Publications by authors named "Thomas E Novotny"

69 Publications

The syndemic challenge of tuberculosis and tobacco use.

Tob Induc Dis 2021 22;19:20. Epub 2021 Mar 22.

School of Public Health, San Diego State University, San Diego, United States.

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http://dx.doi.org/10.18332/tid/133575DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7983221PMC
March 2021

Effects of Unfiltered Cigarettes on Smoking Behavior and Toxicant Exposure: Protocol for a Randomized Crossover Clinical Trial.

JMIR Res Protoc 2020 Dec 8;9(12):e19603. Epub 2020 Dec 8.

Division of Epidemiology and Biostatistics, School of Public Health, San Diego State University, San Diego, CA, United States.

Background: Plastic filters on cigarette butts are a widespread source of nonbiodegradable, toxic environmental waste. State and local legislation to ban the sale of single-use cigarettes may be considered to prevent this waste, but scientific evidence on the impact of switching smokers to unfiltered cigarettes on smoking behavior and toxicant exposures is needed to inform this policy. We have designed an open-label, randomized, 9-week, crossover clinical trial of adult filtered-cigarette smokers who switch to unfiltered cigarettes.

Objective: Our objective is to understand the impact of switching smokers of filtered cigarettes to unfiltered cigarettes on smoking behavior and toxic exposures.

Methods: This trial involves a 1-week baseline period; a 2-week period of smoking filtered or unfiltered cigarettes, where groups are randomly assigned; a 3-week washout period; another 1-week baseline period; and a 2-week crossover period of smoking the opposite condition (ie, filtered or unfiltered cigarettes) for a sufficient sample size of 40 participants. We will determine changes in (1) observed topography (ie, puff count, interpuff interval, and puff volume) and cigarettes smoked per day, via butt counts and self-report, (2) expired carbon monoxide and excretion of urinary cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol, and volatile organic compounds, and (3) participants' knowledge and attitudes toward unfiltered cigarettes, satisfaction with smoking, and intention to quit if they were not able to smoke filtered cigarettes.

Results: This study was funded in June 2018 and approved by the relevant Institutional Review Boards in July 2018. This study has enrolled 37 participants as of October 2020. Data analysis is currently underway, and trial results are expected to be published in spring 2021.

Conclusions: This pilot proof-of-principle study will inform the design of a larger, future research project that can provide robust scientific evidence on our research question. Such a large study could inform possible state or local legislation to ban the sale of single-use filtered cigarettes in order to mitigate the environmental impact of discarded single-use plastic filters.

Trial Registration: ClinicalTrials.gov NCT03749876; https://clinicaltrials.gov/ct2/show/NCT03749876.

International Registered Report Identifier (irrid): DERR1-10.2196/19603.
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http://dx.doi.org/10.2196/19603DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7755531PMC
December 2020

Perceptions About the Impact of Cigarette Filters on the Environment and Smoking-Related Behaviors.

J Adolesc Health 2021 Apr 4;68(4):823-826. Epub 2020 Dec 4.

Division of Adolescent Medicine, Department of Pediatrics, Stanford University, Palo Alto, California. Electronic address:

Purpose: Examine adolescents' and young adults' (AYAs) knowledge and perceptions about the composition and environmental harms of cigarette filters and determine how perceptions are associated with support for policy interventions.

Methods: Cross-sectional, convenience sample from 10 California schools. AYAs (N = 429; 70% < 21 years) were surveyed about tobacco use, perceptions of cigarette filters, their impact on the environment, and cigarette sales bans.

Results: Most agreed that filters are harmful to the environment and not biodegradable (89%, n = 383 respectively); fewer knew filters are made of plastic (43%, n = 185). AYAs who agreed that filters are harmful to the environment were more supportive of cigarette sales bans (OR = 2.78 [95% CI: 1.18, 6.58]).

Conclusions: Knowledge of the environmental harms of cigarettes among AYAs may strengthen support for tobacco control. More research is needed to further understand the knowledge and attitudes about the environmental impact of tobacco and to clarify how this might add support for tobacco-related policies.
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http://dx.doi.org/10.1016/j.jadohealth.2020.10.022DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8012214PMC
April 2021

Remediating Thirdhand Smoke Pollution in Multiunit Housing: Temporary Reductions and the Challenges of Persistent Reservoirs.

Nicotine Tob Res 2021 01;23(2):364-372

School of Public Health, San Diego State University, San Diego, CA.

Introduction: Toxic tobacco smoke residue, also known as thirdhand smoke (THS), can persist in indoor environments long after tobacco has been smoked. This study examined the effects of different cleaning methods on nicotine in dust and on surfaces.

Aims And Methods: Participants had strict indoor home smoking bans and were randomly assigned to: dry/damp cleaning followed by wet cleaning 1 month later (N = 10), wet cleaning followed by dry/damp cleaning (N = 10) 1 month later, and dry/damp and wet cleaning applied the same day (N = 28). Nicotine on surfaces and in dust served as markers of THS and were measured before, immediately after, and 3 months after the cleaning, using liquid chromatography with triple quadrupole mass spectrometry (LC-MS/MS).

Results: Over a 4-month period prior to cleaning, surface nicotine levels remained unchanged (GeoMean change: -11% to +8%; repeated measures r = .94; p < .001). Used separately, dry/damp and wet cleaning methods showed limited benefits. When applied in combination, however, we observed significantly reduced nicotine on surfaces and in dust. Compared with baseline, GeoMean surface nicotine was 43% lower immediately after (z = -3.73, p < .001) and 53% lower 3 months later (z = -3.96, p < .001). GeoMean dust nicotine loading declined by 60% immediately after (z = -3.55, p < .001) and then increased 3 months later to precleaning levels (z = -1.18, p = .237).

Conclusions: Cleaning interventions reduced but did not permanently remove nicotine in dust and on surfaces. Cleaning efforts for THS need to address persistent pollutant reservoirs and replenishment of reservoirs from new tobacco smoke intrusion. THS contamination in low-income homes may contribute to health disparities, particularly in children.

Implications: Administered sequentially or simultaneously, the tested cleaning protocols reduced nicotine on surfaces by ~50% immediately after and 3 months after the cleaning. Nicotine dust loading was reduced by ~60% immediately after cleaning, but it then rebounded to precleaning levels 3 months later. Cleaning protocols were unable to completely remove THS, and pollutants in dust were replenished from remaining pollutant reservoirs or new secondhand smoke intrusion. To achieve better outcomes, cleaning protocols should be systematically repeated to remove newly accumulated pollutants. New secondhand smoke intrusions need to be prevented, and remaining THS reservoirs should be identified, cleaned, or removed to prevent pollutants from these reservoirs to accumulate in dust and on surfaces.
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http://dx.doi.org/10.1093/ntr/ntaa151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7822102PMC
January 2021

Online Simulation Model to Estimate the Total Costs of Tobacco Product Waste in Large U.S. Cities.

Int J Environ Res Public Health 2020 06 30;17(13). Epub 2020 Jun 30.

Cigarette Butt Pollution Project and School of Public Health, San Diego State University, San Diego, CA 92182, USA.

Tobacco product waste (TPW) is one of the most ubiquitous forms of litter, accumulating in large amounts on streets, highways, sidewalks, beaches, parks, and other public places, and flowing into storm water drains, waste treatment plants, and solid waste collection facilities. In this paper, we evaluate the direct and indirect costs associated with TPW in the 30 largest U.S. cities. We first developed a conceptual framework for the analysis of direct and indirect costs of TPW abatement. Next, we applied a simulation model to estimate the total costs of TPW in major U.S. cities. This model includes data on city population, smoking prevalence rates, and per capita litter mitigation costs. Total annual TPW-attributable mean costs for large US cities range from US$4.7 million to US$90 million per year. Costs are generally proportional to population size, but there are exceptions in cities that have lower smoking prevalence rates. The annual mean per capita TPW cost for the 30 cities was US$6.46, and the total TPW cost for all 30 cities combined was US$264.5 million per year. These estimates for the TPW-attributable cost are an important data point in understanding the negative economic externalities created by cigarette smoking and resultant TPW cleanup costs. This model provides a useful tool for states, cities, and other jurisdictions with which to evaluate a new economic cost outcome of smoking and to develop new laws and regulations to reduce this burden.
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http://dx.doi.org/10.3390/ijerph17134705DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7369877PMC
June 2020

Persistent tobacco smoke residue in multiunit housing: Legacy of permissive indoor smoking policies and challenges in the implementation of smoking bans.

Prev Med Rep 2020 Jun 2;18:101088. Epub 2020 Apr 2.

San Diego State University School of Public Health, San Diego, CA, USA.

Secondhand smoke (SHS) is a common indoor pollutant in multiunit housing (MUH). It is also the precursor of thirdhand smoke (THS), the toxic mixture of tobacco smoke residue that accumulates in indoor environments where tobacco has been used. This study examined the levels, distribution, and factors associated with THS pollution in low-income MUH. Interviews were conducted 2016-2018 in a cross-sectional study of N = 220 MUH homes in San Diego, California. Two surface wipe samples were collected per home and analyzed for nicotine, a THS marker, using liquid chromatography-triple quadrupole mass spectrometry. Nicotine was detected in all homes of nonsmokers with indoor smoking bans (Geo Mean = 1.67 µg/m; 95% CI = [1.23;2.30]) and smokers regardless of an indoor ban (Geo Mean = 4.80 µg/m; 95% CI = [1.89;12.19]). Approximately 10% of nonsmokers' homes with smoking bans showed nicotine levels higher than the average level in homes of smokers without smoking bans from previous studies (≥30 µg/m). Housing for seniors, smoking bans on balconies, indoor tobacco use, difficult to reach surfaces, and self-reported African-American race/ethnicity were independently associated with higher THS levels. Individual cases demonstrated that high levels of surface nicotine may persist in nonsmoker homes for years after tobacco use even in the presence of indoor smoking bans. To achieve MUH free of tobacco smoke pollutants, attention must be given to identifying and remediating highly polluted units and to implementing smoking policies that prevent new accumulation of THS. As THS is a form of toxic tobacco product waste, responsibility for preventing and mitigating harmful impacts should include manufacturers, suppliers, and retailers.
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http://dx.doi.org/10.1016/j.pmedr.2020.101088DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7186560PMC
June 2020

How Should Physicians in Low- and Middle-Income Countries Regard Electronic Nicotine Delivery Systems to Facilitate Smoking Cessation?

AMA J Ethics 2020 02 1;22(2):E82-92. Epub 2020 Feb 1.

A doctoral student in public health and policy at the London School of Hygiene and Tropical Medicine and entered specialty training in August 2016 as a public health specialty registrar and a National Institute for Health Research Academic Clinical Fellow.

Electronic nicotine delivery systems (ENDS) have been widely referred to as "safer," "healthier," and more "effective" smoking cessation aids, but little evidence supports such claims. New concerns about pulmonary injuries associated with ENDS suggest reasons for concern about these products' health risks and potential for nicotine addiction. Nevertheless, multinational tobacco companies heavily market ENDS to retain customers with nicotine addiction, and global progress against tobacco use might slow as a result. The tobacco industry has managed to divide the tobacco control community by offering hope of harm reduction without actual evidence of ENDS' effectiveness or long-term safety. Low- and middle-income countries need this evidence to assess ENDS' value in mitigating tobacco use.
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http://dx.doi.org/10.1001/amajethics.2020.82DOI Listing
February 2020

No more butts.

BMJ 2019 Oct 23;367:l5890. Epub 2019 Oct 23.

Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.

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http://dx.doi.org/10.1136/bmj.l5890DOI Listing
October 2019

Environmental accountability for tobacco product waste.

Authors:
Thomas E Novotny

Tob Control 2019 May 30. Epub 2019 May 30.

School of Public Health, San Diego State University, San Diego, CA 92182, USA

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http://dx.doi.org/10.1136/tobaccocontrol-2019-055023DOI Listing
May 2019

Global Health Perspectives on Cigarette Butts and the Environment.

Int J Environ Res Public Health 2019 05 26;16(10). Epub 2019 May 26.

School of Public Health, San Diego State University, San Diego, CA 92106, USA.

Cigarette butts, whuch are also known as tobacco product waste (TPW), are the single most collected item in environmental trash cleanups worldwide. This study used an online survey tool (Qualtrics) to assess knowledge, attitudes, and perceptions regarding this issue among individuals representing the Framework Convention Alliance (FCA). The FCA has about 680 members on its listserv, including non-governmental tobacco control advocacy groups that support the implementation of the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC). Respondents ( = 65) represented countries from all six WHO regions. The majority (82%) had heard the term TPW, and they all considered TPW as an environmental harm at some level. Additionally, 29% of respondents failed to identify that "cigarette filters make smoking easier". Most (73%) correctly identified TPW components; however, fewer (60%) correctly identified the composition of cigarette butts. The majority (57%) were unfamiliar with Extended Producer Responsibility (EPR) and Product Stewardship (PS) as possible environmental intervention strategies. Respondents expressing opinions concurred that adding a litter fee to fund TPW programs will aid in reducing tobacco use and reduce the environmental impacts of TPW (100%); that prevention, reduction, and mitigation of TPW could be an important part of international tobacco control programs (98%); and, that banning smoking in outdoor venues could reduce TPW (95%). Only 16% reported effective prevention or clean-up efforts in their countries. Weighted rankings revealed that respondents' saw the national government, the tobacco industry, and state governments as the most important in addressing TPW. The results of this research will inform continuing international discussions by the FCTC Conference of the Parties (COP) regarding environmental policies that may be addressed within FCTC obligations.
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http://dx.doi.org/10.3390/ijerph16101858DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6572616PMC
May 2019

The benefits of taxing cigarettes in middle income countries.

BMJ 2018 04 11;361:k1433. Epub 2018 Apr 11.

Graduate School of Public Health, San Diego State University, San Diego, CA, USA.

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http://dx.doi.org/10.1136/bmj.k1433DOI Listing
April 2018

Applied global health diplomacy: profile of health diplomats accredited to the UNITED STATES and foreign governments.

Global Health 2018 01 11;14(1). Epub 2018 Jan 11.

Department of Medicine, Division of Global Public Health, University of California, San Diego School of Medicine, San Diego, CA, USA.

Background: Global health diplomacy (GHD) is a burgeoning field bridging the priorities of global health and foreign affairs. Given the increasing need to mobilize disparate global health stakeholders coupled with the need to design complex public health partnerships to tackle issues of international concern, effective and timely cooperation among state actors is critical. Health Attachés represent this coordination focal point and are key diplomatic professionals at the forefront of GHD. Despite their unique mandate, little is published about this profession and the perspectives of those who work in the field.

Methods: Through purposive sampling, we performed in-depth qualitative interviews with seven Health Attachés: three foreign Health Attachés accredited to the United States and four U.S. Health Attachés accredited to foreign governments. Our interviews explored four key topics: the role and mission of Health Attachés, skills needed to perform GHD, examples of successes and challenges in accomplishing their respective missions, and suggestions for the future development of the diplomatic profession.

Results: We identified several lessons to apply to the growing field of GHD. First, GHD actors need to receive appropriate training to successfully negotiate the intersection of global health and foreign affairs. Participants suggested several areas of training that would benefit GHD actors: diplomacy and negotiation, applied science, and cross-cultural competency. Second, participants articulated the need for a career path for GHD practitioners, increased opportunities for on-the-job training and mentored experiences, and GHD competencies with defined levels of mastery that can be used in occupational evaluation and career development.

Conclusions: Our findings indicate that skills in diplomacy and negotiation, applied science, and cross cultural competency are essential for the statecraft of Health Attachés. Additionally, establishing a clear career pathway for Health Attachés is critical for future maturation of the profession and for fostering effective global health action that aligns public health and foreign diplomacy outcomes. Achieving these goals would ensure that this special cadre of diplomats could effectively practice GHD and would also better position Health Attachés to take the lead in advancing shared global health goals among nation states in a new era of twenty-first century diplomacy.
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http://dx.doi.org/10.1186/s12992-017-0316-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5765610PMC
January 2018

Coronary Artery Calcium Volume and Density: Potential Interactions and Overall Predictive Value: The Multi-Ethnic Study of Atherosclerosis.

JACC Cardiovasc Imaging 2017 08;10(8):845-854

Department of Family Medicine and Public Health, University of California, San Diego, La Jolla, California.

Objectives: This study sought to determine the possibility of interactions between coronary artery calcium (CAC) volume or CAC density with each other, and with age, sex, ethnicity, the new atherosclerotic cardiovascular disease (ASCVD) risk score, diabetes status, and renal function by estimated glomerular filtration rate, and, using differing CAC scores, to determine the improvement over the ASCVD risk score in risk prediction and reclassification.

Background: In MESA (Multi-Ethnic Study of Atherosclerosis), CAC volume was positively and CAC density inversely associated with cardiovascular disease (CVD) events.

Methods: A total of 3,398 MESA participants free of clinical CVD but with prevalent CAC at baseline were followed for incident CVD events.

Results: During a median 11.0 years of follow-up, there were 390 CVD events, 264 of which were coronary heart disease (CHD). With each SD increase of ln CAC volume (1.62), risk of CHD increased 73% (p < 0.001) and risk of CVD increased 61% (p < 0.001). Conversely, each SD increase of CAC density (0.69) was associated with 28% lower risk of CHD (p < 0.001) and 25% lower risk of CVD (p < 0.001). CAC density was inversely associated with risk at all levels of CAC volume (i.e., no interaction was present). In multivariable Cox models, significant interactions were present for CAC volume with age and ASCVD risk score for both CHD and CVD, and CAC density with ASCVD risk score for CVD. Hazard ratios were generally stronger in the lower risk groups. Receiver-operating characteristic area under the curve and Net Reclassification Index analyses showed better prediction by CAC volume than by Agatston, and the addition of CAC density to CAC volume further significantly improved prediction.

Conclusions: The inverse association between CAC density and incident CHD and CVD events is robust across strata of other CVD risk factors. Added to the ASCVD risk score, CAC volume and density provided the strongest prediction for CHD and CVD events, and the highest correct reclassification.
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http://dx.doi.org/10.1016/j.jcmg.2017.04.018DOI Listing
August 2017

Tobacco industry responsibility for butts: a Model Tobacco Waste Act.

Tob Control 2017 01 1;26(1):113-117. Epub 2016 Mar 1.

ChangeLab Solutions, Oakland, California, USA.

Cigarette butts and other postconsumer products from tobacco use are the most common waste elements picked up worldwide each year during environmental cleanups. Under the environmental principle of Extended Producer Responsibility, tobacco product manufacturers may be held responsible for collection, transport, processing and safe disposal of tobacco product waste (TPW). Legislation has been applied to other toxic and hazardous postconsumer waste products such as paints, pesticide containers and unused pharmaceuticals, to reduce, prevent and mitigate their environmental impacts. Additional product stewardship (PS) requirements may be necessary for other stakeholders and beneficiaries of tobacco product sales and use, especially suppliers, retailers and consumers, in order to ensure effective TPW reduction. This report describes how a Model Tobacco Waste Act may be adopted by national and subnational jurisdictions to address the environmental impacts of TPW. Such a law will also reduce tobacco use and its health consequences by raising attention to the environmental hazards of TPW, increasing the price of tobacco products, and reducing the number of tobacco product retailers.
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http://dx.doi.org/10.1136/tobaccocontrol-2015-052737DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5256370PMC
January 2017

The environmental and health impacts of tobacco agriculture, cigarette manufacture and consumption.

Bull World Health Organ 2015 Dec 22;93(12):877-80. Epub 2015 Oct 22.

Tobacco Free Initiative, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland .

The health consequences of tobacco use are well known, but less recognized are the significant environmental impacts of tobacco production and use. The environmental impacts of tobacco include tobacco growing and curing; product manufacturing and distribution; product consumption; and post-consumption waste. The World Health Organization's Framework Convention on Tobacco Control addresses environmental concerns in Articles 17 and 18, which primarily apply to tobacco agriculture. Article 5.3 calls for protection from policy interference by the tobacco industry regarding the environmental harms of tobacco production and use. We detail the environmental impacts of the tobacco life-cycle and suggest policy responses.
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http://dx.doi.org/10.2471/BLT.15.152744DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4669730PMC
December 2015

Extended Producer Responsibility and Product Stewardship for Tobacco Product Waste.

Int J Waste Resour 2014 Sep 4;4(3). Epub 2014 Sep 4.

Chief Executive Officer, Cigarette Butt Pollution Project and Professor of Epidemiology, Graduate School of Public Health, San Diego State University, USA.

This paper reviews several environmental principles, including Extended Producer Responsibility (EPR), Product Stewardship (PS), the Polluter Pays Principle (PPP), and the Precautionary Principle, as they may apply to tobacco product waste (TPW). The review addresses specific criteria that apply in deciding whether a particular toxic product should adhere to these principles; presents three case studies of similar approaches to other toxic and/or environmentally harmful products; and describes 10 possible interventions or policy actions that may help prevent, reduce, and mitigate the effects of TPW. EPR promotes total lifecycle environmental improvements, placing economic, physical, and informational responsibilities onto the tobacco industry, while PS complements EPR, but with responsibility shared by all parties involved in the tobacco product lifecycle. Both principles focus on toxic source reduction, post-consumer take-back, and final disposal of consumer products. These principles when applied to TPW have the potential to substantially decrease the environmental and public health harms of cigarette butts and other TPW throughout the world. TPW is the most commonly littered item picked up during environmental, urban, and coastal cleanups globally.
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http://dx.doi.org/10.4172/2252-5211.1000157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4597783PMC
September 2014

Perspectives on Tobacco Product Waste: A Survey of Framework Convention Alliance Members' Knowledge, Attitudes, and Beliefs.

Int J Environ Res Public Health 2015 Aug 18;12(8):9683-91. Epub 2015 Aug 18.

Graduate School of Public Health, San Diego State University, San Diego, CA 92106, USA.

Cigarette butts (tobacco product waste (TPW)) are the single most collected item in environmental trash cleanups worldwide. This brief descriptive study used an online survey tool (Survey Monkey) to assess knowledge, attitudes, and beliefs among individuals representing the Framework Convention Alliance (FCA) about this issue. The FCA has about 350 members, including mainly non-governmental tobacco control advocacy groups that support implementation of the World Health Organization's (WHO) Framework Convention on Tobacco Control (FCTC). Although the response rate (28%) was low, respondents represented countries from all six WHO regions. The majority (62%) have heard the term TPW, and nearly all (99%) considered TPW as an environmental harm. Most (77%) indicated that the tobacco industry should be responsible for TPW mitigation, and 72% felt that smokers should also be held responsible. This baseline information may inform future international discussions by the FCTC Conference of the Parties (COP) regarding environmental policies that may be addressed within FCTC obligations. Additional research is planned regarding the entire lifecycle of tobacco's impact on the environment.
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http://dx.doi.org/10.3390/ijerph120809683DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4555306PMC
August 2015

The tobacco endgame: is it possible?

Authors:
Thomas E Novotny

PLoS Med 2015 May 29;12(5):e1001832. Epub 2015 May 29.

Division of Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, San Diego, California, United States.

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http://dx.doi.org/10.1371/journal.pmed.1001832DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4449011PMC
May 2015

Tobacco Product Waste: An Environmental Approach to Reduce Tobacco Consumption.

Curr Environ Health Rep 2014 6;1:208-216. Epub 2014 May 6.

Graduate School of Public Health, San Diego State University, 5500 Campanile Drive, Hardy Tower 119, San Diego, CA 92182 USA.

Cigarette butts and other tobacco product wastes (TPW) are the most common items picked up in urban and beach cleanups worldwide. TPW contains all the toxins, nicotine, and carcinogens found in tobacco products, along with the plastic nonbiodegradable filter attached to almost all cigarettes sold in the United States and in most countries worldwide. Toxicity studies suggest that compounds leached from cigarette butts in salt and fresh water are toxic to aquatic micro-organisms and test fish. Toxic chemicals have also been identified in roadside TPW. With as much as two-thirds of all smoked cigarettes (numbering in the trillions globally) being discarded into the environment each year, it is critical to consider the potential toxicity and remediation of these waste products. This article reviews reports on the toxicity of TPW and recommends several policy approaches to mitigation of this ubiquitous environmental blight.
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http://dx.doi.org/10.1007/s40572-014-0016-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4129234PMC
May 2014

The Association between active and passive smoking and latent tuberculosis infection in adults and children in the united states: results from NHANES.

PLoS One 2014 24;9(3):e93137. Epub 2014 Mar 24.

San Diego State University, Graduate School of Public Health, San Diego, California, United States of America.

Background: Few studies assessing the relationship between active and passive smoking and tuberculosis have used biomarkers to measure smoke exposure. We sought to determine the association between active and passive smoking and LTBI in a representative sample of US adults and children.

Methods: We used the 1999-2000 US National Health and Nutrition Examination Survey (NHANES) dataset with tuberculin skin test (TST) data to assess the association between cotinine-confirmed smoke exposure and latent tuberculosis infection (LTBI) among adults ages ≥20 years (n = 3598) and children 3-19 years (n = 2943) and estimate the prevalence of smoke exposure among those with LTBI. Weighted multivariate logistic regression was used to measure the associations between active and passive smoking and LTBI.

Results: LTBI prevalence in 1999-2000 among cotinine-confirmed active, passive, and non-smoking adults and children was 6.0%, 5.2%, 3.3% and 0.3%, 1.0%, 1.5%, respectively. This corresponds to approximately 3,556,000 active and 3,379,000 passive smoking adults with LTBI in the US civilian non-institutionalized population in 1999-2000. Controlling for age, gender, socioeconomic status, race, birthplace (US vs. foreign-born), household size, and having ever lived with someone with TB, adult active smokers were significantly more likely to have LTBI than non-smoking adults (AOR = 2.31 95% CI 1.17-4.55). Adult passive smokers also had a greater odds of LTBI compared with non-smokers, but this association did not achieve statistical significance (AOR = 2.00 95% CI 0.87-4.60). Neither active or passive smoking was associated with LTBI among children. Among only the foreign-born adults, both active (AOR = 2.56 (95% CI 1.20-5.45) and passive smoking (AOR = 2.27 95% CI 1.09-4.72) were significantly associated with LTBI.

Conclusions: Active adult smokers and both foreign-born active and passive smokers in the United States are at elevated risk for LTBI. Targeted smoking prevention and cessation programs should be included in comprehensive national and international TB control efforts.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093137PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3963991PMC
November 2014

Smoking cessation and respiratory disease in low-income and middle-income countries.

Lancet Respir Med 2013 Jul 8;1(5):e23-4. Epub 2013 Jul 8.

Department of Health Sciences, University of York, York, YO10 5ZF, UK.

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http://dx.doi.org/10.1016/S2213-2600(13)70123-1DOI Listing
July 2013

An early-stage epidemic: a systematic review of correlates of smoking among Chinese women.

Int J Behav Med 2014 Aug;21(4):653-61

Sydney School of Public Health, The University of Sydney, Sydney, Australia,

Background: Despite the historically low smoking prevalence among Chinese women, there is a trend of future increase.

Purpose: We systematically reviewed the correlates of smoking among Chinese girls and women.

Method: We conducted a systematic review of literature on correlates of smoking among Chinese women using Medline and China Academic Journals databases. Following the PRISMA statement, two investigators independently searched for literature, identified and reviewed papers, assessed the quality of the papers, and extracted information. The characteristics of studies and correlates of smoking were synthesized separately for youth and adults.

Results: A total of 15 articles (11 on adults, 4 on youth) met the inclusion criteria. Based on these studies, peer smoking was the most consistent correlate of smoking among Chinese girls. Among Chinese women, partner smoking, job-related stress, and exposure to cigarettes made for women were consistent correlates of smoking. Knowledge of harms and negative attitudes towards smoking were found to be negatively associated with smoking.

Conclusion: Overall, the evidence base for smoking among Chinese women is limited. Although smoking among Chinese women is still at an early stage, it is becoming more prevalent among specific population subgroups, such as rural-to-urban migrant workers. Although further research is needed, findings from the current study provide a roadmap for research and policy on prevention of smoking among Chinese girls and women.
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http://dx.doi.org/10.1007/s12529-013-9367-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4605608PMC
August 2014

Cigarette smoking and quit attempts among injection drug users in Tijuana, Mexico.

Nicotine Tob Res 2013 Dec 19;15(12):2060-8. Epub 2013 Jul 19.

Joint Doctoral Program in Public Health (Global Health), San Diego State University/University of California San Diego, San Diego, CA;

Introduction: Injection drug use and cigarette smoking are major global health concerns. Limited data exist regarding cigarette smoking behavior and quit attempts among injection drug users (IDUs) in low- and middle-income countries to inform the development of cigarette smoking interventions. We conducted a cross-sectional study to describe cigarette smoking behavior and quit attempts among IDUs in Tijuana, Mexico.

Methods: IDUs were recruited through community outreach and administered in-person interviews. Multivariable Poisson regression models were constructed to determine prevalence ratios (PRs) for quit attempts.

Results: Of the 670 participants interviewed, 601 (89.7%) were current smokers. Of these, median number of cigarettes smoked daily was 10; 190 (31.6%) contemplated quitting smoking in the next 6 months; 132 (22.0%) had previously quit for ≥1 year; and 124 (20.6%) had made a recent quit attempt (lasting ≥1 day during the previous 6 months). In multivariable analysis, recent quit attempts were positively associated with average monthly income (≥3,500 pesos [US$280] vs. <1,500 pesos [US$120]; PR = 2.30; 95% CI = 1.57-3.36), smoking marijuana (PR = 1.38; 95% CI = 1.01-2.90), and smoking heroin (PR = 1.85; 95% CI = 1.23-2.78), and they were negatively associated with number of cigarettes smoked daily (PR = 0.96; 95% CI = 0.94-0.98).

Conclusions: One out of 5 IDUs attempted to quit cigarette smoking during the previous 6 months. Additional research is needed to improve the understanding of the association between drug use patterns and cigarette smoking quit attempts, including the higher rate of quit attempts observed among IDUs who smoke marijuana or heroin compared with IDUs who do not smoke these substances.
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http://dx.doi.org/10.1093/ntr/ntt099DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3819980PMC
December 2013

Acceptability and adoption of handheld computer data collection for public health research in China: a case study.

BMC Med Inform Decis Mak 2013 Jun 26;13(1):68. Epub 2013 Jun 26.

Institute of Basic Medical Sciences at Chinese Academy of Medical Sciences /School of Basic Medicine, Peking Union Medical College, Beijing, China.

Background: Handheld computers for data collection (HCDC) and management have become increasingly common in health research. However, current knowledge about the use of HCDC in health research in China is very limited. In this study, we administered a survey to a hard-to-reach population in China using HCDC and assessed the acceptability and adoption of HCDC in China.

Methods: Handheld computers operating Windows Mobile and Questionnaire Development Studio (QDS) software (Nova Research Company) were used for this survey. Questions on tobacco use and susceptibility were drawn from the Global Adult Tobacco Survey (GATS) and other validated instruments, and these were programmed in Chinese characters by local staff. We conducted a half-day training session for survey supervisors and a three-day training session for 20 interviewers and 9 supervisors. After the training, all trainees completed a self-assessment of their skill level using HCDC. The main study was implemented in fall 2010 in 10 sites, with data managed centrally in Beijing. Study interviewers completed a post-survey evaluation questionnaire on the acceptability and utility of HCDC in survey research.

Results: Twenty-nine trainees completed post-training surveys, and 20 interviewers completed post-data collection questionnaires. After training, more than 90% felt confident about their ability to collect survey data using HCDC, to transfer study data from a handheld computer to a laptop, and to encrypt the survey data file. After data collection, 80% of the interviewers thought data collection and management were easy and 60% of staff felt confident they could solve problems they might encounter. Overall, after data collection, nearly 70% of interviewers reported that they would prefer to use handheld computers for future surveys. More than half (55%) felt the HCDC was a particularly useful data collection tool for studies conducted in China.

Conclusions: We successfully conducted a health-related survey using HCDC. Using handheld computers for data collection was a feasible, acceptable, and preferred method by Chinese interviewers. Despite minor technical issues that occurred during data collection, HCDC is a promising methodology to be used in survey-based research in China.
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http://dx.doi.org/10.1186/1472-6947-13-68DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3706303PMC
June 2013

Irreconcilable conflict: the tobacco industry and the public health challenge of tobacco use.

Authors:
Thomas E Novotny

PLoS Med 2013 28;10(5):e1001457. Epub 2013 May 28.

Graduate School of Public Health, San Diego State University, San Diego, California, USA.

Thomas Novotny reflects on new research by Stanton Glantz and colleagues and the implications of their findings for engaging the tobacco industry on tobacco product regulation.
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http://dx.doi.org/10.1371/journal.pmed.1001457DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3665893PMC
October 2013

Evolution of tobacco labeling and packaging: international legal considerations and health governance.

Am J Public Health 2013 Apr 14;103(4):e39-43. Epub 2013 Feb 14.

Institute of Health Law Studies, California Western School of Law, San Diego, California, USA.

Numerous national governments have recently adopted packaging and labeling legislation to curb global tobacco uptake. This coincides with the World Health Organization's 2011 World No Tobacco Day, which recognized the extraordinary progress of the Framework Convention on Tobacco Control (FCTC). The tobacco industry has presented legal challenges to countries, including Australia, Uruguay, and the United States, for enacting legislation meeting or exceeding FCTC obligations. We argue that national governments attempting to meet the obligations set forth in public health treaties such as the FCTC should be afforded flexibilities and protection in developing tobacco control laws and regulations, because these measures are necessary to protect public health and should be explicitly recognized in international trade and legal agreements.
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http://dx.doi.org/10.2105/AJPH.2012.301029DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3673250PMC
April 2013

Feasibility study of a smoking cessation intervention in Directly Observed Therapy Short-Course tuberculosis treatment clinics in Rio de Janeiro, Brazil.

Rev Panam Salud Publica 2012 Dec;32(6):451-6

Hospital Universitário Clementino Fraga Filho, Universidade Federal de Rio de Janeiro, Rio de Janeiro, Brazil.

A pilot feasibility study was conducted to determine whether Directly Observed Therapy Short-Course (DOTS) workers could be trained to deliver smoking cessation counseling and referral interventions, identify potential barriers to a full-scale randomized controlled trial on the effectiveness of integrated smoking cessation in DOTS, and determine whether tuberculosis (TB) patients who smoke would agree to participate in such a program. DOTS providers in two Rio de Janeiro primary health clinics received 1-day training in cessation counseling. They completed pre- and post-training surveys and participated in post-program focus groups. Patients were surveyed 3 months after program completion, and semiquantitative urine assays for cotinine were used to confirm cessation. Providers' mean self-efficacy scores for cessation counseling improved significantly (advise to quit, assess readiness, assist with quitting, and arrange follow-up) from scores (on a scale of 1-5) of 2-3 pre-training to 3-4 post-training (P < 0.05), with only ability to change motivation not significant. Providers' knowledge about cessation (withdrawal, nicotine replacement therapy, precontemplation) was low before training and did not improve after training (P > 0.1 for all comparisons). Implementation of a smoking cessation intervention by DOTS providers in TB clinics in Brazil is feasible. Randomized controlled trials to test intervention effectiveness in reducing TB-related morbidity must include cross-training for tobacco control and TB providers. Smoking cessation in DOTS programs may be important in reducing the global burden of TB, improving the health of TB patients, and reducing TB transmission in households.
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December 2012

Cigarette-Smoking Intensity and Interferon-Gamma Release Assay Conversion among Persons Who Inject Drugs: A Cohort Study.

Pulm Med 2012 10;2012:828106. Epub 2012 Dec 10.

San Diego State University, 5500 Campanile Drive, San Diego, CA 92182-4162, USA ; Division of Global Public Health, Department of Medicine, School of Medicine, University of California San Diego, 9500 Gilman Drive, MC-0507, San Diego, CA 92093-0507, USA.

We analyzed data from a longitudinal cohort study of persons who inject drugs (PWID) in Tijuana, Mexico, to explore whether cigarette smoking increases the risk of interferon gamma release assay (IGRA) conversion. PWID were recruited using respondent driven sampling (RDS). QuantiFERON-TB Gold In-Tube (QFT) assay conversion was defined as interferon-gamma concentrations <0.35 IU/mL at baseline and ≥0.7 IU/mL at 18 months. We used multivariable Poisson regression adjusted for RDS weights to estimate risk ratios (RRs). Of 129 eligible participants, 125 (96.9%) smoked at least one cigarette during followup with a median of 11 cigarettes smoked daily, and 52 (40.3%) had QFT conversion. In bivariate analysis, QFT conversion was not associated with the number of cigarettes smoked daily (P = 0.716). Controlling for age, gender, education, and alcohol use, the RRs of QFT conversion for smoking 6-10, 11-15, and ≥16 cigarettes daily compared to smoking 0-5 cigarettes daily were 0.9 (95% confidence interval (CI), 0.5-1.6), 0.5 (95% CI, 0.3-1.2), and 0.7 (95% CI, 0.3-1.6), respectively. Although this study did not find an association between self-reported smoking intensity and QFT conversion, it was not powered sufficiently to negate such an association. Larger longitudinal studies are needed to fully explore this relationship.
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http://dx.doi.org/10.1155/2012/828106DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529865PMC
January 2013

Perceived discrimination and smoking among rural-to-urban migrant women in China.

J Immigr Minor Health 2013 Feb;15(1):132-40

Joint Doctoral Program in Public Health, San Diego State University/University of California, San Diego, San Diego, CA, USA.

Smoking may be a coping mechanism for psychosocial stress caused by discrimination. We conducted a cross-sectional survey of rural-to-urban migrant women working as restaurant/hotel workers (RHWs) and those working as sex workers (FSWs) in 10 Chinese cities to investigate whether perceived discrimination is associated with smoking. We interviewed RHWs at medical examination clinics and FSWs at entertainment venues. Modified Poisson regression was used to estimate prevalence ratios. Of the 1,696 RHWs and 532 FSWs enrolled, 155 (9.1%) and 63 (11.8%) reported perceived discrimination, respectively. Perceived discrimination was independently associated with ever tried smoking (prevalence ratio [PR], 1.71; 95% confidence interval [CI], 1.31-2.23) and current smoking (PR, 2.52; 95% CI, 1.32-4.79) among RHWs and ever tried smoking (PR, 1.36; 95% CI, 1.16-1.61) and current smoking (PR, 1.63; 95% CI, 1.28-2.06) among FSWs. Perceived discrimination is associated with higher prevalence of smoking among rural-to-urban migrant women in China.
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http://dx.doi.org/10.1007/s10903-012-9599-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3544985PMC
February 2013

Environmental health impacts of tobacco farming: a review of the literature.

Tob Control 2012 Mar;21(2):191-6

International Development Research Centre, Ottawa, Ontario, Canada.

Objective: To review the literature on environmental health impacts of tobacco farming and to summarise the findings and research gaps in this field.

Methods: A standard literature search was performed using multiple electronic databases for identification of peer-reviewed articles. The internet and organisational databases were also used to find other types of documents (eg, books and reports). The reference lists of identified relevant documents were reviewed to find additional sources.

Results: The selected studies documented many negative environmental impacts of tobacco production at the local level, often linking them with associated social and health problems. The common agricultural practices related to tobacco farming, especially in low-income and middle-income countries, lead to deforestation and soil degradation. Agrochemical pollution and deforestation in turn lead to ecological disruptions that cause a loss of ecosystem services, including land resources, biodiversity and food sources, which negatively impact human health. Multinational tobacco companies' policies and practices contribute to environmental problems related to tobacco leaf production.

Conclusions: Development and implementation of interventions against the negative environmental impacts of tobacco production worldwide are necessary to protect the health of farmers, particularly in low-income and middle-income countries. Transitioning these farmers out of tobacco production is ultimately the resolution to this environmental health problem. In order to inform policy, however, further research is needed to better quantify the health impacts of tobacco farming and evaluate the potential alternative livelihoods that may be possible for tobacco farmers globally.
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http://dx.doi.org/10.1136/tobaccocontrol-2011-050318DOI Listing
March 2012