Smoking-related deaths averted due to three years of policy progress.

OBJECTIVE: To evaluate the global impact of adopting highest-level MPOWER tobacco control policies in different countries and territories from 2007 to 2010. METHODS: Policy effect sizes based on previously-validated SimSmoke models were applied to determine the reduction in the number of smokers as a result of policy adoption during this period. Based on previous research suggesting that half of all smokers die from smoking, we also derived the estimated smoking-attributable deaths (SADs) averted due to MPOWER policy implementation. The results from use of this simple yet powerful method are consistent with those predicted by using previously validated SimSmoke models. FINDINGS: In total, 41 countries adopted at least one highest-level MPOWER policy between 2007 and 2010. As a result of all policies adopted during this period, the number of smokers is estimated to have dropped by 14.8 million, with a total of 7.4 million SADs averted. The largest number of SADs was averted as a result of increased cigarette taxes (3.5 million), smoke-free air laws (2.5 million), health warnings (700,000), cessation treatments (380,000), and bans on tobacco marketing (306,000). CONCLUSION: From 2007 to 2010, 41 countries and territories took action that will collectively prevent nearly 7.5 million smoking-related deaths globally. These findings demonstrate the magnitude of the actions already taken by countries and underscore the potential for millions of additional lives to be saved with continued adoption of MPOWER policies.

Using geographic information system analyses to monitor large-scale distribution of nicotine replacement therapy in New York City.

OBJECTIVE: Since 2003, the New York City Department of Health and Mental Hygiene has distributed nicotine replacement therapy nicotine replacement therapy to adult smokers through annual large-scale distribution programs. METHODS: In 2008, the New York City Department of Health and Mental Hygiene formally integrated geographic information system analyses to track program enrollment, map the geographic density of enrollees, and assess the effects of outreach strategies. RESULTS: Geographic information system analyses provided a unique, near real-time visual method of assessing participation patterns as well as the impact of media and outreach strategies. Among neighborhoods with high smoking prevalence, lower income neighborhoods had higher enrollment compared to higher income neighborhoods. Mapping before and after a press release demonstrated that program interest increased over 700% in one area. CONCLUSION: Although geographic information system analysis is traditionally utilized for large-scale infectious disease surveillance, the New York City Department of Health and Mental Hygiene used GIS to inform and improve an annual large-scale smoking cessation program. These analyses provide unique feedback that can aid public health program planners in improving efficiency and efficacy of service delivery.

Media campaign effectiveness in promoting a smoking-cessation program.

BACKGROUND: Little is known about the perceived barriers among smokers who do not utilize phone-based, population-level smoking-cessation services. PURPOSE: The purpose of this study was to improve understanding of a media campaign's impact in promoting a phone-based, time-limited smoking-cessation program as measured by smoker awareness of the program, untapped interest in the program, perceived barriers to use of the program, and suggested methods for enhanced outreach. METHODS: A random telephone survey of New York City smokers (n=1000) was conducted in 2006 in order to assess awareness of, interest in, and barriers to using the 2006 Nicotine Patch Program. Analyses were conducted in 2006 and 2007. RESULTS: The level of program awareness was high (60% overall), although it varied by demographic subgroup. The level of program interest among smokers unaware of the program was also encouragingly high (54%). Analysis of barriers to program use indicates that enrollment may be increased by addressing hesitance about using patches, developing messages for smokers who do not self-identify as smokers, and clarifying application procedures. Specific outreach strategies suggested by smokers include promotion through direct mail and advertising on public transportation. CONCLUSIONS: These data suggest that the use of mass media is an effective method for informing smokers about cessation services and that enrollment could be improved by modifying public messages to address barriers as well as expanding outreach to specific demographic groups. Improved outreach to smokers may be feasible using the strategies suggested by smokers in this survey. These findings can aid smoking-cessation services in expanding their reach and impact.

Decline in smoking during pregnancy in New York City, 1995-2005.

OBJECTIVES: The 1998 Master Settlement Agreement (MSA) between 46 states and four major tobacco companies increased tobacco control funding and restricted tobacco marketing. In 2002, New York City (NYC) began a comprehensive tobacco control program that raised the price of cigarettes, banned indoor workplace smoking, and increased access to cessation treatment. We examined the temporal pattern of smoking during pregnancy, including ethnic variation in smoking prevalence, relative to the implementation of the MSA and NYC's comprehensive tobacco control program using birth certificate data. METHODS: Using multiple logistic regression, we analyzed NYC birth certificate data to examine prenatal smoking during three time periods: 1995-1998 (pre-MSA), 1999-2002 (post-MSA, pre-NYC tobacco control), and 2003-2005 (post-MSA, post-tobacco control). RESULTS: Overall, 3.0% of 1,136,437 births included were to smoking mothers. The proportion of smoking mothers declined from 4.5% in 1995-1998 to 1.7% in 2003-2005. Compared with non-Hispanic white women, African American women had 2.46 increased odds (95% confidence interval [CI] 2.36, 2.55) of smoking during 1995-1998, and 3.63 increased odds (95% CI 3.39, 3.88) of smoking during 2003-2005, despite an absolute reduction in smoking from 10.4% to 5.0%. Puerto Rican women also smoked considerably more than non-Hispanic white women. CONCLUSIONS: These findings document a striking temporal decline in prenatal smoking in NYC concurrent with changing tobacco control policies. Targeted efforts may be required to address the increasing disparity in prenatal smoking between non-Hispanic white and African American and Puerto Rican women.

Secondhand smoke exposure among nonsmokers nationally and in New York City.

INTRODUCTION: We describe smoking prevalence and secondhand smoke (SHS) exposure among adult nonsmokers in New York City (NYC) across key demographic strata and compare exposure estimates with those found nationally. METHODS: We used serum cotinine data from the 2004 NYC Health and Nutrition Examination Survey (n = 1,767 adults aged 20 years or older) and the 2003-2004 National Health and Nutrition Examination Survey (n = 4,476 adults aged 20 years or older) to assess and compare smoking prevalence and the prevalence of elevated cotinine levels (> or =0.05 ng/ml) among nonsmokers. We conducted multivariate logistic regression to assess independent predictors of elevated cotinine levels in NYC. RESULTS: Although the smoking prevalence in NYC was lower than that found nationally (23.3% vs. 29.7%, p < .05), the proportion of nonsmoking adults in NYC with elevated cotinine levels was greater than the national average overall (56.7% vs. 44.9%, p < .05) and was higher for most demographic subgroups. In NYC, the highest cotinine levels among nonsmokers were among adults aged 20-39 years, males, and Asians. DISCUSSION: Although NYC enacted comprehensive smoke-free workplace legislation in 2003, findings suggest that exposure to SHS remains a significant public health issue, especially among certain subgroups. The finding of a higher prevalence of SHS exposure in NYC despite lower smoking rates is puzzling but suggests that SHS exposure in dense, urban settings may pose a particular challenge.

Gender differences in smoking and cessation behaviors among young adults after implementation of local comprehensive tobacco control.

OBJECTIVES: We sought to study gender differences in young adult smoking declines and enrollment in populationwide cessation services. METHODS: The New York City (NYC) Department of Health and Mental Hygiene implemented populationwide cessation programs to distribute free nicotine replacement therapy (NRT); demographic data were collected from enrollees. Smoking prevalence was assessed using data from the Community Health Survey, an annual population-based survey. RESULTS: Between 2002 and 2005, smoking among young adults in NYC declined from 23.8% to 18.8%, which was explained entirely by a 41.8% decline among young adult women (23.2% to 13.5); prevalence remained at 24% among young adult men. More young adult women enrolled in cessation services than did men, although once enrolled, the likelihood of using NRT was high among both groups. CONCLUSIONS: Among young adults, women have been responsive to comprehensive tobacco control, but men require more-intensive strategies. Population-wide NRT distribution can be effective with young adults overall; however, additional resources need to be devoted to identifying successful outreach strategies for young adult men.

Trends and racial/ethnic disparities in gestational diabetes among pregnant women in New York City, 1990-2001.

We analyzed gestational diabetes mellitus trends in New York City between 1990 and 2001 by using information obtained from birth certificates. Gestational diabetes diagnoses among women who delivered babies increased 46%, from 2.6% (95% confidence interval [CI]=2.5, 2.7) to 3.8% (95% CI=3.7, 3.9) of births. Prevalence was highest among South and Central Asian women (11%). Given risks for adverse fetal outcomes and maternal chronic diabetes, prompt screening is critical. Metabolic control should be maintained during pregnancy and assessed postpartum for women with gestational diabetes.

More than heights and weights: what parents of urban adolescents want from health care providers.

To examine health care providers' expected role in health promotion counseling to urban adolescents from the perspective of parents. Although participating parents wanted health care providers to counsel their adolescents on sensitive health issues, their desires and expectations were rarely met.