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TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES

Preventing tobacco use and helping those who use it to quit can have long-term benefits for individuals and for public health in general. State and federal government agencies, health-care organizations, and other groups that promote public health have developed and implemented tobacco control programs to help to prevent or reduce tobacco use. The programs use taxation, restrictions, mass-media campaigns, and effective and easily accessible behavioral counseling and tobacco-cessation medications. They provide services to varied target audiences, including young people, people with comorbid health problems, those of diverse ethnicities and socioeconomic status, and women.

Evidence-based best practices for tobacco control have been widely promoted and have succeeded in reducing tobacco use in the United States. The committee recognizes, however, that identifying the best practices for specific and diverse populations can be challenging. Reducing tobacco use faces special challenges because tobacco products are legal and easy to acquire, highly addictive, and heavily promoted by a tobacco industry that spends billions of dollars a year to promote tobacco as part of the American culture (CDC, 2007a). Creating a tobacco-free culture will depend on developing an environment that encourages abstinence and makes many types of effective assistance and encouragement accessible to diverse populations. Maintaining a tobacco-free culture will require a sustainable infrastructure for comprehensive programs.

The application of evidence-based best practices for tobacco control in military populations under the jurisdiction of the Department of Defense (DoD) is the subject of Chapter 5; Chapter 6 addresses the same issues for the population of veterans who use the Department of Veterans Affairs (VA) health-care system. The committee believes that well-designed tobacco-control programs can influence tobacco use by military personnel from the time they enter the military until they leave



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4 TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES Preventing tobacco use and helping those who use it to quit can have long-term benefits for individuals and for public health in general. State and federal government agencies, health-care organizations, and other groups that promote public health have developed and implemented tobacco control programs to help to prevent or reduce tobacco use. The programs use taxation, restrictions, mass-media campaigns, and effective and easily accessible behavioral counseling and tobacco-cessation medications. They provide services to varied target audiences, including young people, people with comorbid health problems, those of diverse ethnicities and socioeconomic status, and women. Evidence-based best practices for tobacco control have been widely promoted and have succeeded in reducing tobacco use in the United States. The committee recognizes, however, that identifying the best practices for specific and diverse populations can be challenging. Reducing tobacco use faces special challenges because tobacco products are legal and easy to acquire, highly addictive, and heavily promoted by a tobacco industry that spends billions of dollars a year to promote tobacco as part of the American culture (CDC, 2007a). Creating a tobacco-free culture will depend on developing an environment that encourages abstinence and makes many types of effective assistance and encouragement accessible to diverse populations. Maintaining a tobacco- free culture will require a sustainable infrastructure for comprehensive programs. The application of evidence-based best practices for tobacco control in military populations under the jurisdiction of the Department of Defense (DoD) is the subject of Chapter 5; Chapter 6 addresses the same issues for the population of veterans who use the Department of Veterans Affairs (VA) health-care system. The committee believes that well-designed tobacco-control programs can influence tobacco use by military personnel from the time they enter the military until they leave 115

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116 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS the service and beyond. For military personnel who enter the VA health system, these practices can also influence their tobacco use as veterans. This chapter summarizes what is known about evidence-based best practices for tobacco-control programs in the general population with an emphasis on program components that are or could be most applicable to DoD and VA. The committee hopes that by implementing these practices, DoD will be able to prevent or reduce tobacco use by military personnel in all phases of their military service—from the time they enter the military until they leave the service or retire. Implementing these practices in VA may also reduce tobacco use in veterans. As discussed in the next two chapters, DoD and VA already have in place some of the components and practices, including the infrastructure and regulatory authority, for an effective tobacco-control program; in these instances the committee highlights how the departments can take advantage of current policies and procedures to increase their effectiveness and reach and also emphasizes where additional opportunities for tobacco control may reside. COMPREHENSIVE TOBACCO-CONTROL PROGRAMS Evidence supports the use of a comprehensive tobacco-control program to reduce tobacco consumption (Warner, 2007). A comprehensive approach to tobacco control results in changes that affect the entire population, from the individual to the societal level, by addressing the political, social, cultural, economic, and environmental factors that support the use or nonuse of tobacco. Tobacco-control programs reduce tobacco use at the population level by creating tobacco- free indoor and outdoor areas, restricting young people’s access to tobacco products, limiting tobacco advertising, having sustained counteradvertising campaigns, increasing the cost of tobacco products, and providing easily accessible tobacco-cessation products and services. Comprehensive tobacco-control programs for military and veteran populations could help to do the following: • Foster a tobacco-free culture and denormalize tobacco use in military personnel and veterans. • Prevent the initiation of tobacco use by military personnel and their dependents during active duty and prevent relapse to tobacco use by military personnel and veterans who have quit. • Eliminate exposure of military and veteran personnel, family, co-workers, and others to secondhand smoke and its health consequences.

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117 TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES • Support and promote tobacco cessation in military personnel, veterans, and their dependents. • Identify and eliminate disparities in tobacco treatment between the general population and military personnel or veterans in high-risk populations, including those with mental-health disorders. Numerous entities have developed and implemented successful tobacco-control programs. They include the federal government, specifically the National Cancer Institute (NCI) and the Centers for Disease Control and Prevention (CDC); various state governments; and commercial entities, such as Kaiser Permanente. California has been a leader in establishing a comprehensive tobacco-control program. Its program began in 1988 and adult tobacco use in California decreased from 22.7% to 13.3% by 2006 (CDC, 2007a). California served as the model for Massachusetts, which also developed a comprehensive program that resulted in a decrease in statewide tobacco consumption. California and Massachusetts were among the states that participated in the NCI American Stop Smoking Intervention Study (ASSIST) program and evaluation. See Appendix A for a detailed discussion of effective federal and state comprehensive tobacco-control programs. Comprehensive programs can provide the societal and organizational framework for reducing tobacco use in a population. Although such programs and policies may prevent young people from initiating tobacco use and reduce the exposure of the general population to secondhand smoke, a comprehensive program must also be applicable to people who are already using tobacco regularly. Interventions are needed to assist individual tobacco users, each of whom has a particular level of addiction, particular reasons for smoking and for trying to stop, and possibly concurrent health problems that affect their interest in and ability to quit. The process of creating tobacco-free environments should include educational campaigns to prepare the target communities and build support for the measures to be implemented. Once public support has been garnered, government and political support of tobacco-free policies must remain strong, including enforcement and sanctions for violations to ensure compliance (WHO, 2008). The comprehensive tobacco-control programs noted above and in Appendix A vary in target audience, size, funding sources, and bureaucratic oversight, but they share several key components that contribute to their success: the development and implementation of a strategic plan, dynamic leadership, effective and enforceable policies, communication interventions, adequate resources, appropriate

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118 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS therapeutic interventions (including those for special populations), surveillance, evaluation of effectiveness with feedback, and management capability to bring about change. CDC’s (2007a) Best Practices for Comprehensive Tobacco Control Programs and its Tobacco: Guide to Community Preventive Services (CDC, 2009a) synthesize evidence-based practices into a multidimensional approach to public-health goals across the entire tobacco-use continuum from prevention to cessation. A combination of educational, clinical, and social strategies are recommended to denormalize tobacco use. In CDC’s Best Practices, the strategies are in five broad categories: (1) policies (for example, establishing tobacco-free facilities and increasing the price of tobacco products); (2) health promotion and education, including communication interventions (for example, mass-media antitobacco advertising campaigns and such innovative approaches as text messaging); (3) cessation interventions (for example, health-care-system–based cessation counseling and medications and population-based services, such as toll-free quitlines); (4) surveillance and evaluation; and (5) capacity-building, including administration and management procedures. Direct interventions for individuals, including health promotion and cessation, are important, but the other evidence-based strategies—such as price increases, reduced access to tobacco products, tobacco-free environments, advertising bans, and changes in social perceptions—all contribute to reducing tobacco use and ultimately encourage tobacco cessation (CDC, 2007a). Together, those key components can provide DoD and VA with the capacity to develop and implement a tobacco-control program that can achieve the five categories of strategies cited above. DoD and VA have established comprehensive programs for other public-health goals, such as weight management. In the following sections, the committee describes the key components of comprehensive tobacco-control programs. The committee believes that those key components, if implemented by DoD and VA, could help reduce and prevent tobacco use in their populations. The committee stresses that in addition to the components discussed in this chapter, a comprehensive program in either DoD or VA must begin with strong leadership that has the political and administrative will to effect changes in how the departments conduct their tobacco-control activities. An engaged leadership is also critical for implementing each of the program components presented in Table 4-1. Comprehensive tobacco- control programs with committed leadership and adequate resources are most effective in preventing tobacco use and helping tobacco users to quit. The sections below summarize the best evidence to support the use of the key program components and in the boxes provide a brief

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119 TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES TABLE 4-1 Key Components of Tobacco Control Programs Program Component Program Goals Eliminate Prevent Eliminate Disparities Tobacco- Tobacco- Exposure to Increase in Tobacco Free Use Secondhand Tobacco Use Culture Initiation Smoke Cessation Treatments • • • • Communication interventions • • • • Tobacco-use restrictions • • • • Tobacco retail environment • • Behavioral therapies and medications • • • • Special populations • • • Surveillance and evaluation introduction to possible applications in military and veteran populations. The applications are discussed in greater detail in Chapters 5 (DoD) and 6 (VA) along with policy and program barriers to wider use of the key components. DoD and VA already have some of the policy and infrastructure capabilities, similar to those of states, that would allow them to develop and implement comprehensive tobacco-control programs. The capabilities include leadership, the ability to develop and enforce policies that affect all their constituents, and resources that may be dedicated for specific purposes such as tobacco control. COMMUNICATION INTERVENTIONS No tobacco-control intervention will be effective if it does not reach its target audience: tobacco users. Communication interventions must not only educate tobacco users and others about the hazards of

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120 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS tobacco and provide information on how to access tobacco prevention and cessation services but, first and foremost, must focus on changing the social norm of tobacco use. CDC (2007a) states that “an effective state health communication should deliver strategic, culturally appropriate, and high-impact messages in a sustained, adequately funded campaign integrated into the overall state tobacco program effort.” There are many reasons why tobacco users do not seek assistance when quitting tobacco use, one of which may be a lack of knowledge that such assistance is available. Several approaches may be used to increase tobacco users’ awareness of, and interest in, tobacco-cessation interventions. One communication approach is a mass-media campaign that alerts consumers about the hazards of tobacco use and informs them that assistance is available to help them quit. Product advertising can also alert consumers to tobacco-cessation medications or other programs, such as quitlines. In contrast, the advertising of tobacco products, particularly to young adults, has an enormous effect on increasing demand for tobacco products. Advertising and Promotions The tobacco industry has long understood that mass-media advertising and communication shape attitudes toward its brand images. As a result, cigarettes are one of the most heavily advertised US products, with advertising and promotion expenditures from 1940 to 2005 totaling $250 billion (in 2006 dollars) and reaching $13.5 billion in 2005 alone (in 2006 dollars) (NCI, 2008). Since the 1971 federal ban on television advertising of cigarettes and similar restrictions on the nature of advertising linked to the 1998 Master Settlement Agreement,1 the rate of smoking among people 18–24 years old has steadily declined (CDC, 2007b), but it continues to be a public-health problem as young people initiate tobacco use. Reports such as the Institute of Medicine’s (IOM’s) Ending the Tobacco Problem: Blueprint for the Nation (IOM, 2007), NCI’s The Role of the Media in Promoting and Reducing Tobacco Use (NCI, 2008), CDC’s Best Practices for Comprehensive Tobacco Control Programs (CDC, 2007a) and Tobacco: Guide to Community Preventive Services (CDC, 2009a), and other studies (Saffer and Chaloupka, 2000) have summarized a large body of literature on the effect of advertising on smoking behavior and concluded that the prevailing scientific opinion indicated a causal relationship between tobacco advertising and increased tobacco use. Because of the strong effect of visual advertising on tobacco 1 National Association of Attorneys General. http://www.naag.org/settle.htm (accessed February 2, 2009).

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121 TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES use, the IOM report recommended that all visual advertisements for tobacco products be limited to black-and-white, text-only formats. It also recommended prohibiting all advertising by tobacco companies to minors, regardless of purpose, inasmuch as even ostensibly discouraging advertisements and information-gathering campaigns, such as surveys, may encourage tobacco use. A recent study by Slater et al. (2007) found that advertising and price promotion contribute to the initiation of smoking (moving from one-time experimenters, or “puffers,” to other, more established categories of smokers). The tobacco industry has also strategically targeted such populations as young men and women and racial and ethnic groups. It uses sophisticated advertising to appeal to the demographic and lifestyle characteristics of targeted audiences, such as social acceptance, athleticism, rewarded risk-taking, and masculinity or femininity (NCI, 2008). The committee notes that all of those characteristics are likely to appeal to a military audience that consists of young men and women being asked to undertake arduous duties and possibly risk their lives. Such conclusions have led the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) to call on nations to “undertake a comprehensive ban on all tobacco advertising, promotion and sponsorship . . . in accordance with its constitution or constitutional principles,” but the United States has yet to ratify the FCTC.2 Studies of comprehensive tobacco-advertising bans in several countries indicate that they have reduced consumption (Saffer and Chaloupka, 2000). The tobacco industry has changed its approach to tobacco promotion in response to changing regulatory environments. After implementation of the ban on television advertising, the tobacco industry used outdoor advertising, magazines, point-of-sale advertising, and direct mail to appeal to consumers (IOM, 2007). Point-of-sale advertising is associated with encouraging youth to try smoking (CDC, 2007a). With prices increasing as a result of higher state and federal taxes, the tobacco industry now spends $10 billion a year to provide price-discount promotions to merchants (Pierce, 2007). Price promotions play an important role in tobacco consumption because they counteract the effect of increased cigarette prices. The military services have enacted regulations that restrict or ban the advertising of tobacco products on military installations. VA does not have venues that advertise or sell tobacco products. 2 Current list of signatories can be viewed at: http://www.who.int/fctc/ signatories_parties/en/index.html (accessed May 19, 2009).

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122 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS The independent military newspaper, Stars and Stripes, does not carry tobacco advertising, but installation papers that are commercially owned may have such advertising. VA does not have advertising in its newsletters. Counteradvertising and Public Education Offsetting the tobacco industry’s mass-media influence through counteradvertising is critical for achieving a nonsmoking public norm, including the military or, indeed, any segment of society (CDC, 2007a, 2009a; IOM, 2007; NCI, 2008). Strategies to counter advertising by the tobacco industry include advertising bans and counteradvertising with the goal of preventing smoking initiation, promoting cessation, and changing social norms associated with tobacco use (CDC, 2007a). Strategies to change social norms include tailored, engaging messages for specific audiences. Mass-media campaigns involving television, radio, newspapers, billboards, posters, leaflets, and booklets that deglamorize and denormalize tobacco use have been used successfully as tobacco-control interventions alone and in combination with other program components, such as increased prices for tobacco products and community-based education programs (CDC, 2007a; IOM, 2007; NCI, 2008). Newer communication tools to disseminate counteradvertising information include Web-based advertising, text messaging to personal communication devices, and on-line Web logs (blogs) (CDC, 2007a). Media campaigns should have sufficient reach, frequency, and duration (at least 6 months and preferably 18–24 months) to influence behavior (CDC, 2007a). Many of the mass-media counteradvertising campaigns have focused on preventing or reducing tobacco use by youth and reducing exposure to secondhand smoke (CDC, 2009a). The American Legacy Foundation’s “truth©” antitobacco campaign and the Phillip Morris Company’s “Think. Don’t Smoke” campaign are aimed at adolescents. The American Legacy Foundation’s campaign, particularly its negative advertising, was found to be effective in encouraging antitobacco sentiments in adolescents and in reducing tobacco-use initiation among youth (Farrelly et al., 2009), but the Phillip Morris campaign was not (Apollonio and Malone, 2009). NCI (2008) found that, in general, tobacco-industry youth smoking prevention campaigns have been ineffective and may even have resulted in increased smoking among some young people. CDC (2009a) found that the most effective mass- media education campaigns for decreasing the number of young people and adults who use tobacco, combined with other interventions, lasted at least 2 years. The committee notes that most people entering the military

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123 TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES are in their late teens, therefore, antitobacco messages should be directed at those young adults, particularly young men, who have the highest rates of tobacco use. There is strong evidence that public-education campaigns via broadcast and print media also increase tobacco cessation among both adults and youth (CDC, 2009a). Mass-media campaigns, when combined with such other interventions as the distribution of self-help materials, increased tobacco cessation by about 2 additional quitters per 100 people. Tobacco consumption was reduced by about 13%, and tobacco- use prevalence was reduced by about 3 people per 100 tobacco users (CDC, 2009a). Antitobacco messages that included information about accessing telephone quitlines significantly increased the number of people who called them. The evidence of the effectiveness of mass- media education cessation series (that is, broadcast instructional segments designed to recruit, inform, and motivate tobacco users to try quitting and to succeed) and for cessation contests is still insufficient (CDC, 2009a). The mass media, particularly the news media, have been underused by tobacco-control advocates; however, the use of counteradvertising is effective in reducing smoking among targeted adult and youth populations (CDC, 2007a; IOM, 2007; NCI, 2008). Wakefield et al. (2008) found that antitobacco mass-media campaigns were effective in reducing tobacco use if broadcast at regular intervals. Strong negative messages about the health risks posed by tobacco use are more effective than more neutral or humorous messages or negative messages about the tobacco industry (NCI, 2008). Although the evaluation of mass-media programs comes from heterogeneous studies of varied methodologic quality, meta-analyses demonstrate that mass-media counteradvertising campaigns can be effective in reducing smoking consumption and prevalence (Bala et al., 2008). DoD has a strong mass-media presence both in recruiting and in promoting healthy lifestyles among its military personnel. Such promotional activities can be adapted to promote antitobacco messages. VA can access mass-media outlets—such as newsletters, motivational materials for waiting rooms, and Web sites—to encourage veterans to quit tobacco. DoD has initiated a militarywide antitobacco campaign with the slogan “Quit Tobacco. Make Everyone Proud” that targets military personnel 18–25 years old and includes an interactive Web site.

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124 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Finding: Counteradvertising programs are effective in preventing tobacco initiation and in increasing tobacco cessation in target audiences. TOBACCO-USE RESTRICTIONS Tobacco-free policies have been shown to increase tobacco cessation (CDC, 2009a; US Surgeon General, 2004). Policies and regulations restricting tobacco use adopted outside the DoD and VA systems are described below. They point to similar opportunities for DoD and VA to restrict tobacco use by their target audiences. Such policies and regulations have the potential to affect tobacco use by military personnel and their dependents, civilian employees on military installations, and veterans. Tobacco-use restrictions are most effective when they apply to a variety of public and private settings. Smoking prevalence and annual per-capita consumption are 4% and 14 packs higher, respectively, and quitting rates are 6% lower in states without comprehensive clean- indoor-air laws (Bonta, 2007; Emont et al., 1992). The effects on secondhand smoke, quitting rates, and consumption are maximized when smoking is banned as opposed to restricted to designated areas (Heironimus, 1992; Pizacani et al., 2003). It has been estimated that clean-air laws can reduce smoking prevalence by 10% (Levy and Friend, 2003). Smoking bans in public places and workplaces are generally supported by the public, including smokers (Fong et al., 2006; RTI International, 2005; WHO, 2008). Enforcement of tobacco-free laws and policies is critical for their effectiveness. Comprehensive legislation establishing clear penalties for violations needs to be paired with effective enforcement policies for smoking restrictions to advance tobacco control. Fining the owners of establishments where violations occur is the most effective way to enforce the law (WHO, 2008). Those measures can be combined with penalties for tobacco users who break the rules. Community Settings Community settings for tobacco restrictions include private and public workplaces, restaurants and bars, and hospitals. By January 4, 2009, 23 states had laws calling for 100% smoke-free public and private workplaces, 23 states had laws calling for 100% smoke-free bars, and 28 states had laws calling for 100% smoke-free restaurants (ANRF, 2009a). As a result, over 70% of the US population is protected by some type of 100% smoke-free law, and nearly 40% by a law calling for 100% smoke- free workplaces, restaurants, or bars (ANRF, 2009b). Many states and

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125 TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES municipalities also have laws restricting smoking in prisons, lodgings, malls, and hospitals and health clinics. In 1997, Executive Order 13058 required that all federal buildings be smoke-free. Those measures have traditionally been framed as involving worker-safety issues, and this approach has helped to build public support for smoking bans (WHO, 2008). Research on the effects of workplace tobacco restrictions demonstrates that they are effective in reducing exposure of all workers to secondhand smoke and in promoting cessation by workers who smoke (Bonta, 2007; Brownson et al., 1995, 1997; Fichtenberg and Glantz, 2002; Fong et al., 2006; Glasgow et al., 1997; Moskowitz et al., 2000). Furthermore, results of several studies suggest that smoke-free legislation is associated with decreases in hospital admissions for acute coronary problems (Pell et al., 2008; Sargent et al., 2004). • DoD Instruction 1010.15 states that DoD facilities must be smoke-free to protect civilian and military health, although there are areas that are exempt. • Veterans Health Administration Directive 2008-052 establishes a smoke-free policy for VA health-care facilities; it has effectively eliminated indoor smoking areas for patients and staff, although designated outdoor smoking areas remain. In 1992, the Joint Commission on Accreditation of Healthcare Organizations (now the Joint Commission) issued a mandate that all accredited hospitals except psychiatric hospitals be smoke-free; a year later, 96% of hospitals in the United States were complying with the mandate (Fee and Brown, 2004). At least 2 national hospitals and 1,594 local and state hospitals, health-care systems, and clinics had adopted 100% smoke-free campus-grounds policies as of 2008 (ANRF, 2009c). Implementation of the Joint Commission’s smoke-free standards, although initially aimed at protecting patients, has also had a favorable effect on the smoking behavior of hospital workers (Fee and Brown, 2004; Longo et al., 1996, 2001). There is some resistance to the adoption of tobacco-free restrictions in psychiatric health-care settings. Although it has been argued that smoking helps patients to manage their symptoms and that banning smoking may exacerbate mental illness (Stage et al., 1996), evidence indicates that smoking restrictions can be implemented in psychiatric health-care settings without adverse effects (Alam, 2007;

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186 COMBATING TOBACCO USE IN MILITARY AND VETERAN POPULATIONS Older Americans Report. 2005. City’s housing authority bans smoking in senior apartments. August 5, 2005. OTRU (Ontario Tobacco Research Unit). 2006. The Smoke-Free Ontario Act: Extend protection to children in vehicles. OTRU Update. August 2006. Otten, R., R. C. M. E. Engels, and R. J. J. M. Van Den Eijnden. 2005. Parental smoking and smoking behavior in asthmatic and nonasthmatic adolescents. Journal of Asthma 42(5):349-355. Parkes, G., T. Greenhalgh, M. Griffin, and R. Dent. 2008. Effect on smoking quit rate of telling patients their lung age: The step2quit randomised controlled trial. British Medical Journal 336(7644): 598-600. Patten, C. A., A. A. Drews, M. G. Myers, J. E. Martin, and T. D. Wolter. 2002. Effect of depressive symptoms on smoking abstinence and treatment adherence among smokers with a history of alcohol dependence. Psychology of Addictive Behaviors 16(2):135-142. Pell, J. P., S. Haw, S. Cobbe, D. E. Newby, A. C. Pell, C. Fischbacher, A. McConnachie, S. Pringle, D. Murdoch, F. Dunn, K. Oldroyd, P. Macintyre, B. O’Rourke, and W. Borland. 2008. Smoke-free legislation and hospitalizations for acute coronary syndrome. New England Journal of Medicine 359(5):482-491. Perrin, B. 1998. Effective use and misuse of performance measurement. American Journal of Evaluation 19(3):367-379. Perrin, B. 1999. Performance measurement: Does the reality match the rhetoric? A rejoinder to Bernstein and Winston. American Journal of Evaluation 20(1):101-111. Persson, L. G., and A. Hjalmarson. 2006. Smoking cessation in patients with diabetes mellitus: Results from a controlled study of an intervention programme in primary healthcare in Sweden. Scandinavian Journal of Primary Health Care 24(2):75-80. Phisitkul, K., K. Hegazy, T. Chuahirun, C. Hudson, J. Simoni, H. Rajab, and D. E. Wesson. 2008. Continued smoking exacerbates but cessation ameliorates progression of early type 2 diabetic nephropathy. American Journal of the Medical Sciences 335(4): 284-291. Pierce, J. P. 2007. Tobacco industry marketing, population-based tobacco control, and smoking behavior. American Journal of Preventive Medicine 33(Suppl 6):S327-S334.

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187 TOBACCO-CONTROL PROGRAMS: EVIDENCE-BASED PRACTICES Pizacani, B. A., D. P. Martin, M. J. Stark, T. D. Koepsell, B. Thompson, and P. Diehr. 2003. Household smoking bans: Which households have them and do they work? Preventive Medicine 36(1):99-107. Pizacani, B. A., D. P. Martin, M. J. Stark, T. D. Koepsell, B. Thompson, and P. Diehr. 2004. A prospective study of household smoking bans and subsequent cessation related behaviour: The role of stage of change. Tobacco Control 13(1):23-28. Powell, L. M., J. A. Tauras, and H. Ross. 2005. The importance of peer effects, cigarette prices and tobacco control policies for youth smoking behavior. Journal of Health Economics 24(5):950-968. Prochaska, J. J., P. Gill, and S. M. Hall. 2004a. Treatment of tobacco use in an inpatient psychiatric setting. Psychiatric Services 55(11):1265- 1270. Prochaska, J. J., J. S. Rossi, C. A. Redding, A. B. Rosen, J. Y. Tsoh, G. L. Humfleet, S. J. Eisendrath, M. R. Meisner, and S. M. Hall. 2004b. Depressed smokers and stage of change: Implications for treatment interventions. Drug and Alcohol Dependence 76(2):143- 151. Prochaska, J. J., S. C. Fromont, P. Banys, S. J. Eisendrath, M. J. Horowitz, M. H. Jacobs, and S. M. Hall. 2007. Addressing nicotine dependence in psychodynamic psychotherapy: Perspectives from residency training. Academic Psychiatry 31(1):8-14. Prochaska, J. J., S. M. Hall, J. Y. Tsoh, S. Eisendrath, J. S. Rossi, C. A. Redding, A. B. Rosen, M. Meisner, G. L. Humfleet, and J. A. Gorecki. 2008. Treating tobacco dependence in clinically depressed smokers: Effect of smoking cessation on mental health functioning. American Journal of Public Health 98(3):446-448. Quinn, V. P., J. F. Hollis, K. S. Smith, N. A. Rigotti, L. I. Solberg, W. Hu, and V. J. Stevens. 2009. Effectiveness of the 5-As tobacco cessation treatments in nine HMOs. Journal of General Internal Medicine 24(2):149-154. Rabius, V., K. J. Pike, J. Hunter, D. Wiatrek, and A. L. McAlister. 2007. Effects of frequency and duration in telephone counselling for smoking cessation. Tobacco Control 16(Suppl 1): I71-I74. Ranney, L., C. Melvin, L. Lux, E. McClain, and K. N. Lohr. 2006. Systematic review: Smoking cessation intervention strategies for adults and adults in special populations. Annals of Internal Medicine 145(11):845-856.

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