Cigarette smokers' classification of tobacco products.

INTRODUCTION: Cigarette consumption has declined in the USA. However, cigar consumption has increased. This may be due in part to some cigarette smokers switching to filtered cigars as a less expensive substitute for cigarettes. Additionally, some cigarette smokers may perceive and consume little filtered cigars as cigarettes. The purpose of this study was to determine how cigarette smokers classify tobacco products when presented with photographs of those products. METHODS: An online survey was conducted with a sample of 344 self-identified cigarette smokers. Respondents were presented with pictures of various types of tobacco products, both with and without packaging, and then asked to categorise them as either a cigarette, little cigar, cigarillo, cigar or machine-injected roll-your-own cigarette (RYO). Respondents were also asked about their tobacco use and purchasing behaviour. RESULTS: Overall, respondents had difficulty distinguishing between cigarettes, little cigars, cigarillos and RYO. When presented with images of the products without packaging, 93% of respondents identified RYO as a cigarette, while 42% identified a little cigar as a cigarette. Additionally, respondents stated that they would consider purchasing little cigars as substitutes for cigarettes because of the price advantage. CONCLUSIONS: The results of this survey suggest that when presented with photographs of tobacco products, large proportions of current smokers were unable to differentiate between cigarettes, little cigars, cigarillos, RYO and cigars. Findings have implications for existing public health efforts targeting cigarette smokers, and underscore the need to review current definitions of tobacco products and federal excise taxes on such products.

Relighting behaviour among cigarette smokers seeking treatment: implications for tobacco treatment and policy.

AIMS: During the recent economic downturn, trends towards fewer cigarettes smoked per day have emerged along with the practice of extinguishing and relighting cigarettes. Few studies have characterised factors related to relighting cigarettes and none have explored this behaviour in those seeking tobacco treatment. This study describes treatment-seeking patients who relight cigarettes and examines implications on tobacco policy and treatment. METHODS: Data were collected from a cross-sectional sample of 496 patients at a specialty tobacco treatment programme in New Jersey from 2010 to 2012. RESULTS: Forty-six per cent of the sample reported relighting, and those subjects smoked significantly fewer cigarettes per day (CPD), despite similar levels of dependence and exhaled carbon monoxide (CO) values. In unadjusted analyses, significantly higher rates of relighting were found among females, African-Americans, smokers who had a high school diploma or less, and were unemployed, sick or disabled. Relighting was more prevalent among smokers with higher markers of dependence, menthol smoking and night smoking. In multivariate analyses, markers of dependence and economic factors (employment and education) remained significant. CONCLUSIONS: Characteristics linked to economic factors were related to increased relighting. Implications for tobacco treatment include the impact on pharmacotherapy dosing and counselling interventions. The tobacco control community needs to be aware of this phenomenon. Collecting data on 'smoking sessions per day' might be a more accurate depiction of smoking exposure than CPD.

Cigar use before and after a cigarette excise tax increase in New Jersey.

OBJECTIVE: To determine whether cigarette smokers in New Jersey substituted cigars following a cigarette excise tax increase. METHODS: We examined data from New Jersey's 2001 and 2002 Adult Tobacco Survey (NJATS). Adjusted odds ratios were generated for ever and current cigar use, controlling for demographics and cigarette smoking status. RESULTS: Males, whites, ever cigarette smokers, and those with higher education reported greater ever and current cigar use in both years. The adjusted odds for cigar use among recent quitters were higher in 2002 than in 2001. CONCLUSIONS: When other tobacco products' excise taxes fail to keep pace with cigarettes, there is a real potential for product substitution. Cessation of all tobacco products is necessary for the best public health outcome.

Prevalence and correlates of internet cigarette purchasing among adult smokers in New Jersey.

OBJECTIVE: To examine the prevalence and correlates of internet cigarette purchasing among adult smokers. DESIGN: Analysis of internet purchasing in data from a population based telephone survey of New Jersey households. Logistic regression was used to determine factors associated with internet cigarette purchasing, adjusting for year, demographic, and smoking behaviour variables. PARTICIPANTS: 3447 current cigarette smokers pooled from three cross sectional surveys conducted in 2000, 2001, and 2002. MAIN OUTCOME MEASURES: Ever purchasing tobacco and usually buying cigarettes via the internet. RESULTS: Among all current cigarette smokers, ever having purchased tobacco via the internet increased from 1.1% in 2000 to 6.7% in 2002 and usually buying cigarettes via the internet increased from 0.8% in 2000 to 3.1% in 2002. Among current cigarette smokers with internet access, ever having purchased tobacco via the internet was higher among those who reported smoking 31 or more cigarettes per day (adjusted odds ratio (OR) 3.9, 95% confidence interval (CI) 1.5 to 10.2) and those without a past year quit attempt (adjusted OR 1.8, 95% CI 1.1 to 3.0). Usually purchasing cigarettes via the internet was higher among those aged 45-64 years (adjusted OR 4.4, 95% CI 1.1 to 17.1) and who reported having their first cigarette < or = 30 minutes after waking (adjusted OR 3.3, 95% CI 1.2 to 9.2). CONCLUSIONS: Although higher prices are known to reduce the demand for cigarettes, internet cigarette purchasing is likely to weaken this effect, particularly among heavy, more dependent smokers who are less interested in quitting.

Injury-prevention counseling among residents of internal medicine.

BACKGROUND: The U.S. Preventive Service Task Force's Guide to Clinical Preventive Services and Healthy People 2000 recommend that physicians participate in various counseling activities, including injury prevention. Despite recommendations, rates of physician counseling, particularly injury prevention, are low. This study assessed clinical preventive services and attitudes among physicians. Furthermore, the study illustrates how physicians prioritize injury-prevention counseling relative to other prevention recommendations. METHODS: Personal characteristics (i.e., demographics, specialty orientation, attitudes toward prevention, and personal health behaviors) of the residents were collected by a self-administered survey. We performed a 12-month retrospective chart review of 184 new doctor-patient encounters to determine rates of clinical preventive services that included four injury-prevention services: the use of seatbelts, helmets, and smoke detectors; and the safe storage of firearms. RESULTS: Overall, attitudes toward injury prevention in the context of other clinical preventive services were low. Seatbelt counseling was the only injury-prevention service documented in the charts, and was performed at only one of four clinic sites. CONCLUSIONS: Clinic site as a key predictor of preventive practice may be suggestive of the importance of organizational priorities and professional norms. Future injury-prevention education efforts must aim at improving attitudes of current and future physicians to facilitate positive professional norms.

Worker health and safety training: assessing impact among responders.

A mail survey was conducted among emergency responders who received training at the New Jersey/New York Hazardous Materials Worker Training Center. Responses indicate that technical topics are extremely important (i.e., decontamination, personal protection); that the vast preponderance of trainees felt confident in their ability to recall specific critical concepts in a crisis; and that 42% of respondents (75) had experienced an incident that would have resulted in injury or death without training. Phone surveys for details of specific incidents reported by 43 of the 75 mail survey respondents revealed that anecdotal data provide powerful evidence of the value of training; that extensive and uniform training is needed across jurisdictions; that training should emphasize the technical aspects of health and safety, and should include demonstration and hands-on techniques; and that integrated organizational support for implementation of health and safety practices is critical.

Health behaviors and health promotion/disease prevention perceptions of medical students.

Health promotion and disease prevention must be addressed in medical education, and the assessment of future physicians' health preventive perceptions and behaviors is a critical step in the process. We conducted a cross-sectional survey of 512 medical students enrolled during the 1992-1993 academic year. Outcome measures were self-reported health behaviors and ratings of the importance of prevention. Overall, results indicated that the preponderance of respondents are engaging in healthy behaviors; however, some high-risk behaviors, such as drinking and driving and possible binge drinking, were reported by at least 15% of the respondents. Significant differences were detected regarding students' perceptions; a linear decreasing trend was noted with first-year students rating the importance of prevention the highest and fourth-year students rating it the lowest. Additionally, this study attempted to correlate health behaviors with perceptions. The results show significant relationships between student-reported behaviors and corresponding perceptions. Even though this cohort is healthy overall, some students are engaging in behaviors that are not conducive to maintaining a healthy lifestyle. It is important to identify and address negative health behaviors in this population, not only in terms of personal health, but also in its effect on their interaction with future patient populations. The attrition of interest in prevention during undergraduate medical training is cause for concern; future clinical practice will be strongly motivated by their perceptions. Medical schools should identify health issues and assess preventive health perceptions among students in order to facilitate the adoption of preventive practices by future physicians. Medical Subject Headings (MeSH): health promotion, prevention, medical students, health behavior.

Medical surveillance practices of blue collar and white collar hazardous waste workers.

Given the occupational risks of hazardous waste workers, this study was conducted to explore possible differences in medical surveillance practices among blue and white collar workers. Demographic and medical surveillance data were collected from 636 white collar and 206 blue collar trainees, enrolled in health and safety training courses. Overall, 4.5% of the trainees reported being ill or injured because of hazardous substances. Significant differences (P < .0001) were noted between groups; blue collar trainees were more likely to have been ill or injured. Differences also existed for medical surveillance enrollment; 32% of the white collar trainees report enrollment compared to 19% of the blue collar trainees (P = .004). This study indicates that blue collar trainees are more likely to be injured and less likely to be enrolled in medical surveillance programs. Issues of illness and injury, as well as medical surveillance enrollment, must be addressed; ensuring that all workers receive medical surveillance needed to prevent occupational illness in the hazardous waste field.