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Tobacco use costs approximately $167 billion annually in the U.S., but few tobacco education opportunities are available in schools of public health. Reasons for the discrepancy between the costs of tobacco use and the creation of tobacco training opportunities have not been well explored. Based on the Behavioral Ecological Model, we present 10 recommendations for increasing tobacco training in schools of public health. Six recommendations focus on policy changes within the educational, legislative, and health care systems that influence funds for tobacco training, and four recommendations focus on strategies to mobilize key social groups that can advocate for change in tobacco control education and related policies. In addition, we present a model tobacco control curriculum to equip public health students with the skills needed to advocate for these recommended policy changes. Through concurrent changes in the ecological systems affecting tobacco control training, and through the collaborative action of legislators, the public, the media, and health professionals, tobacco control training can be moved to a higher priority in educational settings.

The managers of beach businesses were randomly assigned to receive no intervention or two newsletters per week for 6 weeks that presented economic consequences of damage to coastal water quality and how to contact politicians. The percentage of proenvironmental political contacts was significantly greater in the experimental (newsletter) group than in the control group. Logistical regression showed that contacts in the newsletter group were more than five times that of controls after adjusting for history of contacts and predisposition to take such action. Results suggest that the intervention can promote political action that could influence environmental policies and human health.

Purpose. This was a pilot study to assess the usability and impact of a feedback-based environmental tobacco smoke (ETS) reduction approach for Latino families. Design. A one-group, pre-post design was used. Methods. Information from hair samples from children analyzed for nicotine was used to create three feedback versions presented in a counterbalanced fashion. The intervention was conducted by a promotora in the participants' homes, with mailed materials and over the phone. Fifty Latino parent-child pairs were recruited. Parents were Spanish-speaking smoking adults (typically the mother) who reported exposing their children to ETS. Intervention efforts included home visits to provide nicotine feedback and counseling, two mailers presenting alternative versions of the feedback, and a supportive telephone call delivered over a 6-week period. Pre-post assessments conducted by a bicultural measurement technician measured parent reports of children's ETS exposure and children's hair nicotine. Parents' liking/usability of the three feedback formats was measured at the post-assessment. Paired t-tests assessed pre-post changes in exposure outcomes. Results. Parents' reports of exposure and children's hair nicotine levels showed statistically significant reductions. Parents liked all three feedback formats, particularly a comparative graphic format. Conclusions. Consistency of the positive findings suggests that this feedback approach to ETS reduction warrants further study with a more rigorous design.

This study examined relationships between social networks and immigration stress among first‐generation Chinese immigrants. Using data from a larger study of health behavior among first‐generation Mandarin/English‐speaking immigrants residing in the Los Angeles metropolitan area (N = 1,183), this study found that Chinese immigrants living closer to immediate family and maintaining larger social networks experienced lower immigration stress. Unexpectedly, immigrants with larger family sizes and who participated in voluntary associations (e.g., religious, alumni, and nationality associations) reported increased immigration stress. The findings suggest that practitioners need to be cautious of a possible downside in designing interventions to expand social networks among immigrant clients. The study is especially important in the context of a rapidly increasing immigrant population from Mainland China to the USA.Key Practitioner Message: ● Working with immigration families should incorporate assessment of their social network; ● Interventions designed to facilitate supportive social networks should differentiate different social network ties; ● Different social network ties may affect the stress level of immigrants differently.

Purpose. This study evaluated the effect of behavioral modeling and social factors promoting stair use. Design. Alternating baseline and intervention phase experimental design. Setting. San Diego International Airport, San Diego, California. Subjects. Stair use was coded for 15,574 filmed participants. Intervention. This study compared the effects of three types of behavioral modeling: natural models (i.e., passersby), single experimental model (i.e., confederate), and confederate model pairs providing verbal prompts. Measures. Variables were coded based on systematic observation of videotapes, including demographics, day and time, and the following indicators of physical and social reinforcement contingencies: dress, luggage, children, social group, and speed. Reliability ranged from .64 to .88. Analysis. Bivariate and logistic regression models stratified by gender. Results. Stair use increased over baseline by 102.6% with no model present and by 61.8% in the presence of natural models for men and women (p < .001). Controlling for multiple covariates, the odds ratios for stair use ranged from 1.76 to 2.93 for men and from 1.82 to 2.54 for women across the levels with natural and confederate models present (all p < .001). Conclusion. Modeling can prompt stair use, and findings for social and environmental reinforcement contingencies support the Behavioral Ecological Model. Modeling may explain partial maintenance of stair use in public areas after removal of prompts (e.g., signs, banners). Results inform interventions for increasing physical activity as part of daily routines.

Purpose. To examine the extent to which theoretical fidelity, or precision in replicating theory-based recommendations, influenced the effectiveness of two walking programs based on social cognitive theory (SCT). Design. Two-group randomized controlled trial. Setting. College town in Virginia. Subjects. Sixty-one sedentary adult women. Intervention. Two 12-week e-mail–based walking programs were compared. The high fidelity program was designed to more precisely follow SCT recommendations for operationalizing mastery procedures than the low fidelity program, which was designed to simulate how mastery procedures were operationalized in most existing SCT-based physical activity programs. Treatment contact and walking prescription were controlled across groups. Measures. The 1-mile walk test of physical fitness and SCT measures were completed at baseline and posttest. Self-reported walking quantity was assessed at baseline, posttest, and 1-year follow-up. Walking logs were completed during the program. Process evaluation measures were completed at posttest. Results. Fifty women completed the study. The high fidelity group improved more than twice as much as the low fidelity group on 1-mile walk test time (86 vs. 32 seconds, p < .05), goal setting (p < .05), and positive outcome expectations (p < .05) and reported greater program satisfaction (p < .01). Conclusion. Theoretical fidelity could advance the quality of physical activity interventions, which have often shown small effects.

Background. This article provides a description and evaluation of a community-sponsored smoking cessation contest. Adapted from previous efforts, "Quit to Win" relied solely on community resources and was promoted to the two million residents of San Diego County, California. Methods. A large recruitment campaign included print and electronic media. Eight hundred and two smokers participated in the contest. Contest entry forms served as the pretreatment measure, quit cards measured smoking status, and follow-up telephone interviews collected additional data on three groups: joiners, nonjoiners, and comparison subjects. Results. Thirty-five percent of the participants reported being smoke-free two months after the program. Television was by far the most effective promotional medium, while individuals who received a promotional flyer were somewhat more likely to actually join the contest than those who heard of it through other sources. Self-confidence, outcome expectations, and lighter smoking habit were predictive of contest participation. Of joiners, those with a greater fear of suffering from withdrawal were less likely to quit. Discussion. The approximate cost per quitter was $17.25 based on the direct budget expenses for the contest. However, this does not include the significant cost of the many donated services. Large smoking cessation contests can be cost-effective while providing direct and indirect benefits to anti-tobacco efforts.

Purpose.The study examines the relationship between children's television (TV) viewing and physical fitness.Design.Cross-sectional data from questionnaires and objective measures were analyzed.Setting.Data were collected during the fall of 1990 from public elementary school students in a suburban California city.Subjects.Approximately 98% of eligible students participated. Of these, 10% were dropped due to missing data, yielding a final sample of 284 girls and 304 boys.Measures.Children reported their amount of TV viewing on a typical summer day; parents reported their child's TV viewing on a typical weekday during the school year. Cardiovascular fitness was the 1-mile run/walk. Body fat was both the child's body mass index (BMI) and skinfolds. Additional measures included muscular strength/endurance and flexibility.Results.Mile run/walk times were associated with both parental (η2= . 051 and . 031 for boys and girls, respectively) and child reports (η2= . 020 and . 028) of the child's amount of TV viewing. Parental reports, but not child reports, of the child's TV viewing were related to BMI (η2= .041 and .058) and skinfolds (η2= .050 and .029). Neither measure of children's TV viewing was related to muscular strength/endurance or flexibility.Conclusions.Children's TV viewing seems to be weakly and inconsistently related to various components of physical fitness. However, given the tracking of cardiovascular disease risk factors from childhood into adulthood and the high proportion of children who watch television, these relationships are worthy of further study.

Secondhand smoke exposure (SHS) causes a disproportionate health burden for children, yet existing smoke-free laws are often poorly enforced. We monitored air quality while observing children and adult nonsmokers present in public venues during Ramadan, a period of Muslim religious observance marked by family and social gatherings, in Jakarta, Indonesia. A repeated-measures design was used to assess indoor air quality during and after Ramadan in 43 restaurants and in five smoke-free control venues. Fine particulate matter of 2.5 microns or less (PM2.5) was sampled. The average number of children and active smokers present in each venue was also observed. PM2.5 levels were significantly higher during Ramadan (mean 86.5 µg/m3) compared with post-Ramadan (mean 63.2 µg/m3) in smoking venues (p = 0.015). During Ramadan, there were more active smokers (p = 0.012) and children (p = 0.051) observed in venues where smoking occurred, compared with the same venues post-Ramadan. Poor enforcement of the smoke-free law in Jakarta has failed to protect children from SHS exposure in public venues during Ramadan. Collaboration between the government, NGOs (such as the Indonesian Cancer Foundation (YKI) and the Smoking Control Foundation (LM3)), religious leaders, and venue owners and managers must be developed to ensure that the comprehensive smoking bans apply to all venues, and that smoke-free laws are enforced.

Purpose. This study examines the individual and environmental correlates of home smoking bans among a population-based sample of Mexican-Americans. Design. A telephone survey on tobacco use and home policies was conducted using stratified, random sampling of listed phone numbers. Setting. Surveys were completed by telephone in San Diego, California. Subjects. The sample consisted of San Diego adult residents of Mexican descent (N=1,103). Measures. The interview included questions on home rules regarding smoking in the household and a number of potential correlates, based on the Behavioral Ecological Model (BEM). This model emphasizes the influence of family, social, and cultural factors on health behaviors. Results. Overall, 90.6% of all respondents reported a ban on smoking in the home. Multivariate analyses indicated that home bans on smoking are more likely among individuals that do not smoke, live with children, are more acculturated to U.S. society, report greater aversion to ETS, and/or report more social pressure against indoor smoking. In contrast, smoking bans are less likely among Mexican Americans who live with smokers. Conclusions. Individual and environmental factors play a protective role by increasing the likelihood of smoking bans in the home of Mexican-descent individuals. These factors should be considered for the design of interventions to sustain and promote the adoption of smoking bans in the home among this and other populations.