New Zealand tobacco retailers' attitudes to selling tobacco, point-of-sale display bans and other tobacco control measures: a qualitative analysis.

AIMS: We aimed to explore New Zealand tobacco retailers' views on selling tobacco, the forthcoming 2012 point of sale display ban and two other potential tobacco control interventions in the retail setting: compulsory sales of nicotine replacement therapy and licensing of tobacco retailers. METHODS: We carried out in-depth interviews with 18 retailers from a variety of store types where tobacco was sold. Stores were selected from a range of locations with varying levels of deprivation. We used thematic analysis to analyse the data. RESULTS: All but four of the retailers were ambivalent about selling tobacco, would rather not sell it, or fell back on a business imperative for justification. Only one retailer was explicitly unconcerned about selling tobacco products. Most participants had few or no concerns about the removal of point-of-sale displays. Issues which were raised were mainly practical and logistical issues with the removal of displays. Only three thought sales would definitely be reduced. The majority of the retailers were not opposed to a possible requirement that nicotine replacement therapy products be made available wherever tobacco products are sold. Ten supported a licensing or registration scheme for tobacco retailers, and only three were opposed. CONCLUSIONS: We found widespread ambivalence about selling tobacco. There was considerable support for the licensing of tobacco retailers and other potential tobacco control measures. The retailers' attitudes about potential financial costs and security issues from a tobacco display ban were at odds with the tobacco industry predictions and the views of retailers' organisations. Some retailers appear to be potential allies for tobacco control. This is in contrast to retailer organisations, which may be out of step with many of their members in their strong opposition to retail tobacco control interventions.

Informing outdoor smokefree policy: methods for measuring the proportion of people smoking in outdoor public areas.

INTRODUCTION: To advance the design and implementation of outdoor smokefree area policies, we aimed to develop simple, low-cost methods for measuring smoking in a variety of public places. METHODS: Two methods were developed and were used by solo observers during March 2011-February 2012 to measure the proportion of people smoking at a variety of sites. RESULTS: Both methods performed well (n=5553 people observed); the first at 58 sites in the UK and New Zealand (n=3191 observed); the second at 33 sites in New Zealand (n=2362 observed), with significant differences found between the smoking at types of sites and between countries. For the two countries combined, the proportions of people smoking (amongst those over 12 years) in children's play areas was significantly lower compared to all the other sites combined (risk ratio=0.39; 95%CI: 0.20 to 0.76; p=0.002). CONCLUSIONS: Solo observers can establish the proportion of people smoking in a range of outdoor sites. Such methods can inform outdoor smokefree area policymaking by providing baseline and post-policy data to enable location targeting and policy evaluation.

Qualitative exploration of public and smoker understanding of, and reactions to, an endgame solution to the tobacco epidemic.

BACKGROUND: There is increasing interest in ending the tobacco epidemic and in applying 'endgame' solutions to achieve that goal at national levels. We explored the understanding of, and reactions to, a tobacco-free vision and an endgame approach to tobacco control among New Zealand smokers and non-smokers. METHODS: We recruited participants in four focus groups held in June 2009: Maori (indigenous people) smokers (n=7); non-Maori smokers (n=6); Maori non-smokers (n=7); and non-Maori non-smokers (n=4). Participants were from the city of Whanganui, New Zealand. We introduced to them the vision of a tobacco-free New Zealand and the concept of a semi-autonomous agency (Tobacco-Free Commission [TFC]) that would control the tobacco market as part of an endgame approach. RESULTS: There was mostly strong support for the tobacco-free New Zealand vision among all groups of participants. The reason most commonly given for supporting the vision was to protect children from tobacco. Most participants stated that they understood the TFC concept and reacted positively to it. Nevertheless, rather than focusing on organisational or structural arrangements, participants tended to focus on supporting the specific measures which a future TFC might facilitate such as plain packaging of tobacco products. Various concerns were also raised around the TFC, particularly around the feasibility of its establishment. CONCLUSIONS: We were able to successfully communicate a complex and novel supply-side focused tobacco control policy intervention to smokers and non-smokers. The findings add to the evidence from national surveys that there is public support, including from smokers, for achieving a tobacco-free vision and using regulatory and policy measures to achieve it. Support for such measures may be enhanced if they are clearly communicated and explained with a rationale which stresses protecting children and future generations from tobacco smoking.

Determination of chlorinated paraffins in sediments from the Firth of Clyde by gas chromatography with electron capture negative ionisation mass spectrometry and carbon skeleton analysis by gas chromatography with flame ionisation detection.

Short chain chlorinated paraffins (SCCPs) are a group of persistent organic pollutants (POPs) of increasing concern, but are to date not widely investigated in the environment, largely due to the challenges involved in their quantification. Here, SCCPs were quantified in marine sediments from the Firth of Clyde, Scotland, by gas chromatography with electron capture negative ionisation mass spectrometry (GC-ECNIMS) and through carbon skeleton analysis by gas chromatography with flame ionisation detection (GC-FID), and the analytical challenges encountered are discussed. Concentrations in the sediments ranged from 0.4 to 69 µg kg(-1) when determined by GC-ECNIMS, and from 5.6 to 379 µg kg(-1) when determined by GC-FID. For 8 out of 11 samples, analysis by GC-FID gave higher results than analysis by GC-ECNIMS. Unexpected aspects of the analysis, such as the presence of high concentrations of longer chain chlorinated paraffins in the samples, are also presented.

Identifying opportunities for chlamydia screening among American Indian women.

Medical record review was used to identify missed opportunities for chlamydia screening among 103 American Indian/Alaska Native women. Of these, 69% had received a pregnancy test and 74% had received a urine test in the previous 12 months. Chlamydia screening may increase if linked to the other routine clinical testing.

Daring to dream: reactions to tobacco endgame ideas among policy-makers, media and public health practitioners.

BACKGROUND: Tobacco control strategies have mainly targeted reducing demand. Supply-side focused measures, though less familiar, deserve consideration, particularly to achieve 'endgame' tobacco control aims (e.g. achieving close to zero smoking prevalence). We explored attitudes towards supply-side focused 'endgame' tobacco control approaches and how they can be best communicated with senior policymakers, journalists, and public health practitioners. METHODS: We identified five supply-side focused approaches which could potentially lead to the tobacco endgame: two structural models and three discrete actions. The structural models were: (i) a Nicotine Authority to coordinate tobacco control activities and regulate the nicotine/tobacco market for public health aims; and (ii) a Tobacco Supply Agency acting as a monopoly purchaser of tobacco products and controlling the tobacco supply for public health aims. The actions were: (a) allocating progressively reducing tobacco product import quotas (the 'sinking lid') until importation and commercial sale of tobacco products ceased; (b) making tobacco companies responsible for reducing smoking prevalence with stringent financial penalties if targets were missed; and (c) new laws to facilitate litigation against tobacco companies. These approaches were presented as means to achieve a tobacco free New Zealand by 2020 to 19 senior policymakers, journalists, and public health physicians in two focus groups and eight interviews, and their reactions sought. RESULTS: The tobacco-free vision was widely supported. Participants engaged fully with the proposed tobacco control approaches, which were viewed as interesting or even intriguing. Most supported increasing the focus on supply-side measures. Views differed greatly about the desirability, feasibility and likely effectiveness of each approach. Participants identified a range of potential barriers to implementation and challenges to successfully advocating and communicating these approaches. The current framing of tobacco as a risky but legal commodity was noted as an important potential barrier to implementing endgame approaches. CONCLUSIONS: Endgame tobacco control approaches were considered to be viable policy options. Further policy analysis, research and public discussion are needed to develop endgame approaches. A significant change in the public framing of tobacco may be a prerequisite for implementing endgame solutions.

Smoker interest in lower harm alternatives to cigarettes: national survey data.

INTRODUCTION: The aim of this study was to examine knowledge and attitudes to lower harm alternatives to cigarettes among New Zealand (NZ) smokers. METHODS: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) utilizes the NZ Health Survey (a national sample). From this sample, we surveyed adult smokers (N = 1,376). RESULTS: Knowledge about smokeless tobacco was poor, with only 16% regarding such products as less harmful than ordinary cigarettes. Only 7% considered such products to be "a lot less" harmful. When participants were asked to assume that these products were much less harmful than cigarettes, 34% of smokers stated that they would be interested in trying smokeless tobacco products, with another 11% saying "maybe" or "don't know." In the multivariate analysis, Maori smokers were significantly more interested in trying smokeless products than Europeans in all 3 models considered (e.g., Model 1: adjusted odds ratio [AOR] = 1.71, 95% CI = 1.23-2.37). There was also significantly increased interest for those concerned about the impact of smoking on health and quality of life in the future (AOR = 1.44, 95% CI = 1.17-1.78). But interest did not vary significantly by 2 measures of socioeconomic status and varied inconsistently by 2 measures of financial stress. DISCUSSION: The finding that one third of smokers said that they would be interested in trying smokeless products suggests that these products could have a role as part of a tobacco epidemic endgame that phases out smoked tobacco. Differences in interest level by ethnic group may be relevant to stimulating further work in this area (e.g., among those health workers concerned for smokers with the highest need to quit).

Physical activity and incident diabetes in American Indians: the Strong Heart Study.

The authors examined the association between total physical activity (leisure-time plus occupational) and incident diabetes among 1,651 American Indians who participated in the Strong Heart Study, a longitudinal study of cardiovascular disease and its risk factors among 13 American Indian communities in 4 states (North Dakota, South Dakota, Oklahoma, and Arizona). Discrete Cox models were used to examine the association between physical activity level (in tertiles), compared with no physical activity, and incident diabetes, after adjustment for potential confounders. During 10 years of follow-up (f1989-1999), 454 incident cases of diabetes were identified. Compared with participants who reported no physical activity, those who reported any physical activity had a lower risk of diabetes: Odds ratios were 0.67 (95% confidence interval (CI): 0.46, 0.99), 0.67 (95% CI: 0.45, 0.99), and 0.67 (95% CI: 0.45, 0.99) for increasing tertile of physical activity, after adjustment for age, sex, study site, education, smoking, alcohol use, and family history of diabetes. Further adjustment for body mass index and other potential mediators attenuated the risk estimates. These data suggest that physical activity is associated with a lower risk of incident diabetes in American Indians. This study identifies physical activity as an important determinant of diabetes among American Indians and suggests the need for physical activity outreach programs that target inactive American Indians.

The road we travel: Maori experience of cancer.

AIM: This research explores Maori experiences of cancer. It does so to shed light on the causes of cancer inequalities for Maori. METHODS: The views of 44 Maori affected by cancer--including patients, survivors, and their whanau (extended families)--were gathered in five hui (focus groups) and eight interviews in the Horowhenua, Manawatu, and Tairawhiti districts of New Zealand. After initial analysis, a feedback hui was held to validate the findings. RESULTS: Maori identified effective providers of cancer services such as Maori health providers. They also identified positive and negative experiences with health professionals. The involvement of whanau in the cancer journey was viewed as highly significant as was a holistic approach to care. Participants had many suggestions for improvements to cancer services such as better resourcing of Maori providers, cultural competence training for all health workers, the use of systems 'navigators', and the inclusion of whanau in the cancer control continuum. CONCLUSION: The research identifies a range of health system, healthcare process, and patient level factors that contribute to inequalities in cancer for Maori. It also explores the role of racism as a root cause of these inequalities and calls for urgent action.

Metabolic syndrome and the development of CKD in American Indians: the Strong Heart Study.

BACKGROUND: Metabolic impairments that precede type 2 diabetes, such as metabolic syndrome, may contribute to the development of chronic kidney disease (CKD). This study documents the prevalence and incidence of CKD and the prospective association between metabolic syndrome and CKD in American Indians without diabetes in the Strong Heart Study. STUDY DESIGN: Prospective cohort study. SETTING & PARTICIPANTS: American Indians aged 45 to 74 years from 3 geographic regions were recruited by using tribal records and were assessed every 3 years from 1989 to 1999 as part of the Strong Heart Study. Participants with type 2 diabetes, on dialysis therapy, or who received a kidney transplant at baseline examination were excluded. PREDICTOR: Metabolic syndrome, defined using Adult Treatment Panel III criteria. OUTCOMES & MEASUREMENTS: CKD was measured by using estimated glomerular filtration rate (eGFR) and urinary albumin-creatinine ratio (ACR) dichotomized at conventional cutoff values. The association between metabolic syndrome and incident CKD was evaluated by using multivariable Cox proportional hazards models and binomial regression, with statistical adjustment for confounders (age, sex, study center, education, and smoking). RESULTS: Metabolic syndrome was present in 896 (37.7%) and absent in 1,484 participants (62.3%) at baseline. The prevalence of ACR of 30 mg/g or greater at baseline examination was 12.1%, with 290 new cases and an incidence of 233/10,000 person-years. The prevalence of eGFR less than 60 mL/min/1.73 m(2) was 7.8%, with 189 new cases and an incidence of 138/10,000 person-years. The prevalence of CKD was 17.8%, with 388 new cases and an incidence of 342/10,000 person-years. The adjusted hazard ratio for CKD associated with metabolic syndrome was 1.3 (95% confidence interval [CI], 1.1 to 1.6). Equivalent hazard ratios for ACR greater than 30 mg/g and eGFR less than 60 mL/min/1.73 m(2) were 1.4 (95% CI, 1.0 to 1.9) and 1.3 (95% CI, 1.0 to 1.6), respectively. The relationship between metabolic syndrome and kidney outcomes was stronger in those who developed diabetes during follow-up. LIMITATIONS: Intraindividual variability in serum creatinine and ACR measures may have resulted in some misclassification of participants by outcome status. CONCLUSIONS: Metabolic syndrome is associated with an increased risk of developing CKD in American Indians without diabetes. The mechanism through which metabolic syndrome may cause CKD in this population likely is the development of diabetes.

The distribution and composition of hydrocarbons in sediments from the Fladen Ground, North Sea, an area of oil production.

The distribution and composition of hydrocarbons in sediment from the Fladen Ground oilfield in the northern North Sea have been investigated. The total PAH concentrations (2- to 6-ring parent and alkylated PAHs, including the 16 US EPA PAHs) in sediments were relatively low (<100 microg kg(-1) dry weight). The PAH, the Forties crude and diesel oil equivalent concentrations were generally higher in sediment of fine grain size and higher organic carbon concentration. PAH distributions and concentration ratios indicated a predominantly pyrolytic input, being dominated by the heavier, more persistent, 5- and 6-ring compounds, and with a high proportion of parent PAHs. The n-alkane profiles of a number of the sediments contained small, high boiling point, UCMs, indicative of weathered oil arising from a limited petrogenic input. The geochemical biomarker profiles of the sediments that contained UCMs showed a small bisnorhopane peak and a high proportion of norhopane relative to hopane, indicating that there was contamination from both Middle Eastern and North Sea oils. Therefore contamination was not directly as a result of oil exploration activity in the area. The most likely source of petrogenic contamination was from general shipping activity.