AJPH June 2015 highlights

Date: Jun 11 2015


AJPH research: Smoke-free laws, sleeping pills and car crashes, indoor tanning warnings

In this month’s release, find new embargoed research about smoke-free laws and reports of asthma symptoms; sleeping pills and car crash risk; and warning messages in indoor tanning facilities.

Contact: For copies of articles or full table of contents of an issue, contact Kimberly Short, 202-777-2511.

American Journal of Public Health highlights:
1. States with smoke-free laws report fewer asthma symptoms
2. For new users, sleeping pills may double car crash risk
3. Graphic and risk-oriented warnings may be most effective in limiting indoor tanning

States with smoke-free laws report fewer asthma symptoms
New research from the American Journal of Public Health finds non-smoking adults are less likely to report asthma symptoms in states that have enacted smoke-free indoor air laws.

Researchers analyzed data from the 2007-2011 Behavior Risk Factor Surveillance System Asthma Call-Back Survey to assess the impact of smoke-free indoor air laws on second-hand smoke exposure, asthma attacks and doctor visits for asthma symptoms. Data from Iowa, Illinois and Maryland, states that had enacted smoke-free indoor air laws in 2008, were compared against data from Texas and West Virginia where no statewide smoking restrictions had been constituted. Understanding that asthma attacks can result from a range of risk factors other than second hand smoke exposure including gender, socioeconomic status, use of indoor combustion devices, pets and mold, researchers controlled for these risk factors to investigate its interactions with secondhand smoke and asthma.

Findings revealed a significant decrease in second hand smoke exposure in states with comprehensive smoke-free indoor air laws. In addition, compared to states with no smoke-free indoor air laws, non-smoking adults had lower odds of reporting asthma symptoms and were also less likely to report fewer doctor visits as a result of severe asthma symptoms in states with such laws in place.

“We have demonstrated the efficacy of the enactment of comprehensive smoke-free indoor air laws in reducing asthma symptoms and the number of doctor visits owing to severe asthma symptoms in a fully adjusted model. Several previous studies support our findings although their samples were not representative of the entire nation,” the authors explain.

[“Comprehensive U.S. Statewide Smoke-Free Indoor Air Legislation and Secondhand Smoke Exposure, Asthma Prevalence and Related Doctor Visits: 2007-2011.” Contact: Dong-Chul Seo, PhD, College of Health Sciences, Ewha Womans University, Seoul, South Korea.]

For new users, sleeping pills may double car crash risk
New research from the American Journal of Public Health finds that sedative hypnotic medication use could nearly double the risk of motor vehicle crash among new users of the medications.

Researchers developed a cohort study of participants who had a drug benefit through Group Health Cooperative, were between 21 and 79 years old, were Washington state residents and had Washington state driving licenses. The population's medical encounters and prescription records were combined with Washington State driver’s license records and motor vehicle crash records. The researchers sought to understand associations between motor vehicle crashes and three types of sedative agents: temazepam, zolpidem and trazodone.

For new users of all three prescriptions, exposure nearly doubled the risk of motor vehicle crashes. Among the three drugs analyzed, temazepam appeared to offer the least risk. The increased risk could last for a period of up to one year of continuous prescription filling for new users.

“Depending on an individual’s need to drive regularly combined with a medical indication for sedative use, the choice of a particular sedative may affect the risk of crashing. Prescribers, pharmacists and patients should discuss this potential risk and consider the implications of this analysis when selecting a sedative hypnotic medication,” the researchers recommend.

[“Sedative Hypnotic Medication Use and the Risk of Motor Vehicle Crash.” Contact: Ryan Hansen, PharmD, PhD, University of Washington, Seattle, Washington.]

Graphic, risk-oriented warnings may be most effective in limiting indoor tanning
Messaging that emphasizes the risk of tanning and contains graphic imagery may be the most effective at helping women decide not to tan, according to new research from the American Journal of Public Health.

Researchers surveyed more than 600 non-Hispanic white women ages 18-30. The survey assessed their responses to five different messages about tanning. One message mirrored the current required FDA warnings; two were gain-framed messages which highlighted the benefits of not tanning paired with images depicting healthy skin; and two were loss-framed messages which focused on the risks associated with tanning paired with images showing damaged skin. Participants’ intentions to tan, past tanning experiences and additional demographic information were collected and analyzed.

Results from the study indicated that loss-framed graphic messaging was most effective in lowering intentions to tan indoors compared to text only or gain-framed graphic messaging. While loss-framed messaging was the most effective in affecting intention to tan indoors, gain-framed messages did show stronger intentions to quit indoor tanning compared to text only messages.

“Given the established link between indoor tanning and skin cancer risk, the substantial public health burden of skin cancer, and the findings of this study, a public health communication approach closer to the FDA’s warning for tobacco products may be warranted,” the authors suggest.

[“Framing Indoor Tanning Warning Messages to Reduce Skin Cancer Risks Among Young Women: Implications for Research and Policy.” Contact: Darren Mays, PhD, MPH, Department of Oncology, Georgetown University Medical Center, Washington, D.C.]

Find a full list of research papers to be published online on June 11, 2015, at 4 p.m. EDT below:
  • Association between Connecticut's Permit-to-Purchase Handgun Law and Homicides 
  • National and State Treatment Need and Capacity for Opioid Agonist Medication Assisted Treatment 
  • Sedative Hypnotic Medication Use and the Risk of Motor Vehicle Crash 
  • Framing Indoor Tanning Warning Messages to Reduce Skin Cancer Risks among Young Women: Implications for Research & Policy 
  • Implications of Georgia's ban on abortions after 22 weeks gestation 
  • The Impact of Electronic Cigarette Trial on Cigarette Smoking by College Students: A Prospective Analysis 
  • Enhancing Syndromic Surveillance With On-line Respondent-Driven Detection
  • Feed first, ask questions later: Alleviating and understanding caregiverCaregiver food insecurity in an urban children's hospital 
  • Has treatment scale-up been associated with reduced HIV-related stigma in sub-Saharan Africa? A longitudinal cross-country analysis 
  • HIV prevalence and awareness of positive serostatus in Bogotá, Colombia 
  • Life course partnership status and biomarkers in mid-life: Evidence from the 1958 British birth cohort
  • Decreasing hepatitis C incidence among a population of repeat anti-HCV testers, British Columbia, Canada, 1993-2011 
  • Social network diagramming as an applied tool for public health: Lessons learned from a hepatitis C cluster 
  • Comprehensive statewide smoke-free indoor air legislation and secondhand smoke exposure, asthma prevalence and related visits to doctors, USA, 2007-2011 
  • Impact of mandatory carbon monoxide (CO) alarms: An investigation of effects on detection and poisoning rates in New York City 
  • Bereavement Following Informal Care-Giving: Assessing Mental Health Burden using Linked Population Data 
  • Effects of Participation and Collaboration on Perceived Effectiveness of Core Public Health Functions 
  • Hospital Contributions to the Delivery of Public Health Activities in U.S. Metropolitan Areas: National and Longitudinal Trends 
  • Local Public Health Department Characteristics Associated with Likelihood to Participate in National Accreditation 
  • Environmental Influences on HIV Medication Adherence: The Role of Neighborhood Disorder 
  • Love, trust, and HIV risk among female sex workers and their intimate male partners 
  • A Low-Cost Partner Notification Strategy for the Control of Sexually Transmitted Diseases: A Case Study from Louisiana 
  • The joint effects of structural racism and income inequality on small for gestational age birth 
  • Early life state of residence characteristics and later life hypertension, diabetes and ischemic heart disease 
  • Obesogenic Dietary Practices of Latino and Asian Subgroups of Children in California: An Analysis of the California Health Interview Survey, 2007-2012 
  • Prevalence of inadequate hydration among U.S. children and disparities by gender and race/ethnicity: National Health and Nutrition Examination Survey, 2009-2010. 
  • Racial/Ethnic Differences in Combat and non-Combat Associated Traumatic Brain Injury (TBI) Severity in the Veterans Health Administration (VHA): 2004-2010 
  • State Firearm Legislation and Nonfatal Firearm Injuries 
  • Higher Gasoline Prices Mean Safer Roads, But How Long Does it Take? 
  • Hispanic Men in the United States: Acculturation and Recent Sexual Behaviors with Female Partners, 2006-2010 
  • Latino Population Growth and Hospital Uncompensated Care in California
  • Environmental factors associated with social participation of older adults living in metropolitan, urban and rural areas, from the NuAge study 

The articles above were published online June 11, 2015, at 4 p.m. (EDT) by the American Journal of Public Health under “First Look.” “First Look” articles have undergone peer review, copyediting and approval by authors but have not yet been printed to paper or posted online by issue. The American Journal of Public Health is published by the American Public Health Association, www.apha.org, and is available at www.ajph.org.

Complimentary online access to the Journal is available to credentialed members of the media. Address inquiries to Kimberly Short at APHA, 202-777-2511, or email her. A single print issue of the Journal is available for $35 from the Journal’s Subscriptions department. If you are not a member of the press, a member of APHA or a subscriber, online single issue access is $30 and online single article is $22 at www.ajph.org or for direct customer service, call 202-777-2516, or email

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The American Journal of Public Health is the monthly journal of the American Public Health Association. APHA champions the health of all people and all communities by strengthening the profession of public health, sharing the latest research and information, promoting best practices and advocating for public health issues and policies grounded in research. More information is available at www.apha.org.