Effect of tobacco related policy change on smoking behavior
Initial Award Abstract
Changes in public policy with regard to smoking, and changes in the environment within which the smoker lives and smokes, are felt to be powerful influences driving cessation. Policy-based interventions, by their very nature, are implemented in large populations, and are therefore very difficult to evaluate using a traditional controlled trial experimental design. Evidence from naturally occurring experiments on policy changes suggest that changes in smoking behaviors result from changes in workplace restrictions on smoking, increases in the cost of cigarettes, and physician advice to quit smoking. However, the self-selected nature of these natural experiments make it difficult to answer the question of whether the: change in policy facilitates the change in smoking behavior at the general population level, or whether the change in attitudes about smoking and smoking behaviors enable changes in policies. For example, the lower prevalence of smoking in workplaces that restrict smoking may be due to restrictions on smoking increasing the number of smokers who successfully quit, or it may be due to those workplaces with fewer smokers being more likely to implement a smoke-free workplace.
We propose to use survey data collected in California and nationally to expand our understanding of the relationships between smoking policy changes and smoking behavioral changes, and to define the time course of these changes. Specifically, we will:
1. Examine the effect of workplace restrictions on cessation attempts and successful smoking
cessation. Evaluate the persistence of the effect of workplace restrictions on cessation rates
to see whether the change in smoking behavior is facilitated by the process of initiating work
place restrictions or by the actual limitation of smoking behavior over time.
2. Define the demographic distribution of smokers seeing a physician in the last 12 months and
of receiving physician advice to quit smoking. Evaluate the effectiveness of this advice in
California, as well as examine its relative effectiveness by demographic characteristics and
number of cigarettes per day.
3. Evaluate the impact of increases in cigarette costs on short and long term smoking cessation
success and the duration of the effect of increases in cost on cessation. |
Public policy changes with regard to smoking as well as changes in the environment in which the smoker lives and smokes are felt to strongly influence smoking cessation. Evidence from naturally occurring experiments that have examined smoking policy initiatives have shown that changes in smoking behavior can result from workplace smoking restrictions, increases in the cost of cigarettes and physician advice to quit smoking. The purpose of this grant was to use survey data collected in California and nationally to expand our understanding of the relationships between smoking policy changes and smoking behavior changes and to define the time course of these changes.
We used the 1990 and 1996 California Tobacco Survey (CTS) to examine the relationship between machine-measured nicotine yields and the number of cigarettes smoker per day. Using machine-measured nicotine levels for individual cigarette subspecies, we found a significant inverse relationship between the nicotine level of cigarettes and the average number of cigarettes smoked per day. We also used sales-weighted nicotine as a measure of the nicotine yield to examine this relationship. We found that for both survey years, smokers of cigarettes with nicotine levels below 0.95 mg. smoked 20% more cigarettes per day compared to smokers of medium-nicotine cigarettes. However, there was no difference in the mean number of cigarettes smoked per day between smokers of medium and high-nicotine cigarettes.
Analyses of smoking cessation from the 1999 CTS showed having more education or being an African American were associated with a greater likelihood of attempting to make a change in smoking status during the past 12 months. Other characteristics such as being female, older than 44 and smoking more than 4 cigarettes per day were associated with a lower likelihood of attempting to make a change in smoking status during the past 12 months. Being Hispanic or graduating from college or graduate school was associated with a greater likelihood of being a former smoker for 3 or more months at the time of the survey interview.
Analyses of the CTS data also showed significant increases in the proportions of smokers seeing a physician and receiving cessation advice between the 1996 and 1999 surveys. In 1996, smokers receiving advice were more likely to make a change in smoking behavior and to make a quit attempt than smokers who did not receive advice. In 1999, these differences were not observed. Physician’s advice to quit was not associated with becoming a former smoker of any length in either survey year.
Currently, we are examining the temporal relationship between the cigarette tax increase in January 1999 in California and the introduction of NRT products over-the-counter with quitting behavior. Preliminary results from these analyses suggest that quitting increased in the months following the tax increase and that the rate of former smokers who used NRT increased in the months following the availability of NRT over-the-counter. |