What Helps and What Hinders the Creation of a Smoke-free Home: A Qualitative Study of Fathers in Scotland.

INTRODUCTION: Few studies have explored fathers' views and experiences of creating a smoke-free home, with interventions largely targeting mothers. This study aimed to identify barriers and facilitators to fathers creating a smoke-free home, to inform future intervention development. METHODS: Eighteen fathers who were smokers and lived in Scotland were recruited from Dads' community groups, Early Years Centres and through social media advertising. Semi-structured interviews explored their views and experiences of creating a smoke-free home. A theory-informed thematic analysis using the COM-B model highlighted ways in which capability, opportunity, and motivations shaped fathers' home smoking behaviors. RESULTS: Several fathers understood the health risks of second-hand smoke exposure through public health messaging associated with recent smoke-free legislation prohibiting smoking in cars carrying children. Limited understanding of effective exposure reduction strategies and personal mental health challenges reduced some fathers' ability to create a smoke-free home. Fathers were keen to maintain their smoke-free home rules, and their motivations for this largely centered on their perceived role as protector of their children, and their desire to be a good role model. CONCLUSIONS: Fathers' abilities to create a smoke-free home are shaped by a range of capabilities, opportunities, and motivations, some of which relate to their role as a father. Establishing a fuller understanding of the contextual and gender-specific factors that shape fathers' views on smoking in the home will facilitate the development of interventions and initiatives that fathers can identify and engage with, for the broader benefit of families and to improve gender equity and health. IMPLICATIONS: Our findings can inform future development of father-centered and household-level smoke-free home interventions. They identify fathers' views and experiences and help reframe smoking in the home as a gendered family-wide issue, which is important in building consensus on how best to support parents to create a smoke-free home. Our findings highlight the need for additional research to develop understanding of the ways in which gender-related aspects of family structures, heterosexual relationships, and child living arrangements influence home smoking rules and how to tailor interventions accordingly.

Why sex and gender matter in implementation research.

BACKGROUND: There has been a recent swell in activity by health research funding organizations and science journal editors to increase uptake of sex and gender considerations in study design, conduct and reporting in order to ensure that research results apply to everyone. However, examination of the implementation research literature reveals that attention to sex and gender has not yet infiltrated research methods in this field. DISCUSSION: The rationale for routinely considering sex and gender in implementation research is multifold. Sex and gender are important in decision-making, communication, stakeholder engagement and preferences for the uptake of interventions. Gender roles, gender identity, gender relations, and institutionalized gender influence the way in which an implementation strategy works, for whom, under what circumstances and why. There is emerging evidence that programme theories may operate differently within and across sexes, genders and other intersectional characteristics under various circumstances. Furthermore, without proper study, implementation strategies may inadvertently exploit or ignore, rather than transform thinking about sex and gender-related factors. Techniques are described for measuring and analyzing sex and gender in implementation research using both quantitative and qualitative methods. The present paper describes the application of methods for integrating sex and gender in implementation research. Consistently asking critical questions about sex and gender will likely lead to the discovery of positive outcomes, as well as unintended consequences. The result has potential to strengthen both the practice and science of implementation, improve health outcomes and reduce gender inequities.

Smoking on the margins: a comprehensive analysis of a municipal outdoor smoke-free policy.

BACKGROUND: This study examined the formulation, adoption, and implementation of a ban on smoking in the parks and beaches in Vancouver, Canada. METHODS: Informed by Critical Multiplism, we explored the policy adoption process, support for and compliance with a local bylaw prohibiting smoking in parks and on beaches, experiences with enforcement, and potential health equity issues through a series of qualitative and quantitative studies. RESULTS: Findings suggest that there was unanimous support for the introduction of the bylaw among policy makers, as well as a high degree of positive public support. We observed that smoking initially declined following the ban's implementation, but that smoking practices vary in parks by location. We also found evidence of different levels of enforcement and compliance between settings, and between different populations of park and beach users. CONCLUSIONS: Overall success with the implementation of the bylaw is tempered by potential increases in health inequities because of variable enforcement of the ban; greatest levels of smoking appear to continue to occur in the least advantaged areas of the city. Jurisdictions developing such policies need to consider how to allocate sufficient resources to enhance voluntary compliance and ensure that such bylaws do not contribute to health inequities.

Smoking cessation during pregnancy and relapse after childbirth in Canada.

OBJECTIVE: This analysis was undertaken to determine the rates and determinants of smoking cessation during pregnancy and smoking relapse after childbirth in Canada. METHODS: We used data from the Maternity Experiences Survey, a cross-sectional study of mothers who gave birth to a singleton baby in Canada in 2006. A total of 1586 mothers who smoked occasionally or daily before pregnancy were included in the analysis. RESULTS: The rate of smoking cessation during pregnancy was 53.0% (95% CI 50.3% to 55.7%). Higher pre-pregnancy smoking frequency, Inuit origin, being aged ≥ 35 years, lower education, not attending prenatal classes, lack of social support, stress before or during pregnancy, and living with a smoker were independently associated with higher risk of continued smoking, while First Nations (off-reserve) origin was associated with a lower risk. Among those who had quit smoking, 47.1% (95% CI 43.5% to 50.6%) relapsed postpartum. Living with a smoker, not having breastfed, and having stopped breastfeeding were independently associated with a higher risk of relapse. CONCLUSION: This study highlights the need to tailor smoking cessation and prevention interventions for some high-risk groups of women.

Objectif : Cette analyse a été menée pour déterminer les taux et les déterminants de l'arrêt tabagique pendant la grossesse et de la rechute post-partum au Canada. Méthodes : Nous avons utilisé les données de l'Enquête sur l'expérience de la maternité, soit une étude transversale sur des mères ayant accouché à la suite d'une grossesse simple au Canada en 2006. En tout, 1 586 mères ayant fumé occasionnellement ou quotidiennement avant la grossesse ont été incluses dans l'analyse. Résultats : Le taux d'arrêt tabagique pendant la grossesse était de 53,0 % (IC à 95 %, 50,3 % - 55,7 %). Une consommation de cigarettes plus élevée avant la grossesse, être d'origine inuite, être âgée de 35 ans ou plus, être moins scolarisée, la non-participation à des cours prénataux, le manque de soutien social, le stress avant ou pendant la grossesse et la cohabitation avec un fumeur étaient associés de façon indépendante à un risque accru de poursuite du tabagisme, tandis que le fait d'être issue des Premières Nations (hors-réserve) était associé à un risque moindre. Parmi les mères qui avaient cessé de fumer, 47,1 % (IC à 95 %, 43,5 % - 50,6 %) ont recommencé à fumer après l'accouchement. La cohabitation avec un fumeur, ne pas avoir allaité et avoir cessé d'allaiter étaient associés de façon indépendante à un risque accru de rechute. Conclusion : Cette étude souligne la nécessité d'adapter les interventions d'abandon et de prévention du tabagisme aux groupes de femmes exposées à des risques élevés.

Gender-transformative health promotion for women: a framework for action.

Gender inequity is a pervasive global challenge to health equity. Health promotion, as a field, has paid only limited attention to gender inequity to date, but could be an active agent of change if gender equity became an explicit goal of health promotion research, policy and programmes. As an aspect of gendered health systems, health promotion interventions may maintain, exacerbate or reduce gender-related health inequities, depending upon the degree and quality of gender-responsiveness within the programme or policy. This article introduces a framework for gender-transformative health promotion that builds on understanding gender as a determinant of health and outlines a continuum of actions to address gender and health. Gender-transformative health promotion interventions could play a significant role in improving the lives of millions of girls and women worldwide. Gender-related principles of action are identified that extend the core principles of health promotion but reflect the significance of attending to gender in the development and use of evidence, engagement of stakeholders and selection of interventions. We illustrate the framework with examples from a range of women's health promotion activities, including cardiovascular disease prevention, tobacco control, and alcohol use. The literature suggests that gender-responsiveness will enhance the acceptance, relevance and effectiveness of health promotion interventions. By moving beyond responsiveness to transformation, gender-transformative health promotion could enhance both health and social outcomes for large numbers of women and men, girls and boys.

Tobacco Cessation Interventions for Underserved Women.

Despite high rates of smoking among some subgroups of women, there is a lack of tailored interventions to address smoking cessation among women. We identify components of a women-centered approach to tobacco cessation by analyzing 3 bodies of literature: sex and gender influences in tobacco use and addiction; evidence-based tobacco cessation guidelines; and best practices in delivery of women-centered care. Programming for underserved women should be tailored, build confidence and increase motivation, integrate social justice issues and address inequities, and be holistic and comprehensive. Addressing the complexity of women's smoking and tailoring appropriately could help address smoking among subpopulations of women.

Gender, smoking and tobacco reduction and cessation: a scoping review.

Considerations of how gender-related factors influence smoking first appeared over 20 years ago in the work of critical and feminist scholars. This scholarship highlighted the need to consider the social and cultural context of women's tobacco use and the relationships between smoking and gender inequity. Parallel research on men's smoking and masculinities has only recently emerged with some attention being given to gender influences on men's tobacco use. Since that time, a multidisciplinary literature addressing women and men's tobacco use has spanned the social, psychological and medical sciences. To incorporate these gender-related factors into tobacco reduction and cessation interventions, our research team identified the need to clarify the current theoretical and methodological interpretations of gender within the context of tobacco research. To address this need a scoping review of the published literature was conducted focussing on tobacco reduction and cessation from the perspective of three aspects of gender: gender roles, gender identities, and gender relations. Findings of the review indicate that there is a need for greater clarity on how researchers define and conceptualize gender and its significance for tobacco control. Patterns and anomalies in the literature are described to guide the future development of interventions that are gender-sensitive and gender-specific. Three principles for including gender-related factors in tobacco reduction and cessation interventions were identified: a) the need to build upon solid conceptualizations of gender, b) the importance of including components that comprehensively address gender-related influences, and c) the importance of promoting gender equity and healthy gender norms, roles and relations.

Considering Sex and Gender in Therapeutics throughout the Product Life Cycle: A Narrative Review and Case Study of Gilteritinib.

Background: Biological sex-related factors influence pharmacokinetic, pharmacodynamic, and disease processes that may affect the predictability of drug dosing and adverse effects, which may in turn have clinical consequences for patients' lives. Nonetheless, sex-related factors are not always taken into account in clinical trial design or clinical decision-making, for multiple reasons, including a paucity of studies that clearly and objectively study and measure sex-disaggregated and sex-related outcomes, as well as gaps in regulatory and policy structures for integrating these considerations. Objectives: To complete a narrative review and use a case study to understand available evidence, inform future research, and provide policy considerations that incorporate information on sex- and gender-related factors into clinician-facing resources. Methods: A comprehensive review of available literature was conducted using a sex- and gender-based analysis plus (SGBA Plus) approach to identify sex- and/or gender-disaggregated information for gilteritinib, a chemotherapeutic agent. Systematic searches were performed in MEDLINE (Ovid), Embase (Ovid), CENTRAL (Wiley), International Pharmaceutical Abstracts (Ovid), Scopus, and ClinicalTrials.gov, from inception to March 18, 2021. The information was then summarized and compared with the Canadian product monograph for this drug. Results: Of 311 records screened, 3 provided SGBA Plus information as a component of outcomes, rather than just as categories or demographic characteristics. Of these, 2 were case studies, and 1 was a clinical trial. No studies from the ClinicalTrials.gov database that were in progress at the time of this review provided details about sex-disaggregated outcomes. The Canadian product monograph did not include sex-disaggregated outcome data. Conclusions: The available evidence from clinical trials, other published literature, and guidance documents does not provide details about sex-disaggregated outcomes for gilteritinib. This paucity of available evidence may create a challenge for clinicians who are making decisions about the efficacy and safety of prescribed therapies in sex-specific populations that have not been well studied.

Contexte: Les facteurs liés au sexe biologique influencent les processus pharmacocinétiques, pharmacodynamiques et pathologiques, qui peuvent avoir une incidence sur la prévisibilité du dosage des médicaments et des effets indésirables. Ceci peut à son tour avoir des conséquences cliniques sur la vie des patients. Néanmoins, les facteurs liés au sexe ne sont pas toujours pris en compte dans la conception des essais cliniques ou la prise de décision clinique, et cela pour de nombreuses raisons ­ notamment le manque d'études qui examinent et mesurent clairement et objectivement les résultats ventilés par sexe et liés au sexe ainsi que les lacunes dans les réglementations et structures politiques pour intégrer ces considérations. Objectifs: Mener un examen narratif et utiliser une étude de cas pour comprendre les preuves disponibles, éclairer les recherches futures et fournir des considérations politiques qui intègrent des informations sur les facteurs liés au sexe et au genre dans les ressources destinées aux cliniciens. Méthodes: Une revue complète de la littérature disponible a été réalisée à l'aide d'une analyse comparative fondée sur le sexe et le genre Plus (ACSG Plus) pour identifier les informations ventilées par sexe et/ou par genre pour le giltéritinib, un agent chimiothérapeutique. Des recherches systématiques ont été effectuées dans MEDLINE (Ovid), Embase (Ovid), CENTRAL (Wiley), International Pharmaceutical Abstracts (Ovid), Scopus et ClinicalTrials.gov, depuis la création de chaque base de données jusqu'au 18 mars 2021. Ces informations ont ensuite été résumées et comparées avec la monographie canadienne de produit pharmaceutique pour ce médicament. Résultats: Sur les 311 documents examinés, 3 ont fourni des informations ACSG Plus en tant que composante des résultats, plutôt que simplement en tant que catégories ou caractéristiques démographiques. Parmi ceux-ci, 2 étaient des études de cas et 1 était un essai clinique. Aucune étude de la base de données ClinicalTrials.gov en cours au moment de cette revue n'a fourni de détails sur les résultats ventilés par sexe. La monographie de produit canadienne ne comprenait pas de données sur les résultats ventilées par sexe. Conclusions: Les preuves disponibles issues d'essais cliniques, d'autres publications et de documents d'orientation ne fournissent pas de détails sur les résultats ventilés par sexe pour le giltéritinib. Ce manque d'éléments probants disponibles peut constituer un défi pour les cliniciens qui prennent des décisions sur l'efficacité et l'innocuité des thérapies prescrites chez des populations sexospécifiques qui n'ont pas été bien étudiées.

Sex, Gender, and the Regulation of Prescription Drugs: Omissions and Opportunities.

The regulation of prescription drugs is an important health, safety, and equity issue. However, regulatory processes do not always consider evidence on sex, gender, and factors such as age and race, omissions that advocates have highlighted for several decades. Assessing the impact of sex-related factors is critical to ensuring drug safety and efficacy for females and males, and for informing clinical product monographs and consumer information. Gender-related factors affect prescribing, access to drugs, needs and desires for specific prescribed therapies. This article draws on a policy-research partnership project that examined the lifecycle management of prescription drugs in Canada using a sex and gender-based analysis plus (SGBA+) lens. In the same time period, Health Canada created a Scientific Advisory Committee on Health Products for Women, in part to examine drug regulation. We report on grey literature and selected regulatory documents to illustrate the extent to which sex and gender-based analysis plus (SGBA+) is utilized in regulation and policy. We identify omissions in the management of prescription drugs, and name opportunities for improvements by integrating SGBA+ into drug sponsor applications, clinical trials development, and pharmacovigilance. We report on recent efforts to incorporate sex disaggregated data and recommend ways that the management of prescription drugs can benefit from more integration of sex, gender, and equity.

Partner support for smoking cessation during pregnancy: a systematic review.

INTRODUCTION: Pregnancy is a key time to leverage receptivity to smoking reduction or cessation in both pregnant women and their partners. A partner's smoking status and support for the pregnant/postpartum woman's efforts to reduce or quit smoking may impact her smoking behavior. METHODS: A systematic literature review of interventions to enhance partner support for pregnant/postpartum women's smoking reduction or cessation and cessation treatments for the partners themselves identified 855 unique references, which were examined for relevance, yielding 9 intervention studies. RESULTS: This narrative review analyzed a range of interventions including mass media campaigns, ultrasound scans, video, self-help manuals, counselling, and nicotine replacement therapies (NRTs) aimed at pregnant women and/or their partners. One randomized controlled trial (RCT) showed significant results for an intervention, which included a partner-targeted component in which pregnant women received health counselling, video and printed information, while partners received a booklet explaining the importance of quitting together. Three studies (1 RCT cluster, 1 pre-post test, 1 RCT) demonstrated no effect in improving smoking cessation among pregnant women. Two RCTs included free NRTs, telephone counselling, and multiple contacts as components of effective intervention for male partners, but impact on overall quit rates may not be sustainable postpartum. Seven studies (4 pre-post test, 2 RCT, 1 RCT cluster) found no effect of the intervention on partner smoking cessation. CONCLUSIONS: Despite the importance of partner smoking, there are very few effective smoking cessation interventions for pregnant/postpartum women that include or target male partners, suggesting the need for further intervention development and research to establish the utility of this approach.

Women and tobacco: a call for including gender in tobacco control research, policy and practice.

OBJECTIVES: Female smoking is predicted to double between 2005 and 2025. There have been numerous calls for action on women's tobacco use over the past two decades. In the present work, evidence about female tobacco use, progress, challenges and ways forward for developing gendered tobacco control is reviewed. METHODS: Literature on girls, women and tobacco was reviewed to identify trends and determinants of tobacco use and exposure, the application of gender analysis, tobacco marketing, the impact of tobacco control on girls and women and ways to address these issues particularly in low-income and middle-income countries. RESULTS: Global female tobacco use is increasingly complex, involving diverse products and factors including tobacco marketing, globalisation and changes in women's status. In high-income countries female smoking is declining but is increasingly concentrated among disadvantaged women. In low-income and middle-income countries the pattern is more complex; in several regions the gap between girls' and boys' smoking is narrow. Gendered analyses and approaches to tobacco control are uncommon, especially in low-income and middle-income countries. CONCLUSIONS: Tobacco control has remained largely gender blind, with little recognition of the importance of understanding the context and challenges of girl's and women's smoking and secondhand smoke exposure. There has been little integration of gender considerations in research, policy and programmes. The present work makes a case for gender and diversity analyses in tobacco control to reflect and identify intersecting factors affecting women's tobacco use. This will help animate the WHO Framework Convention on Tobacco Control's concern for gender specificity and women's leadership, and reduce the impact of tobacco on women.

How have health promotion frameworks considered gender?

This paper provides an overview of five key internationally recognized health promotion frameworks and assesses their consideration of gender. This analysis was conducted as part of the Promoting Health in Women project, a Canadian initiative focused on generating a framework for effective health promotion for women. To date, no review of health promotion frameworks has specifically focused on assessing the treatment of gender. This analysis draws on a comprehensive literature review that covered available literature on gender and health promotion frameworks published internationally between 1974 and 2010. Analysis of five key health promotion frameworks revealed that although gender was at times mentioned as a determinant of health, gender was never identified and integrated as a factor critical to successful health promotion. This superficial attention to the role of gender in health promotion is problematic as it limits our capacity to understand how gender influences health, health contexts and health promotion, as well as our ability to integrate gender into future comprehensive health promotion strategies.

Smoking cessation programs targeted to women: a systematic review.

The authors of this systematic review aimed to examine tobacco interventions developed to meet the needs of women, to identify sex- and gender-specific components, and to evaluate their effects on smoking cessation in women. The authors searched electronic databases in the Cochrane Central Register of Controlled Trials, MEDLINE, PubMed, EBSCO, PsychINFO, CINHAL, and EMBASE; the search was not restricted by publication date. Data was extracted from published peer-reviewed articles on participants, setting, treatment models, interventions, length of follow-up, and outcomes. The main outcome variable was abstinence from smoking. A total of 39 studies were identified. In efficacy studies, therapists addressed weight concerns and non-pharmacological aspects of smoking, taught mood/stress management strategies, and scheduled the quit date to be timed to the menstrual cycle. In effectiveness studies, therapists were peer counselors, provided telephone counseling, and/or distributed gendered booklets, videos, and posters. Among efficacy studies, interventions addressing weight gain/concerns showed the most promising results. If medication can support smoking cessation in women and how it interacts with non-pharmacological treatment also warrant further research. For effectiveness studies, the available evidence suggests that smoking should be addressed in low-income women accessing public health clinics. Further attention should be devoted to identifying new settings for providing smoking cessation interventions to women from disadvantaged groups. Women-specific tobacco programs help women stop smoking, although they appear to produce similar abstinence rates as non-sex/gender specific programs. Offering interventions for women specifically may reduce barriers to treatment entry and better meet individual preferences of smokers. Developing approaches that fully account for the multiple challenges treatment-seeking women face is still an area of research.

Transcending the Male-Female Binary in Biomedical Research: Constellations, Heterogeneity, and Mechanism When Considering Sex and Gender.

Accounting for the influences of sex- and gender-related factors on health is one of the most interesting and important challenges in contemporary health research. In biomedical research, models, experimental designs, and statistical analyses create particular challenges in attempting to incorporate the complex, dynamic, and context-dependent constructs of sex and gender. Here, we offer conceptual elaborations of the constructs of sex and gender and discuss their application in biomedical research, including a more mechanism-oriented and context-driven approach to experimental design integrating sex and gender. We highlight how practices of data visualization, statistical analysis, and rhetoric can be valuable tools in expanding the operationalization of sex and gender biomedical science and reducing reliance on a male-female binary approach.

Sex, Gender and Health: Mapping the Landscape of Research and Policy.

Including sex and gender considerations in health research is considered essential by many funders and is very useful for policy makers, program developers, clinicians, consumers and other end users. While longstanding confusions and conflations of terminology in the sex and gender field are well documented, newer conceptual confusions and conflations continue to emerge. Contemporary social demands for improved health and equity, as well as increased interest in precision healthcare and medicine, have made obvious the need for sex and gender science, sex and gender-based analyses (SGBA+), considerations of intersectionality, and equity, diversity and inclusion initiatives (EDI) to broaden representation among participants and diversify research agendas. But without a shared and precise understanding of these conceptual areas, fields of study, and approaches and their inter-relationships, more conflation and confusion can occur. This article sets out these areas and argues for more precise operationalization of sex- and gender-related factors in health research and policy initiatives in order to advance these varied agendas in mutually supportive ways.

Sex, Gender, and Alcohol Use: Implications for Women and Low-Risk Drinking Guidelines.

Alcohol use is coming under increasing scrutiny with respect to its health impacts on the body. In this vein, several high-income countries have issued low-risk drinking guidelines in the past decade, aiming to educate the public on safer levels of alcohol use. Research on the sex-specific health effects of alcohol has indicated higher damage with lower amounts of alcohol for females as well as overall sex differences in the pharmacokinetics of alcohol in male and female bodies. Research on gender-related factors, while culturally dependent, indicates increased susceptibility to sexual assault and intimate partner violence as well as more negative gender norms and stereotypes about alcohol use for women. Sex- and gender-specific guidelines have been issued in some countries, suggesting lower amounts of alcohol consumption for women than men; however, in other countries, sex- and gender-blind advice has been issued. This article reports on a synthesis of the evidence on both sex- and gender-related factors affecting safer levels of drinking alcohol with an emphasis on women's use. We conclude that supporting and expanding the development of sex- and gender-specific low-risk drinking guidelines offers more nuanced and educative information to clinicians and consumers and will particularly benefit women and girls.

A Sex- and Gender-Based Analysis of Adverse Drug Reactions: A Scoping Review of Pharmacovigilance Databases.

Drug-related adverse events or adverse drug reactions (ADRs) are currently partially or substantially under-reported. ADR reporting systems need to expand their focus to include sex- and gender-related factors in order to understand, prevent, or reduce the occurrence of ADRs in all people, particularly women. This scoping review describes adverse drug reactions reported to international pharmacovigilance databases. It identifies the drug classes most commonly associated with ADRs and synthesizes the evidence on ADRs utilizing a sex- and gender-based analysis plus (SGBA+) to assess the differential outcomes reported in the individual studies. We developed a systematic search strategy and applied it to six electronic databases, ultimately including 35 papers. Overall, the evidence shows that women are involved in more ADR reports than men across different countries, although in some cases, men experience more serious ADRs. Most studies were conducted in higher-income countries; the terms adverse drug reactions and adverse drug events are used interchangeably, and there is a lack of standardization between systems. Additional research is needed to identify the relationships between sex- and gender-related factors in the occurrence and reporting of ADRs to adequately detect and prevent ADRs, as well as to tailor and prepare effective reporting for the lifecycle management of drugs.

Volunteered, negotiated, enforced: family politics and the regulation of home smoking.

The protection of children from secondhand smoke in their homes remains a key objective for health agencies worldwide. While research has explored how parents can influence the introduction of home smoking restrictions, less attention has been paid to the role of wider familial and social networks as conduits for positive behaviour changes. In this article we explore how people living in Scotland have introduced various home smoking restrictions to reduce or eliminate children's exposure to tobacco smoke, and how some have gone on to influence people in their wider familial and social networks. The results suggest that many parents are willing to act on messages on the need to protect children from smoke, leading to the creation of patterns of smoking behaviour that are passed on to their parents and siblings and, more widely, to friends and visitors. However, while some parents and grandparents apparently voluntarily changed their smoking behaviour, other parents found that they had to make direct requests to family members and some needed to negotiate more forcefully to protect children, albeit often with positive results.

Health in All Policies--all talk and little action?

For three decades, Canadian and international researchers have been suggesting that improving population and public health requires attention to a range of determinants and factors and that concerted and coordinated action on the part of non-health ministries and organizations might be necessary to achieve this goal. Suggestions have been made for collaboration and integration by explicitly designing intersectoral actions and interventions and assessing the impact of all policies and programs for their effects on health. While some progress has been made on these goals, it is minor compared to the size of the problem. This article addresses one type of intersectoral action, Health in All Policies (HiAP), and asks questions about why it has not gained a place in governments across Canada. Possible barriers are suggested, such as current structural and political factors that prevent long-range, shared strategies to improve health. Suggestions are made for generating economic and evaluative data on HiAP, developing more sensitive tools for measuring HiAP and adopting explicit "trans-sectoral" approaches to policy-making.