American Journal of Preventive Medicine Supplement: "Minnesota’s Investment in Applied Tobacco Control Research: Findings to Inform Practice and Policy" - November 2012

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A November 2012 supplement to the peer-reviewed American Journal of Preventive Medicine featured eight articles from ClearWay Minnesota-funded research grantees, five articles from ClearWay Minnesota-funded research projects, a review article by two experts from the U.S. Food and Drug Administration (FDA) and a commentary by Dr. Howard Koh, Assistant Secretary for Health at the U.S. Department of Health and Human Services.  You can access copies of all the articles by visiting the ClearWay Minnesota website

The Public Health Law Center staff Warren Ortland, Susan Weisman, Brooke Nunn and Michael Freiberg authored articles published in this supplement.

Secondhand Smoke and Smoke-Free Policies in Owner-Occupied Multi-Unit Housing

Authors: Martha J. Hewett, MS, Warren H. Ortland, JD, Betsy E. Brock, MPH, Curtis J. Heim, MS

Background: Studies have documented movement of secondhand smoke (SHS) between units in multi-unit buildings, but none has focused on owner-occupied units in common-interest communities (CICs). In Minnesota, approximately 170,000 households (8%) live in such units. CIC households may experience long-term SHS exposure because owner-occupants typically live in the same unit for many years.

Purpose: This study estimated the prevalence of SHS incursion in CICs and assessed residents’ attitudes toward SHS incursions and interest in smokefree policies.

Methods: A stratified sample of Minnesota CIC owner-occupants was surveyed in 2009, with analysis in 2010–2011. Data were weighted to account for differing sampling, response, and coverage rates by stratum, then calibrated to population control totals for housing type, age, and smoking status.

Results: The response rate was 35.6%, with 495 completions. Twenty-eight percent of households reported SHS incursion into their unit in the preceding 6 months; 59% of these said this bothers them a lot. Only 6% report that their CIC has a smokefree policy for residents’ units. Forty-two percent would prefer such a policy whereas 26% would prefer smoking-permitted. Sixty-three percent definitely and 17% probably would choose a no-smoking building over a smoking-permitted building if they were buying a new unit, and 46% would be willing to pay more for such a unit.

Conclusions: Secondhand smoke incursion is common in CICs, and interest in smokefree CICs greatly exceeds the supply. Given the known health risks of SHS exposure, tobacco control efforts in multi-housing should address CICs as well as rental households.

(Am J Prev Med 2012;43(5S3):S187–S196) © 2012 American Journal of Preventive Medicine

Influencing Taft-Hartley Funds to Provide Tobacco Cessation Benefits

Authors: Susan R. Weisman, JD, Deborah Hennrikus, PhD, Kelvin Choi, PhD, Brooke Nunn, MPH, MSW, Jean L. Forster, PhD, MPH, Mary Kay Hunt, MPH, Rodney Skoog, BA, Wade Luneburg, Bernie Hesse, BA

Background: Taft–Hartley Health and Welfare Funds (“funds”) administer health insurance plans that cover approximately nine million U.S. adults. Unionized workers covered by funds work primarily in blue- and pink-collar occupations and smoke at a rate almost twice that of workers in other occupations. Most funds do not provide comprehensive coverage for tobacco cessation treatment for fund participants (workers, family members, and retirees).

Purpose: This study tested a pilot intervention to increase the provision and promotion of cessation benefits among Minnesota-based funds by educating the funds’ advisors.

Methods: Tailored educational outreach was conducted to advisors (administrators, consultants, attorneys) of 10 Minnesota-based funds (2009 –2011). Pre- and post-intervention advisor interviews measured perceptions/knowledge/attitudes about tobacco use, cessation, coverage, and promotion of benefits. Pre- and post-intervention data on benefit provision were collected from Summary Plan Descriptions (SPDs) and Summary Material Modifications (SMMs) of 10 Minnesota-based funds and 19 comparison funds in Massachusetts and Washington, and compared in 2011. SPDs/SMMs were scored on benefit adequacy, comparing services covered and the extent to which they met DHHS recommendations.

Results: Minnesota-based funds provided significantly higher coverage (except for copays and preconditions) pre-intervention. However, there were no significant differences between Minnesota and comparison funds in rate of improvement in benefits over time. At follow-up, advisors reported a significant increase in confidence in their knowledge to address smoking issues in funds. Advisors also reported sharing intervention information with fund trustees.

Conclusions: Educational strategies to influence advisors who provide guidance to fund trustees may help to increase advisors’ confidence to address cessation benefit improvement.

(Am J Prev Med 2012;43(5S3):S237–S241) © 2012 American Journal of Preventive Medicine

Federal Approaches to the Regulation of Non-Cigarette Tobacco Products

Author: Michael J.A. Freiberg, JD

Context: Under a grant funded by ClearWay MinnesotaSM and in partnership with nationally recognized experts in tobacco product regulation, the Public Health Law Center investigated how laws at every level apply, or fail to apply, to noncigarette tobacco products—also called “other tobacco products.”

Evidence acquisition: During the years 2010–2011, standard legal research techniques were used to identify and compile relevant statutes, regulations, decisions, pleadings, proposals, and related materials. Sources included standard commercial legal databases such as LexisNexis and Westlaw, online sources for pending rules and legislation, and direct contact with courts for legal pleadings and unpublished decisions. These legal authorities related to many aspects of the regulation, including price, flavorants, youth access, marketing restrictions, and product design of other tobacco products. Five of these products were used as case studies: dissolvable tobacco products, electronic cigarettes, little cigars, snus, and water pipes.

Evidence synthesis: Research during the years 2010–2011 revealed that the federal regulation of other tobacco products lags behind the regulation of more “traditional” tobacco products, such as cigarettes and moist snuff. Federal regulatory options to expand regulation of these products were identified.

Conclusions: The article highlights several federal policy interventions that would address gaps in the regulation of other tobacco products. The FDA must determine whether these interventions will benefit public health and, if so, to what extent—the legal criteria for intervention under the federal Family Smoking Prevention and Tobacco Control Act.

(Am J Prev Med 2012;43(5S3):S249 –S254) © 2012 American Journal of Preventive Medicine