Suchergebnisse

Purpose: This study addresses the dearth of population-based research on how comprehensive household smoke-free rules (ie, in the home and car) relate to tobacco use and secondhand smoke (SHS) exposure among adolescents. Design: Analysis of 2014 Minnesota Youth Tobacco Survey. Setting: Representative sample of Minnesota youth. Participants: A total of 1287 youth who lived with a smoker. Measures: Measures included household smoke-free rules (no rules, partial rules—home or car, but not both—and comprehensive rules), lifetime and 30-day cigarette use, 30-day cigarette and other product use, and SHS exposure in past 7 days in home and car. Analysis: Weighted multivariate logistic, zero-inflated Poisson, and zero-inflated negative binomial regressions were used. Results: Compared to comprehensive rules, partial and no smoke-free rules were significantly and positively related to lifetime cigarette use (respectively, adjusted odds ratio [AOR] = 1.80, 95% confidence interval [CI] = 1.24-2.61; AOR = 2.87, 95% CI = 1.93-4.25), and a similar significant pattern was found for 30-day cigarette use (respectively, AOR = 2.20, 95% CI = 1.21-4.02; AOR = 2.45, 95% CI = 1.34-4.50). No smoke-free rules significantly predicted using cigarettes and other tobacco products compared to comprehensive rules. In both descriptive and regression analyses, we found SHS exposure rates in both the home and car were significantly lower among youth whose household implemented comprehensive smoke-free rules. Conclusions: Comprehensive smoke-free rules protect youth from the harms of caregiver tobacco use. Relative to both partial and no smoke-free rules, comprehensive smoke-free rules have a marked impact on tobacco use and SHS exposure among youth who live with a smoker. Health promotion efforts should promote comprehensive smoke-free rules among all households and particularly households with children and adolescents.

Purpose. This paper investigated whether stage of change for health behaviors was associated with the presence of chronic conditions. Design. A stratified cross-sectional survey by mail with telephone follow-up. Settings. This study was conducted at a mixed-model HMO with 650,000 members based in Minnesota. Subjects. The sample consisted of a random sample of 8000 HMO members age 40 or over with systematic oversampling of members with hypertension, diabetes, dyslipidemia, or heart disease. Measures. In addition to demographics, readiness to change for physical activity, fat intake, fruit and vegetable intake, and smoking were assessed. Results. The adjusted response rate was 82.4%. In a logistic regression analysis, members with one or more than one chronic condition had greater readiness to change for three out of four risk factors compared to members with no chronic conditions. Conclusions. The stage-of-change distribution of HMO members with chronic conditions suggests that members at highest risk of adverse health outcomes have the greatest readiness to change behavioral risk factors. Based on these observations, targeted, stage-specific efforts to support behavior change are likely to be both acceptable and effective in HMO members with chronic conditions. Improving stage of change for behavioral risk factors for members with diabetes may present special problems and opportunities.

Purpose. Evaluate a tailored approach for tobacco dependence treatment for American Indians. Design. A single-group design evaluation of a culturally specific curriculum for tobacco dependence treatment was implemented. Baseline assessment, program utilization, and 90-day follow-up interview data were analyzed. Setting. Fond du Lac Reservation in rural Minnesota and Mashkiki Waakaaigan Pharmacy in Minneapolis, Minnesota. Subjects. American Indian adults (N = 317). Intervention. Four 1-hour individual or group sessions of behavioral counseling paired with pharmacotherapy. Measures. Demographic variables, program satisfaction, and tobacco use behaviors. Analysis. Descriptive statistics; for abstinence, a smoking = missing analysis was used, assuming all nonrespondents were still smoking. Results. Sixty-three percent of participants completed the program. The 90-day follow-up response rate was 47%. Of those who completed, 47% reported abstinence at the 90-day follow-up. Missing = smoking analysis yielded a 21.8% quit rate. Continuing smokers cut their daily smoking by half from 17 to eight cigarettes, 88% reported an increase in self-efficacy for their next quit, and 44% planned to quit within 30 days. Conclusion. Evidence-based tobacco dependence treatment programs tailored to be culturally specific have the potential to significantly affect the burden of tobacco-related disparities among American Indians. (Am J Health Promot 2011;25[5 Supplement]:S66-S69.)

Purpose. To test whether a mailing describing new coverage for smoking cessation medications increases benefit knowledge, utilization, and quitting. Methods. This randomized controlled trial assigned participants to benefit communication via (1) standard contract changes or (2) enhanced communication with direct-to-member postcards. A sample of 1930 self-identified smokers from two Minnesota health plans took surveys before and 1 year after the benefit's introduction. The follow-up response rate was 80%. A multilevel logistic estimator tested for differences in benefit knowledge and smoking behavior from baseline. Results. More enhanced than standard communication respondents knew about the benefit (39.0% vs. 22.2%, p < .0001) at follow-up. Groups did not differ on bupropion utilization (24.6% vs. 23.1%, p = .92); nicotine replacement therapy utilization (26.9% vs. 25.9%, p = .26), or cessation (12.8% vs. 15.6%, p = .32). Conclusion. Although limited by the low intervention intensity and potential social desirability bias, information about new coverage alone does not appear to increase quitting behaviors.

As state and local governments increase restrictions on cigarette smoking, tobacco manufacturers have shifted to marketing alternative tobacco products. Tobacco control laws need to be updated to reflect this shifting marketplace. With the 2010 enactment of the Tobacco Modernization and Compliance Act, Minnesota addressed regulatory gaps and created a model law for other states. We have detailed the updated definitions of tobacco and tobacco products and identified ways that future laws could be strengthened.

Purpose: To examine locations of secondhand smoke (SHS) exposure among nonsmokers, 7 years after a statewide smoke-free policy. Design: Data collected via statewide, random digit dial telephone survey. Response rates were 64.7% for landline and 73.5% for cell phone. Setting: Minnesota, 2014. Participants: Representative sample of 7887 nonsmoking adults. Measures: Self-reported locations of SHS exposure and opinions on smoke-free restrictions. Analysis: Descriptive statistics and logistic regression. Results: A total of 35.5% of nonsmokers reported SHS exposure in the past 7 days. The greatest proportion of exposure occurred in community settings (31.7%) followed by cars (6.9%) and in the home (3.2%). Young adults were more likely to be exposed in a home or car than older adults. Nonsmokers living with a smoker were 39.6 (20.6-75.8) times more likely to be exposed to SHS in their home and 5.3 (4.1-6.8) times more likely to be exposed in a car, compared to those who did not live with a smoker. Conclusion: SHS exposure continues after comprehensive smoke-free policies restricted it from public places. Disparities in exposure rates exist for those who live with a smoker, are young, and have low incomes. Findings suggest the need for additional policies that will have the greatest public health benefit.

Conventional wisdom once held that the demand for addictive substances like cigarettes, alcohol, and drugs was unlike that for any other economic good and, therefore, unresponsive to traditional market forces. Recently, however, researchers from two disparate fields, economics and behavioral psychology, have found that increases in the overall price of an addictive substance can significantly reduce both the number of users and the amounts those users consume. Changes in the "full price" of addictive substances—including monetary value, time outlay, effort to obtain, and potential penalties for illegal use—yield marked variations in behavioral outcomes and demand. The Economic Analysis of Substance Use and Abuse brings these distinctive fields of study together and presents for the first time an integrated assessment of their data and results. Unique and innovative, this multidisciplinary volume will serve as an important resource in the current debates concerning alcohol and drug use and abuse and the impacts of legalizing illicit drugs