Citation

Puntambekar, N., Pednekar, M., Adhikari, K., Quah, A.C.K., Fong, G.T., Driezen, P.*, Gupta, P. C. (2018). Awareness of tobacco advertising, promotion and sponsorship in four states: findings from TCP India Survey - Wave 1 and Wave 2. Tobacco Induced Diseases, 16(Suppl1), A191.

Abstract

Background: India's Cigarette and Other Tobacco Products Act (COTPA) of 2003 prescribes a complete ban on all forms of tobacco advertisements, promotions and sponsorships (TAPS) of events by tobacco companies across India. We examined the level of variation and predictors of awareness of TAPS in four Indian states.

Methods: We used data from the International Tobacco Control Policy (TCP) Survey India from Wave1 (Aug 2010- Dec 2011) and Wave2 (Aug 2012-Dec 2013) consisting of 10,585 and 10,501 respondents, respectively, surveyed from Madhya Pradesh (MP), Bihar (BR), Maharashtra (MH) and West Bengal (WB). Bivariate analysis and multivariable logistic regression was used to investigate associations between sociodemographic factors, states and TAPS awareness. All analyses were performed using SPSS V. 20.0

Results: Noticing tobacco advertisements was highest in MH (78.5%) and lowest in WB (50.1%) in Wave 1, while in Wave 2, it was highest in MP (83.5%) and lowest in WB (32.6%). Noticing tobacco promotions and sponsorships was highest in MP (promotions: 35.7%, sponsorships: 14.4%) in Wave 1, while in Wave 2, it was highest in WB (promotions:15.0%, sponsorships:10.8%). Across waves, education was a predictor of noticing tobacco advertisements, promotions and sponsorships. In Wave 1, but not Wave 2, noticing tobacco advertisements (OR:2.11) and promotions (OR:2.02) was highest among the youngest age group (15-17yrs) compared to corresponding oldest age group (55yrs+). Noticing advertisements and sponsorships remained consistent in urban areas across both waves. In Wave 1 tobacco promotions were observed twice as frequently among rural population as compared urban population but the association was reversed in Wave 2.

Conclusions: Awareness of tobacco marketing varied across the four states of India to observe a greater impact of the tobacco control legislation. This study suggests that even though policies are the same in all states, a coordinated effort is required to implement the law on TAPS ban consistently.

Citation

Yong, H.H., Borland, R., Cummings, K.M., Partos, T. (2018). Do predictors of smoking relapse change as a function of duration of abstinence? Findings from the United States, Canada, United Kingdom and Australia. Addiction, 113(7), 1295-1304.

Abstract

Aims: To estimate predictors of time to smoking relapse and test if prediction varied by quit duration.

Design: Longitudinal cohort data from the International Tobacco Control Four-Country survey with annual follow up collected between 2002 and 2015.

Setting: Canada, United States, United Kingdom and Australia.

Participants: A total of 9171 eligible adult smokers who had made at least one quit attempt during the study period.

Measurements: Time to relapse was the main outcome. Predictor variables included pre-quit baseline measures of nicotine dependence, smoking and quitting-related motivations, quitting capacity and social influence, and also two post-quit measures, use of stop-smoking medications and quit duration (1–7 days, 8–14 days, 15–31 days, 1–3 months, 3–6 months, 6–12 months, 1–2 years and 2+ years), along with socio-demographics.

Findings: All factors were predictive of relapse within the first 6 months of quitting but only wanting to quit, quit intentions and number of friends who smoke were still predictive of relapse in the 6–12-month period of quitting [hazard ratios (HR) = 1.20, P < 0.05; 1.13, P < 0.05; and 1.21, P < 0.001, respectively]. Number of friends smoking was the only remaining predictor of relapse in the 1–2 years quit period (HR = 1.19, P = 0.001) with none predictive beyond the 2-year quit period. Use of stop-smoking medications during quit attempts was related negatively to relapse during the first 2 weeks of quitting (HR = 0.71–0.84), but related positively to relapse in the 1–6-month quit period (HR = 1.29–1.54). Predictive effects of all factors showed significant interaction with quit duration except for perceiving smoking as an important part of life, prematurely stubbing out a cigarette and wanting to quit.

Conclusions: Among adult smokers in the United States, Canada, United Kingdom and Australia, factors associated with smoking relapse differ between the early and later stages of a quit attempt, suggesting that the determinants of relapse change as a function of abstinence duration.

Citation

Ma, B., Yong, H.H., Borland, R., McNeill, A., Hitchman, S.C. (2018). Factors associated with future intentions to use personal vaporizers among those with some experience of vaping. Drug and Alcohol Review, 37(2), 216-225.

Abstract

Introduction and Aims: Personal vaporisers (PV), including e-cigarettes, may be a harm reduction strategy for tobacco control. This study aims to identify factors associated with future intentions to vape among smokers and ex-smokers in Australia and the UK.

Design and Methods: Cross-sectional data of smokers and ex-smokers (n = 1199, mean age = 45.3 years, 44.8% male), collected in 2014/2015 and divided into four subgroups: smoking past vapers (SPV), smoking vapers (SV), ex-smoking past vapers (ESPV) and ex-smoking vapers (ESV), from the International Tobacco Control Australia and UK surveys were analysed by using regression models.

Results: Higher vaping satisfaction increased vaping intentions for all groups except ESPV. Perceiving PVs as less harmful predicted intentions to vape for all groups except ESV. The importance of PVs for stopping smoking predicted lower intentions to continue vaping for SV, but higher intentions to initiate vaping for SPV. The importance of PVs for cutting down smoking was a positive predictor only for SPV. Among ex-smokers, importance for maintaining not smoking was a positive predictor for ESPV, but not for ESV. The importance of perceiving vapour being less harmful also depended on vaping status for ex-smokers. The only country interaction was that only in the UK was perceiving PVs as less harmful associated with intention among SPV.

Discussion and Conclusion: Factors influencing intentions vary by smoking and/or vaping status, with greater differences between the ex-smoker subgroups. This is consistent with PVs being seen as a way of managing smoking, rather than something that has intrinsic value, for all except the ex-smoking vapers.

Citation

Ma, B., Yong, H.H., Borland, R., McNeill, A., Hitchman, S.C. (2018). Factors associated with future intentions to use personal vaporizers among those with some experience of vaping. Drug and Alcohol Review, 37(2), 216-225.

Abstract

Introduction and Aims. Personal vaporisers (PV), including e‐cigarettes, may be a harm reduction strategy for tobacco control. This study aims to identify factors associated with future intentions to vape among smokers and ex‐smokers in Australia and the UK.

Design and Methods. Cross‐sectional data of smokers and ex‐smokers (n = 1199, mean age = 45.3 years, 44.8% male), collected in 2014/2015 and divided into four subgroups: smoking past vapers (SPV), smoking vapers (SV), ex‐smoking past vapers (ESPV) and ex‐smoking vapers (ESV), from the International Tobacco Control Australia and UK surveys were analysed by using regression models.

Results. Higher vaping satisfaction increased vaping intentions for all groups except ESPV. Perceiving PVs as less harmful predicted intentions to vape for all groups except ESV. The importance of PVs for stopping smoking predicted lower intentions to continue vaping for SV, but higher intentions to initiate vaping for SPV. The importance of PVs for cutting down smoking was a positive predictor only for SPV. Among ex‐smokers, importance for maintaining not smoking was a positive predictor for ESPV, but not for ESV. The importance of perceiving vapour being less harmful also depended on vaping status for ex‐smokers. The only country interaction was that only in the UK was perceiving PVs as less harmful associated with intention among SPV.

Discussion and Conclusion. Factors influencing intentions vary by smoking and/or vaping status, with greater differences between the ex‐smoker subgroups. This is consistent with PVs being seen as a way of managing smoking, rather than something that has intrinsic value, for all except the ex‐smoking vapers.

Citation

Seo, H.G., Kim, Y., Xu, S.S., Quah, A.C.K., Boudreau, C., Yan, M., Thompson, M.E., Fong, G.T. (2018). Tobacco control policies in the Republic of Korea and the methods of the ITC Korea Surveys. Journal of the Korean Society for Research on Nicotine and Tobacco, 9(Suppl 1), S1-10.

Abstract

Policies that promote the social unacceptability of smoking may also result in smoking-related stigma. The aim of this study is to evaluate how norms against smoking and socioeconomic status (SES) are associated with stigma among smokers. We used data from a panel of adult smokers who participated in the 2008–2012 administrations of the International Tobacco Control Policy Evaluation Survey in Mexico (n = 6670 observations) and Uruguay (n = 3296 observations).

Generalized estimating equations were used to account for correlations in the outcomes over time within individuals. We evaluated if injunctive smoking norms (i.e. significant other norms and societal norms), descriptive smoking norms (i.e. number of smoking friends), and two markers of SES (i.e. education and income) were associated with different aspects of smoking-related stigma (i.e. feeling uncomfortable, negative stereotype of smokers, and perceived marginalization). We found that stronger anti-smoking injunctive norms were associated with higher levels of all indicators of perceived stigma in Mexico and Uruguay. Having fewer smoking friends was associated with feeling uncomfortable and perceived marginalization in Mexico. Higher income and education were associated with a stronger negative stereotype of smokers in Mexico.

Lower income and education were associated with a stronger negative stereotype of smokers in Uruguay. Study results suggest that factors that drive the social unacceptability of tobacco may stigmatize smokers, although further research is needed to determine whether policy-promoted stigmatization produces undesirable outcomes (e.g. lower cessation rates).

Citation

Lee, E.S., Seo, H.G., Fong, G.T., Yan, M., Driezen, P. (2018). Awareness of Korean adult smokers about national smoking cessation programs in Korea: findings from the 2016 International Tobacco Control Policy Evaluation Korea Survey. Journal of the Korean Society for Research on Nicotine and Tobacco, 9(Suppl 1), S22-30.

Abstract

Background: There are effective intervention program for smoking cessation such as clinics at public health centres, quitlines, residential cessation program, and insurance program in South Korea. The purpose of this study is to investigate awareness and utilization of smoking cessation program in current smokers.
Methods: We analyzed data from the ITC Korea Survey, a telephone survey of a nationally representative sample of 2,000 adult smokers, conducted from June 2015 to June 2016. Frequency of awareness, intention to use, and utilization about smoking cessation program were reported in current smokers. To evaluate influence of smoking related factors like nicotine dependence on awareness, intention to use, and use about smoking cessation program of current smokers, logistic regression was used. All analyses were performed with use of STATA version 11.
Results: In case of the insurance program to help quit, current smokers have an awareness about it (36.9%) and an interest in using it (50.3%). The proportion of current smoker utilizing quit program was 32.3% for public clinic, 0.9% for residential program, 7.4% for insurance program to help quit, and 3.0% for Quitlines. Higher utilization was observed current smokers over 40 years of age, married, with daily smoking amount (above 10/d), with quit attempt in the last 1 year (OR 1.32, 95% CI 1.04-1.68), and with smoking cessation plan (OR 2.47, 95% CI 1.85-3.29).
Conclusion: A small percentage of current smokers participated the government providing smoking cessation program in Korea, even though their awareness is relatively good. Further strategy is necessary to encourage current smoker to participate smoking cessation program.

Abstract

Background: This paper aimed to present proportion of awareness and use of e-cigarettes and vaping behaviors among adult smokers in South Korea.

Methods: We used data of current adult smokers participating in the International Tobacco Control (ITC) survey Korea in 2016. The frequency analysis and cross analysis were used to present the proportion of awareness, experience, current use, reasons for use and vaping behaviors of e-cigarettes, and logistic regression analysis was used to present factors associated with awareness, experience, and current e-cigarette use. All data were submitted to complex sample survey data analysis using SPSS version 23.0 (SPSS Inc., Chicago, IL, USA) and weighted to represent the Korean population.

Results: Out of 2000 adult smokers, the proportion of awareness, experience, and current use e-cigarettes were 93.8%, 33.8%, and 5.5%, respectively. In multivariable logistic regression analysis, younger age groups were associated with increased odds ratios (ORs) for awareness, higher consumption of tobacco and no past quit attempt were associated with increased ORs for experience, and higher income groups were associated with increased ORs for current use of e-cigarettes. The common reasons for using e-cigarettes were because of thinking that using e-cigarettes were more acceptable than smoking and less harmful to other people, and makes it easier to cut down on smoking. Most e-cigarette users vaped nicotine-contained e-cigarettes and bought them at e-cigarettes shop.

Conclusion: E-cigarette awareness and use increased among Korean smokers especially among higher income groups. Careful monitoring of behavior of using e-cigarettes is needed.

Citation

Hummel, K., Candel, M.J.J.M., Nagelhout, G.E., Brown, J., van den Putte, B., Kotz, D., Willemsen, M.C., Fong, G.T., West, R., de Vries, H. (2018). Construct and predictive validity of three measures of intention to quit smoking: Findings from the International Tobacco Control (ITC) Netherlands Survey. Nicotine and Tobacco Research, 20(9), 1101-1108.

Abstract

Introduction: The aim of the study was to compare the construct validity and the predictive validity of three instruments to measure intention to quit smoking: a Stages of Change measure, the Motivation To Stop Scale (MTSS) and a Likert scale. We used the Theory of Planned Behaviour as theoretical framework.

Methods: We used data from the International Tobacco Control (ITC) Netherlands Survey. We included smokers who participated in three consecutive survey waves (n=980). We measured attitude, subjective norm, and perceived behavioural control in 2012, intention to quit with three instruments in 2013, and having made a quit attempt in the last year in 2014. We conducted Structural Equation Modelling with three models for the instruments of intention separately, and with one model that included the three instruments simultaneously.

Results: All three instruments of intention were significantly and positively related to attitude and perceived behavioural control but none was related to subjective norm. All three instruments were significantly and positively related to making a quit attempt. The relation of the Likert scale with making a quit attempt (β=0.38) was somewhat stronger than that of the Stages of Change measure (β=0.35) and the MTSS (β=0.22). When entering the three instruments together into one model, only the Likert scale was significantly related to making a quit attempt.

Conclusions: All three instruments showed reasonable construct validity and comparable predictive validity. Under the studied conditions, the Likert scale performed slightly better than the Stages of Change measure and the MTSS.

Implications: An assessment of the Stages of Change, the Motivation To Stop Scale (MTSS) and a Likert scale showed comparable predictive and construct validity as measures for intention to quit smoking. All three instruments can be used in future research; however, under the studied theoretical framework, i.e. the Theory of Planned Behaviour, the Likert scale performed slightly better than the other two instruments.

Citation

El-Toukhy, S., Choi, K., Hitchman, S.C., Bansal-Travers, M., Thrasher, J.F., Yong, H.H., O’Connor, R.J., Shang, C. (2018). Banning tobacco price promotions, smoking-related beliefs, and behaviour: findings from the International Tobacco Control Four Country (ITC 4C) Survey. Tobacco Control, 27(3), 310-318.

Abstract

Background: Ecological models emphasise multilevel influences on health behaviours. While studies show that exposure to price promotions is associated with smoking behaviour and its antecedents, less is known about whether these associations differ by macro-level factors such as national price promotion policies.

Methods: Current and former smokers (N=4698) from the International Tobacco Control Policy Evaluation Project four-country cohort were included in weighted multivariate logistic regression models to examine individual-level associations between exposure to price promotions at waves 7 and 8 (conducted in 2008–2009 and 2010–2011) and beliefs (social and injunctive norms, functional value of smoking, misconceptions around smoking and beliefs of tobacco industry and its regulations) and behaviour at wave 8, stratified by whether countries allow (Australia and USA) or ban (Canada and UK) price promotions.

Results: Associations between exposure to price promotions and smoking-related beliefs and behaviour differed by national price promotion policies. In countries that allow price promotions, participants repeatedly exposed to price promotions at waves 7 and 8 were more likely to associate functional values to smoking (ie, calms down when stressed (adjusted OR (AOR) 1.83) and to be current smokers at wave 8 (AOR 1.94). In countries that ban price promotions, participants repeatedly exposed to price promotions were less likely to hold misconceptions around smoking (ie, harsher smoke is more dangerous).

Conclusions: Differential associations emerged between exposure to price promotions, smoking-related beliefs and behaviour across countries with and without a price promotions ban. Adopting price promotion bans could ameliorate the associations between exposure to price promotions and smoking beliefs and behaviours.

Citation

Cho, Y. J., Thrasher, J. F., Yong, H.-H., Szklo, A. S., O'Connor, R. J., Bansal-Travers, M., Hammond, D., Fong, G. T., Hardin, J., Borland, R. (2018). Path analysis of warning label effects on negative emotions and quit attempts: A longitudinal study of smokers in Australia, Canada, Mexico, and the US. Social Science & Medicine, 197, 226-234.

Abstract

Background: Cigarette pack health warning labels can elicit negative emotions among smokers, yet little is known about how these negative emotions influence behavior change.

Objective: Guided by psychological theories emphasizing the role of emotions on risk concern and behavior change, we investigated whether smokers who reported stronger negative emotional responses when viewing warnings reported stronger responses to warnings in daily life and were more likely to try to quit at follow-up.

Methods: We analyzed data from 5439 adult smokers from Australia, Canada, Mexico, and the US, who were surveyed every four months from September 2012 to September 2014. Participants were shown warnings already implemented on packs in their country and reported negative emotional responses (i.e., fear, disgust, worry), which were averaged (range = 1 to 9). Country-stratified logistic and linear generalized estimating equations were used to analyze the effect of negative emotional responses on self-reported responses to warnings in daily life (i.e., attention, risk concern, avoidance of warnings, forgoing planned cigarettes) and quit attempts at follow-up. Models were adjusted for socio-demographic and smoking-related characteristics, survey wave, and the number of prior surveys answered.

Results: Smokers who reported stronger negative emotions were more likely to make quit attempts at follow-up (Adjusted ORs ranged from 1.09 [95% CI 1.04 to 1.14] to 1.17 [95% CI 1.12 to 1.23]; p < .001) than those who reported lower negative emotions. This relationship was mediated through attention to warnings and behavioral responses to warnings. There was no significant interaction of negative emotions with self-efficacy or nicotine dependence.

Conclusion: Negative emotions elicited by warnings encourage behavior change, promoting attention to warnings and behavioral responses that positively predict quit attempts.

Citation

Meijer, E., Van den Putte, B., Gebhardt, W.A., Van Laar, C., Bakk, Z., Dijkstra, A., Fong, G.T., West, R., Willemsen, M.C. (2018). A longitudinal study into the reciprocal effects of identities and smoking behaviour: findings from the ITC Netherlands Survey. Social Science & Medicine, 200, 249-257.

Abstract

Objective: Although it has been found that identity constructs related to smoking are associated with changes in smoking behaviour, the direction of causal associations is as yet unclear. This study aims to clarify the nature and direction of these associations.

Methods: In this longitudinal study we examined the reciprocal relations between identity constructs (i.e., smoker self-identity, quitter self-identity and smoker group-identity), intention to quit and smoking and quitting behaviour among a sample of 1036 smokers and ex-smokers, using cross-lagged structural equation modelling. Moreover, we tested whether these relations differed by socio-economic status (SES).

Results: Identity and smoking behaviour were reciprocally related in that in intention to quit and smoking behaviour consistently predicted identity change, and identity predicted (changes in) intentions to quit and smoking behaviour. Behaviour appears more important for identity change than identity for behaviour change. Furthermore, quitter self-identity appears more important than smoker self- and group-identity. Relationships did not differ significantly between SES-groups. The findings were replicated using a crossvalidation sample.

Conclusion: Results imply that changing smoking behaviour may be a vehicle to change smoking-related identity. Moreover, strengthening identification with quitting is more crucial for quit success than decreasing smoker identities. The finding that behaviour may be more important for identity than vice versa, if replicated, may call for additions to identity theories.

Citation

Chen, M., Thompson, M.E., Wu, C. (2018). Empirical likelihood methods for complex surveys with data missing-by-design. Statistica Sinica, 28(4).

Abstract

We consider nonrandomized pretest-posttest designs with complex survey data for observational studies. We show that two-sample pseudo empirical likelihood methods provide efficient inferences on the treatment effect, with a missing-by-design feature used for forming the two samples and the baseline information incorporated through suitable constraints. The proposed maximum pseudo empirical likelihood estimators of the treatment effect are consistent and pseudo empirical likelihood ratio confidence intervals are constructed through bootstrap calibration methods. The proposed methods require estimation of propensity scores which depend on the underlying missing-by-design mechanism. A simulation study is conducted to examine finite sample performances of the proposed methods under different scenarios of nonignorable and ignorable missing patterns. An application to the International Tobacco Control Policy Evaluation Project Four Country Surveys is also presented to demonstrate the use of the proposed methods for examining the mode effect in survey data collection.

Citation

Choi, Y.J., Seo, H.G., Kim, Y., Fong, G.T., Yan, M., Driezen, P. (2018). Tobacco related knowledge is associated with heaviness of smoking index (HSI) and intention to quit among Korean smokers: findings from 2016 ITC Korea Survey. Journal of the Korean Society for Research on Nicotine and Tobacco, 9(Suppl 1), S31-S38.

Abstract

Background: International Tobacco Control project (ITC) was performed in South Korea for evaluation of the effects of smoking control policies in compliance with FCTC. We tested the association between the level of knowledge and heaviness of smoking index (HSI), and intention to quit smoking.

Methods: The study followed the same methodology by ITC policy evaluation project. Trained call center staffs interviewed 2000 current smokers (1800 men and 200 women, aged 19-65) on the phone. Tobacco-related knowledge was evaluated by asking participants the diseases related with smoking such as stroke, impotence, visual loss, peripheral vascular disease, bladder cancer, and breast cancer. Multivariate logistic regression was used for statistical analysis, which was adjusted by age, sex, education level, annual household income, alcohol consumption frequency, and heaviness of smoking index.

Results: High HSI score (3-6) was associated with low knowledge score (Odds ratio (OR) 0.80, 95% confidence interval (CI) 0.65-0.99). Smokers who had intention to quit smoking in any future were also more likely to be in a high knowledge score group (10-14 vs. 0-9 out of 14) (OR 1.50, 95% CI 1.19-1.89).

Conclusion: Smokers who had higher HSI or had no intention to quit tended to have lower level of knowledge regarding health risk of smoking. This implies that education and public awareness on health risk of tobacco could be more effective when targeted to these smokers.

Citation

Kim, E.Y., Kim, Y., Choi, Y.J., Seo, H.G., Yan, M., Driezen, P., Fong, G.T. (2018). Change of support for smoke-free area and perception of effectiveness of smoking ban policy among Korean smokers: findings from the 2010, 2016 International Tobacco Control Policy Evaluation Survey in Korea. Journal of the Korean Society for Research on Nicotine and Tobacco, 9(Suppl 1), S39-50.

Abstract

Background: Smoke-free policies have been reinforced in recent years in South Korea. We investigated factors that influenced support for smoke-free area (SSA) and perception of effectiveness of smoking ban policy (PESP) and examined whether SSA and PESP changed between 2010 and 2016.

Methods: We analyzed wave 3 (2010) and new wave 1 (2016) data from the International Tobacco Control (ITC) Survey in Korea. Telephone survey was conducted among Korean smokers aged ≥19 in 2010 (n=1,560) and 2016 (n=2,000). Differences between survey data in 2010 versus 2016 were evaluated by t-test. Multiple linear regression analysis was performed to analyze factors associated with SSA and PESP, and the changes of those factors over time.

Results: Smokers in 2016 had greater SSA and more positive PESP than in 2010. Respondents who were married, had plan to quit smoking within 6 months, initiated smoking later in their life, or had less nicotine dependency were more likely to present greater SSA and more positive PESP. Respondents had lesser SSA when they answered that smoking was allowed in bars and restaurants in their neighborhood, and workplace they belonged compared to those who experienced smoke-free policy in all three of the places. Older ages were associated with more positive PESP.

Conclusion: Smokers changed their SSA and PESP more positively in 2016 than 2010. Reinforced smoke-free policies would lead smokers to have more favorable SSA and PESP and possibly contribute to reduction in smoking rate.

Citation

Lee, C., Yong, H.H., Borland, R., McNeill, A., Hitchman, S.C. (2018). Acceptance and patterns of use of vaping in Australia and the United Kingdom: results from the International Tobacco Control Survey. Drug & Alcohol Dependence, 185, 142-48.

Abstract

Background: This study examined the prevalence and correlates of (1) perceived social acceptability of personal vaporizer (PV)/e-cigarette use, and (2) reported vaping in public and private places, in the UK and Australia with different regulatory environments for PVs.

Methods: Data analyzed come from 2849 smokers and recent ex-smokers in the UK and Australia who participated in the 2014 wave of the International Tobacco Control Survey.

Results: UK respondents were more likely to think vaping is socially acceptable than Australians (56.4% vs. 27.9%; p < 0.001). Having quit smoking, observing vaping in smoke-free (SF) public places, and believing vaping is less harmful than smoking was all significantly associated with greater perceived social acceptability of vaping in both countries. However, vaping status and that of friends and family were more influential in Australia than in the UK. Vaping was reported as much more common in private, than public, settings in both countries. UK vapers were more likely to report vaping in SF public places (OR = 2.66; 95% CI = 1.5-4.7; p < 0.01) and at home (OR = 2.44; 95% CI = 1.5-3.9; p < 0.001), but not in their car when controlling for demographic factors and vaping and smoking status.

Conclusion: The acceptability of vaping was greater among those who were more exposed to vaping and not just among those with some personal experience of vaping, suggesting no strong social barriers to increased use. Vaping in SF public places was less common than in homes, and both were more common in the UK than in Australia, suggesting some social constraints on use, particularly in Australia.

Citation

van Mourik, D.J.A., Candel, M.J.J.M., Nagelhout, G.E., Willemsen, M.C., Fong, G.T., Hummel, K., van den Putte, B., de Vries, H. (2018). Support for a point-of-sale cigarette display ban among smokers: findings from the International Tobacco Control (ITC) Netherlands Survey. BMC Public Health, 18, 740.B

Abstract

Background: Displaying tobacco products at point-of-sale (PoS) has become an important marketing strategy for the tobacco industry. This study was designed to (1) examine how support for a PoS cigarette display ban changed among Dutch smokers between 2010 and 2015 and (2) identify the variables that predict support among smokers for a PoS cigarette display ban.

Methods: Longitudinal data from six annual survey waves (2010-2015) from the International Tobacco Control (ITC) Netherlands Survey were analyzed. The sample consisted of between 1279 and 1800 smokers per year. Smokers were asked whether they supported a complete ban on displays of cigarettes inside shops and stores.

Results: Support for a PoS cigarette display ban increased from 28.9% in 2010 to 42.5% in 2015 (OR = 1.40, p < 0.001). A multiple logistic regression analysis revealed that support for a PoS display ban of cigarettes was more likely among smokers who had more knowledge about the health risks of smoking (OR = 3.97, p < 0.001), believed smoking-related health risks to be severe (OR = 1.39, p < 0.001), had a more positive attitude towards quitting smoking (OR = 1.44, p = 0.006), reported stronger social norms to quit smoking (OR = 1.29, p = 0.035), had a higher self-efficacy for quitting smoking (OR = 1.31, p = 0.001), and had stronger intentions to quit smoking (OR = 1.23, p = 0.006).

Conclusions: This paper showed that support for a PoS display ban of cigarettes increased among smokers in the Netherlands over the years. To further increase support, educational campaigns about the dangers of smoking, and campaigns that encourage quitting may be needed.

Citation

Vardavas, C., Bécuwe, N., Demjén, T., Fernández, E., McNeill, A., Mons, U., Tountas, Y., Trofor, A., Tsatsakis, A., Rohde, G., Willemsen, M.C., Prezewozniak, K., Zatoński, W., Fong, G.T., on behalf of the EUREST-PLUS Consortium. (2018). Study protocol of European Regulatory Science on Tobacco (EUREST-PLUS): policy implementaton to reduce lung disease. Tobacco Induced Diseases, 16(Suppl 2), 3-10.

Abstract

Efforts to mitigate the devastation of tobacco-attributable morbidity and mortality in the European Union (EU) are founded on its newly adopted Tobacco Products Directive (TPD) along with the first-ever health treaty, the WHO Framework Convention on Tobacco Control (FCTC). The aim of this Horizon 2020 Project entitled European Regulatory Science on Tobacco: Policy Implementation to Reduce Lung Disease (EURESTPLUS) is to monitor and evaluate the impact of the implementation of the TPD across the EU, within the context of WHO FCTC ratification. To address this aim, EUREST-PLUS consists of four objectives: 1) To create a cohort study of 6000 adult smokers in six EU MS (Germany, Greece, Hungary, Poland, Romania, Spain) within a pre-TID vs post- TPD implementation study design; 2) To conduct secondary dataset analyses of the Special Eurobarometer on Tobacco Survey (SETS); 3) To document changes in e-cigarette product parameters (technical design, labelling/packaging and chemical composition) pre-TID vs post-TPD; and 4) To enhance innovative joint research collaborations on chronic non-communicable diseases. Through this methodological approach, EUREST-PLUS is designed to generate strong inferences about the effectiveness of tobacco control policies, as well as to elucidate the mechanisms and factors by which policy implementation translates to population impact. Findings from EUREST-PLUS have potential global implications for the implementation of innovative tobacco control policies and its impact on the prevention of lung diseases.

Abstract

Background: The Canadian government has committed to an endgame target of less than 5% tobacco use by 2035. The aims of this study were to assess baseline levels of support for potential endgame policies among Canadian smokers, by province/region, demographic characteristics and smoking-related correlates, and to identify predictors of support.

Methods: We analyzed data for 3215 adult (age ≥ 18 yr) smokers from the Canadian arm of the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. We estimated weighted percentages of support for endgame measures for 6 provinces/regions of the country. We used weighted logistic regression models to identify predictors of support for 14 endgame strategies.

Results: Among cigarette endgame policies, support was highest for reducing nicotine content (70.2%), raising the legal age for purchase (69.8%), increasing access to alternative nicotine products (65.8%) and banning marketing (58.5%). Among e-cigarette policies, there was majority support for restricting youth access (86.1%), restricting nicotine content (64.9%), prohibiting use in smokefree places (63.4%) and banning marketing (54.8%). The level of support for other endgame measures ranged from 28.9% to 45.2%. Support for cigarette and e-cigarette policies was generally higher among smokers with intentions to quit and those from Quebec. Support for e-cigarette policies was generally lower among smokers who also used e-cigarettes daily.

Interpretation: There is considerable support among Canadian smokers for endgame policies that go beyond current approaches to tobacco control. Our findings provide a baseline for evaluating future trends in smokers’ support for innovative measures to radically reduce smoking rates in Canada.

Citation

Levy, D. (2018). Communicating accurate and complete information. Addictive Behaviours, 76, 386-387.

Highlights:

• Consumers should be provided with the best information about the risks of different tobacco products to make informed choices.
• However, better information is needed about effectively communicating relative as well as absolute risks.
• In particular, studies are needed on communicating the risks of dual use.

Citation

Levy, D., Tam, J., Kuo, C., Fong, G.T., Chaloupka, F.J. (2018). The impact of implementing tobacco control policies: the 2017 tobacco control policy scorecard. Journal of Public Health Management and Practice, 24(5), 448-457.

Abstract

The Tobacco Control Scorecard, published in 2004, presented estimates of the effectiveness of different policies on smoking rates. Since its publication, new evidence has emerged. We update the Scorecard to include recent studies of demandreducing tobacco policies for high-income countries. We include cigarette taxes, smoke-free air laws, media campaigns, comprehensive tobacco control programs, marketing bans, health warnings, and cessation treatment policies. To update the 2004 Scorecard, a narrative review was conducted on reviews and studies published after 2000, with additional focus on 3 policies in which previous evidence was limited: tobacco control programs, graphic health warnings, and marketing bans. We consider evaluation studies that measured the effects of policies on smoking behaviors. Based on these findings, we derive estimates of short-term and long-term policy effect sizes. Cigarette taxes, smoke-free air laws, marketing restrictions, and comprehensive tobacco control programs are each found to play important roles in reducing smoking prevalence. Cessation treatment policies and graphic health warnings also reduce smoking and, when combined with policies that increase quit attempts, can improve quit success. The effect sizes are broadly consistent with those previously reported for the 2004 Scorecard but now reflect the larger evidence base evaluating the impact of health warnings and advertising restrictions.

No abstract is available.

Citation

Heckman, B., Fong, G.T., Borland, R., Hitchman, S.C., O’Connor, R.J., Bickel, W.K., Stein, J., Yong, H.H., Nahhas, G., Pope, D., Shang, C., Cheng, K.W., Levy, D., Cummings, K.M. (2019). The impact of vaping and regulatory environment on cigarette demand: Behavioral economic perspective across four countries. Addiction, 114(Suppl 1), 123-133.

Abstract

Background and Aims: Government regulations of nicotine vaping products (NVP) have evolved rapidly during the past decade. The impact of NVP regulatory environment and vaping on cigarette demand is unknown. The current study aims to investigate whether or not respondents’ reported cigarette demand, as measured by a hypothetical cigarette purchase task, varies with (1) smoking status, (2) vaping status or (3) NVP regulatory environment (country used as proxy).

Design: Cross‐sectional survey data from wave 1 of the International Tobacco Control (ITC) Four Country Smoking and Vaping (4CV) Survey (2016).

Setting: Australia, Canada, England and the United States.

Participants: A total of 10 316 adult smokers.

Measurements: A hypothetical purchase task asked smokers to estimate how many cigarettes they would purchase for consumption in a single day across multiple cigarette prices. Responses were used to derive measures of cigarette demand. Overall sensitivity of cigarette consumption to price increases was quantified to index cigarette demand elasticity, whereas estimated consumption when cigarettes are free was used to index cigarette demand intensity.

Findings: A majority of the non‐daily smokers had previously smoked daily (72.3%); daily vapers were more likely to be former daily smokers (89.9%) compared to non‐daily vapers (70.1%) and non‐vapers (69.2%) (P < 0.001). The smoking status × vaping status interaction was significant for cigarette demand intensity (F = 4.93; P = 0.007) and elasticity (F = 7.30; P = 0.001): among non‐daily smokers, vapers reported greater intensity but lower elasticity (i.e. greater demand) relative to non‐vapers (Ps < 0.05). Among daily smokers, daily vapers reported greater intensity relative to non‐vapers (P = 0.005), but vaping status did not impact elasticity (Ps > 0.38). Intensity was higher in Australia compared with all other countries (Ps < 0.001), but elasticity did not vary by country (F = 2.15; P = 0.09).

Conclusions: In a hypothetical purchase task, non‐daily smokers showed lower price elasticity if they used e‐cigarettes than if they did not, while there was no clear difference in elasticity between e‐cigarette users and non‐users among daily smokers or according to regulatory environment of their country with regard to e‐cigarettes.

Citation

Braverman-Bronstein, A., Thrasher, J.F., Hernández-Ávila, M., Reynales-Shigematsu, L.M., Barrientos-Gutierrez, T. (2018). Concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes in Mexico. Harm Reduction Journal, 15(1), 50.

Abstract

Background: Article 10 of the World Health Organization Framework Convention on Tobacco Control states the need for industry disclosure of tobacco contents and emissions. Currently, the profiles of key tobacco compounds in legal and illegal cigarettes are largely unknown. We aimed to analyze and compare concentrations of nicotine, nitrosamines, and humectants in legal and illegal cigarettes collected from a representative sample of smokers.

Methods: Participants of the International Tobacco Control cohort provided a cigarette pack of the brand they smoked during the 2014 wave. Brands were classified as legal or illegal according to the Mexican legislation. Nicotine, nitrosamines, glycerol, propylene glycol, and pH were quantified in seven randomly selected packs of each brand. All analyses were done blinded to legality status. Average concentrations per brand and global averages for legal and illegal brands were calculated. Comparisons between legal and illegal brands were conducted using t tests.

Results: Participants provided 76 different brands, from which 6.8% were illegal. Legal brands had higher nicotine (15.05 ± 1.89 mg/g vs 12.09 ± 2.69 mg/g; p < 0001), glycerol (12.98 ± 8.03 vs 2.93 ± 1.96 mg/g; p < 0.001), and N-nitrosanatabine (NAT) (1087.5 ± 127.0 vs 738.5 ± 338 ng/g; p = 0.006) concentrations compared to illegal brands. For all other compounds, legal and illegal brands had similar concentrations.

Conclusion: Compared to illegal cigarettes, legal brands seem to have higher concentrations of nicotine, NAT, and glycerol. Efforts must be made to implement and enforce Article 10 of the Framework Convention on Tobacco Control to provide transparent information to consumers, regulators, and policymakers; and to limit cigarette engineering from the tobacco industry.

Citation

Hummel, K., Nagelhout, G.E., Fong, G.T., Vardavas, C., Papadakis, S., Herbec, A., Mons, U., van den Putte, B., Borland, R., Fernández, E., de Vries, H., McNeill, A., Gravely, S., Przewoźniak, K., Kovacs, P., Trofor, A., Willemsen, M.C., on behalf of the EUREST-PLUS Consortium. (2018). Quitting activity and use of cessation assistance reported by smokers in eight European countries: Findings from the EUREST-PLUS ITC Europe Surveys. Tobacco Induced Diseases, 16(Suppl 2), 57-73.

Abstract

Introduction: There is clear evidence that the use of cessation aids significantly increases the likelihood of successful smoking cessation. The aim of this study was to examine quitting activity and use of cessation aids among smokers from various European countries. Subgroup differences were also examined for sex, income, education, and age in each country.

Methods: Cross-sectional data were collected in 2016 from 10683 smokers in eight European countries participating in the ITC Project: England (n=3536), Germany (n=1003), Greece (n=1000), Hungary (n=1000), the Netherlands (n=1136), Poland (n=1006), Romania (n=1001), and Spain (n=1001). We measured quitting activity, including quit attempts in the previous 12 months and intention to quit, use of cessation aids (i.e. medication, quitlines, internet, local services, e-cigarettes), and whether respondents had received advice from health professionals about quitting and e-cigarettes.

Results: Quit attempts were most common in England (46.3%) and least common in Hungary (10.4%). Quit intention was highest in England and lowest in Greece. Use of e-cigarettes to quit was highest in England (51.6%) and lowest in Spain (5.0%). Use of cessation aids was generally low across all countries; in particular this was true for quitlines, internet based support, and local services. Receiving health professional advice to quit was highest in Romania (56.5%), and lowest in Poland (20.8%); few smokers received advice about e-cigarettes from health professionals. No clear differences were found for sex and income groups. Across countries, smokers with lower education reported less quitting activity.

Conclusions: Quitting activity and use of cessation methods were low in most countries. Greater quit attempts and use of cessation aids were found in England, where large investments in tobacco control and smoking cessation have been made. Health professionals are important for motivating smokers to quit and promoting the effectiveness of various methods, but overall, few smokers get advice to quit.

Citation

Kahnert, S., Demjén, T., Tountas, Y., Trofor, A., Przewoźniak, K., Zatónski, W.A., Fernández, E., McNeill, A., Willemsen, M.C., Kyriakos, C.N., Fong, G.T., Vardavas, C. Mons, U., on behalf of the EUREST-PLUS Consortium. (2018). Extent and correlates of self-reported exposure to tobacco advertising, promotion, and sponsorship in smokers: findings from the EUREST-PLUS ITC Europe Surveys. Tobacco Induced Diseases, 16(Suppl 2), 74-84.

Abstract

Introduction: Tobacco advertising, promotion and sponsorship (TAPS) are known to promote tobacco consumption and to discourage smoking cessation. Consequently, comprehensive TAPS bans are effective measures to reduce smoking. The objective of this study was to investigate to what extent smokers are exposed to TAPS in general, and in various media and localities, in different European countries.

Methods: A cross-sectional analysis of national representative samples of adult smokers in 2016 from Germany, Greece, Hungary, Poland, Romania, and Spain (EUREST-PLUS Project, n=6011), as well as England (n=3503) and the Netherlands (n=1213) (ITC Europe Surveys) was conducted. Prevalence of self-reported TAPS exposure is reported by country, and socioeconomic correlates were investigated using logistic regression models.

Results: Self-reported exposure to TAPS varied widely among the countries, from 15.4 % in Hungary to 69.2 % in the Netherlands. In most countries, tobacco advertising was most commonly seen at the point of sale, and rarely noticed in mass media. The multivariate analysis revealed some variation in exposure to TAPS by sociodemographic factors. Age showed the greatest consistency across countries with younger smokers (18–24 years) being more likely to notice TAPS than older smokers.

Conclusions: TAPS exposure tended to be higher in countries with less restrictive regulation but was also reported in countries with more comprehensive bans, although at lower levels. The findings indicate the need for a comprehensive ban on TAPS to avoid a shift of marketing efforts to less regulated channels, and for stronger enforcement of existing bans.