DATA SOURCE: Telephone survey of the 52 US departments of correction.

MAIN OUTCOME MEASURES: Current tobacco policy; distribution of free tobacco; availability of smoking cessation programming and cessation aids.

PARTICIPANTS: Complete responses were received from 51 of 52 (98%) departments, while one provided partial information.

RESULTS: The majority of correctional systems (60%) reported total tobacco bans on prison grounds, with most remaining facilities (27%) having an indoor ban on tobacco use. No prisons distributed free tobacco. No major violence was reported relating to the implementation of stricter tobacco policies, however many respondents noted that tobacco became a major contraband item following the implementation of a total ban. While most prison systems with an indoor tobacco ban (86%) reported having tobacco cessation programmes, few of those with total bans (39%) continued such programmes after the initial transition period.

CONCLUSION: Total tobacco bans have often been accompanied by the termination of tobacco cessation programmes. Such actions undermine efforts to promote long-term cessation resulting in a missed public health opportunity.

Design: Longitudinal survey research.

Setting: A well-established community-based psychiatric rehabilitation program in Hamilton, Ontario, Canada providing long-term intensive case management and rehabilitation skills training.

Participants: Stable community outpatients diagnosed with schizophrenia were surveyed initially in 1995 (N = 102) and then re-surveyed eleven years later in 2006 (N = 76).

Main Outcome Measures: Self-report of smoking status.

Results:Smoking rates dropped significantly over time, with evidence that the number of ‘quitters’ tripled over the past decade and the number of ‘everyday’ smokers decreased by almost a third from 63.2% down to 43.3% (p < .001).

Conclusions: The findings from the present study suggest that it is possible to obtain reduced smoking prevalence over time in a selected schizophrenia outpatient sample, though further research is required to better understand the factors related to quitting smoking in individuals with schizophrenia.

Data sources: A structured search of databases and a manual search of reference lists was conducted. Randomized controlled trials published in English or German between August 2001 and August 2006 targeting youths up to 18 years of age were assessed independently by two researchers according to pre-defined inclusion criteria and with regard to methodological quality.

Data extraction: Data abstraction was performed and cross-checked by two researchers. Where appropriate, pooled effect estimates were calculated and tested in sensitivity analyses.

Data synthesis: Out of 3555 articles, 35 studies met the inclusion criteria. The follow-up duration ranged from 12 months to 120 months. Although the overall effectiveness of prevention programs showed considerable heterogeneity, the majority of studies reported some positive long-term effects for behavioral smoking prevention programs. There was evidence that community-based and multisectorial interventions were effective in reducing smoking rates; in contrast, the evidence for school-based programs alone was inconclusive. Regardless of the type of intervention, the reductions observed in smoking rates were only modest.

Conclusion: The present review identified moderate evidence for the effectiveness of behavioral interventions to prevent smoking. Although evidence for the effectiveness of school-based interventions was inconclusive, evidence for the effectiveness of community-based and multisectorial interventions was somewhat stronger. Future research should investigate the effectiveness of specific intervention components and the cost-effectiveness of interventions analysed in methodologically high-quality studies.

Aims: To determine the critical windows of SHS exposure and the duration of its impact on serious infectious morbidity in the first 8 years of life.

Methods: The Hong Kong children of 1997 birth cohort is a prospective, population based study of 8327 children comprising 88% of all births in April and May 1997, of whom 7402 (89%) were followed up until their 8th birthday in 2005. We used multivariable Cox regression to assess the relation between post-natal SHS exposure and risk of first admission to public hospitals (together accounting for >95% total bed-days overall) for respiratory, other and all infections from birth to 8.0 years of age, for all individuals and for vulnerable sub-groups.

Results: Overall, household SHS exposure within 3 metres in early life was associated with a higher risk of admission for infectious illness up until 8 years of age (HR 1.14, 95% CI 1.00 to 1.31), after adjustment for sex, birth-weight, gestational age, feeding method, maternal age, highest parental education and proxies of preferred service sector. The association was strongest in the first 6 months of life (HR 1.45, 95% CI 1.15 to 1.83). In vulnerable sub-groups such as premature babies, the association held through to 8 years old (HR 2.00, 95% CI 1.08 to 3.72). Infants exposed to SHS in the first 3 months of life were most vulnerable to infectious causes of hospitalisation.

Conclusion: Household SHS exposure in early infancy increases severe infectious morbidity requiring hospital admission. Reducing SHS exposure in infants and particularly in more vulnerable infants will lower the bed-days burden due to infectious causes.

Data sources: Medical, nursing, psychological, social science and grey literature databases, bibliographies, hand-searches, and contact with authors.

Study selection: Studies were included (n=84) if they reported the effects of any population-level tobacco control intervention on smoking behaviour or attitudes in individuals or groups with different demographic or socio-economic characteristics.

Data extraction: Data extraction and quality assessment for each study were conducted by one reviewer and checked by a second.

Data synthesis: Data were synthesised using graphical (‘harvest plot’) and narrative methods. No strong evidence of differential effects was found for smoking restrictions in workplaces and public places, although those in higher occupational groups may be more likely to change their attitudes or behaviour. Smoking restrictions in schools may be more effective in girls. Restrictions on sales to minors may be more effective in girls and younger children. Increasing the price of tobacco products may be more effective in reducing smoking among lower-income adults and those in manual occupations, although there was also some evidence to suggest that adults with higher levels of education may be more price-sensitive. Young people aged under 25 are also affected by price increases, with some evidence that boys and non-white young people may be more sensitive to price.

Conclusions: Population-level tobacco control interventions have the potential to benefit more disadvantaged groups and thereby contribute to reducing health inequalities.

Methods: Cross-sectional data were derived from national health surveys from 18 European countries. In the analyses we distinguished between country, sex, two age groups (25-39 and 40-59 years) and educational level. Age-standardised cumulative quit ratios were calculated as total former-smokers divided by total ever-smokers. In regression analyses we explored the correlation between national quit ratios and the national score on the Tobacco Control Scale.

Results: Quit ratios were especially high (>45%) in Sweden, England, Netherlands, Belgium and France, and relatively low (<30%) in Lithuania and Latvia. Higher educated smokers were more likely to have quit smoking than lower educated smokers in all age-sex groups in all countries. National score on the tobacco control scale was positively associated with quit ratios in all age-sex groups. The association of quit ratios with score on TCS did not show consistent differences between high and low educated. Of all tobacco control policies of which the TCS is constructed, price policies showed the strongest association with quit ratios, followed by an advertising ban.

Conclusion: Countries with more developed tobacco control policies have higher quit ratios than countries with less developed tobacco control policies. High and low educated smokers benefit about equally from the nation-wide tobacco control policies.

Objective: To examine tobacco use prevalence and tobacco cessation training among students pursuing advanced degrees in health professions.

Methods: The Global Health Professions Student Survey (GHPSS) has been conducted among 3rd year students attending dental, medical, nursing, and pharmacy schools. The GHPSS was conducted in schools during regular lectures and class sessions. GHPSS follows an anonymous, self-administered format for data collection.

Results: The GHPSS was completed by at least one of the four target disciplines in 31 countries between 2005 and 2007 for a total of 80 survey sites. In 47 of the 80 sites, over 20% of the students currently smoked cigarettes; and in 29 of 77 sites, over 10% of the students currently used other tobacco products. GHPSS data showed that the majority of health professional students recognized that they are role models in society, believed that they should receive training on counseling patients to quit using tobacco, but in 73 of 80 sites less than 40% of the students reported they received such training.

Conclusions: Health professional schools, public health organizations, and education officials should discourage tobacco use among health professionals and work together to design and implement programs that train all health professionals in effective cessation-counseling techniques. If the goal of the tobacco control community is to reduce substantially the use of tobacco products, then resources should be invested in improving the quality of education of health professionals with respect to tobacco control.

Participants: The data come from the first 4 waves (2002-2005) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, United States, United Kingdom, and Australia (15,450 individual cases).

Design: The UK ban on misleading descriptors occurred around the 2nd wave of data collection in the ITC survey, permitting us to compare beliefs about light cigarettes among adult smokers in the UK both before and after the ban, with beliefs in the three other ITC countries unaffected by the ban.

Results: There was a substantial decline in reported beliefs about the benefits of Lights in the UK following the policy change and an associated public information campaign, but by 2006 (i.e., Wave 4), these beliefs rebounded slightly and the change in beliefs was no greater than in the United States, where there was no policy change.

Conclusion: The findings reveal that high levels of misperceptions about light cigarettes existed among smokers in all four countries before and after the EU ban took effect. We cannot conclude that the policy of removing some aspects of misleading labels has been effective in changing beliefs about light cigarettes. Efforts to correct decades of consumer misperceptions about light cigarettes must extend beyond simply removing "light and mild" brand descriptors.

Methods: Analysis of previously secret tobacco industry documents and multimedia materials.

Results: The failure of RJ Reynolds' (RJR) 1988 "smokeless" cigarette, Premier, was in part due to widespread bad word-of-mouth about the product's flavor, quality, and difficulty of use. In 1994 RJR introduced an updated version of Premier, the ostensibly "reduced-risk" Eclipse cigarette. RJR developed viral marketing channels to promote Eclipse using 1) exploratory interviews to motivate consumers to spread the word about Eclipse prior to market release; 2) promotional videos featuring positive feedback from test group participants to portray majority consensus among triers; 3) Tupperware-like parties for Eclipse where participants received samples to pass around in their social circles; and 4) the Eclipse website's bulletin board as a forum for potential users to discuss the brand in their own words. These strategies targeted the brand's likeliest adopters, recruited informal and credible representatives of the product unaffiliated with RJR, and controlled the information spread about the product.

Conclusions: Viral marketing techniques may be particularly useful to promote new tobacco products such as Eclipse that have limited appeal and need a highly motivated audience of early adopters and acceptors. Such techniques help evade the mass rejection that could follow mass promotion, circumvent marketing restrictions, and allow tobacco companies to benefit from health claims made by consumers. Cigarette manufacturers must be held accountable for perceived health benefits encouraged by all promotional activities including viral marketing.