American Journal of Health Promotion

To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior.

Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program.

Random telephone interviews within 18 California counties.

A representative sample of 1315 adult smokers, aged 25 years and older.

The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS).

Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05).

These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.

Evaluate the long-term impact of telephone-based interventions that target high risk, ready-to-change individuals.

Quasi-experimental design with pre/post comparisons of lifestyle-related health risks between participants and nonparticipants.

Six organizations from the private and public sectors.

Subjects were 607 intervention participants who were compared with a control group of 1134 eligible nonparticipants.

Health risk assessment at baseline and at an average of 2 years later measured risk in 13 lifestyle areas.

Programs were offered in seven areas: back care, cholesterol control, eating habits, exercise and activities, stress management, tobacco use, and weight control. Each program was conducted by a trained health educator who provided information and counseling to facilitate change in the area selected by the participant. All counseling was done by telephone and included three to five contacts over a 1-year period.

Binary logistic regression models controlling for gender and age revealed both specific and general effects. Participants were 1.8 to 3.5 times as likely as nonparticipants to reduce the targeted risk in six of seven risk areas. In addition, participants were 1.7 to 3.5 times as likely as nonparticipants to reduce their risks in nine of 13 areas not targeted by the intervention (i.e., general effect). Overall, participants significantly reduced their number of risks, whereas nonparticipants significantly increased their risk (difference of .85 risks).

Results show that at-risk participants make long-term improvements in health risks directly related to the intervention in which they participate. Results also suggest that this intervention may help individuals develop behavior-change skills they can apply to other lifestyle issues.

To examine relationships between cigarette smoking, alcohol use, and dietary intake.

Respondents to the U.S. Department of Agriculture's Continuing Survey of Food Intakes by Individuals, a nationwide probability sample conducted from January 1994 through January 1997 (n = 23,602; response rate = 80%), were selected. Adults ages 19 years and older were grouped according to their smoking and drinking habits. Selected demographic variables, food group servings, food energy, and densities of selected nutrients were compared.

In-home interviews were conducted in the 50 states and the District of Columbia.

The selected sample (n = 6745) included 3229 nonsmokers, 1701 former smokers, and 1808 current smokers, and 2284 abstainers, 2713 occasional drinkers, 1000 moderate drinkers, and 748 liberal drinkers.

Responses to standard questionnaires were examined by Student's t-test, χ², one-way analysis of variance, and univariate and multivariate analyses of covariance.

Men were more likely than women to be current smokers and liberal drinkers (64% vs. 40% and 62%) vs. 38%). For both, the use of cigarettes and alcohol was closely related. An additive relationship was observed between smoking/drinking classification and lower food group servings and nutrient intakes. Although cigarette and alcohol use may have been underreported, these findings support previous ones showing poor food choices along with lower nutrient intakes as smoking and drinking increase.

Smoking and drinking habits may alter individuals' food selections and nutrient intakes. Future interventions for health promotion may achieve greater success by targeting multiple risk factors simultaneously or sequentially.

Physicians acknowledge the need to advise their patients about dietary habits, but they may not have the training or tools to do this efficiently. In the context of a randomized trial, we investigated the feasibility of enlisting physicians to implement a dietary intervention in the primary care setting.

Physicians from 14 primary care practices were assigned via randomization to introduce a self-help booklet to promote dietary change at routine appointments. Delivery of the booklet was recorded by these intervention physicians at the clinic appointment; intervention participants were asked 3 months later in a telephone interview about whether they received and used the booklet.

According to physician documentation, 95 % of intervention participants who kept an appointment (n = 935) received the booklet; among participants completing a 3-month interview (n = 890), 96% reported the same. However, only about 50% of participants reported receiving the booklet from their physician; the remainder received the booklet from other clinic staff. Overall, 93 % reported reading at least part of the booklet. Use of the booklet varied little whether it was delivered by a physician or staff person, but it was more likely to be read as time spent discussing the booklet increased.

Physician cooperation and evidence of intervention effectiveness support the use of primary care for the delivery of interventions to change diet; training the entire health team and repeating dietary advice at subsequent visits may improve the success of such interventions.