Preventing alcohol use post-bariatric surgery: patient perspectives on a technology-based approach.

BACKGROUND: Nearly two-thirds of patients engage in alcohol use after bariatric surgery, while a substantial number meet criteria for alcohol use disorder after their procedure. Given that pre-surgical education may not be sufficient, alternative methods of preventing post-surgical drinking are needed. We sought feedback on a proposed technology-based intervention to reduce alcohol use for individuals who have undergone bariatric surgery. METHODS: Twenty patients who consumed alcohol post-surgery completed qualitative interviews where they provided opinions on sample intervention content, delivery method, timing, and other aspects of a two-session web-based intervention followed by tailored text messaging for 6 months. Interviews were recorded, transcribed, and coded using thematic analysis principles. RESULTS: Participants strongly endorsed using technology to deliver an alcohol intervention, citing the interactivity and personal tailoring available in the proposed software. Education about the effects of post-surgical drinking and learning new coping strategies for social situations were the two most salient themes to emerge from questions about intervention content. Throughout the interviews, participants strongly highlighted the importance of measuring patient readiness to change alcohol use and matching intervention content to such motivation levels. Respondents felt that text messages could extend what they had learned, but also requested additional non-alcohol content (e.g., recipes, exercise tips). Most participants agreed that an online forum consisting of peers and professionals with whom they could ask questions and interact would be useful. CONCLUSION: Web- and text message-based interventions may be an acceptable approach to prevent alcohol use post-bariatric surgery.

Patient perceptions regarding alcohol use after bariatric surgery.

INTRODUCTION: Patients who have undergone bariatric surgery are at increased risk of an alcohol use disorder. Though patients understand this risk, the majority engage in post-surgical alcohol use. This suggests that education alone is not sufficient to reduce post-surgical drinking. To prevent development of post-surgical alcohol use disorders, we need better understanding of the reasons patients use alcohol following surgery. The purpose of this study was to identify factors associated with post-surgical alcohol use. METHOD: Patients (N = 20) who were 1-3 years post-bariatric surgery and were consuming alcohol at least twice monthly participated in a 60-min interview. Participants responded about their knowledge regarding risk of post-surgical alcohol use and reasons why patients may start drinking. Deductive and inductive coding were completed by two independent raters. RESULTS: Although nearly all participants were aware of the risks associated with post-surgical alcohol use, most believed that lifelong abstinence from alcohol was unrealistic. Common reasons identified for using alcohol after bariatric surgery included social gatherings, resuming pre-surgical use, and addiction transfer. Inductive coding identified three themes: participants consumed alcohol in different ways compared to prior to surgery; the effect of alcohol was substantially stronger than pre-surgery; and beliefs about why patients develop problematic alcohol use following surgery. CONCLUSION: Patients consume alcohol after bariatric surgery for a variety of reasons and they do not believe recommending abstinence is useful. Understanding patient perceptions can inform interventions to minimize alcohol use after bariatric surgery. Modifications to traditional alcohol relapse prevention strategies may provide a more robust solution to decreasing negative outcomes experienced by individuals undergoing bariatric surgery.

Prevalence and Correlates of Current and Former Smoking among Urban Transit Workers.

Transit workers constitute a blue-collar occupational group that have elevated smoking rates relative to other sectors of employed adults in the United States. This study analyzed cross-sectional tobacco survey data from 935 workers (60% African American; 37% female) employed at an urban public transit agency in California. Prevalence of current and former smoking was 20.3% and 20.6%, respectively. Younger workers were less likely than older workers to be current or former smokers. Having a complete home smoking ban was associated with decreased likelihood of being a smoker [odds ratio (OR) = 0.04, 95% confidence interval (CI) = 0.01-0.17], as were neutral views about whether it is easy for a smoker to take a smoking break during their shift (OR = 0.50, 95% CI 0.28-0.88). Current smoking among the sample is > 50% higher than the adult statewide prevalence. Potential points of intervention identified in this study include perceived ease of worksite smoking breaks and establishing home smoking bans. Tailored cessation efforts focusing on older transit workers more likely to smoke are needed to reduce tobacco-related disparities in this workforce.

Measuring Indoor Air Quality and Engaging California Indian Stakeholders at the Win-River Resort and Casino: Collaborative Smoke-Free Policy Development.

Most casinos owned by sovereign American Indian nations allow smoking, even in U.S. states such as California where state laws restrict workplace smoking. Collaborations between casinos and public health workers are needed to promote smoke-free policies that protect workers and patrons from secondhand tobacco smoke (SHS) exposure and risks. Over seven years, a coalition of public health professionals provided technical assistance to the Redding Rancheria tribe in Redding, California in establishing a smoke-free policy at the Win-River Resort and Casino. The coalition provided information to the casino general manager that included site-specific measurement of employee and visitor PM2.5 personal exposure, area concentrations of airborne nicotine and PM2.5, visitor urinary cotinine, and patron and staff opinions (surveys, focus groups, and a Town Hall meeting). The manager communicated results to tribal membership, including evidence of high SHS exposures and support for a smoke-free policy. Subsequently, in concert with hotel expansion, the Redding Rancheria Tribal Council voted to accept a 100% restriction of smoking inside the casino, whereupon PM2.5 exposure in main smoking areas dropped by 98%. A 70% partial-smoke-free policy was instituted ~1 year later in the face of revenue loss. The success of the collaboration in promoting a smoke-free policy, and the key element of air quality feedback, which appeared to be a central driver, may provide a model for similar efforts.

Smoking cessation among transit workers: beliefs and perceptions among an at-risk occupational group.

BACKGROUND: Transit workers, in comparison to the general population, have higher rates of smoking. Although smoking cessation programs are often available through workers' HMOs, these programs are frequently underutilized. Quitting practices, including participation in cessation programs, are often associated with beliefs about smoking behaviors and the ability to quit. We analyzed how transit workers' beliefs about cessation might function as barriers to or facilitators of participating in cessation activities. FINDINGS: We conducted 11 focus group discussions with 71 workers (45% female; 83% African American) at an urban public transit agency. Most participants (83%) were bus operators. Only current smokers and former smokers were recruited. Both current and former smokers recognized the need to quit and some were familiar with or at least aware of cessation programs and pharmaceutical aids offered through their HMO. Many, however, believed there were factors, such as smoker's readiness to quit, recognition of the elements of addiction, and personal or observed experience with cessation, that facilitated or impeded successful quit attempts. CONCLUSION: Beliefs play an important role and influence the extent to which transit workers participate in smoking cessation. Being cognizant of and addressing these beliefs so that workers gain an informed understanding is important when designing cessation programs. Doing so may help in creating tobacco cessation efforts that are seen as both attractive and beneficial to transit workers.

Stigma among California's Medical Marijuana Patients.

The enactment of California's Proposition 215 stipulates that patients may use marijuana for medical reasons, provided that it is recommended by a physician. Yet, medical marijuana patients risk being stigmatized for this practice. This article examines the way in which medical marijuana patients perceive and process stigma, and how it affects their interactions and experiences with others. Eighteen semi-structured interviews of medical marijuana patients were carried out using a semi-structured interview guide. Most patients circumvented their own physicians in obtaining a recommendation to use medicinal marijuana, and also used a host of strategies in order to justify their medical marijuana use to family, friends, and colleagues in order to stave off potential stigma. The stigmatization of medical marijuana thus has a profound effect on how patients seek treatment, and whether they seek medical marijuana treatment at all.

Evaluating the implementation process of a citywide smoke-free multiunit housing ordinance: insights from community stakeholders.

We evaluated the implementation process of Richmond, California's citywide smoke-free multiunit housing ordinance. We conducted semistructured focus groups with multiunit housing tenants, owners, and managers. Residents understood the harms of secondhand smoke but lacked accurate information about the ordinance and questioned its enforceability. They shared concerns that the city lacked cessation resources for smokers wishing to quit because of the ordinance. To increase compliance with the ordinance, tenants, owners, and managers need accurate information.

Exposure to celebrity-endorsed small cigar promotions and susceptibility to use among young adult cigarette smokers.

Small cigar smoking among young adult cigarette smokers may be attributed to their exposure to its advertisements and promotions. We examined the association between exposure to a celebrity music artist's endorsement of a specific brand of small cigars and young adult cigarette smokers' susceptibility to smoking that brand. Venue-based sampling procedures were used to select and survey a random sample of 121 young adult cigarette smokers, aged 18-35. Fourteen percent reported exposure to the artist's endorsement of the small cigar and 45.4% reported an intention to smoke the product in the future. The odds of small cigar smoking susceptibility increased threefold for those who reported exposure to the endorsement compared to those not exposed (OR = 3.64, 95% CI 1.06 to 12.54). Past 30-day small cigar use (OR = 3.30, 95% CI 1.24 to 8.74) and past 30-day cigar use (OR = 5.08, 95% CI 1.23, 21.08) were also associated with susceptibility to smoke a small cigar. An association between young adult cigarette smokers' exposure to the music artist's small cigar endorsement and their susceptibility to smoke small cigars was found. This association underscores the importance of monitoring small cigar promotions geared toward young people and their impact on small cigar product smoking.

Changes in smoking-related norms in bars resulting from California's Smoke-Free Workplace Act.

California's Smoke-Free Workplace Act--CA Labor Code Sec. 6404.5(a)--was extended to bars in 1998. This article analyzes changes in normative beliefs and behaviors related to bar smoking in the decade following the adoption of the Act. In a series of studies evaluating the smoke-free workplace law in bars, researchers conducted extensive observations and interviews with bar staff and patrons, health officials, and law enforcement personnel in three California counties. Smoking outside became a normal pause in the social environment and created a new type of bar socializing for outside smokers. Although some bar owners and staff reported initially resenting the responsibility to uphold the law, once norms regarding cigarettes and smoking began changing, bar workers experienced less conflict in upholding the law. Non-smoking behavior within bars also became the normative behavior for bar patrons. California's Smoke-Free Workplace Act has both reflected and encouraged normative beliefs and behaviors related to smoking in bars. The findings indicate that such shifts are possible even in contexts where smoking behaviors and attitudes supporting smoking were deeply entrenched. Recommendations include attending to the synergistic effect of education and policy in effective tobacco control programs.

Law in practice: obstacles to a smokefree workplace policy in bars serving Asian patrons.

The California smokefree workplace ordinance (AB13) has been well-received, even in bars where deeply established traditions of smoking may exist. However, a closer investigation of bars where indoor smoking persists revealed that bar workers in some ethnic minority communities continue to be exposed to secondhand smoke in their workplaces. To identify sociocultural factors that may impede the adoption of AB13, the researchers conducted 150 observations and 29 patron and staff interviews in 50 California bars serving Asian patrons in Los Angeles and San Francisco counties. Observers witnessed indoor smoking in 82% of the bars. Interviews revealed that social relationships, social interactions, and a tendency to avoid confrontation complicated the positive reception of AB13 within these bars. Accounting for sociocultural factors provides a nuanced understanding of the challenges involved in implementing tobacco control policy in such diverse settings and may allow for culturally appropriate tobacco policy development and implementation in other jurisdictions.

Cultural factors related to smoking in San Francisco's Irish bars.

California's Smoke-Free Workplace Act was extended to include bars in 1998. While the majority of bars in the state have become smoke free, in many bars patrons and staff continue to smoke despite the law. The authors present findings from a study which assessed cultural factors related to continued smoking in bars in the city of San Francisco. In bars serving primarily Irish migrants, tight-knit relations within the local Irish bar community together with a reluctance to be the first Irish bar to ban smoking were found to contribute to continued indoor smoking. The findings illustrate challenges to implementing tobacco control policies within ethnic subpopulations and particularly highlight the importance of considering how cultural dynamics within subpopulations may help or hinder such policies.

Unintended consequences of smoke-free bar policies for low-SES women in three California counties.

BACKGROUND: To amplify earlier studies of unintended consequences of public policies, this article illustrates both negative and positive unanticipated consequences of smoke-free workplace policies in California bars for women of low SES. METHODS: The article relies on thematic analysis in 2008 of qualitative data gathered between 2001 and 2007 from three mixed-method studies of tobacco use in and around bars where indoor smoking is prohibited. RESULTS: Unanticipated consequences primarily occurred when bars did comply with the law and smokers went outside the bar to smoke, particularly when smokers stood on the street outside the bar. Key negative consequences for women who smoked outside of bars included threats to their physical safety and their public image. For women living near bars, increased smoking on the street may have increased their exposure to secondhand smoke and disruptive noise. For some women, however, unanticipated negative consequences were identified with noncompliant bars. Smokers were conjectured to congregate in the smaller number of bars where smoking was still allowed, resulting in increased exposure to secondhand smoke for low-SES women working in these bars. A common positive unintended consequence of the tobacco control ordinance was increased social circulation and solidarity, as smokers gathered outside bars to smoke. CONCLUSIONS: Smoke-free workplace laws in bars can have both negative and positive consequences for workers and smokers, and low-income women in particular.

Correlates of persistent smoking in bars subject to smokefree workplace policy.

This study's goal was to characterize physical and social environments of stand-alone bars associated with indoor smoking despite California's smokefree workplace law. In a random sample of 121 stand-alone bars in San Francisco, trained observers collected data on patrons, staff, neighborhood, indoor settings and smoking behaviors. Using bivariate (chi-square) and hierarchical linear modeling analyses, we identified four correlates of patrons' indoor smoking: 1) bars serving predominantly Asian or Irish patrons, 2) ashtrays, 3) bartender smoking, and 4) female bartenders. Public health officials charged with enforcement of smokefree bar policies may need to attend to social practices within bars, and heighten perceptions of consistent enforcement of smokefree workplace laws.

Dimensions of problem drinking among young adult restaurant workers.

BACKGROUND: Nationwide surveys identify food service workers as heavy alcohol users. OBJECTIVES: This article analyzes dimensions and correlates of problem drinking among young adult food service workers. METHODS: A telephone survey of national restaurant chain employees yielded 1,294 completed surveys. RESULTS: Hazardous alcohol consumption patterns were seen in 80% of men and 64% of women. Multivariate analysis showed that different dimensions of problem drinking measured by the AUDIT were associated with workers' demographic characteristics, smoking behaviour, and job category. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE: These findings offer evidence of extremely high rates of alcohol misuse among young adult restaurant workers.

CHALLENGES TO IMPLEMENTING AND ENFORCING CALIFORNIA'S SMOKE-FREE WORKPLACE ACT IN BARS.

California's 1995 Smoke-Free Workplace Act-Assembly Bill 13 (AB 13)-was extended to bars in 1998. This paper examines the challenges faced by officials responsible for implementing and enforcing the law. As part of a series of studies evaluating AB 13 in bars, researchers conducted confidential in-depth interviews with 35 state, county and municipal authorities and representatives of non-governmental agencies. The interviews were recorded, transcribed, coded and analyzed by themes and respondent categories. Data from structured observations in sampled bars and interviews with bar staff and patrons offer contextual information. Analyses indicated the following challenges: 1) an ineffective administrative structure, 2) problems associated with the complaint-driven system used to enforce the law, 3) lack of funding for enforcement, 4) low prioritization of enforcement, and 5) the minimal deterrence effect of the sanctioning penalties. The findings indicate why indoor smoking may continue in some bars despite the state law prohibiting smoking in workplaces. Many municipalities, states and countries may be considering restricting smoking in workplaces including bars, and our findings show that clear delineation of procedures and enforcement criteria, as well as funding and substantive penalties, should be considered in drafting these laws.

Contribution of occupational factors to current smoking among active-duty U.S. Navy careerists.

Rates of cigarette smoking among active-duty U.S. military personnel remain elevated, ranging from 23% among Air Force personnel to 38% among Army personnel. The purpose of this study was to estimate the contribution of occupational factors to current smoking and heavy smoking among a sample of Navy careerists (those with at least 7 years of military service), and to determine if gender moderates these associations. Participants in the study (n = 2,922) were randomly recruited within over-sampled strata of women and racial/ethnic minorities, and voluntarily completed confidential self-administered questionnaires on drinking, smoking, demographic, and occupational factors during 2001-2002. Approximately 23% of study participants reported current smoking; 9% reported heavy smoking. Multivariate logistic regression models were developed to estimate the contribution of occupational factors to current smoking and heavy smoking. The results indicated that careerists in the enlisted ranks were significantly more likely to be current smokers and heavy smokers compared with careerist officers. In addition, those who were deployed at sea were significantly more likely to report current smoking compared with those not currently deployed at sea. Mean daily ounces of alcohol were also significantly associated with likelihood of current and heavy smoking. Gender did not modify the association between occupational factors and smoking. Because aspects of the work environment are potentially modifiable, understanding the role of occupational factors vis-à-vis smoking can aid in smoking prevention and cessation efforts within the military.

Social Organization in Bars: Implications for Tobacco Control Policy.

This paper considers social roles and relationships of the patrons, staff and owners of bars as critical factors determining adherence to public health policies, and specifically California's smokefree workplace law. Specific elements of social organization in bars affecting health policy include the community within which the bar is set, the unique identity the bar creates, the bar staff and patrons who enact this identity, and their bar society. These elements were found to contribute to the development of power relations within the bar and solidarity against the outside world, resulting in either resistance to or compliance with smokefree workplace policy.

Tobacco free workplace policies and low socioeconomic status female bartenders in San Francisco.

STUDY OBJECTIVE: Multiple studies have found that, compared with employees in other settings, workers in bars and restaurants have been exposed to high levels of secondhand smoke, putting them at increased risk for health complications. Among these bar employees are many women of low socioeconomic status (SES). Smoke free workplace ordinances have been extended to bars and restaurants in cities and states throughout the USA; some bars, however, continue to be out of compliance with these laws. The objective of this study is to assess the relation between bartender gender and smoke free workplace compliance in bars. DESIGN: This paper reports on analyses of observational data on compliance with smoke free workplace policy in 121 randomly selected bars together with qualitative data from semi-structured interviews with bartenders and patrons in bars. SETTING: San Francisco County bars. MAIN RESULTS: Findings from this research showed that smoke free policy non-compliance was associated with bars in which women were bartenders, increasing their tobacco exposure compared with male bartenders. In interviews, although some female bartenders expressed ambivalence toward the smoke free ordinance, many others described experiencing positive health and social consequences when the bars in which they worked could eliminate interior smoking. CONCLUSIONS: The analyses presented here shed light on the benefits of improving the workplace environment for low SES female bartenders through the extension of strong smoke free workplace policies to all workplaces, including bars.

Did substance use change after September llth? An analysis of a military cohort.

The purpose of this study was to assess changes in alcohol, tobacco, and other drug use after the terrorist attacks of September 11 among a cohort of young military personnel consisting of 661 active duty Navy personnel, including 164 women. Paired sample t tests were computed to assess mean differences in substance use in the 30 days before and after September 11. Average daily alcohol consumption significantly declined in the 30 days after September 11 among enlisted personnel (n = 315) and officers (n = 360). Significant increases in the usual number of cigarettes smoked and in the number of days using prescription drugs after September 11 were observed among enlisted personnel, but not among officers. Increased use of cigarettes and prescription drugs among enlisted personnel after September 11 suggests that some sectors of the military may turn to tobacco and other substances to cope with traumatic circumstances such as the events of September 11.