Scientific Journal Articles
Levy, D. T., Sweanor, D., Sanchez-Romero, L. M., O'Connor, R., Goniewicz, M. L., & Borland, R. (2020). Altria-Juul Labs deal: why did it occur and what does it mean for the US nicotine delivery product market. Tobacco control, 29(e1), e171-e174.
Showing 401-425 of 622 Results
Kennedy, et al. 2012. Smoking cessation interventions from health care providers before and after the national smoke-free law in France
Background: Smoking cessation advice from health care providers (HCP) is well-known to be associated with increased quitting. This study sought to understand the extent to which smokers in France who visited a HCP around the time of the implementation of the national ban on smoking received encouragement to quit from a HCP and what kinds of intervention were provided. HCP may have a unique opportunity during the implementation phase of smoke-free laws to address their patients’ smoking behaviours to increase the likelihood of success at a time when smokers’ readiness and interest in quitting may be higher.
Methods: Telephone interviews were conducted among adult smokers (n = 1067) before and after the two-phase 2007 and 2008) national ban on indoor smoking as part of the International Tobacco Control (ITC) France Survey. In the survey, smokers were asked whether they had visited a HCP in the past 6 months and, if so, whether they had received cessation encouragement, and/or other interventions to support quitting such as prescriptions for stop-smoking medication.
Results: Most smokers (61%) reported visiting a HCP in the 6 months prior to the first phase of the national smoke-free ban, and 58% after the time of the hospitality ban. Of these, most reported they did not receive any assistance from a HCP before (54%) or after (64%) the smoke-free law. Among those who reported an intervention, the most common were only encouragement to quit (58% in Wave 1 and 49% in Wave 2), or receiving both encouragement and a pamphlet (31% in both Wave 1 and 2). The combination of prescriptions for stop-smoking medicine and encouragement to quit increased from 8% in 2007 to 22% in 2008. The smokers who received an intervention were more likely (OR 1.9, 95% CI: 1.2–2.9) to report that they were thinking about quitting.
Discussion: This study demonstrates that HCP in France are well positioned to provide smoking cessation encouragement and other interventions to a majority of smokers and thus the importance of taking measures to increase their involvement, particularly when populationlevel tobacco control policies, such as smoke-free laws, are being implemented.[download PDF]
King, et al. 2012. The decline of menthol cigarette smoking in Australia, 1980– 2008
Introduction: Concerns have been expressed that menthol cigarettes are highly conducive to uptake and hence function as “starter cigarettes” for adolescents. There is strong evidence for this in the United States. If menthol cigarettes are critical to uptake for some adolescents, they might be expected to remain popular among adolescents independent of promotional activity. We analyzed trends in the market share of menthol brands in Australia among both adolescents and adults to provide further insights into the determinants of menthol cigarette smoking.
Methods: We used the Australian Secondary Students Alcohol and Drug Survey (1984–2008), the Smoking and Health Survey (1980–1998), and the International Tobacco Control Four Nations Survey (2002–2008) to estimate market share of brands. Measures were reported use of all menthol brands for adults and use of the Alpine brand for adolescents.
Results: Menthol smoking was much more popular among female smokers of all age groups in the early 1980s. During the 1980s and 1990s, use declined markedly in the 18–29 age groups, while remaining relatively stable among older smokers. Use of Alpine declined markedly among adolescents in the 1980s and 1990s. However, during this period, Alpine remained more popular among experimenting than regular smokers.
Conclusions: Both Alpine and other menthol brands are now primarily “older women’s cigarettes” in Australia. The trends in declining popularity among younger smokers suggest that targeted marketing plays a major role in determining menthol brand market share. Alpine has played a role as a “starter” cigarette in Australia but that role has decreased markedly since the 1980s. Within the Australian context, “light/mild” brands may have taken over the role of easier-to-smoke cigarettes that attract experimenting smokers.[download PDF]
Borland, et al. 2012. How much unsuccessful quitting activity is going on among adult smokers? Data from the International Tobacco Control Four Country cohort survey
Aims: To document accurately the amount of quitting, length of quit attempts and prevalence of plans and serious thought about quitting among smokers.
Design: We used longitudinal data from 7 waves of the International Tobacco Control Policy Evaluation Four Country Survey (ITC-4). We considered point-prevalence data and cumulative prevalence over the 7 years of the study. We also derived annual estimates of quit activity from reports of quit attempts starting only within more recent time-frames, to control for biased recall.
Setting: Australia, Canada, the United Kingdom and the United States.
Participants: A total of 21 613 smokers recruited across seven waves.
Measurements: Reported life-time quit attempts, annual quit attempts, length of attempts, time since last attempt started, frequency of aborted attempts, plans to quit and serious thought about quitting.
Findings: Around 40.1% (95% CI: 39.6–40.6) of smokers report attempts to quit in a given year and report an average of 2.1 attempts. Based on free recall, this translates to an average annual quit attempt rate of 0.82 attempts per smoker. Estimates derived only from the preceding month to adjust for recall bias indicate an annual rate of approximately one attempt per smoker. There is a high prevalence of quitrelated activity, with more than a third of smokers reporting thoughts or actions related to quitting in a given month. More than half the surveyed smokers eventually succeeded in quitting for at least 1 month, and a majority of these for over 6 months.
Conclusions: Smokers think a great deal about stopping and make many unsuccessful quit attempts. Many have been able to last for extended periods and yet they still relapsed. More attention needs to be focused on translating quit-related activity into long-term abstinence.[download PDF]
Nagelhout, et al. 2012. Comparative impact of smoke-free legislation on smoking cessation in three European countries [access full article]
Background: Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success.
Methods: Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England).
Results: In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England.
Conclusion: The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts[download PDF]
Sansone, et al. 2012. Knowledge of health effects and intentions to quit among smokers in India: Findings from the Tobacco Control Policy (TCP) India Pilot Survey
Awareness of the health risks of smoking is an important factor in predicting smoking-related behaviour; however, little is known about the knowledge of health risks in low-income countries such as India. The present study examined beliefs about the harms of smoking and the impact of health knowledge on intentions to quit among a sample of 249 current smokers in both urban and rural areas in two states (Maharashtra and Bihar) from the 2006 TCP India Pilot Survey, conducted by the ITC Project. The overall awareness among smokers in India of the specific health risks of smoking was very low compared to other ITC countries, and only 10% of respondents reported that they had plans to quit in the next six months. In addition, smokers with higher knowledge were significantly more likely to have plans to quit smoking. For example, 26.2% of respondents who believed that smoking cause CHD and only 5.5% who did not believe that smoking causes CHD had intentions to quit (χ2 = 16.348, p < 0.001). Important differences were also found according to socioeconomic factors and state: higher levels of knowledge were found in Maharashtra than in Bihar, in urban compared to rural areas, among males, and among smokers with higher education. These findings highlight the need to increase awareness about the health risks of smoking in India, particularly in rural areas, where levels of education and health knowledge are lower.[download PDF]
Siahpush , et al. 2012. Tobacco expenditure, smoking-induced deprivation and financial stress: Results from the International Tobacco Control (ITC) Four-Country Survey
Introduction and Aims: While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS).
Design and Methods: We used data from wave 7 (2008–2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS.
Results: In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS.
Conclusions: Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.[download PDF]
Yong, et al. 2012. Stability of cigarette consumption over time among continuing smokers: A latent growth curve analysis
Objectives: This paper examined the stability over time of daily cigarette consumption of continuing smokers and explored factors that might account for the patterns of change in consumption using a latent growth curve (LGC) analytic approach.
Methods: Data come from the first 5 waves of the International Tobacco Control Four-Country Survey, conducted in Canada, the United States, the United Kingdom, and Australia where a cohort of over 2,000 smokers from each country were recruited and followed up annually with replenishment.
Results: Raw data revealed that continuing smokers showed a marked steep decline in cigarettes per day during the first 2 waves followed by a gentler linear decline in consumption over the remaining waves of the study period. This pattern of change in cigarette consumption was best modelled using a piecewise linear LGC model. Baseline consumption level was highest in Australia and lowest in the United Kingdom, although the rate of decline was similar across the 4 countries. Being older than 55 years and having made at least 1 quit attempt were related to greater rate of decline in consumption.
Conclusion: Continuing smokers who are unwilling or unable to quit smoking can and do attempt to reduce their daily cigarette consumption over time. Factors such as making a quit attempt even if unsuccessful and experiencing smoking bans at work and at homes can contribute to reduced smoking among this group, which suggests that interventions focusing in on these factors, along with providing cessation help, may greatly improve their chances of quitting smoking altogether.[download PDF]
Young, et al. 2012. Trends in roll-your-own smoking: Findings from the ITC Four-Country Survey (2002–2008)
Objective: To establish the trends in prevalence, and correlates, of roll-your-own (RYO) use in Canada, USA, UK and Australia, 2002–2008.
Methods: Participants were 19,456 cigarette smokers interviewed during the longitudinal International Tobacco Control (ITC) Four-Country Survey in Canada, USA, UK, and Australia.
Results: “Predominant” RYO use (i.e., >50% of cigarettes smoked) increased significantly in the UK and USA as a proportion of all cigarette use (both P < .001) and in all countries as a proportion of any RYO use (all P < .010). Younger, financially stressed smokers are disproportionately contributing to “some” use (i.e., ≤50% of cigarettes smoked). Relative cost was the major reason given for using RYO, and predominant RYO use is consistently and significantly associated with low income.
Conclusion: RYO market trends reflect the price advantages accruing to RYO (a product of favourable taxation regimes in some jurisdictions reinforced by the enhanced control over the amount of tobacco used), especially following the impact of the Global Financial Crisis; the availability of competing low-cost alternatives to RYO; accessibility of duty-free RYO tobacco; and tobacco industry niche marketing strategies. If policy makers want to ensure that the RYO option does not inhibit the fight to end the tobacco epidemic, especially amongst the disadvantaged, they need to reduce the price advantage, target additional health messages at (young) RYO users, and challenge niche marketing of RYO by the industry.[download PDF]
Hall, et al. 2012. Do time perspective and sensation-seeking predict quitting activity among smokers? Findings from the Interntational Tobacco Control (ITC) Four Country Survey
Personality factors such as time perspective and sensation-seeking have been shown to predict smoking uptake. However, little is known about the influences of these variables on quitting behavior, and no prior studies have examined the association cross-nationally in a large probability sample. In the current study it was hypothesized that future time perspective would enhance – while sensation-seeking would inhibit – quitting activity among smokers. It was anticipated that the effects would be similar across English speaking countries. Using a prospective cohort design, this cross-national study of adult smokers (N=8845) examined the associations among time perspective, sensation-seeking and quitting activity using the first three waves of data gathered from the International Tobacco Control Four Country Survey (ITC-4), a random digit dialed telephone survey of adult smokers from the United Kingdom, United States, Canada and Australia. Findings revealed that future time perspective (but not sensation-seeking) was a significant predictor of quitting attempts over the 8-month follow-up after adjusting for socio-demographic variables, factors known to inhibit quitting (e.g., perceived addiction, enjoyment of smoking, and perceived value of smoking), and factors known to enhance quitting (e.g., quit intention strength, perceived benefit of quitting, concerns about health effects of smoking). The latter, particularly intention, were significant mediators of the effect of time perspective on quitting activity. The effects of time perspective on quitting activity were similar across all four English speaking countries sampled. If these associations are causal in nature, it may be the case that interventions and health communications that enhance future-orientation may foster more quit attempts among current smokers.[download PDF]
Borland, et al. 2012. Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) Policy Evaluation Surveys
Aims: To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support.
Design: Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary).
Settings: Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States.
Participants: Samples of smokers from 15 countries.
Measurements: Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits.
Findings: Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (<20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available.
Conclusions: There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.[download PDF]
Li, et al. 2012. The association between exposure to point-of-sale anti-smoking warnings and smokers’ interest in quitting and quit attempts: Findings from the International Tobacco Control Four Country Survey
Aims: This study aimed to examine the associations between reported exposure to anti-smoking warnings at the point-of-sale (POS) and smokers’ interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries.
Design: A prospective multi-country cohort design was employed.
Setting: Australia, Canada, the United Kingdom and the United States.
Participants: A total of 21 613 adult smokers who completed at least one of the seven waves (2002–08) of the International Tobacco Control Four Country Survey were included in the analysis.
Measurements: Reported exposure to POS anti-smoking warnings and smokers’ interest in quitting at the same wave and quit attempts over the following year.
Findings: Compared to smokers in Canada, the United Kingdom and the United States, Australian smokers reported higher levels of awareness of POS anti-smoking warnings, and this difference was consistent over the study period. Over waves in Australia (but not in the other three countries) there was a significantly positive association between reported exposure to POS anti-smoking warnings and interest in quitting [adjusted odds ratio = 1.139, 95% confidence interval (CI) 1.039–1.249, P < 0.01] and prospective quit attempts (adjusted odds ratio = 1.216, 95% CI 1.114–1.327, P < 0.001) when controlling for demographics, smoking characteristics, overall salience of anti-smoking information and awareness of anti-smoking material from channels other than POS.
Conclusions: Point-of-sale health warnings about tobacco are more prominent in Australia than the United Kingdom, the United States or Canada and appear to act as a prompt to quitting.[download PDF]
Wilson, et al. 2012. Hazardous patterns of alcohol use are relatively common in smokers: ITC Project (New Zealand)
Aims: To describe patterns of alcohol use in a nationally-representative sample of New Zealand smokers.
Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from a national survey: the NZ Health Survey (NZHS). From this sample we surveyed adult smokers (n=1376).
Results: A third (33.1%) of these smokers had a drinking pattern that was considered hazardous (i.e., AUDIT scores greater than and equal to 8). These figures were much higher than for non-smokers in the NZHS (at 13.1%). In both the univariate and multivariate analyses, hazardous drinking patterns were significantly more common among: younger smokers, male smokers, and Māori smokers (e.g., adjusted odds ratio for the latter: 1.43, 95%CI: 1.05-1.95). The same pattern of more hazardous drinking was also seen (but in the univariate analysis only), for smokers with financial stress and for moderate individuallevel deprivation.
Conclusions: These findings provide additional evidence that hazardous drinking patterns are elevated in New Zealand smokers overall and particularly in some groups of smokers. Given the international evidence that hazardous drinking may impede quitting, policy makers could consider the potential benefits of improved alcohol control as part of the national strategy to curtail the tobacco epidemic and achieve the government's "Smokefree Nation 2025" goal. Such an approach could also reduce this country's high levels of alcohol-related harm and reduce gender and ethnic health inequalities.[download PDF]
Nagelhout, et al. 2012. Does smoke-free legislation and smoking outside bars increase feelings of stigmatization among smokers? Findings from the International Tobacco Control (ITC) Netherlands Survey
This study examined whether smokers’ perceived level of stigmatization changed after the implementation of smoke-free hospitality industry legislation and whether smokers who smoked outside bars reported more perceived stigmatization. Longitudinal data from the International Tobacco Control (ITC) Netherlands Survey was used, involving a nationally representative sample of 1447 smokers aged 15 years and older. Whether smoke-free legislation increases smokers’ perceived stigmatization depends on how smokers feel about smoking outside. The level of perceived stigmatization did not change after the implementation of smoke-free hospitality industry legislation in the Netherlands, possibly because most Dutch smokers do not feel negatively judged when smoking outside.[download PDF]
Edwards, et al. 2012. Support for a tobacco endgame and increased regulation of the tobacco industry among New Zealand smokers: results from a National Survey
Aim: To examine the prevalence of smoker support for a ban on cigarette sales in 10 years time and increased regulation of the tobacco industry and to investigate the independent associations of support for these measures.
Methods: The authors surveyed opinions among adult smokers in two survey waves (N=1376 and N=923) from the New Zealand arm of the International Tobacco Control Policy Evaluation Survey during 2007–2009. The authors report prevalence of support stratified by age, gender and ethnicity. The authors carried out multivariate analyses to identify significant associations among potential determinants (demographics, socioeconomic status, mental health and smoking-related beliefs and behaviours) of support.
Results: Most New Zealand smokers supported greater regulation of the tobacco industry (65%) and more government action on tobacco (59%). Around half (46%) supported banning sales of cigarettes in 10 years time, provided effective nicotine substitutes were available. In a fully adjusted model, significant associations with support for greater tobacco company regulation included Māori ethnicity, experience of financial stress and greater awareness about the harms of smoking. Significant associations with support for a ban on tobacco sales in 10 years time included increasing area-based deprivation level, increasing intention to quit and greater concern about the health effects of smoking.
Conclusions: The findings suggest that most smokers will support stronger government action to control the tobacco industry and that many support radical ‘endgame’ approaches. Greater support among Māori, more deprived and possibly Pacific smokers, is an important finding, which could inform the design and implementation of new policies given the very high smoking prevalence among these groups and hence high priority for targeted tobacco control interventions. Perceived difficulties in gaining public support should not impede the introduction of rigorous tobacco control measures needed to achieve a tobaccofree New Zealand.[download PDF]
Huang, et al. 2012. Incidence and correlates of receiving cigarettes as gifts and selecting preferred brand because it was gifted: Findings from the ITC China Survey_ABSTRACT
Background: Giving cigarettes as gifts is a common practice in China, but there have been few systematic studies of this practice. The present study was designed to estimate the incidence of receiving cigarettes as gifts, correlates of this practice, and its impact on brand selection in a representative sample of urban adult smokers in China.
Methods: Data were analyzed from Wave 2 of the International Tobacco Control (ITC) China Survey, where 4843 adult urban smokers were interviewed in six major Chinese cities between October 2007 and January 2008. The incidence of most recent cigarette acquisition due to gifting and the prevalence of preferred brand selection due to having received it as a gift were estimated. Bivariate and adjusted logistic regression models were estimated to identify factors associated with these two outcomes.
Results: The incidence of receiving cigarettes as a gift at most recent cigarette acquisition was 3.5%. Smokers who received these gifted cigarettes were more likely to be female, older, have higher educational attainment, live in Beijing, and smoke fewer cigarettes per day. The prevalence of choosing one’s preferred brand due to having received it as a gift was 7.0%, and this was more likely among smokers who lived in Beijing and Guangzhou, had lower educational attainment, smoked less frequently, and had smoked their preferred brand for less than one year.
Conclusions: The 3.5% incidence of one’s most recent cigarette acquisition due to gifting is consistent with prevalence estimates based on longer reference periods and translates into the average smoker receiving a gift of cigarettes approximately five times a year. Gifting also appears to have a significant influence on brand preference. Tobacco control interventions in China may need to de-normalize the practice of giving cigarettes as gifts in order to decrease the social acceptability of smoking.[download PDF]
Purpose: Pictorial health warnings on cigarette packages are a prominent and effective means of communicating the risks of smoking; however, there is little research on effective types of message content and sociodemographic effects. This study tested message themes and content of pictorial warnings in Mexico.
Methods: Face-to-face surveys were conducted with 544 adult smokers and 528 youth in Mexico City. Participants were randomized to view 5-7 warnings for two of 15 different health effects. Warnings for each health effect included a text-only warning and pictorial warnings with various themes: “graphic” health effects, “lived experience”, symbolic images, and testimonials.
Results: Pictorial health warnings were rated as more effective than text-only warnings. Pictorial warnings featuring “graphic” depictions of disease were significantly more effective than symbolic images or experiences of human suffering. Adding testimonial information to warnings increased perceived effectiveness. Adults who were female, older, had lower education, and intended to quit smoking rated warnings as more effective, although the magnitude of these differences was modest. Few interactions were observed between socio-demographics and message theme.
Conclusions: Graphic depictions of disease were perceived by youth and adults as the most effective warning theme. Perceptions of warnings were generally similar across socio-demographic groups.[download PDF]
Li, et al. 2012. Effects of the cigarette excise tax adjustment on cigarette retail prices and intention to quit smoking in China in 2009 (Language: Chinese)
There is no abstract available for this publication.[download PDF]
Perez-Hernandez, et al. 2012. Autorreporte de exposición a publicidad y promoción de tabaco en una cohorte de fumadores mexicanos [Self-reported exposure to tobacco advertising and promotion in a cohort of Mexican smokers]
Objective: To determine in a population-based sample of smokers the level exposure to tobacco industry marketing through different channels before and after their restriction through the General Tobacco Control Law of 2008.
Materials and Methods: Data were analyzed from a cohort of adult smokers from four Mexican cities who were surveyed in 2007 and 2008. GEE models were estimated for each indicator of advertising and promotion exposure.
Results: Increases were found in report of receiving free samples of tobacco (3.7-8.1%), branded clothing (3.6- 6.4%), noticing tobacco industry sponsored events (1.9-4.7%) and noticing ads in bars (21.4-28%). Noticing outdoor advertising decreased over this time (54.7 a 47.2%).
Conclusions: Our findings confirm tobacco industry shifting of marketing efforts when advertising and promotion bans are not comprehensive. There is a need to monitor compliance with marketing bans while working to make them comprehensive.[download PDF]
Objective: The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects.
Methods: Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering).
Results: Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering.
Conclusions: Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.[download PDF]
Thrasher, et al. 2012. Hacia el consumo informado de tabaco en México: Efecto de las advertencias en población fumadora [Towards informed tobacco consumption in Mexico: Effects of pictorial warning labels among smokers]
Objective: Evaluate the effect of the first pictorial warning labels on cigarette packs in Mexican smokers.
Materials and Methods: A population-based representative cohort of smokers from seven Mexican cities was surveyed before (2010) and after (2011) the implementation of pictorial warning labels. To determine the change variables representing the cognitive and behavioral impact of pictorial warnings, bivariate and adjusted generalized estimating equations were estimated. Data from the second survey (2011) were analyzed to determine the factors associated with aided recall of specific pictorial warnings, as well as the factors associated with self-report of the impact that these warnings had.
Results: From 2010 to 2011, significant increases were found in smoker's knowledge about smoking risks, the toxic components of tobacco, and the quitline number for receiving cessation assistance. Recall and impact of specific pictorial warnings was generally broad and equally distributed across the smoker population. In comparison with recent ex-smokers interviewed in 2010, more recent ex-smokers in 2011 reported that pack warnings had influenced their decision to quit (RM=2.44, 95% IC 1.27-4.72).
Conclusion: The first pictorial warning labels on cigarette packages in Mexico have had a significant impact on knowledge and behavior.[download PDF]
Wilson, et al. 2012. Smokefree cars to protect children and denormalise smoking: a mini-review of New Zealand literature
The Associate Minister of Health (Hon Tariana Turia) has signalled interest in the New Zealand Government developing legislation to protect child health by limiting smoking in cars with children.1 Such a move would be part of an international trend that has seen such laws covering most Australian states, Canadian Provinces and some US States (including California).2 3 It would also be consistent with other actions to limit hazards and improve safety within cars: compulsory seat belts, compulsory car seats for infants, and bans on mobile phone use while driving (as recently enacted by the last National Party-led Government in New Zealand). Smokefree cars would help reduce the burden of child illness, given the evidence for the role of secondhand smoke (SHS) in “sudden infant death syndrome (SIDS), asthma, altered respiratory function, infection, cardiovascular effects, behaviour problems, sleep difficulties, increased cancer risk, and a higher likelihood of smoking initiation”.4 Reducing these impacts could in turn reduce both private and tax-payer funded health system costs (given international evidence on SHS impacts on health costs5–7). It is expected that the move would help reduce smoking uptake in children by providing positive smokefree modelling (given New Zealand evidence8 and international evidence4). To provide background and context to further policy-maker discussions on this topic, we tabulate the New Zealand literature relevant to smokefree car policies that we could identify on Medline and on health organisation websites in New Zealand (Table 1).[download PDF]
Wilson, et al. 2011. Smokers have varying misperceptions about the harmfulness of menthol cigarettes: National survey data [access full article]
Objective: To describe the prevalence of menthol use and perceptions of relative harmfulness among smokers in an ethnically diverse population where tobacco marketing is relatively constrained (New Zealand).
Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) utilises the NZ Health Survey (a national sample). From this sample we surveyed adult smokers, with Wave 2 (n=923) covering beliefs around menthol cigarettes.
Results: Agreement with the statement that “menthol cigarettes are less harmful than regular cigarettes” was higher in smokers who were: older, Māori, Pacific, Asian, financially stressed and had higher levels of individual deprivation. Most of these associations were statistically significant in at least some of the logistic regression models (adjusting for socio-economic and smoking beliefs and behaviour). In the fully-adjusted model this belief was particularly elevated in Pacific smokers (adjusted odds ratio [aOR] = 7.36, 95% CI = 1.92 - 28.27) and also in menthol smokers (aOR = 4.58, 95% CI = 1.94-10.78). Most smokers in this study (56%), and especially menthol smokers (73%), believed that menthols are “smoother on your throat and chest”.
Conclusion: Various groups of smokers in this national sample had misperceptions around the relative harmfulness of menthols, which is consistent with most previous studies.
Implications: This evidence, along with a precautionary approach, supports arguments for enhanced regulation of tobacco marketing and tobacco ingredients such as menthol.[download PDF]
Siahpush , et al. 2011. Socioeconomic differences in the effectiveness of the removal of the “light” descriptor on cigarette packs: Findings from the International Tobacco Control (ITC) Thailand Survey [access full article]
Many smokers incorrectly believe that “light” cigarettes are less harmful than regular cigarettes. To address this problem, many countries have banned “light” or “mild” brand descriptors on cigarette packs. Our objective was to assess whether beliefs about “light” cigarettes changed following the 2007 removal of these brand descriptors in Thailand and, if a change occurred, the extent to which it differed by socioeconomic status. Data were from waves 2 (2006), 3 (2008), and 4 (2009) of the International Tobacco Control (ITC) Thailand Survey of adult smokers in Thailand. The results showed that, following the introduction of the ban, there was an overall decline in the two beliefs that “light” cigarettes are less harmful and smoother than regular cigarettes. The decline in the “less harmful” belief was considerably steeper in lower income and education groups. However, there was no evidence that the rate of decline in the “smoother” belief varied by income or education. Removing the “light” brand descriptor from cigarette packs should thus be viewed not only as a means to address the problem of smokers‘ incorrect beliefs about “light” cigarettes, but also as a factor that can potentially reduce socioeconomic disparities in smoking-related misconceptions.[download PDF]
Ross, et al. 2011. Predictors of what smokers say they will do in response to future price increases. Findings from the International Tobacco Control (ITC) Four Country Survey [access full article]
Introduction: Given the impact of higher tobacco prices on smoking cessation, we studied the role of future cigarette prices on forming expectation about smoking behavior.
Methods: Using a random sample of 9,058 adult cigarette smokers from the United States, Canada, Australia, and the United Kingdom collected in 2002, we examined predictors of what smokers say they will do in response to a hypothetical 50% increase in the price they paid for their last cigarette purchase. A series of regression analyses examined factors associated with intentions that have a positive impact on health, that is, intentions to quit and/or to consume fewer cigarettes.
Results: The quit and/or smoke less intentions were more pronounced among those who lived in areas with higher average cigarette prices and who paid higher prices for their brand of choice during the last purchase. The magnitude of the price increase is a more important predictor of an intention to quit/smoke less compared with the average cigarette price.
Conclusions: The availability of alternative (cheaper) cigarette sources may reduce but would not eliminate the impact of higher prices/taxes on smokers’ expected behavior that has been linked to actual quit intentions and quitting in follow-up surveys.[download PDF]
Licht, et al. 2011. How do price minimizing behaviors impact smoking cessation? Findings from the International Tobacco Control (ITC) Four Country Survey [access full article]
This paper examines how price minimizing behaviors impact efforts to stop smoking. Data on 4,988 participants from the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey who were smokers at baseline (wave 5) and interviewed at a 1 year follow-up were used. We examined whether price minimizing behaviors at baseline predicted: (1) cessation, (2) quit attempts, and (3) successful quit attempts at one year follow up using multivariate logistic regression modeling. A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation. Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes. Smokers who engaged in any price/tax avoidance behaviors were 28% less likely to report cessation. Persons using low/untaxed sources were less likely to quit at follow up, those purchasing cartons were less likely to make quit attempts and quit, and those using discount cigarettes were less likely to succeed, conditional on making attempts. Respondents who utilized multiple behaviors simultaneously were less likely to make quit attempts and to succeed. SES did not modify the effects of price minimizing behaviors on cessation outcomes. The data from this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at to reduce reducing smoking prevalence through price and tax increases among all SES groups.[download PDF]