHS hospital site. Methods Eighty-five medical and nursing staff working in acute medicine at the Queen Elizabeth Hospital, Gateshead, completed a questionnaire reporting their behavior when exposed to smokers on NHS hospital sites. Results Over 50% of medical and nursing staff reported that they would not challenge patients, staff or visitors smoking on NHS trust site. There was a trend for employees to be more likely to challenge patients than visitors, and to be more likely to challenge visitors than other staff. Fear of aggression was the most commonly reported reason for not challenging smokers. Conclusions Most medical and nursing staff report that they do not enforce NHS smoke-free regulations and do not challenge smokers on NHS sites. This is due to many real and perceived barriers including fear of aggression. Overcoming these barriers is an important area of research to guide successful implementation of future smoking policy. There may be scope for improvement through training in NHS policy and in non-confrontational communication skills.

Sinha J. History and Development of the Leading International Drug Control Conventions. Ottawa Canada: Library of Parliament (Canada) Canadian Parliament, Senate Special Committee On Illegal Drugs, February 21, 2001. (64 refs.)

This is a special report prepared for the Canadian Parliament's Senate Special Committee On Illegal Drugs. It reviews the history and development of international drug control conventions. The current legal and administrative framework for international drug control is laid out in three international Conventions negotiated in 1961 under the auspices of the United Nations (UN). These include (1) the Single Convention on Narcotic Drugs, 1961 (Single Convention) as amended by the Protocol Amending the Single Convention on Narcotic Drugs, 1961; the Convention on Psychotropic Substances (Psychotropics Convention); and the Convention against Illicit Traffic in Narcotic Drugs and Psychotropic Substances (Trafficking Convention). These agreements were the product of multiple prior conferences and international agreements, dating back to the 1909. The first portion of this report summarizes these earlier initiatives beginning with the 1909 Shangai Conference, and followed by the 1912 Hague International Opium Convention, the 1925 Geneva Opium Conventions, the 1931 Geneva Narcotics Manufacturing and Distribution Limitation Convention/1931 Bangkok Opium Smoking Agreement, the 1936 Geneva Trafficking Convention, events of World War II, the 1946 Lake Success Protocol, the 1948 Paris Protocol, and the 1953 New York Opium Protocol. The history of international drug control gives insight into the philosophical and practical underpinnings of the three drug Conventions. Beginning in an era of morally tainted racism and colonial trade wars, prohibition-based drug control grew to international proportions at the insistence of the United States. America and the colonial powers were confronted with the effects of drug addiction and abuse at home, but rather than address both demand -- the socio-medical nature of such problems -- and supply, they focused uniquely on the latter and attempted to stem the flow of drugs into their territories. In doing so, they earned political capital back home and shifted the cost and burden of drug control to predominantly Asian and Latin American developing countries with no cultural inclination or resources to take on such an intrusive task-- and no economic or military power to refuse what was imposed on them. The Western control advocates' prohibition focus also stimulated the growth and development of the global illicit drug trade. And ironically, the system has had very little overall success in controlling the supply of drugs at the source. Nonetheless, supply-oriented activists largely achieved their goal of creating a prohibition-based international drug control system. The role of the pharmaceutical companies in the emergence of these conventions is described. The Single Convention consolidated the system under the UN into one key narcotics control document - an instrument representing the compromises between the domestic and economic interests of predominantly Western, drug manufacturing nations. The Psychotropics Convention represented a weakening of the control structure because of the overwhelming influence of European and North American pharmaceutical interests throughout negotiations. The Trafficking Convention firmly established a system of international criminal drug control law that uses criminalization and penalization to combat global drug trafficking. Although the three Conventions do leave member countries some leeway to craft drug control strategies shaped to their particular socio-cultural, political and economic realities, this flexibility is clearly limited by an overarching structure based on prohibition and criminalization. Note: This is a special report prepared for the Canadian Parliament's Senate Special Committee On Illegal Drugs.

Stepanov I; Jensen J; Hatsukami D; Hecht S. New and traditional smokeless tobacco: Comparison of toxicant and carcinogen levels. Nicotine & Tobacco Research 10(12): 1773-1782, 2008. (48 refs.)

Declining cigarette use and spreading bans on smoking in public places in the United States are encouraging the U.S. cigarette industry to turn to another tobacco category, smokeless tobacco products. Currently, a number of new brands are being test marketed, including Taboka, Marlboro Snus, Camel Snus, and Skoal Dry. We report here levels of tobacco-specific nitrosamines (TSNAs), alkaloids, anions, polycyclic aromatic hydrocarbons (PAH), and volatile aldehydes in these products, and compare them to the most popular traditional moist snuff brands. Total TSNAs averaged 1.97g/g dry weight tobacco in Taboka, Marlboro Snus, and Camel Snus, 4.54g/g tobacco in Skoal Dry, and 7.42g/g tobacco in traditional brands. The amounts of unprotonated nicotine averaged 0.961mg/g tobacco in Taboka, Marlboro Snus, and Skoal Dry, 7.22mg/g tobacco in Camel Snus, and 7.57mg/g tobacco in traditional brands. Levels of minor tobacco alkaloids were relatively high in Taboka, Marlboro Snus, and Skoal Dry, as compared to other products analyzed here. Levels of nitrite and nitrate in new U.S. smokeless tobacco products and the Swedish snus General were lower than those in the other products. Remarkably high levels of chloride and some PAH were observed in the traditional moist snuff. Crotonaldehyde levels were about five times higher in Taboka and Marlboro Snus than in traditional products. The large variation in the levels of some toxicants and carcinogens analyzed here indicates that more effort is required from the U.S. tobacco industry to further reduce their amounts in new and traditional smokeless tobacco products.

Summerlin-Long SK; Goldstein AO. A statewide movement to promote the adoption of tobacco-free school policies. Journal of School Health 78(12): 625-632, 2008. (16 refs.)

Since most tobacco users become addicted to nicotine as teenagers, prevention efforts for youth remain central to comprehensive prevention programs. National and state efforts that encourage adoption and enforcement of comprehensive tobacco-free school (TFS) policies can lead to significant reductions of youth tobacco use. In 2003, North Carolina (NC) Health and Wellness Trust Fund grantees began to focus statewide on the adoption of and compliance with TFS policies in NC schools. This study examined 46 NC districts that passed TFS policies between 2003 and early August of 2005 to see what factors were important in policy passage in order to support the continued promotion of TFS policy adoption across the state. Detailed interviews were conducted with 118 key informants who were intimately involved with passage of their school districts' TFS policies, and results were coded and analyzed for common themes. The study found several strategies key to adoption of TFS policies: effective leadership from organizations and individuals in positions of influence, grassroots organizing from community coalitions and youth groups, and communication strategies that optimally position policy adoption and compliance. States that have not yet achieved TFS policy adoption can focus on leadership development, grassroots organizing, and improved communication to advance their advocacy efforts.

Sweanor D. Tobacco Law Symposium. A Canadian's perspective: The limits of tobacco regulation. William Mitchell Law Review 34: 1595-1604, 2008. (54 legal refs.)

Summary: ... In examining the way policy changes have so dramatically reduced cigarette consumption in Canada, there can be a tendency to think that Canada is somehow different from other countries and that tobacco control policies were somehow easier to achieve. ... This raises some interesting questions, not the least of which is why a lawyer who was a key player in so many of these regulatory battles, who built a career around fighting for such measures and convincing others that policy interventions were the most important measures available to counter the health toll of smoking, would now be asked to talk about "the limits to regulation." ... To be honest to our long term health objectives, however, it is extremely important to critically examine what has been accomplished through policy interventions, to be open to the thought that some of our interventions have not achieved all of our goals, and to think about where tobacco control policy needs to head in the future. ... "Checked all the Boxes" Canadian tobacco control advocates are perhaps in an ideal position to consider the limits of regulation because Canada is one of a growing number of countries that have implemented virtually all of the components of traditional comprehensive strategies to reduce smoking. ... A tremendous number of smokers are impacted when workplaces and public areas go smoke-free, but once we move into the realm of "tidying up the leftovers" - such as trying to extend smoke-free policies into areas like shared residential buildings - we can expect less overall impact, simply because we are dealing with far smaller numbers of affected people. ... For instance, a regulatory strategy could include advertising less toxic tobacco products to current smokers as an alternative to cigarettes, mandating smoker-friendly package messaging aimed directly at facilitating cessation, or differentiating between the culpability of different tobacco companies as a way of changing the behavior of the tobacco companies that are benefiting most from a status quo centered on cigarettes. ... This orientation is also strongly at odds with past successful efforts to regulate goods and services which have been principally based on the recognition of differential risks and the resulting ability of regulation to reduce death, injury, and disease.

Thyrian JR; John U. Measuring Activities in Tobacco Control across the EU. The MATOC. Substance Abuse Treatment, Prevention, and Policy 1(e-article 9), 2006. (7 refs.)

Background: Objectives of this study are (a) to develop a comprehensive and economic tool to estimate tobacco control (TC) activities in single EU member states, (b) to compare TC activities between member states of the EU. This article provides the questionnaire and gives a benchmark of EU member states according to their perceived TC activities. Methods: An international workshop was specifically initiated to develop the questionnaire "Measuring Activities in Tobacco Control (MATOC)". TC experts from 8 European countries participated and chose 40 items to cover 11 general topics of TC. At the World Conference of Tobacco or Health in Helsinki 2003 participants were asked to fill out the questionnaire. N = 142 participants from EU-member states returned questionnaires. Results: Subjects from the tobacco field in Finland gave the highest TC values to their country, followed by Sweden, Ireland, the UK and the Netherlands. The least active countries in TC were Greece and Germany, behind Austria, Spain, Belgium and Portugal. Italy, France and Denmark constituted the middle field. Conclusion: The MATOC provides a profile of TC across European countries and delivers results that are plausible and fit into the existing findings. The data presented here fulfils the purpose to illustrate what is possible with the MATOC and underlines the value of such an approach in delivering information for policy makers and TC advocates how TC is perceived in each country. Yet, further validity testing is necessary, the number of experts per country differs and is partly rather small. Further research with the MATOC should encounter these limitations. The procedure though could serve as model of practice for alcohol and legal drug policy as well.

Thyrian JR; Panagiotakos DB; Polychronopoulos E; West R; Zatonski W; John U. The relationship between smokers' motivation to quit and intensity of tobacco control at the population level: A comparison of five European countries. BMC Public Health 8(e-article 2), 2008. (20 refs.)

Background: Smoking prevalence differs significantly across Europe. In addition, there are considerable differences in tobacco control activities across European countries. The relationship between prevalence and policy is under-researched. The present analysis examines the motivation to change smoking behaviour across 5 different European countries that differ considerably in their tobacco control activities. Methods: A population-based, representative survey of 1750 smokers, aged 16-59, from 5 different European countries (Germany, Greece, Poland, Sweden, UK) was used. Demographic variables, smoking status and the motivation to stop smoking were assessed. Motivation was assessed as, first, intending to quit (using the stages of change plus a modified stage for Precontemplation), and second, the desire to quit. Results: The majority of smokers want to stop smoking (73.5%), while only 35.0% want to stop definitely. Across countries, 10.2% definitely do not want to stop. Most of the smokers can be categorised in the Precontemplation stage (between 62.6% and 77.7% depending on the country), one of the stages of change categories. The relationship between the stages of change and the country under examination is statistically significant (chi-square = 43.466, p < 0.001). In countries with a high level of tobacco control, the proportion of people in Precontemplation is lower than in countries with low tobacco control activity. Conclusion: There are differences in the stages of change between the countries under examination. However, the categorisation of the countries into low, medium and high tobacco control activity used in this analysis does not explain these differences. Most smokers want to stop smoking, but a high proportion cannot indicate a time-frame when this is going to happen. Tobacco control efforts or other kinds of support might encourage these smokers to actually try to stop. Longitudinal studies at the population level are needed to assess, relate or monitor tobacco control activities and the intention to stop.

Tyc VL. Introduction to the special issue: Tobacco control strategies for medically at-risk youth. (editorial). Journal of Pediatric Psychology 33(2): 113-118, 2008. (41 refs.)

Vogt I; Schmid M. Heroin control policy, (german). Suchttherpie 9(3): 111-118, 2008. (69 refs.)

In the United States, since the 1920ies, heroin is the archetypal "bad" drug. In fighting the bad drug, the United States in the 1970ies invented the "war on drugs" which is going on until today and in which all countries in the world are involved. The German drug policies in between 1970 and 1990 were oriented along the American model. However, when after 1985 the rates of HIV-infections of intravenous injecting drug dependents increased rapidly as well as the numbers of drug related death cases social work actors and political actors in the arena were asked to re-evaluate the drug policy. In the 1990, drug policies and politics changed and harm reduction measures (HRM) were introduced. In its context, discussions to introduce heroin-supported treatment for opiate dependents sprung up. At the end of the 1990ies, the German model project of heroin-supported treatment for opiate dependents was set up. The results were published in 2007. They show, that the study group of severely dependents which were treated with heroin, profit significantly from this type of treatment in comparison with a control group of those treated with methadone only. Thus, the criteria to (re-)introduce heroin as a medication are fulfilled. Anyway, there is strong resistance of political and other pressure groups to change the drug laws accordingly. Regarding current political trends, the chances to (re-)introduce diacetyomorphin (heroin) as a medication in Germany, are rather dim.

Wakefield MA; Durkin S; Spittal MJ; Siahpush M; Scollo M; Simpson JA et al. Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence. American Journal of Public Health 98(8): 1443-1450, 2008. (59 refs.)

Objectives. We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence. Methods. We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws. Results. Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence. Conclusions. Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.

Wakefield M; Liberman J. Back to the future: Tobacco industry interference, evidence and the Framework Convention on Tobacco Control. (editorial). Tobacco Control 17(3): 145-146, 2008. (9 refs.)

Warner KE; Mendez D; Alshanqeety O. Tobacco control success versus demographic destiny: Examining the causes of the low smoking prevalence in California. American Journal of Public Health 98(2): 268-269, 2008. (7 refs.)

We examined the effect of demographics on California's low smoking prevalence. We estimated that if the United States had the same demographics as California, then the US adult smoking prevalence in 2005 would have been 19.3%, 1.6 percentage points lower than the reported 20.9% for the United States, but 4.1 percentage points higher than California's prevalence of 15.2% in 2005. Tobacco control appears to be a much more important factor than demographics in determining California's low smoking rates.

WHO Regional Office for Europe; Aruaudova A. Seventh Futures Forum: On unpopular decisions in public health. Copenhagen: World Health Organization, 2005. (0 refs.)

Public health decisions often create strong public resistance from the people who do not expect to benefit from them. Opposition arises because people are afraid that the proposed changes will deprive them of services, rights or freedoms. The most outspoken opponents of a decision are usually those who anticipate suffering individual or collective financial, social or political losses. Thus, decision-makers are frequently confronted with a situation of controversy. On the one hand, their professional judgement tells them that a certain decision is necessary because it will bring health gains; they therefore have to go ahead with it. On the other hand, they understand that this decision may be potentially unpopular and may trigger resistance. The WHO's 7th Futures Forum aimed to identify tools for making public health decisions more acceptable and popular. This report summarizes the discussions at the Seventh Futures Forum held in November 2004 in St Julian's, Malta. This Futures Forum based its work on presenting practical cases from countries followed by open discussions and an exchange of experience and ideas. Each section outlines one specific problem and the key points from the country case studies and summarizes the debate on that problem. The summary highlights some approaches that all participants agreed would usually work in their country and, separately, some solutions on which there is no consensus that may be useful in one country but not applicable to another. Section 1 deals with how policy-makers can adjust to the public while remaining firm in pursuing health objectives; section 2 focuses on the ways of measuring the public demand (tobacco is used as the case example); section 3 describes practices and ideas for predicting how the public will accept a decision; section 4 pulls together the ideas shared by the participants on how to make public health decisions more popular, using alcohol as the case example; and section 5 discusses the issue of popularity in the light of the divergent roles governmental health officials play in managing unpopular decisions. The concluding section sets forth specific suggestion for making public health efforts more popular and acceptable.

Williams TT; Jason L; Pokorny SB. Youth attitudes towards tobacco control laws: The influence of smoking status and grade in school. Journal of Child & Adolescent Substance Abuse 17(2): 1-14, 2007. (28 refs.)

This study examined adolescent attitudes towards tobacco control laws. An exploratory factor analysis, using surveys from over 9,000 students; identified the following three factors: (1) youth attitudes towards the efficacy of tobacco control laws, (2) youth attitudes towards tobacco possession laws and (3) youth attitudes towards tobacco sales laws. Findings revealed that smokers reported less favorable attitudes towards the efficacy of tobacco control laws, tobacco possession laws, and tobacco sales laws than non-smokers. In addition, youth in lower grade levels reported more support for the efficacy of tobacco control laws and tobacco possession laws than those in higher grades. Findings indicate that there are different dimensions of youth attitudes towards tobacco control laws, and that smoking status and grade in school have important relationships to these different factors. This understanding might better allow the perspectives of youth to be an additional consideration when developing and implementing laws aimed at minimizing underage smoking.

Wu CF. State responsibility for tobacco control: The right to health perspective. Asian Journal of WTO & Iternational Health Law and Policy 3(2): 379-421, 2008. (57 refs.)

Tobacco smoking, which has been proven to cause various illnesses (lung cancer emphysema, cardiovascular disease) and early death, has been declared an emergency public health crisis by the World Health Organization (WHO). To fight this crisis, the Framework Convention on Tobacco Control [hereinafter FCTC], the first health-related treaty sponsored by the WHO, came into force in 2005 and addresses various aspects of tobacco control, from tobacco smuggling to tobacco advertising and the extent of the liability of tobacco companies. Although the FCTC demonstrates the idea that tobacco control is a major health issue requiring firmer state action than in the past, some of its key provisions are non-mandatory and fail to comprehensively protect individuals' right to health. To address these shortfalls, this article applies the framework of the right to health as a supplemental strategy to explore and examine the state's responsibility in tobacco control - including the state's responsibility to provide smoking cessation services, to combat tobacco smuggling, and to guarantee individuals access to health-related tobacco information, among other issues. This article finds that applying human rights institutions to address tobacco-related human rights violations can help identify a state's failure to carry out effective tobacco control initiatives, strengthen the voice of public health, and concretize the scope of applicable rights under international laws. The right-to-health paradigm then can bring new perspectives to addressing the challenges the FCTC faces and can effectively complement global tobacco control efforts.

Wye PM; Bowman JA; Wiggers JH; Baker A; Knight J; Carr VJ et al. Smoking restrictions and treatment for smoking: Policies and procedures in psychiatric inpatient units in Australia. Psychiatric Services 60(1): 100-107, 2009. (53 refs.)

Objective: Tobacco smoking is the leading preventable cause of death and disease in Australia. Even though smoking prevalence in the general population has been reduced (20% smoke), prevalence rates remain high among psychiatric inpatients (70%-90%). This study aimed to identify smoking policies and procedures in public psychiatric inpatient units in New South Wales, Australia; the provision of "smoking care" in such units (for example, quit-smoking advice or nicotine replacement therapy); and policies and procedures associated with the assessment of smoking status and provision of smoking care. Methods: A cross-sectional survey was mailed to all public psychiatric inpatient units in New South Wales for completion by nurse unit managers. Results: Of the 131 units, 123 units completed and returned surveys (94%). Over one-third (36%) of respondents reported instances in which inpatients began smoking during their admission. A similar proportion (39%) reported that staff provided cigarettes to patients who smoked when patients' supply was expended. Fifty percent of respondents reported that all patients were assessed for smoking status; however, 70% reported that nicotine dependence was not assessed. Units on which staff adhered to smoking restrictions were three times as likely to assess patients' smoking status as units where staff never adhered to restrictions (odds ratio=3.05, p=.01). Conclusions: Inadequate establishment of nonsmoking environments and of smoking restriction enforcement as well as inconsistencies in the provision of smoking care were evident. The findings suggest that failure of psychiatric services to provide smoking care is systemic and not related to particular types of services (for example acute versus nonacute or regional versus metropolitan).