Air quality, mortality, and economic benefits of a smoke - free workplace law for non-smoking Ontario bar workers.

We estimated the impact of a smoke-free workplace bylaw on non-smoking bar workers' health in Ontario, Canada. We measured bar workers' urine cotinine before (n = 99) and after (n = 91) a 2004 smoke-free workplace bylaw. Using pharmacokinetic and epidemiological models, we estimated workers' fine-particle (PM2.5 ) air pollution exposure and mortality risks from workplace secondhand smoke (SHS). workers' pre-law geometric mean cotinine was 10.3 ng/ml; post-law dose declined 70% to 3.10 ng/ml and reported work hours of exposure by 90%. Pre-law, 97% of workers' doses exceeded the 90th percentile for Canadians of working age. Pre-law-estimated 8-h average workplace PM2.5 exposure from SHS was 419 µg/m(3) or 'Very Poor' air quality, while outdoor PM2.5 levels averaged 7 µg/m(3) , 'Very Good' air quality by Canadian Air Quality Standards. We estimated that the bar workers' annual mortality rate from workplace SHS exposure was 102 deaths per 100000 persons. This was 2.4 times the occupational disease fatality rate for all Ontario workers. We estimated that half to two-thirds of the 10620 Ontario bar workers were non-smokers. Accordingly, Ontario's smoke-free law saved an estimated 5-7 non-smoking bar workers' lives annually, valued at CA $50 million to $68 million (US $49 million to $66 million).

Factors associated with the adoption of a smoking ban in Quebec households.

The home represents an important source of exposure to environmental tobacco smoke for non-smokers, including children, who live with smokers. Our goal is to identify the sociodemographic factors associated with the adoption of smoking bans in "smoker households" in Quebec. Selected associations are compared with three other Canadian provinces (Ontario, British Columbia and Nova Scotia). This is a cross-sectional study involving 2648 respondents. Logistic regression analysis is employed. Few smoker households in Quebec (21%) have a ban on smoking; the presence of a non-smoker is strongly linked to the existence of such a ban; the presence of a child under the age of 6 is less strongly associated with the adoption of a ban in Quebec than in the other provinces, and the presence of an adolescent shows no association whatsoever. In addition to the child health benefits of household smoking bans, greater emphasis should be placed on the impact that such bans can have on children's future smoking behaviour. One option from a health promotion standpoint might be to organize a campaign aimed at non-smokers who live with smokers, in order to urge them to be less tolerant of environmental tobacco smoke.

Body mass index and mortality in women: follow-up of the Canadian National Breast Screening Study cohort.

OBJECTIVE: The present study was conducted to examine the relationship between obesity and all-cause mortality in women. STUDY DESIGN AND SETTINGS: The subjects were women enrolled from 1980 to 1985 in a Canadian randomized trial, the National Breast Screening Study (NBSS) to evaluate the efficacy of mammographic screening. Mortality was ascertained by record linkage to the Canadian Mortality Data Base. Hazard ratios (HR) for the association between body mass index (BMI) and all-cause mortality were obtained from Cox proportional hazard regression models. RESULTS: During an average follow-up period of 16.5 years, 2566 deaths were identified among the 49 165 women, age 40-59 y at enrollment. The risk of all-cause death increased linearly above a BMI of 22 kg/m(2) and the trend was statistically significant. The HR (and 95% confidence intervals) in the various categories of BMI (kg/m(2)) were: BMI<18.5: 1.12 (0.99-1.25); BMI 18.5-21.9: 1.00 (reference); BMI 22-24.9: 1.15 (1.11-1.18); BMI 25.0-27.9: 1.28 (1.24-1.32); BMI 28.0 -29.9: 1.34 (1.29-1.39); BMI 30.0-34.9: 1.30 (1.25,1.35); and BMI > or =35.0: 1.40 (1.33-1.47). CONCLUSION: This study confirms the association of high BMI with increased all-cause mortality in women.

Dimensions underlying legislator support for tobacco control policies.

OBJECTIVE: To propose and test a new classification system for characterising legislator support for various tobacco control policies. DESIGN: Cross sectional study. SUBJECTS: Federal and provincial legislators in Canada serving as of October 1996 who participated in the Canadian Legislator Study (n = 553; response rate 54%). MAIN OUTCOME MEASURES: A three factor model (Voters, Tobacco industry, Other interest groups) that assigns nine tobacco control policies according to legislators' hypothesised perceptions of which group is more directly affected by these policies. RESULTS: Based on confirmatory factor analysis, the proposed model had an acceptable fit and showed construct validity. Multivariate analysis indicated that three of the predictors (believing that the government has a role in health promotion, being a non-smoker, and knowledge that there are more tobacco than alcohol caused deaths) were associated with all three factor scales. Several variables were associated with two of the three scales. Some were unique to each scale. CONCLUSIONS: Based on our analyses, legislator support for tobacco control policies can be grouped according to our a priori factor model. The information gained from this work can help advocates understand how legislators think about different types of tobacco control policies. This could lead to the development of more effective advocacy strategies.

Is nicotine dependence related to smokers' support for restrictions on smoking?

OBJECTIVES: To examine the relationship between nicotine dependence and attitudes, predicted behaviours and support regarding restrictions on smoking. DESIGN: Population-based, computer-assisted, telephone survey of adults in Ontario, Canada using a two-stage stratified sampling design; 1764 interviews were completed (65% response rate) yielding 424 (24%) cigarette smokers, of whom 354 (83%) smoked daily. The Heaviness of Smoking Index was used as a measure of nicotine dependence. MAIN OUTCOME MEASURE: Attitudes toward smoking restrictions, predicted compliance with more restrictions, and support for total smoking bans. RESULTS: Attitudes favorable to smoking restrictions tended to decrease with increased nicotine dependence, but the associations were not statistically significant after adjusting for demographic variables. Predicted compliance with more restrictions on smoking decreased with higher levels of dependence, as did support for a total ban on smoking in restaurants, workplaces, bingo halls, and hockey arenas. Support for smoking bans in food courts, family fast food restaurants, and bars and taverns did not vary significantly with level of nicotine dependence. CONCLUSIONS: Level of nicotine dependence is associated with intended behaviors and support for smoking restrictions in some settings. These results have implications for tobacco control programs and policies.

Diffusion theory and drug use.

This paper examines the applicability of the diffusion model to drug use. A variety of studies that employ the diffusion model to examine drug-related behaviour, including the use of alcohol, tobacco and illicit drugs, are discussed. Studies include those that focus on "natural" or spontaneous diffusion and those in which diffusion of a drug or a drug-related intervention is planned. Most studies examined support the application of the diffusion model in the study of drug use. The model is particularly valuable when new substances are introduced to a population or subgroup. The addition of economic and other forms of availability as a determinant of adoption would increase the power of the model. Recommended directions for research are outlined. The diffusion model has been used successfully in the study of drug use for several decades. More rigorous designs would strengthen this type of research and provide direction for policymakers and those involved in public health and education.

'Light' and 'mild' cigarettes: who smokes them? Are they being misled?

Using two population-based surveys of Ontarians, we examined the proportions of smokers who smoke 'light' and 'mild' cigarettes (L/M). We compared L/M smokers to regular cigarette smokers regarding demographic, health knowledge, and smoking characteristics and examined their health-related perceptions of L/M and reasons for smoking them. Use of these cigarettes increased from 71% in 1996 to 83% in 2000. Those who smoked L/M were more likely to be female, to be less addicted, and to be more advanced toward quitting. In 1996, one in five believed that smoking L/M lowers the risk of cancer and heart disease. In 1996 and 2000, respectively, 44% and 27% smoked L/M to reduce health risks, 41% and 40% smoked them as a step toward quitting, and 41% in both years said they would be more likely to quit if they learned L/M could provide the same tar and nicotine as regular cigarettes. These data provide empirical support for banning 'light' and 'mild' on cigarette packaging.

Heterogeneity among smokers and non-smokers in attitudes and behaviour regarding smoking and smoking restrictions.

OBJECTIVE: To determine if smokers and non-smokers cluster into meaningful, discrete subgroups with distinguishable attitudes and behaviours regarding smoking and smoking restrictions. DESIGN: Qualitative research with 45 smokers guided development of questionnaire items applied in a population based telephone survey of 432 current smokers and 1332 non-smokers in Ontario, Canada. METHODS: Cluster analysis of questionnaire items used to categorise adult smokers and non-smokers; comparison of clusters on sociodemographic characteristics and composite knowledge and attitude scores. RESULTS: Smokers clustered in three groups. "Reluctant" smokers (16%) show more concern about other people discovering that they smoke, but parallel "easygoing" smokers (42%) in supporting restrictions on smoking and not smoking around others. "Adamant" smokers (42%) feel restrictions have gone too far, and are less likely to accommodate non-smokers. Significant gradients across categories in the expected direction were observed with respect to smoking status, stage of change, knowledge, and attitude scores, and predicted compliance with restrictions, validating the proposed typology. Non-smokers also clustered into three groups, of which the "adamant" non-smokers (45%) are the least favourably disposed to smoking. "Unempowered" non-smokers (34%) also oppose smoking, but tend not to act on it. "Laissez-faire" non-smokers (21%) are less opposed to smoking in both attitude and behaviour. A significant gradient across categories in the expected direction was observed with respect to composite scores regarding knowledge of the health effects of active and passive smoking and a composite score on support for restrictions on smoking in public places. CONCLUSION: Recognition and consideration of the types of smokers and non-smokers in the population and their distinguishing characteristics could inform the development of tobacco control policies and programmes and suggest strategies to assist implementation.

Knowledge about tobacco and attitudes toward tobacco control: how different are smokers and nonsmokers?

Using data from a 1996 random-digit-dialing computer-assisted telephone survey of Ontario adults, 424 smokers and 1,340 nonsmokers were compared regarding knowledge about the health effects of tobacco use, attitudes toward restrictions on smoking and other tobacco control measures, and predictions of compliance with more restrictions. The response rate was 65%. Smokers were less knowledgeable than nonsmokers. Smokers were also less likely to support bans on smoking in specific locations, but majorities of both groups supported some restriction in most settings. Smokers were more likely than nonsmokers to predict that most smokers would comply with more restrictions, and more than three quarters indicated that they, themselves, would comply. Sizable proportions of both groups, especially smokers, failed to appreciate the effectiveness of taxation in reducing smoking. Support for other control measures also differed by smoking status. Both knowledge and smoking status were independently associated with support for more restrictions and other tobacco control policy measures.

Commentary. monitoring tobacco use in canada: the need for a surveillance strategy.

Smoking behaviour has been monitored nationally through population surveys for 35 years in Canada, but these surveys have not been as consistent or rigorous as the magnitude of the smoking problem demands. Inconsistent methods and irregular survey intervals are just two of the characteristics that have made it difficult to know exactly how smoking is changing. Further, an absence of routine data on tobacco control policies (other than the price of cigarettes) has hampered understanding of the determinants of changing prevalence. The advent of two survey series--Canadian Tobacco Use Monitoring Survey (CTUMS) and Canadian Community Health Survey (CCHS) promises to change this situation for the better. We suggest that both are critical elements of a national smoking surveillance system and that, with a commitment to CTUMS in particular, Health Canada could set a new international standard for surveillance.

Gender differences in alcohol consumption and adverse drinking consequences: cross-cultural patterns.

AIMS: To examine the consistency and/or variability of gender differences in drinking behavior cross-culturally. DESIGN, SETTING, PARTICIPANTS: Women's and men's responses in 16 general population surveys from 10 countries, analyzed by members of the International Research Group on Gender and Alcohol. MEASUREMENTS: Comparable measures of drinking, versus abstention, typical drinking frequencies and quantities, heavy episodic drinking, intoxication, morning drinking, and alcohol-related family and occupational problems. FINDINGS: Women and men differed little in the probability of currently drinking versus abstaining, but men consistently exceeded women in typical drinking frequencies and quantities and in rates of heavy drinking episodes and adverse drinking consequences, while women were consistently more likely than men to be life-time abstainers. In older age groups, both men and women drank smaller quantities of alcohol and were more likely to stop drinking altogether, but drinking frequencies did not change consistently with age. CONCLUSIONS: A theoretical synthesis proposes that gender roles may amplify biological differences in reactions to alcohol, and that gender differences in drinking behavior may be modified by macrosocial factors that modify gender role contrasts.

Interactions between smokers and non-smokers in public places: a qualitative study.

Few studies have employed a qualitative approach to better understand how both smokers and non-smokers experience and make sense of no-smoking restrictions in their daily lives. We describe qualitative research involving an examination of self-reported interpersonal interactions between smokers and non-smokers in public places regarding exposure to environmental tobacco smoke (ETS). Five focus group discussions and twenty individual in-depth interviews were conducted with smokers and non-smokers in the Metropolitan Toronto region as a complement to a quantitative survey of the adult population of Ontario. Strategies used by non-smokers in responding to ETS exposures included verbal confrontations, non-verbal cues, use of a third party, and moving away. The perceived consequences of such actions, as described by both smokers and non-smokers, are discussed, together with implications for tobacco control policy and practice.