Public Health

To determine the prevalence of tobacco use among Centers for Disease Control and Prevention (CDC)/Agency for Toxic Substances and Disease Registry (ATSDR) employees and the effect of the smoke-free policy on smoking behavior and air quality at work. A stratified telephone survey of 1181 CDC/ATSDR employees randomly selected from employee rosters. CDC/ATSDR work sites in Atlanta, Georgia, and other major CDC locations throughout the United States and Puerto Rico. Randomly selected employees of CDC/ATSDR1, or about 22% of the total CDC/ATSDR population; 98% of eligible persons selected agreed to participate. Demographic and smoking history variables, attitudes toward and impact of the smoke-free policy on smoking behavior, and self-report changes in air quality were the measures used. Overall cigarette smoking prevalence was only 11.1%. One percent reported using chewing tobacco, 1.1% reported smoking a pipe, and 1.4% reported smoking cigars. Average self-reported, daily cigarette consumption significantly decreased after the smoking ban took effect. Overall, 90% of the employees supported the smoke-free policy, and 80% of the employees believed that smokers were complying with the smoke-free policy. Most employees believed that the air quality of work areas and nonwork areas (65% and 69%, respectively) had improved since the smoke-free policy was implemented. These findings are consistent with previous evaluations of smoke-free policies and suggest that most employees are generally supportive of workplace smoking restrictions. Such policies can also have a positive impact on smoking behavior and perceived air quality.

Smokeless tobacco has many adverse health effects. We analyzed long-term national trends in smokeless tobacco use. We used 1987 to 2000 National Health Interview Survey data for adults aged 18 years and older, 1986 to 2003 data from Monitoring the Future surveys of adolescents, and 1991 to 2003 data from the Youth Risk Behavior Survey for 9th- to 12th-grade students to examine overall and demographic-specific trends. Smokeless tobacco use among adult and adolescent females was low and showed little change. Smokeless tobacco use among men declined slowly (relative decline=26%), with the largest declines among those aged 18 to 24 years or 65 years and older, Blacks, residents of the South, and persons in more rural areas. Overall and demographic-specific data for adolescent boys indicate that smokeless tobacco use increased for 12th-grade students from 1986 until the early 1990s, but has subsequently declined rapidly in all grades since then (range of relative overall declines=43% to 48%). Smokeless tobacco use has declined sharply, especially among adolescent boys. Ongoing prevention and cessation efforts are needed to continue this trend.

Dopaminergic genes are likely candidates for heritable influences on cigarette smoking. In an accompanying article, Lerman et al. (1999) report associations between allele 9 of a dopamine transporter gene polymorphism (SLC6A3-9) and lack of smoking, late initiation of smoking, and length of quitting attempts. The present investigation extended their study by examining both smoking behavior and personality traits in a diverse population of nonsmokers, current smokers, and former smokers (N = 1,107). A significant association between SLC6A3-9 and smoking status was confirmed and was due to an effect on cessation rather than initiation. The SLC6A3-9 polymorphism was also associated with low scores for novelty seeking, which was the most significant personality correlate of smoking cessation. It is hypothesized that individuals carrying the SLC6A3-9 polymorphism have altered dopamine transmission, which reduces their need for novelty and reward by external stimuli, including cigarettes.

To identify recent studies in the scientific literature that evaluated structured postgraduate public health and biomedical training programs and reported career outcomes among individual trainees, a comprehensive search of several databases was conducted to identify published studies in English between January 1995 and January 2012. Studies of interest included those that evaluated career outcomes for trainees completing full-time public health or biomedical training programs of at least 12 months duration, with structured training offered on-site. Of the over 600 articles identified, only 13 met the inclusion criteria. Six studies evaluated US federal agency programs and six were of university-based programs. Seven programs were solely or predominantly of physicians, with only one consisting mainly of PhDs. Most studies used a cohort or cross-sectional design. The studies were mainly descriptive, with only four containing statistical data. Type of employment was the most common outcome measure (n = 12) and number of scientific publications (n = 6) was second. The lack of outcomes evaluation data from postgraduate public health and biomedical training programs in the published literature is a lost opportunity for understanding the career paths of trainees and the potential impact of training programs. Suggestions for increasing interest in conducting and reporting evaluation studies of these structured postgraduate training programs are provided.

This study examined the associations of susceptibility, conceptualized as both a cognition (risk) and as affect (worry) and their possible interaction, with cancer screening behaviors. Data for this study were obtained from the 2003 Health Information National Trends Survey (HINTS). Hierarchical regression models assessed the ability of risk, worry and their interaction (after controlling for other important variables) to predict cancer-screening behaviors. Results found that risk and worry (but not their interaction) were associated with regular mammography screening and having had a sigmoidoscopy or colonoscopy but with neither FOBT nor PSA screening. The findings suggest that risk and worry are both important in predicting some types of screening behavior and that these variables operate independently.

Data from four National Health Interview Surveys were combined, and a birth-cohort analysis was undertaken to determine the age when regular smoking is initiated. By the age of 25 years, most smokers have already become regular smokers. Among men, the proportion of each birth cohort who become regular smokers has declined at a rate of about 1.0% for each year of birth since 1945. There has been no identifiable decline in successive birth cohorts of women. For those born in the most recent birth cohorts, there was no sex difference in the proportion who became regular smokers. The proportion of smokers beginning to smoke during the secondary-school years (less than or equal to 18 years of age) has increased steadily, especially among people with a high-school education or less. However, in the latest birth cohort (1960-1962), over 18% of ever smokers with at least a high-school education did not start to smoke regularly until their young-adult years (19-24 years of age). If the effect of tobacco-education programs in the schools is to postpone the uptake of regular smoking, it is important to have tobacco policies in place in other areas of society that will maintain non-smoking behavior through the young-adult years. Accordingly, the banning of smoking in colleges, universities, and worksites, as well as in secondary schools, may significantly decrease the proportion of young people who eventually become regular smokers.