American Journal of Public Health June 2005 Highlights
The articles highlighted below appear in the June issue of the American Journal of Public Health, the Journal of the American Public Health Association.
Intensive tobacco control measures can sharply reduce smoking rates
Comprehensive tobacco control efforts, including raising cigarette taxes, making workplaces smoke free and offering free and readily accessible nicotine patches, have a widespread impact on lowering smoking rates.
According to a study of the impact of tobacco control measures in New York City, smoking prevalence among adult residents dropped by 11 percent from 2002-2003 after the city implemented a sweeping tobacco control strategy. That strategy includes increased cigarette excise taxes; legal action that made virtually all workplaces, including bars and restaurants, smoke free; increased cessation services, including a large-scale nicotine patch program; education; and evaluation. The resulting decrease meant 140,000 fewer people smoked in the year following the tobacco control implementation.
In California, where a tobacco-tax increase already helped the state’s smoking rate drop a decade earlier, an additional 50-cent-per-pack state cigarette tax that went into effect in 1999 and a 45-cent-per-pack increase stemming from the Master Settlement Agreement of 1998 helped reduce cigarette consumption in the state by 2.4 packs per capita per quarter.
[From: “ Adult Tobacco Use Levels After Intensive Tobacco Control Measures: New York City, 2002-2003.” Contact: Thomas R. Frieden, MD, MPH, New York City Department of Health and Mental Hygiene, New York, N.Y., firstname.lastname@example.org. Also from: “A Major State Tobacco Tax Increase, the Master Settlement Agreement, and Cigarette Consumption: The California Experience.” Contact: Hai-Yen Sung, PhD, Institute for Health and Aging, University of California at San Francisco, email@example.com.]
Elderly Suicide Victims More Likely to Have Fallen to Their Deaths
Suicide is a major public health problem among those age 65 and older, and a recent study found suicidal people in that age group who live in cities are more likely than their younger counterparts to choose falling from height as their suicide method and to choose to jump from their own homes or apartment buildings.
Nationally, firearms are the most common method of suicide for those age 65 and older, according to earlier studies, yet factors that influence older people's suicide methods are not well understood. In this study, researchers compared suicide methods of elderly and younger adults in New York City. They found the elderly suicide victims were more likely to have fallen to their deaths from high places than younger adults. In the study of all New York suicides from 1990 through 1998, falls from heights were the most common method used by those age 65 and older, while firearms were most commonly used by those age 15-34. Among people age 65 and older who committed suicide, they were significantly more likely than younger people who committed suicide to have fallen from their homes (86.3 percent vs. 69.4 percent).
The study’s authors said their results highlight “the need for knowledge about depression among urban elderly residents, a condition that is often untreated or treated inadequately.”
[From: “ Preference for Fall From Height as a Method of Suicide by Elderly Residents of New York City.” Contact: Robert C. Abrams, MD, Department of Psychiatry, New York Presbyterian Hospital, New York, N.Y., firstname.lastname@example.org.]
Raising tobacco taxes could curb youth’s cigar habits
The only way to effectively turn teens away from smoking cigars is to raise prices, and one way to do that would be taxing cigars at the same rate as cigarettes.
Almost 14 percent of the males and 6 percent of the females in grades 6-12 surveyed as part of the National Youth Tobacco Survey said they smoked cigars, and most of them lived in states with clean indoor air laws as well as laws banning youth access to tobacco. Those youth living in states with so-called “purchase laws” that penalize youth and merchants were actually more likely to smoke cigars than those living in other states.
Cigars currently are taxed at a lower rate than cigarettes, “even though they produce similar, devastating health effects,” the study’s authors wrote. They estimated a 5 percent reduction in the prevalence of youth cigar smoking if state and federal lawmakers “simply taxed cigarettes at the same rate as cigarettes.”
[From: “ Effects of Public Policy on Adolescents’ Cigar Use: Evidence From the National Youth Tobacco Survey.” Contact: Jeanne S. Ringel, PhD, RAND, Santa Monica, Calif., email@example.com.]
Long-Lasting Depression More Common Among Blacks and Mexican Americans
While depression seems much more common among whites than blacks or Mexican Americans, the opposite is true when it comes to a milder mood disorder known as dysthemia.
Researchers interviewed more than 8,000 people age 15-40 and found depression was much more prevalent among whites than blacks or Mexican Americans, and poverty was a contributing factor for depression only among whites. Yet for dysthemic disorder, which is characterized by long-lasting mild depression and such symptoms as insomnia, tearfulness and pessimism, the prevalence was much higher among blacks and Mexican Americans than whites. Lack of education was a significant risk factor for dysthemic disorder, which prevents a person from fully enjoying life.
The findings, which were based on the National Health and Nutrition Examination Survey III conducted from 1988 to 1994, show the importance of defining types of depression when addressing racial and ethnic disparities of the mental health problem. The study’s authors said more research into the issue is needed to shed light on possible contributing factors such as unemployment, rural residence and related disorders, including substance abuse and anxiety.
[From: “ Prevalence of Depression by Race/Ethnicity: Findings from the National Health and Nutrition Examination Survey III.” Contact: Stephanie A. Riolo, MD, MPH, Child and Adolescent Psychiatry, Department of Psychiatry, University of Michigan, Ann Arbor, firstname.lastname@example.org.]
Smokers with access to low-tax cigarettes less likely to quit
Smokers who bought low-taxed cigarettes from American Indian reservations were half as likely to try to quit and had less success when they did attempt to kick the habit compared to smokers who bought full-price cigarettes.
A random telephone survey of 1,548 adults, including 908 smokers, in two New York counties between October 2002 and 2003 found the percentage of smokers who tried to quit was far lower if those smokers frequented American Indian reservations for their cigarettes. And while those smokers who bought cigarettes on reservations were half as likely to try to quit, they also had lower smoking cessation rates than those who bought full-price cigarettes.
Cigarettes are a revenue source on these reservations, yet the study’s authors said low-price cigarettes are a dangerous incentive that keeps many smokers going back for more.
[From: “ Access to Low-Taxed Cigarettes Deters Smoking Cessation Attempts.” Contact: Andrew Hyland, PhD, Roswell Park Cancer Institute, Department of Health Behavior, Buffalo, N.Y., email@example.com.]