Tobacco Info

From Tobacco Info No. 7 - October 2011
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Abstracts review by the Ontario Tobacco Research Unit

The Ontario Tobacco Research Unit (OTRU) is a research network that is recognized as a Canadian leader in tobacco control research, monitoring and evaluation. Browse Current Abstracts on Tobacco Control, a monthly list of selected journal articles and reports on tobacco topics, with an emphasis on Canadian authors and research, or visit the online library catalogue to search thousands of citations related to smoking and tobacco at

Smoke-free laws

Satterlund and colleagues writing in the Journal of Community Health analyzed barriers to adopting and implementing local-level tobacco control policies. The authors examined the evaluation reports of 96 local outdoor smoking projects funded by the California Tobacco Control Program for barriers to implementation. The barriers were grouped in three primary areas: politically polarizing barriers, organizational barriers and local political orientation. The barriers identified in this study underscore the need for an organized action plan in adopting local tobacco policy. The authors also suggest potential strategies to offset the barriers, including: (1) having a ‘champion’ who helps to carry an objective forward; (2) tapping into a pool of youth volunteers; (3) collecting and using local data as a persuasive tool; (4) educating the community in smoke-free policy efforts; (5) working strategically within the local political climate; and (6) demonstrating to policy makers the constituent support for proposed policy.

Nagelhout and co-authors, in Social Science and Medicine, investigated the factors that were associated with individual smokers reporting smoking in bars after the implementation of smoke-free laws.  The study included 3,147 adult smokers surveyed pre and post smoke-free bar implementation as part of the International Tobacco Control Europe surveys from Ireland, France, the Netherlands and Germany. Partial smoke-free legislation in the Netherlands and Germany was only moderately effective in reducing smoking in bars (from 88% to 34% and from 87% to 44%, respectively) compared to countries with comprehensive legislation (Ireland and France) which almost completely eliminated smoking in bars (from 97% to 3% and from 84% to 3%, respectively). Smokers, who were more supportive of the ban, were more aware of the harm of SHS and who had negative opinions of smoking, were less likely to smoke in bars post-ban.

Smoking in the movies

Stan Glantz and colleagues in the CDC Weekly found encouraging news of a downward trend in the number of onscreen tobacco incidents in youth rated (G, PG, PG-13) movies, decreasing 71.6%, from 2,093 incidents in 2005 to 595 in 2010. Similarly, the average number of incidents per youth-rated movie decreased 66.2%, from 20.1 in 2005 to 6.8 in 2010. The degree of decline, however, varied substantially by motion picture company. The three companies with published policies designed to reduce tobacco use in their movies had an average decrease in tobacco incidents of 95.8%, compared with an average decrease of 41.7% among the three major motion picture companies and independents without policies. This finding indicates that an enforceable policy aimed at reducing tobacco use in youth-rated movies can lead to substantially fewer tobacco incidents in movies and help prevent adolescent initiation to smoking.

Sleep and smoking

Two separate studies published in the journals Psychology of Addictive Behaviors, and Addictive Behaviors, evaluated the link between disturbed sleep and difficulty in quitting smoking.  Peters et al., in the former paper, examined 385 smokers who completed a survey of sleep quality and evidence of waking during the night to smoke.  Smokers with co-occurring night smoking and sleep disturbance were at a greater risk for continuing to smoke than smokers with neither risk factor.  On the other hand, Okun and co-authors in Pittsburgh found no relationship between quitting and sleep quality among 322 female smokers, over three months of follow up.  Drowsiness, insomnia and sleep quality changed over time but none were associated with relapse.

Smoking cessation

A recent meta-analysis in the Canadian Medical Association Journal raises safety concerns about the potential for an increased risk of serious adverse cardiovascular events associated with the use of varenicline among tobacco users. Among 14 double-blind randomized controlled trials involving 8,216 participants, ranging in duration from seven to 52 weeks, varenicline was associated with a significantly increased risk (odds ratio of 1:7) of serious adverse cardiovascular events in smokers using varenicline compared with smokers on the placebo. The review by Singh and colleagues suggests that physicians should carefully balance the risk of serious cardiovascular events associated with varenicline use against the known benefits of the drug on smoking cessation.

In an article published in the Lancet, Free et al. described and evaluated an innovative smoking cessation program that was delivered automatically to participants using cell phone texting.  The single blind randomized trial, titled txt2stop, using an independent telephone randomization system, allowed participants to register to a text messaging smoking cessation service comprising motivational messages and behavioural-change support, or to a control group that received text messages unrelated to quitting.  Smokers in the texting group were more than twice as likely to have quit smoking at six months as the control group.

In the Journal of Men’s Health, Okoli and colleagues from British Columbia reviewed the literature for male-centred interventions.  Despite the importance of smoking to the burden of disease among men, only two randomized controlled studies were found tailored specifically to men.  The few descriptive studies that have examined smoking cessation outcomes in men-only programs called for more men-centred interventions. The authors suggest that the factors underpinning men’s smoking and cessation require further research attention and that future studies are needed to examine, incorporate and evaluate sex and gender-specific factors related to smoking cessation outcomes among men.

By Michael Chaiton