Tobacco use in Tennessee is higher than the national average and the decline in usage rate has stalled. The smokefree policy enacted to address this health issues contains several exemptions and does not repeal preemption that was introduced in 1994. In March 2013, the Governor unveiled Health and Wellness Initiatives, including reduction in the use of "tobacco products." To achieve this goal, two approaches should be considered and integrated into the initiative to facilitate the decline in tobacco use - policy and population. On the policy approach, the Governor should consider working for the repeal of state preemption of local tobacco control policymaking by the 1994 Prevention of Youth Access to Tobacco Act, and for removing exemption for certain venues from the Non-Smoker Protection Act. On the population approach, the Governor should consider focusing on young adults as an integral part of the target group and tobacco-free campuses as a strategy for addressing tobacco use among such group. All these conform to the Initiatives' strategy of "localized ownership."

Introduction Though Africa is in Stage 1 of the tobacco epidemic, lack of effective public smoking laws or political will implies that secondhand smoke (SHS) exposure may be high in youth. The study objective is to estimate prevalence and identify determinants of SHS exposure among never-smoker adolescents in Africa and make cross-country comparisons. Methods Pooled data from the Global Youth Tobacco Surveys conducted in 25 African countries during 2006–2011 were used. Based on the venue of exposure in past 7 days, SHS was categorized into exposure inside, outside, and overall exposure (either inside or outside of the home), respectively. Data were analyzed in 2015 using logistic regression models to identify factors related to SHS exposure in three venues. Results About 21% and 39% of adolescents were exposed to SHS inside or outside of the home, with overall exposure of 45%. In all 25 African countries, parental smoking was significantly associated with SHS exposure inside the home (ORs ranging from 3.02 [95% CI=2.0, 4.5] to 14.65 [95% CI=10.0, 21.5]). Peer smoking was associated with SHS exposure outside the home in 18 countries (ORs ranging from 1.45 [95% CI=1.0, 2.1] to 3.00 [95% CI=1.8, 5.1]). Parental smoking, peer smoking, and anti-smoking messages in media were identified as three major factors associated with SHS exposure. Conclusions A significant proportion of never-smoking adolescents in Africa are exposed to SHS, suggesting the need for countries to adopt policies to protect never smokers through the implementation of the WHO Framework Convention on Tobacco Control.

The World Health Organization has fostered a new global public policy - the Framework Convention for Tobacco Control (FCTC). Until the 1980s, tobacco control was the sole preserve of states. Now, most countries accept the transnational nature of policy. We explain this shift by identifying mutually reinforcing changes in key policy process elements: transnational actors became a source of policy learning; an international venue 'institutionalized' new policies; networks began to include tobacco control groups and exclude tobacco companies; socioeconomic shifts undermined public support, and the economic case, for tobacco; and the dissemination of scientific evidence helped actors reframe the image of tobacco, from an economic good to a health crisis. These elements combined to produce an environment conducive to 'comprehensive' tobacco control. Yet the implementation of the FCTC has been slow and uneven, reflecting the continued importance of domestic policy environments, most of which are not conducive to major policy change.

Objectives. Weestimated the prevalence and determinants of secondhand smoke (SHS) exposure among nonsmoking adolescents in 9 West African countries. Methods. We conducted a pooled analysis with nationally representative 2006 to 2009 Global Youth Tobacco Survey data. We used descriptive statistics to determine the prevalence of SHS exposure and inferential statistics using a multivariable logistic regression model to determine factors associated with SHS exposure. We investigated average marginal effect results that show the probability of SHS exposure, adjusting for all other attributes. Results. SHS exposure inside the home ranged from 13.0% to 45.0%; SHS exposure outside the home ranged from24.7%to 80.1%. Parental or peer smoking behaviorswere significantly associatedwith higher probability of SHS exposure in all 9 countries. Knowledge of smoking harm, support for smoking bans, exposure to antismoking media messages, and receptivity of school tobacco education were significantly associated with higher SHS exposure in most countries. Conclusions. West African policymakers should adopt policies consistent with Article 8 of the World Health Organization Framework Convention on Tobacco Control and its guidelines and public health education to promote smoke-free households.

Introduction: Country-level evidence from Africa on the prevalence of tobacco use and the role played by both demographic and socioeconomic factors, as influences on the use of tobacco products, is sparse. This paper analyzes the determinants of tobacco use in Ghana and explores the association between tobacco use and poverty in the country. Methods: Data from the 2008 Ghana Demographic and Health Survey, a nationally representative survey of households (n = 12,323), were used to generate descriptive statistics and characterize tobacco use in the country. A logistic regression model was used to evaluate the relationships between tobacco use and age, place of residence, region, education status, wealth, marital status, alcohol use, and whether the person has children. Unadjusted and adjusted odds ratios were calculated for tobacco users and nonusers on the likelihood of their purchase of selected commodities indicative of living standards. Results: Tobacco use was significantly higher among those living in poverty stricken regions, those with less education, lower levels of wealth, parents, and alcohol users. Tobacco use was significantly higher among men (7%) than women (0.4%), and it increased to a peak age of 41.4 years before it declined. Using tobacco was also associated with a lower likelihood of purchasing health insurance. Discussion: Tobacco use is inextricably related to poverty in Ghana. Policies should be formulated to target populations and regions with higher tobacco prevalence to combat both poverty and tobacco use simultaneously.

Objective To examine why the Framework Convention on Tobacco Control did not include an explicit trade provision and delineate the central arguments in the debate over trade provision during the negotiations. Methods Triangulate interviews with participants in the FCTC negotiations, the FCTC negotiations documents, and tobacco industry documents. Results An explicit FCTC trade provision on relation between international trade and public health became a contentious issue during the negotiations. As a result, two conflicting positions, health-over-trade and opposition to health-over-trade emerged. Opposition to explicit trade language giving health priority was by both tobacco industry and countries that generally supported strong FCTC provisions because of concerns over 'disguised protectionism' and setting a precedent whereby governments could forfeit their obligations under pre-existing treaties. Owing to lack of consensus among political actors involved in the negotiations, a compromise position eliminating any mention of trade emerged, which was predicated on belief among some in the public health community that public health would prevail in future trade versus health conflicts. Conclusion The absence of an explicit FCTC trade provision was due to a political compromise rather than the impact of international trade agreements and decisions on public health and lack of consensus among health advocates. This failure to include an explicit trade provision in the FCTC suggests that the public health community should become more involved in trade and health issues at all levels of governance and press the FCTC Conference of the Parties for clarification of this critical issue.

Purpose: We sought to identify unique barriers and facilitators to breast cancer screening participation among women aged 40 and older from Mississippi who were categorized as current, overdue, and never screeners. Methods: Cross-sectional data from a 2003 population-based survey with 987 women aged 40 and older were analyzed. Chi-square analysis and multinomial logistic regression examined how factors organized under the guidance of the Model of Health Services Utilization were associated with mammography screening status. Results: Nearly one in four women was overdue or had never had a mammogram. Enabling factors, including poor access to care (no annual checkups, no health insurance) and to health information, lack of social support for screening, and competing needs, were significantly associated with being both overdue and never screeners. Pertaining to factors unique to each screening group, women were more likely to be overdue when they had no usual source of health care and believed that treatment was worse than the disease. In turn, women were more likely to be never screeners when they were African American, lacked a provider recommendation for screening, and held the fatalistic view that not much could be done to prevent breast cancer. Conclusion: Similar and unique factors impact utilization of mammography screening services among women. Those factors could inform efforts to increase screening rates.

Objectives. To examine the differences in adolescent birth rates by deprivation and Health Professional Shortage Areas (HPSAs) in rural and urban counties of the United States in 2017 and 2018. Methods. We analyzed available data on birth rates for females aged 15 to 19 years in the United States using the restricted-use natality files from the National Center for Health Statistics, American Community Survey 5-year population estimates, and the Area Health Resources Files. Results. Rural counties had an additional 7.8 births per 1000 females aged 15 to 19 years (b = 7.84; 95% confidence interval [CI] = 7.13, 8.55) compared with urban counties. Counties with the highest deprivation had an additional 23.1 births per 1000 females aged 15 to 19 years (b = 23.12; 95% CI = 22.30, 23.93), compared with less deprived counties. Rural counties with whole shortage designation had an additional 8.3 births per 1000 females aged 15 to 19 years (b = 8.27; 95% CI = 6.86, 9.67) compared with their urban counterparts. Conclusions. Rural communities across deprivation and HPSA categories showed disproportionately high adolescent birth rates. Future research should examine the extent to which contraceptive access differs among deprived and HPSA-designated rural communities and the impact of policies that may create barriers for rural communities.

Introduction. This paper deals with the impact of contextual features, such as sex, age, mother tongue, health status, health literacy, Internet use experience, and frequency of health information seeking on health information searching. Method. An interactive information retrieval approach was used to study users' searching behaviour. An online survey and experiment using simulated situation technique were used as data collection methods. The online survey gathered data about user features, such as sex, age, mother tongue, health status, health literacy, Internet use experience, and health information seeking. An experiment was then carried out using four simulated tasks to collect information about health information searching. Analysis. The multiple linear regression analysis method was used to identify contextual factors affecting query length and number of queries. In addition, binary logistic regression analysis method was used to identify contextual factors affecting result clicking. Results. Frequent health information seeking leads to more queries and long query length, and English as a mother tongue and being healthy contribute to long query length. Queries with spelling errors and those formulated outside task descriptions are found to be ineffective. Conclusion. Contextual features such as frequency of health information seeking, mother tongue, and health status influence query formulation. In addition, spelling errors and source of query affect the effectiveness of queries. The findings could be useful for health information retrieval systems to learn and predict users’ information needs to aid effective retrieval.

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