Does the type of CIA policy significantly affect bar and restaurant employment in Minnesota cities?

Clean indoor air (CIA) policies that include free-standing bars and restaurants have been adopted by communities to protect employees in all workplaces from exposure to environmental tobacco smoke, most notably employees working in restaurants and free-standing bars. However, due to the perception of negative economic effects on alcohol-licensed hospitality businesses, partial CIA policies (those that provide an exemption for free-standing bars) have been proposed as a means to reduce the risk of economic effects of comprehensive CIA policies applied to all worksites. Bar and restaurant employment per capita were used to determine if partial CIA policies produced differential economic effects compared to comprehensive CIA policies. Ten cities in the state of Minnesota were studied from 2003-2006. Economic data were drawn from monthly employment in bars and restaurants, and a pooled time-series was completed to evaluate three types of local CIA policies: Comprehensive, partial, or none beyond the state law. Communities with a comprehensive CIA policy had a decrease of 9 employees per 10,000 residents compared with communities with partial CIA policies (p = 0.10). Communities with any type of CIA policy (partial or comprehensive) had an increase of 3 employees per 10,000 residents compared to communities without any CIA policies (p = 0.36). There were no significant differential economic effects by CIA policy type in Minnesota cities. These findings support the adoption of comprehensive CIA policies to provide all employees protection from environmental tobacco smoke exposure.

The relationship between local clean indoor air policies and smoking behaviours in Minnesota youth.

BACKGROUND: While clean indoor air (CIA) policies are intended to reduce exposure to second-hand smoke in the workplace, restrictions in public workplaces have the potential to discourage youth smoking. There is growing evidence from cross-sectional and ecological studies, but limited evidence from longitudinal studies that this is so. OBJECTIVE: To evaluate the association between local CIA policies and smoking behaviours among Minnesota youth over time. DESIGN, SETTING AND SUBJECTS: A cohort of 4233 Minnesota youths, ages 11 to 16 at baseline, was interviewed via telephone for 6 years (2000-2006). Individual, family and community level variables were collected from participants every 6 months. A generalised estimating equation (GEE) logistic regression was used to assess the relationship between CIA policies and past-month smoking in youth over time. The analysis was controlled for potential confounders at individual and community levels. RESULTS: There was not significant association between CIA policies and youth smoking behaviours in the multivariate analyses. At the individual level, parental smoking significantly increased the odds of smoking nearly 40% and close friend smoking increased the odds of past-month smoking by nearly 100% for each close friend. Banning smoking in the home was significantly associated with a 12% reduction in the odds of past-month smoking. CONCLUSION: After accounting for other community and individual level factors known to be associated with youth smoking, there was no significant association between CIA policies and past-month smoking for youth over time.

The smoke you don't see: uncovering tobacco industry scientific strategies aimed against environmental tobacco smoke policies.

OBJECTIVES: This review details the tobacco industry's scientific campaign aimed against policies addressing environmental tobacco smoke (ETS) and efforts to undermine US regulatory agencies from approximately 1988 to 1993. METHODS: The public availability of more than 40 million internal, once-secret tobacco company documents allowed an unedited and historical look at tobacco industry strategies. RESULTS: The analysis showed that the tobacco industry went to great lengths to battle the ETS issue worldwide by camouflaging its involvement and creating an impression of legitimate, unbiased scientific research. CONCLUSIONS: There is a need for further international monitoring of industry-produced science and for significant improvements in tobacco document accessibility.

The effects of community policies to reduce youth access to tobacco.

OBJECTIVES: This study tested the hypothesis that adoption and implementation of local policies regarding youth access to tobacco can affect adolescent smoking. METHODS: A randomized community trial was conducted in 14 Minnesota communities. Seven intervention communities participated in a 32-month community-organizing effort to mobilize citizens and activate the community. The goal was to change ordinances, merchant policies and practices, and enforcement practices to reduce youth access to tobacco. Outcome measures were derived from surveys of students before and after the intervention and from tobacco purchase attempts in all retail outlets in the communities. Data analyses used mixed-model regression to account for the clustering within communities and to adjust for covariates. RESULTS: Each intervention community passed a comprehensive youth access ordinance. Intervention communities showed less pronounced increases in adolescent daily smoking relative to control communities. Tobacco purchase success declined somewhat more in intervention than control communities during the study period, but this difference was not statistically significant. CONCLUSIONS: This study provides compelling evidence that policies designed to reduce youth access to tobacco can have a significant effect on adolescent smoking rates.

Youth access to tobacco: policies and politics.

The late 1980s marked the beginning of a sea change in research and intervention on tobacco use by young people, when the first studies were published demonstrating the ease with which adolescents could purchase cigarettes. Since then concern with the commercial availability of tobacco products to youth has grown, becoming deeply entrenched in both research and policy efforts. This paper reviews the history of restrictions on youth access to tobacco, the evidence that commercial sources of tobacco are available and important to adolescents, and the rationale for various components of policies to restrict access. We also review the recent expansion of policies addressing youth access to tobacco at all levels of government, the tobacco industry response to this expansion, and issues that have arisen as this expansion has developed.

Creating tobacco control policy at the local level: implementation of a direct action organizing approach.

This article describes the community activation and policy change process in seven Minnesota communities involved in the Tobacco Policy Options for Prevention (TPOP) study. The study's intervention employed a direct action organizing model, which relies on mobilizing large numbers of people to alter decision making and leverage the power of elites. As part of the organizing process, TPOP organizers and teams made 1,319 personal contacts with community members, generated 309 media stories, and initiated 445 public events related to tobacco use. These actions resulted in the establishment of comprehensive tobacco ordinances in all seven communities. The authors discuss the goals, training, activities and political factors relevant to four phases of the TPOP intervention: information gathering and team recruitment, community awareness building and ordinance development, preparing for city council, and ordinance establishment and enforcement. Included are suggestions for practitioners interested in using policy change and community-based advocacy to resolve public health problems.

Perceived and measured availability of tobacco to youths in 14 Minnesota communities: the TPOP Study. Tobacco Policy Options for Prevention.

INTRODUCTION: Availability of tobacco to young people is believed to be an important factor in the onset of tobacco use. We still do not have a complete picture of how tobacco is obtained by youths or how access can be curtailed. DESIGN: This article describes tobacco availability to youths in 14 communities that are part of a randomized trial, known as TPOP (Tobacco Policy Options for Prevention). The data reported here were obtained from student surveys and tobacco-purchase attempts by underage confederates. RESULTS: Students who have smoked at least once were likely to cite social sources for cigarettes. However, more than half of weekly smokers and almost one third of tenth-grade ever smokers reported purchasing cigarettes in the last 30 days. Tobacco-purchase attempts by confederate buyers at all outlets resulted in an overall success rate of 40.8%, lower than previously reported for urban communities. Fifty-five percent of the over-the-counter outlets had no self-service displays of tobacco at baseline. Store factors that predicted purchase success include tobacco location; purchase success was lower when all tobacco was locked or behind a service counter. The percentage of smokers who reported purchasing their own tobacco soon after starting to smoke was highest in towns where purchase success by teenage study confederates was highest. CONCLUSIONS: These results suggest that sources of cigarettes shift from social to commercial with age and that sources of cigarettes for rural youths may be different than for urban youths.

Adolescent smokers' provision of tobacco to other adolescents.

OBJECTIVES: This study examined adolescent smokers provision of tobacco to other adolescents. METHODS: Data from a survey of 8th-, 9th-, and 10th-grade students in Minnesota were analyzed by using mixed-model logistic regression. RESULTS: More than two thirds (68.8%) of adolescent smokers had provided tobacco to another adolescent in the previous 30 days. Mother's smoking, number of friends who smoke, owning tobacco merchandise, number of cigarettes smoked in the past week, source of last cigarette (commercial), and recent attempt to buy cigarettes were associated with providing. CONCLUSIONS: The social availability of tobacco to youth needs further examination.

The role of social influences and tobacco availability on adolescent smokeless tobacco use.

OBJECTIVE: To examine the potential explanatory effect of various demographic, social influence, sanction, and tobacco availability variables on the use of smokeless tobacco (ST) by adolescent males. DESIGN: The data used in our analyses are from a community-based tobacco policy intervention trial that included a 60-item baseline school survey. During Spring 1993, all 8th, 9th, and 10th-grade students enrolled in 14 school districts in small Minnesota cities were surveyed. We used mixed-model logistic regression to determine which variables were significantly correlated with smokeless tobacco use by males in the past week. RESULTS: Of this sample of 2924 adolescent males, 10% (n = 291) reported using smokeless tobacco in the past week. Compared to the overall sample, smokeless tobacco users reported higher family and friend use of smokeless tobacco. In addition, 64% of users reported smoking in the past 30 days, and almost half (49.1%) said they had attempted to purchase tobacco in the past 30 days. Variables found to be significantly associated with smokeless tobacco use in the past week included younger age, having a best friend using tobacco, inflated perceptions of their peers' use of tobacco products, beliefs that school and parental sanctions are not high for tobacco use, recent tobacco purchase, and perceived belief that tobacco is not difficult to obtain from social sources. CONCLUSIONS: This study confirms previous research correlating demographic and social influence factors with ST use and demonstrates the role that sanction and availability variables play in ST use.

Measurement of alcohol and tobacco availability to underage students.

Communities Mobilizing for Change on Alcohol (CMCA) and Tobacco Policy Options for Prevention (TPOP) are randomized multicommunity trials designed to reduce the availability of alcohol (CMCA) and tobacco (TPOP) products to underage youth. We assessed the test-retest reliability and internal consistency of perceived availability measures developed for surveys of middle and high school students. Two questionnaires were administered twice, each to separate student populations (CMCA: 9th graders; TPOP; 8th graders) 21 to 26 days apart. A total of 111 (CMCA) and 70 (TPOP) subjects participated at both times (participation rate of 93.3% and 84.3%, respectively). There were no statistically significant differences in the distribution of demographic variables, alcohol or tobacco use variables, or availability variables across administrations. The scales assessing perceived access to alcohol or tobacco had high internal consistency (Cronbach's alpha of 0.84 for alcohol and 0.77 for tobacco), but moderate to low test-retest correlations (0.58 and 0.13, respectively). Single-item measures of sources of alcohol and tobacco and reported buy attempts also had moderate to low test-retest correlates (0.10-0.65). We recommend that items assessing tobacco and alcohol availability to underage youth be further developed.

Project Northland: outcomes of a communitywide alcohol use prevention program during early adolescence.

OBJECTIVES: Project Northland is an efficacy trial with the goal of preventing or reducing alcohol use among young adolescents by using a multilevel, communitywide approach. METHODS: Conducted in 24 school districts and adjacent communities in northeastern Minnesota since 1991, the intervention targets the class of 1998 (sixth-grade students in 1991) and has been implemented for 3 school years (1991 to 1994). The intervention consists of social-behavioral curricula in schools, peer leadership, parental involvement/education, and communitywide task force activities. Annual surveys of the class of 1998 measure alcohol use, tobacco use, and psychosocial factors. RESULTS: At the end of 3 years, students in the intervention school districts report less onset and prevalence of alcohol use than students in the reference districts. The differences were particularly notable among those who were nonusers at baseline. CONCLUSIONS: The results of Project Northland suggest that multilevel, targeted prevention programs for young adolescents are effective in reducing alcohol use.

Survey of city ordinances and local enforcement regarding commercial availability of tobacco to minors in Minnesota, United States.

OBJECTIVES: To determine the extent and nature of local ordinances to regulate tobacco sales to minors, the level of enforcement of local and state laws concerning tobacco availability to minors, and sanctions applied as a result of enforcement. DESIGN: Tobacco control ordinances were collected in 1993 from 222 of the 229 cities greater than or equal to 2000 population in Minnesota, United States. In addition a telephone survey with the head of the agency responsible for enforcement of the tobacco ordinances was conducted. MAIN OUTCOME MEASURES: Presence or absence of legislative provisions dealing with youth and tobacco, including licensure of tobacco retailers, sanctions for selling tobacco products to minors, and restrictions on cigarette vending machines, self-service merchandising, and point-of-purchase advertising; and enforcement of these laws (use of inspections and "sting" operations, and sanctions imposed on businesses and minors). RESULTS: Almost 94% of cities required tobacco licences for retailers. However, 57% of the cities specified licences for cigarettes only. Annual licence fees ranged from $10 to $250, with the higher fees adopted in the previous four years. More than 25% of the cities had adopted some kind of restriction on cigarette vending machines, but only six communities had banned self-service cigarette displays. Three cities specified a minimum age for tobacco sales staff. Fewer than 25% of police officials reported having conducted compliance checks with minors or in-store observations of tobacco sales to determine if minors were being sold tobacco during the current year. Police carrying out compliance checks with youth were almost four times as likely to issue citations as those doing in-store observations. More than 90% of police reported enforcement of the law against tobacco purchase or possession by minors, and nearly 40% reported application of penalties against minors. CONCLUSIONS: Almost 75% of the cities have done nothing to change policies or enforcement practices to encourage compliance with tobacco age-of-sale legislation, and only a few of the remaining cities have adopted optimal policies. In addition, officials in Minnesota cities are much more likely to use enforcement strategies against minors who buy tobacco than against merchants who sell tobacco.

Weight concerns and change in smoking behavior over two years in a working population.

The hypothesis that weight concerns are related to less successful smoking cessation and greater relapse among ex-smokers was prospectively evaluated. A population-based sample of 4981 working women and men 17 to 71 years of age was surveyed at 32 work sites. Current and previous weight loss efforts and smoking behavior were self-reported at baseline and 2 years later. Dieting and weight concerns were unrelated to smoking cessation or relapse. However, female smokers who had previously participated in a formal weight control program were three times more likely to quit smoking than those without a history of participation (25% vs 11%; odds ratio = 3.25, 95% confidence interval = 1.86, 5.67). Weight concerns and dieting efforts do not appear to inhibit smoking cessation or increase relapse in adults.

Predictors of weight change over two years among a population of working adults: the Healthy Worker Project.

The present study examined behavioural predictors of body weight cross-sectionally and longitudinally in a cohort of 1639 male and 1913 female employees in 32 companies participating in a worksite intervention study for smoking cessation and weight control. Dietary intake, current and previous dieting behaviours, and physical activity were examined for their association with body weight over the two-year period. Cross-sectionally in both men and women, history of previous dieting, previous participation in a formal weight loss programme, current dieting and meat consumption were positively related to body weight while high intensity activity was negatively related to body weight. Prospectively, history of participation in a formal weight loss programme and dieting to lose weight at baseline, and increased consumption over time of french fries, dairy products, sweets and meat, independently predicted increases in body weight in women. Women who were dieting to lose weight or who had previously participated in a formal weight loss programme at baseline gained 1.99 lb and 1.74 lb more, respectively, than those who were not dieting to lose weight or who had not previously participated in a formal weight loss programme. Increased exercise, either walking or high intensity activity, predicted decreases in body weight in women (1.76 lb and 1.39 lb, respectively, for each session increase per week). In men, previous participation in a formal weight loss programme predicted increases in body weight over the two-year period. Men who had previously participated in a formal weight loss programme at baseline gained 4.83 lb more than those who had never previously participated in a formal weight loss programme. Increases in consumption of sweets and egg were prospectively related to increases in body weight, while increased walking and high intensity activity were related to decreases in body weight (0.86 lb and 3.54 lb, respectively, for each session increase per week). These results suggest the role that specific diet and exercise behaviours may play in body weight changes over time.

Dieting status and its relationship to weight, dietary intake, and physical activity changes over two years in a working population.

The present study prospectively examined changes in dietary intake, physical activity and weight associated with self-reported efforts to lose weight in a cohort of 3671 men and women sampled from the general population. Dieting efforts, dietary intake, physical activity and weight were measured at two points in time, 24 months apart. At baseline, current dieters reported consuming fewer dairy products, sweets, meat, soft drinks and fried potatoes (all p's < .0001), and engaging more frequently in high-intensity physical activity (p < .0001) than those not currently dieting. At follow-up, current dieters reported consuming fewer sweets (p < .0001) and fried potatoes (p < .0008), and engaging more frequently in moderate-intensity physical activity (p < .02) than those not currently dieting. Prospectively, those who initiated weight-loss diets showed the largest decrease in consumption of sweets (p < .0001), soft drinks (p < .0001), and fried potatoes (p < .01), and increase in frequency of high-intensity physical activity (p < .0001) and moderate-intensity physical activity (p < .007). Those initiating weight-loss diets were the only group to lose weight (1 lb.). Those dieting at baseline but not at follow-up gained the most weight (4 lbs.). Self-reports of current dieting correspond to reported changes in dietary intake and physical activity, and to measured changes in weight over the same time period. Individuals who report dieting to lose weight have healthier eating and exercise patterns than those who do not report dieting.

Restrictive smoking policies in the workplace: effects on smoking prevalence and cigarette consumption.

BACKGROUND: Thirty-two worksites participating in a randomized trial of worksite health promotion aimed at reducing smoking and obesity were categorized at baseline and 2 years later as having either restrictive or unrestrictive smoking policies. Between the two assessment points, 16 sites received health promotion interventions. RESULTS: At baseline 15 sites had restrictive policies and 17 unrestrictive policies. Smoking restrictions were associated with significantly lower smoking prevalence and higher lifetime quit rates among ever smokers. They also were associated with more recent quit attempts and lower daily cigarette consumption, although these effects were not significant. Between baseline and follow-up, 9 of the 17 worksites that had few smoking restrictions at baseline became restrictive. Although neither baseline smoking policies nor changes in smoking policy predicted change in smoking prevalence or in the frequency of quit attempts, smokers in sites changing from unrestrictive to restrictive policies reported a significant reduction in daily cigarette consumption. CONCLUSIONS: The worksite health promotion program was successful in reducing smoking prevalence in intervention sites compared to controls. However, the existence of restrictive smoking policies neither helped nor hindered these intervention efforts. The present data are believed to support the idea that restrictive smoking policies have beneficial effects on the smoking habits of employees, but that the magnitude of this effect is modest.

The worksite component of variance: design effects and the Healthy Worker Project.

Variance estimates in worksite health promotion studies depend partly on the intraclass correlation coefficient (ICC). ICC quantifies homogeneity of a variable within worksites. ICC would be zero for randomly formed worksites, but is generally positive because employees tend to share personal characteristics. The ratio comparing the variance estimated from worksite means with that estimated from individuals under simple random sampling is the design effect (DEFF). A DEFF of 1.0 indicates no excess variance due to worksite. The Healthy Worker Project (HWP) was a 32 worksite cross-sectional and longitudinal study of a weight and smoking intervention program. ICCs in cross-sectional surveys for health-related outcome variables ranged from 0.006 to 0.009, DEFFs from 2.0 to 2.6 ICCs/DEFF's in longitudinal analysis were smaller; ICCs ranged from -0.002 to 0.003, DEFFs from 0.7 to 1.5. Positive ICCs substantially increased variance estimates at a single measurement, yet variance of longitudinal analysis was less subject to worksite dependence. It is concluded the worksite component of variance is real and should not be ignored, although the worksite component of variance is small in these longitudinal analyses. This observation should be replicated before it is used in other worksite health promotion research.

Effects of work-site health promotion on illness-related absenteeism.

This study examined the effects of work-site health promotion on employee absenteeism. Thirty-two work sites were randomized to programs for weight control and smoking cessation or to no treatment for 2 years. The prevalence of self-reported absences from work was assessed at baseline and follow-up. Results using work site as the unit of analysis showed a net reduction in the percent of workers reporting a sick day in the last month in treatment versus control work sites of 3.7% (P = .04) and 3.4% (P = .06) in cross-sectional and cohort analysis, respectively. Further analyses found that the rate of participation in smoking (P = .09) but not weight programs (P = .72) was positively associated with change in sick day prevalence and that this effect was strongest in baseline smokers (P = .002). It is concluded that work-site smoking cessation programs may yield important short-term economic benefits by reducing employee absenteeism.

Correlates of high fat/calorie food intake in a worksite population: the Healthy Worker Project.

Behavioral and sociodemographic correlates of high fat/calorie food consumption were examined in a population-based sample of working adults (N = 2038 men; N = 2335 women). Relative weight, dieting history, and cigarette smoking were significantly related to total energy intake from high fat/calorie foods. Relative weight was positively related to the intake of meat, eggs, fried potatoes, and fats. Current dieting to lose weight was associated with a lower intake of all foods, except alcohol and fats. These foods were unrelated to dieting status in men and positively related to dieting status in women. Physical activity and smoking were related to higher intake of high fat/calorie foods. Smokers consumed fewer sweet foods than nonsmokers, however. These results underscore the importance of controlling for dieting status, as well as other behavioral and demographic variables, in population studies of dietary intake. They also suggest factors that may be important in the etiology of unhealthy eating patterns and potential targets for dietary intervention.