Location restrictions on smoking: assessing their differential impacts and consequences in the workplace.

OBJECTIVES: To analyze existing evidence on the impact of two types of location restrictions on smoking: workplace bans and bans in hospitality settings, and to assess the extent to which they differentially affect subpopulations. METHODS: A review of international studies on location restrictions on smoking published between 1990-2007. RESULTS: Although workplace smoking bans reduce exposure to second-hand smoke (SHS) at work, their effects on overall cigarette consumption and smoking prevalence may be uneven across the population. Bans in hospitality settings reduce SHS exposure among workers, but have potentially uneven effects based on the interactions between gender, socio-economic status (SES) and ethnicity. The unintended consequences of smoking bans are also more likely to be experienced by low SES groups. CONCLUSIONS: Although location restrictions on smoking reduce SHS exposure and may serve to positively impact smoking behaviours, there is preliminary evidence that they may have a reduced impact on subpopulations such as low-income groups, although further research is needed.

Factors associated with condom use among Aboriginal people: a systematic review.

OBJECTIVES: To review evidence on factors associated with condom use among Aboriginal people and the methodological quality of studies assessing these factors. METHODS: A systematic review of published and unpublished literature was undertaken. Searches of databases and indexes were performed and authors were contacted directly. Studies reporting on associations between any independent variables and a condom use outcome were included. Data on the quality of each study was extracted, and the strength of evidence for associations between risk factors and condom use outcomes was assessed by counting the number of studies and sample size of each study. RESULTS: Searches yielded 17 analyses on 10 independent samples that met the inclusion criteria. Most studies were cross-sectional and utilized small non-representative samples. Some evidence for a negative association between condom use and having a steady partner emerged; and a negative association between White male/Alaska Native female sex partner pairs was found. Evidence was insufficient to judge associations between other risk factors and condom use. CONCLUSIONS: The quality and quantity of evidence regarding the predictors of condom use in Aboriginal populations is limited. A concerted effort in primary research on facilitators of and barriers to condom use which are specific to and appropriate for Aboriginal people is needed to inform effective condom promotion interventions for Aboriginal communities.

Tobacco policies and vulnerable girls and women: toward a framework for gender sensitive policy development.

This article assesses the effects of comprehensive tobacco control policies on diverse subpopulations of girls and women who are at increased vulnerability to tobacco use because of disadvantage. The authors report on a recent assessment of experimental literature examining tobacco taxation; smoking location restrictions in public and private spaces; and sales restrictions. A comprehensive search was undertaken to identify relevant studies and evaluation reports. Gender based and diversity analyses were performed to identify pertinent sex differences and gender influences that would affect the application and impact of the policy. Finally, the results were contextualised within the wider literature on women's tobacco use and women's health. The authors consider not only the intended policy effects, but also explicitly examine the gendered and/or unintended consequences of these policies on other aspects of girls and women's health and wellbeing. A framework for developing gender sensitive tobacco programmes and policies for low income girls and women is provided.

Substance use among women in shelters for abused women and children. Programming opportunities.

OBJECTIVE: This study explores changes in the use of alcohol and other substances by women in British Columbia as they moved into shelters for abused women and again three months later. We see this time as a key life transition, and potentially a rich opportunity for influencing women's substance use behaviour. The purpose of this study was to document changes in the level of use of alcohol and other substances and the levels of stress among women as they moved through shelters for abused women. METHODS: Standardized questionnaires augmented by qualitative interviews were employed to measure alcohol and substance use, experiences of abuse, and levels and types of stressors facing women in this situation. FINDINGS: Significant reductions in women's use of alcohol and stimulants were observed from Interview I to Interview II, but there was no significant reduction in use of other depressants or tobacco use. Levels of stress decreased and sources of stress changed for the women after the shelter experience. Stress connected to relationship with partners had the most significant decrease, followed by mental health, housing, and legal issues. Women reported barriers to accessing financial aid and services for substance use outside of the shelter. CONCLUSIONS: Women's experiences of violence and substance use were found to be interconnected in complex ways and changes in substance use were affected by a range of influences, such as financial concerns, mothering, relationships, levels of social support, and physical and mental health issues. Substance-using women who have experienced violence are an underserved population and a multi-sectoral response designed to address psychosocial, relational, and structural issues could better help them improve their overall health.

What are the effects of tobacco policies on vulnerable populations? A better practices review.

BACKGROUND: While comprehensive tobacco policies have reduced the prevalence of smoking in Canada, some groups remain vulnerable to tobacco use and display high rates of smoking. This article reviews three types of tobacco policies--tax and price, smoking location restrictions and sales restrictions--and examines the consequences for Aboriginal people, youth and low-income people. METHODS: A better practices review model was used to assess the strength of studies published between 1990 and 2004 that examined the effects of these tobacco policies on the three vulnerable populations of interest. A total of 72 studies were assessed and 42 judged medium or high strength. A gender-based and diversity analysis was applied to assess the differential impacts on females and males and/or diverse characteristics within these populations. Intended and unintended consequences were examined. FINDINGS: Few studies assessed the potential or differential effects of tobacco policies on the three selected populations. In these, it was difficult to disentangle the effects of each policy in a comprehensive tobacco control environment, and there is need for improved indicators and greater attention to sex and gender analysis. CONCLUSIONS: Research is required to measure the intended and unintended impacts of tobacco policies on populations vulnerable to tobacco use. There are problems in assessing these studies that could be resolved with more precise indicator development. An equity-based framework for assessing the effects of tobacco policies is needed that is conceptually linked to health determinants and inequities. The article concludes with a set of recommendations for research, evaluation, policy and ethics arising from this review.

Substance use by women using domestic violence shelters.

This study investigated the connections between stressors, substance use, and experience of violence among women (N = 125) who accessed help from domestic violence shelters in British Columbia, Canada between October 2001 and June 2003. Changes in substance use and stressors following a shelter stay were explored, using both qualitative and quantitative methods. Women generally decreased their use of alcohol and stimulants, and this change was found to be integrally connected to social and structural supports made available to them. Future research that augments current stress models of addiction by considering social and structural factors that come into play in women's substance use and domestic violence is suggested. The study's limitations are noted.