Research Paper On Smoking In Public Places

Sample 1. Smoking Ban in Public Places

Tobacco as a stimulant can be used in several different ways but the most common way it is used is smoking it in the form of cigarettes. Smoking is legal in most countries in the world but in the last couple of years there have been debates about whether or not smokers should be allowed to smoke anywhere they want. It is common knowledge that the ban of smoking in public places is majorly for the protection of non smokers from the side effects of smoking, but there are other factors which inform the decision to impose a ban on smoking in public places (Robbins 38). This paper seeks to investigate both the benefits and side effects of smoking in public and finally argue a case for or against the ban on smoking in public places.

Proponents of the ban of smoking in public places argue that because not everyone is a smoker, the smell of cigarette smoke is offensive to non-smokers. They also cite the health effects that second hand cigarette smoke has on the non-smokers who are fond of being around smokers. Some radical proposers to the ban, who also support a total ban on the use of tobacco, further cite the effects that smoking has on the health of the smokers themselves. On the other hand, opponents of the ban argue that if smoking in public places should be illegal then cigarettes would be illegal or contraband products. They also argue that smoking ban in public places is an infringement into their particular rights as people who engage in a legitimate act. Another reason why smokers feel offended by ban in public smoking is the fact that smoking as a practice is protected by the law and as it stands, they are engaging in a legal activity which should not be interfered with. Some of them go as far as arguing that there are more harmful environmental hazards like industrial smoke, motor vehicles exhaust fumes and smoke resulting from the burning of trash or garbage (Sloan 85). These, they argue, have greater environmental effects than just smoking. Some opponents also say that the general public has no reason to think that everybody’s natural goal is or must be to maximise their lifespan.

There are several economic benefits directly attached to the production and sale of tobacco in many parts of the world. Tobacco has been known to support agricultural output, earn several countries foreign revenue for being a major export commodity, provide income for households, and generate both direct and indirect employment in many countries. For instance, in Greece, the northern parts of the country are mostly mountainous and do not support much agriculture other than tobacco cultivation. In fact, it is deemed as one of the most profitable and stable segments of the agriculture sector in Greece earning the farmers an average of 7,000 – 10,000 euro per hectare and during the recent economic downturn, only 25% of the total jobs lost were lost in the tobacco industry (Hahn et al, 2009). Tobacco employs most of the residents of northern Greece both directly, through cultivation of the crop, and indirectly, mainly in the processing, sales and distribution of the finished product. Other countries which benefit socio-economically from the culture of tobacco include Brazil; Malawi, in Africa; Canada; and the United States, especially the state of Kentucky.

Tobacco as a stimulant also has some health benefits. Research shows that the nicotine in tobacco as a mild stimulant acts within the nervous system to help in relaxation and reduce anxiety (Sloan, 2004). Tobacco also increases the rate of metabolism in the human body and suppresses appetite. These effects can help one to reduce body weight and keep obesity in check. Smoking has also been linked to lowering the risk of Parkinson’s disease and some forms of heart attacks.

On the flipside, research has also revealed a lot of negatives about smoking especially in public places. It has been proven that second hand smoke can cause breathing problems to non smokers (Hahn et al, 2009). This happens when a non smoker, especially one who is allergic to smoke, inhales the smoke exhaled by the smoker and the smoke reaches his or her respiratory system causing itchiness in their systems thereby causing inflammations in the lungs resulting in difficulty in breathing problems and sometimes respiratory diseases. Second hand smoke also causes eyesores especially to non smokers who are allergic to smoke (Shetty, 2009). This is as a result of smoke coming into contact with the non smoker’s eyes resulting to itching of the eyes.

Medical research has also shown that second hand smoke, just like the first smoke inhaled by the smoker, can lead to heart diseases (Shetty, 2009). The cause of heart diseases is attributed to the stimulation effect of nicotine which increases pulse rate. With time the heart develops some kind of dependency on nicotine and in the event that nicotine is lacking or in short supply, the heart’s functioning is interfered with. Smoking and exposure second hand smoke are also likely causes of several forms of cancer, but most commonly lung cancer and cervical cancer. This is as a result of the tar present in tobacco, which is capable of changing the structures of the body’s cells. This contributes to the causes of the various forms of cancer…

Sample 2. Do e-cigarettes really not so harmful for health as traditional cigarettes or this opinion has appeared due to well-thought marketing strategy?

It is known the fact that habit is quite a strong phenomenon in human life. There are many habits that are quite easy to get, it can be done even accidentally. However, it can be difficult to break a habit. As far as breaking the habit can be quite difficult, it is common practice to try not to destroy the habit at all but change it in some more positive way. Nowadays people see such positive way in e-cigarettes as alternatives to the traditional tobacco cigarettes. A popularity of e-cigarettes and their widespread image as a harmless alternative to the traditional tobacco cigarettes could be the reason why there is quite a high number of studies which consider the harmfulness of the e-cigarettes. However, even though the studies showed that in general e-cigarettes are less harmful than tobacco cigarettes, they are a quite new phenomenon from the historical view, thus their harmfulness is not conclusive.

The main and one of the most obvious argument to support harmless of the e-cigarettes is the fact that in their system it is lack of combustion. An operating principle of e-cigarettes is more like aerosol than the traditional tobacco cigarettes. This can be a reason why, compared to traditional cigarettes, e-cigarettes have less toxicant exposure for their users (Callahan-Lyon, Priscilla ii36). However, comparing e-cigarettes with the traditional cigarettes, one can notice that e-cigarettes have a more complex system and elements that are more saturated with harmful substances. This is a reason why “users and others may experience secondhand or thirdhand exposures through direct physical contact with product components, or inhaling secondhand aerosol” (Callahan-Lyon, Priscilla ii36). In this way, product components, and secondhand aerosol of e-cigarettes are more harmful to the users and others that the traditional tobacco cigarettes.

However, considering an effect of the e-cigarettes, one can say that it is more positive than the effect of the traditional tobacco cigarettes. Thus, e-cigarettes, especially those with nicotine, reduce lung function less than the traditional tobacco cigarettes (Harrell, Paul Truman et al. 4). Besides, e-cigarettes do not appear to significantly affect complete blood count, in contradistinction to tobacco cigarettes (Harrell, Paul Truman et al. 4). Moreover, “studies reported that although both e-cigarettes and tobacco cigarettes increased pulse, increased inflammatory markers, and impacted measures of myocardial function, these changes were only significant for tobacco cigarettes” (Harrell, Paul Truman et al. 4). Callahan-Lyon, Priscilla also noticed that PM emissions from e-cigarettes were fifteen times lower than emissions after use of traditional cigarettes (37). In this way, the evidence from above clearly showed that effect of the e-cigarettes could be much less harmful to health than the effect of the traditional tobacco cigarettes.

There is one more fact that must be taken into account in this context. As far as e-cigarettes are considered as less harmful than the traditional tobacco cigarettes, there is a quite high number of people who regard e-cigarettes as a safe alternative or even as aids for treatment from nicotine addiction. One must notice that such approach is not quite correct. The first and the most important fact is that e-cigarettes, even though they are less harmful than the traditional tobacco cigarettes still can harm health. Even though e-cigarettes are less harmful than the traditional cigarettes, they are not an absolutely safe alternative. Harrell, Paul Truman et al. noticed that e-cigarettes could be a less harmful source of nicotine than traditional tobacco cigarettes, “but evidence of decreased harm with long-term use is not available” (38). Considering e-cigarettes as aids for treatment from nicotine addiction one can notice that e-cigarettes are not regulated by The US Food and Drug Administration (FDA) as drug delivery devices, they are rather regulated as tobacco products (Ebbert, Jon O. et al. 129). Moreover, Ebbert, Jon, et al. refer to the American Heart Association, noticing that clinicians should not recommend e-cigarettes as primary cessation aids, and should advise patients to consider a quit date for using e-cigarettes and not plan to use them indefinitely (132). Thus, even if e-cigarettes are less harmful than the traditional tobacco cigarettes they can not be as aids for treatment of nicotine addiction or as a permanent safe alternative to the traditional cigarettes.

The facts from the above allow one to make a conclusion about the harmfulness of e-cigarettes. The evidence from the studies showed that complex system of e-cigarettes could have more intensive harmful substances than a system of the traditional tobacco cigarettes. In this way, e-cigarettes can be more harmful than the traditional cigarettes. However, harm from such elements are rather the accidents than a natural result of using e-cigarettes. On the contrary, the studied that compared using the traditional cigarettes and e-cigarettes showed that e-cigarettes in all respects are less harmful than the traditional tobacco cigarettes. Thus, in general, e-cigarettes are less harmful than the traditional cigarettes. However, even being less harmful than the traditional cigarettes they still are harmful and cannot be considered as aids for treatment from nicotine addiction or as the permanent safe alternative to the traditional cigarettes.

Works Cited

Callahan-Lyon, Priscilla. “Electronic Cigarettes: Human Health Effects.” Tobacco Control, vol 23, no. suppl 2, 2014, pp. ii36-ii40.

Ebbert, Jon O. et al. “Counseling Patients On The Use Of Electronic Cigarettes.” Mayo Clinic Proceedings, vol 90, no. 1, 2015, pp. 128-134.

Harrell, Paul Truman et al. “Electronic Nicotine Delivery Systems (‘‘E-Cigarettes’’): Review Of Safety And Smoking Cessation Efficacy.” Otolaryngology – Head And Neck Surgery, vol 151, no. 3, 2014, pp. 1-13.

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Abstract

We examined college student reactions to a statewide public smoke-free policy, campus policies and private restrictions through an online survey among 2260 students at a 2-year college and a university and 12 focus groups among smokers. Among survey participants, 34.6% smoked in the past month (35.0% daily, 65.0% non-daily). Correlates of receptivity to public policies included attending the university, not living with smokers and non-smoker status (versus daily and non-daily smoking). Correlates of receptivity to outdoor campus policies included being a university student, unmarried, without children, from homes where parents banned indoor smoking and a non-smoker. Correlates of having home restrictions included not living with smokers, no children, parents banning indoor smoking and non-smoker status. Correlates of having car restrictions included attending the university, not living with smokers, having children, parents banning indoor smoking and non-smoker status. Qualitative findings indicated support for smoke-free policies in public (albeit greater support for those in restaurants versus bars) and on campus. Participants reported concern about smokers’ and bar/restaurant owners’ rights, while acknowledging several benefits. Overall, 2-year college students and smokers (non-daily and daily) were less supportive of smoke-free policies.

Introduction

Over 18 million students are enrolled in colleges and universities in the United States [1]. During college, many people experiment with or initiate smoking and one-third become addicted [2, 3]. Although pro-tobacco marketing attempts to normalize smoking particularly among young adults [4], smoke-free policies make smoking less socially acceptable [5–8]. Unfortunately, 83% of students reported any secondhand smoke (SHS) exposure in the past week, with exposure being most common in restaurants or bars or in personal settings (i.e. homes, cars) (38%) [9]. Thus, it is important to examine college student reactions to smoke-free policies in public places and on campuses as well as the practice of implementing private restrictions.

Firstly, assessing student reactions to public smoke-free policies is important in understanding their attitudes regarding tobacco control. In October 2007, Minnesota implemented a statewide smoking ban, the Freedom to Breathe Act. This law is applied to all public places, including bars, restaurants, private clubs, bowling alleys, hotel lobbies and public transportation. Minnesota was preceded by 22 other states, Washington, DC, and Puerto Rico in passing such a policy. Greater support for smoke-free policies has been associated with being female [10, 11], higher education and higher income [10–13]. Among smokers, support for these policies is related to greater intent to quit and lower cigarette consumption [14]. The current investigation examines student reactions to the Minnesota ban.

Secondly, it is critical to understand college student reactions to campus policies. Although restrictive smoking policies on college campuses may discourage smoking onset or facilitate cessation, many colleges and universities are reluctant to establish them for fear of student objections [15]. A 2003 national study [16] indicated that 54% of the colleges banned smoking in all campus buildings and student residences [17]. Most students (88% of never smokers and 58% of smokers) favor smoke-free indoor policies, with less support for outdoor policies (43% of never smokers and 7% of smokers). Interestingly, the vast majority (98% of never smokers and 82% of smokers) indicates that the right to breathe clean air should take priority over the right to smoke [15]. Other research has corroborated these findings [18]. Central to the current study, this study examines reactions to current policies on two campuses that have not established outdoor smoke-free policies but are exploring that possibility, as endorsed by several national organizations, including the American College Health Association.

Third, it is important to understand how college students approach tobacco control and the management of SHS exposure in their personal settings, such as their homes and cars. This is especially relevant given that public smoke-free policies may increase implementation of private restrictions [19]. Having home restrictions is associated with lower reported levels of smoking and less SHS exposure [20]. Furthermore, having restrictions is associated with recent quit attempts [21], quitting smoking [22] and preventing relapse [23, 24]. Less is known about the impact of having restrictions in vehicles. Thus, research is needed to examine this area.

Rates of non-daily smoking have increased alongside a national decline in daily tobacco consumption [25, 26]. While non-daily smoking has been viewed as an unstable condition between daily smoking and quitting, newer research shows that this pattern of tobacco use may represent a chronic low-level (≤10 cigarettes per day) form of consumption [27–29]. This group represents a wide range of smoking patterns among the general population and particularly among college students [30]. The young adulthood population has been particularly affected [25]. This change may have occurred as a result of a rise in tobacco control policies [25, 28]. Smokers enforcing smoke-free policies at home are much more likely to be light or intermittent smokers [25]. Thus, it is critical to examine how daily versus non-daily smokers respond to smoke-free policies.

Another interesting factor to consider in relation to attitudes regarding tobacco control policies is type of post-secondary education pursued. Two-year college and university students differ in their sociodemographic characteristics, as well as their smoking behaviors and attitudes. Two-year college students are more likely to be female, older, married and employed [31]. After controlling for sociodemographics, attending a 2-year college predicts smoking [31]. Moreover, 2-year college students have more positive attitudes regarding smoking; specifically, they are more open to relationships with smokers, less concerned about smoking-related health consequences and less supportive of tobacco control policies (e.g. tax increases, restricting tobacco marketing) [32]. Thus, these differences in attitudes toward smoke-free policies among technical college students and university students may be critical in developing effective intervention strategies for the two settings.

Given the aforementioned literature, the purpose of this study was to examine college student attitudes regarding public and campus smoke-free policies, implementation of private policies and specific factors related to reactions to smoke-free policies among students at a 2-year college and a 4-year university.

Materials and methods

Our mixed-methods approach utilized a quantitative survey and focus groups to examine college student reactions to public, campus and private smoke-free policies. This research was approved by the University of Minnesota Institutional Review Board (IRB# 0712S22941).

Survey research

In October 2008, a random sample of 5500 undergraduate students at a 4-year university (yielded from a random number generator and the list of student e-mails) and all 3334 young adults at a technical college were invited to complete an online survey. Students received up to three e-mails containing a link to the consent form with the option of declining participation. Students who consented were directed to the survey. As an incentive for participation, participants were entered into a drawing for cash prizes of $2500, $250 and $100 at each school.

Of those invited to participate, 2700 (30.6%) completed the survey (technical college: 30.1%, N = 1004; university: 30.8%, N = 1696). This response rate approximates response rates previously found using an online administration among college students [33, 34]. Moreover, Internet surveys yield similar statistics regarding health behaviors compared with mail and phone surveys despite yielding lower response rates [35]. The present study focused on students aged 18–25 years; thus, 2260 (748 technical colleges and 1512 university students) are included in these analyses. Although we cannot assume that our sample is representative of the student populations present within the college settings, preliminary analyses indicated that gender, age and ethnic representations were not significantly different from the overall student body populations.

Measures

Demographic characteristics

Demographic characteristics assessed included age, gender, ethnicity and parental educational attainment.

Social factors.

We assessed marital status, place of residence (i.e. whether living with parents or elsewhere) and other smokers living in the home, children living in the home, parental home smoking rules and whether parents smoked.

Smoking behaviors.

Participants were asked, ‘In the past 30 days, on how many days did you smoke a cigarette (even a puff)?’ and ‘On the days that you smoke, how many cigarettes do you smoke on average?’ These questions have been used in previous research and have been shown to be reliable and valid with similar populations [36, 37]. Students reporting smoking ≥1 day in the past 30 days were considered current smokers. For the multivariate analyses, smokers were further categorized into non-daily smokers (i.e. smoked between 1 and 29 days in the past 30 days) and daily smokers (i.e. smoked every day of the past 30 days) [38–40]. Among smokers, we assessed readiness to quit smoking in the next 30 days.

Attitudes regarding public smoke-free policies.

Participants were asked, ‘Because of the public smoking ban on smoking in restaurants and bars, do you go out more, less or does it make no difference?’ (1 = ‘less’, 2 = ‘no difference’, 3 = ‘more’) [41]. We asked, ‘How important is it to you to have a smoke-free environment inside bars, lounges, clubs and restaurants?’ using a four-point Likert-type scale (1 = ‘not at all important’ to 4 = ‘very important’) [42]. We also asked, ‘How do you feel about the law prohibiting smoking in all public buildings and restaurants?’ and ‘How do you feel about smoking being prohibited in Minnesota bars?’ using a four-point Likert-type scale (1 = ‘disapprove strongly’ to 4 = ‘approve strongly’) [42]. Exploratory factor analysis identified a common underlying factor among these items. Thus, the responses to these four questions were added to develop an overall score indicating level of receptivity to public smoke-free policies and demonstrated internal consistency (Cronbach's alpha = 0.86).

Attitudes about campus smoking policies.

Participants were asked, ‘What effect, if any, do you think a policy making this campus completely smoke-free would have on: student quality of life, student learning and student enrollment?’ using a five-point Likert-type scale (1 = ‘extremely negative’ to 5 = ‘extremely positive’) [43]. Exploratory factor analysis identified a common underlying factor among these items. Thus, the responses to these three questions were added to develop an overall score indicating level of receptivity to campus smoke-free policies and demonstrated internal consistency (Cronbach's alpha = 0.86).

Private smoking policies.

Participants were asked, ‘Which of the following best describes the rules about smoking in your home?: (i) no one is allowed to smoke anywhere, (ii) smoking is allowed in some places or at some times, or (iii) smoking is permitted anywhere; there are no rules’ [44]. This question was adapted to examine rules in cars; participants were asked which statement best describes the rules about smoking in their cars with the same response options as well as an option stating ‘I do not own a car’. These variables were dichotomized as complete restrictions versus other (partial or no restrictions).

Data analysis

Bivariate analyses were conducted examining differences between schools, genders and smoking status. Ordinary least squares regression was used to examine correlates of receptivity to public and campus policies, and binary logistic regression was used to determine correlates of implementation of private restrictions. Variables with a statistically significant bivariate relation to the outcomes of interest at P < 0.05 were entered into the models; using backwards stepwise entry, factors significantly contributing to the models at α = 0.05 were allowed to remain in the model. PASW 17.0 (IBM, Chicago, IL, USA) was used for all analyses.

Focus group research

In Spring 2009, we conducted 12 in-person focus groups with 73 college student smokers (i.e. any smoking in the past 30 days) aged 18–25 years recruited from the online survey. Focus group participants were recruited from those who completed the online survey the prior semester and indicated that they had smoked in the past 30 days. For each group, approximately 30 participants were invited to participate via telephone and e-mail. As an incentive, participants received $50. Participants were recruited into 1 of 12 groups (ranging from 6 to 12 participants per group), each being homogenous in gender (male and female) and school (2-year college, university; i.e. three groups per stratum).

Prior to beginning the focus groups, participants read and signed an informed consent and completed a brief questionnaire assessing demographics and smoking behavior using questions similar to those described above.

A trained focus group moderator (the lead author) facilitated group discussion on (i) attitudes about the statewide smoking ban, (ii) reactions to current campus policies and the potential implementation of outdoor smoke-free policies and (iii) the implementation of restrictions in private spaces (within the home or car). Each session lasted 90 min. All sessions were audiotaped, transcribed and observed by a research assistant.

Data analysis

Qualitative data were analyzed according to the principles outlined in Morgan and Krueger [45]. NVivo 7.0 (QSR International, Cambridge, MA, USA) was used for text coding and to facilitate the organization, retrieval and systematic comparison of data. Transcripts were independently reviewed by the first author and two master of public health graduate students to generate preliminary codes. They then refined the definition of primary (i.e. major topics explored) and secondary codes (i.e. recurrent themes within these topics) and independently coded each transcript. The independently coded transcripts were compared, and consensus for coding was reached. Quantitative data from the focus group surveys were analyzed using PASW 17.0 (IBM).

Results

Survey research

Table I provides survey participant characteristics as well as bivariate analyses comparing 2-year college and university students and males and females. Results of individual questions regarding receptivity to public and campus policies and implementation of private restrictions are presented in Fig. 1.

Table I.

Survey participant characteristics and attitudes regarding smoke-free policies

Variable Total, N (%) or mean (SD) 2-Year college, N (%) or mean (SD) University, N (%) or mean (SD) P
N2260 (100.0) 748 (33.1) 1512 (66.9) — 
Sociodemographic variables 
    Age (SD) 20.38 (1.89) 20.24 (1.93) 20.44 (1.86) 0.02 
    Female (%) 1400 (61.9) 499 (66.7) 901 (59.6) 0.001 
    Two-year college (%) 748 (33.1) — — — 
    Non-Hispanic White (%) 1935 (85.5) 704 (93.9) 1231 (81.4) 0.001 
    Parental education ≥ bachelors (%) 861 (38.1) 172 (22.9) 689 (45.7) <0.001 
    Married/living with/partner (%) 475 (21.0) 231 (30.8) 244 (16.2) <0.001 
    Smoker living in home (%) 834 (37.3) 323 (43.5) 511 (34.2) <0.001 
    Children in the home (%) 382 (17.1) 178 (24.0) 204 (13.7) <0.001 
    Parents allow smoking in home (%) 422 (18.9) 195 (26.2) 227 (15.2) <0.001 
    Parents smoked in home (%) 908 (40.7) 363 (49.1) 545 (36.6) <0.001 
Smoking variables 
    Days smoked in past 30 days (SD) 5.88 (10.77) 8.36 (12.53) 4.65 (9.54) <0.001 
    Average cpd (SD) 4.96 (4.88) 5.99 (5.42) 4.27 (4.36) <0.001 
    Smoked in the past 30 days (%) 781 (34.6) 317 (43.5) 466 (31.9) <0.001 
    Daily smokers (%) 273 (12.2) 149 (19.9) 125 (8.3) <0.001 
    Non-daily smokers (%) 508 (22.5) 168 (22.5) 341 (22.6) <0.001 
    Ready to quit in next 30 days (%) 230 (31.5) 83 (27.1) 147 (34.7) 0.030 
Smoking restrictions 
    Receptivity to public policies (SD) 12.29 (2.76) 11.83 (2.87) 12.53 (2.67) <0.001 
    Receptivity to campus ban (SD) 10.50 (3.01) 10.10 (2.81) 10.69 (3.09) <0.001 
    Complete home ban (%) 1°825 (81.3) 595 (80.0) 1°230 (82.0) 0.14 
    Complete car ban (%) 1°196 (53.4) 340 (45.8) 856 (57.1) <0.001 
Variable Total, N (%) or mean (SD) 2-Year college, N (%) or mean (SD) University, N (%) or mean (SD) P
N2260 (100.0) 748 (33.1) 1512 (66.9) — 
Sociodemographic variables 
    Age (SD) 20.38 (1.89) 20.24 (1.93) 20.44 (1.86) 0.02 
    Female (%) 1400 (61.9) 499 (66.7) 901 (59.6) 0.001 
    Two-year college (%) 748 (33.1) — — — 
    Non-Hispanic White (%) 1935 (85.5) 704 (93.9) 1231 (81.4) 0.001 
    Parental education ≥ bachelors (%) 861 (38.1) 172 (22.9) 689 (45.7) <0.001 
    Married/living with/partner (%) 475 (21.0) 231 (30.8) 244 (16.2) <0.001 
    Smoker living in home (%) 834 (37.3) 323 (43.5) 511 (34.2) <0.001 
    Children in the home (%) 382 (17.1) 178 (24.0) 204 (13.7) <0.001 
    Parents allow smoking in home (%) 422 (18.9) 195 (26.2) 227 (15.2) <0.001 
    Parents smoked in home (%) 908 (40.7) 363 (49.1) 545 (36.6) <0.001 
Smoking variables 
    Days smoked in past 30 days (SD) 5.88 (10.77) 8.36 (12.53) 4.65 (9.54) 

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