Citation

Adkison, S., O’Connor, R.J., Bansal-Travers, M., Hyland, A., Borland, R., Yong, H.H., Cummings, K.M., McNeill, A., Thrasher, J.F., Hammond, D., Fong, G.T. (2013). Electronic nicotine delivery systems: International Tobacco Control Four-Country Survey. American Journal of Preventive Medicine, 44(3), 207-215.

Abstract

Background: Electronic nicotine delivery systems (ENDS) initially emerged in 2003 and have since become widely available globally, particularly over the Internet.

Purpose: Data on ENDS usage patterns are limited. The current paper examines patterns of ENDS awareness, use, and product-associated beliefs among current and former smokers in four countries.

Methods: Data come from Wave 8 of the International Tobacco Control Four-Country Survey, collected July 2010 to June 2011 and analyzed through June 2012. Respondents included 5939 current and former smokers in Canada (n_1581); the U.S. (n_1520); the United Kingdom (UK; n_1325); and Australia (n_1513).

Results: Overall, 46.6% were aware of ENDS (U.S.: 73%, UK: 54%, Canada: 40%, Australia: 20%); 7.6% had tried ENDS (16% of those aware of ENDS); and 2.9% were current users (39% of triers). Awareness of ENDS was higher among younger, non-minority smokers with higher incomes who were heavier smokers. Prevalence of trying ENDS was higher among younger, nondaily smokers with a high income and among those who perceived ENDS as less harmful than traditional cigarettes. Current use was higher among both nondaily and heavy (_20 cigarettes per day) smokers. In all, 79.8% reported using ENDS because they were considered less harmful than traditional cigarettes; 75.4% stated that they used ENDS to help them reduce their smoking; and 85.1% reported using ENDS to help them quit smoking.

Conclusions: Awareness of ENDS is high, especially in countries where they are legal (i.e., the U.S. and UK). Because trial was associated with nondaily smoking and a desire to quit smoking, ENDS may have the potential to serve as a cessation aid.

Citation

Partos, T.R., Borland, R., Yong, H.H., Hyland, A., Cummings, K.M. (2013). The quitting rollercoaster: How recent quitting history affects future cessation outcomes (data from the International Tobacco Control 4-Country Cohort Study). Nicotine & Tobacco Research, 15(9), 1578-1587.

Abstract

Introduction: Most smokers have a history of unsuccessful quit attempts. This study used data from 7 waves (2002–2009) of the International Tobacco Control 4-country cohort study to examine the role of smokers’ quitting history (e.g., recency, length, and number of previous quit attempts) on their subsequent likelihood of making a quit attempt and achieving at least 6 months of sustained abstinence.

Methods: Generalized estimating equations were used, allowing for estimation of relationships between variables across repeated observations while controlling for correlations from multiple responses by the same individual (29,682 observations from 13,417 individuals).

Results: The likelihood of a future quit attempt increased independently with recency and number of prior attempts. By contrast, the likelihood of achieving sustained abstinence of at least 6 months was reduced for smokers with a failed quit attempt within the last year (15.1% vs. 27.1% for those without, p < .001). Two or more failed attempts (vs. only one) in the previous year were also associated with a lower likelihood of achieving sustained abstinence (OR: 0.57, 95% CI: 0.38–0.85). Effects persisted after controlling for levels of addiction, self-efficacy to quit, and use of stop-smoking medications.

Conclusions: There appears to be a subset of smokers who repeatedly attempt but fail to remain abstinent from tobacco. Understanding why repeated attempts might be less successful in the long term is an important research priority because it implies a need to tailor treatment approaches for those who are motivated to quit but persistently relapse back to smoking.

Citation

Sansone, N., Fong, G.T., Lee, W.B., Laux, F., Sirirassamee, B., Seo, H.G., Omar, M., Jiang, Y. (2013). Comparing the experience of regret and its predictors among smokers in four Asian countries: Findings from the ITC Surveys in Thailand, South Korea, Malaysia, and China. Nicotine & Tobacco Research, 15(10), 1663-1672.

Abstract

Introduction: Nearly all smokers in high-income Western countries report that they regret smoking (Fong, G. T., Hammond, D., Laux, F. L., Zanna, M. P., Cummings, M. K., Borland, R., & Ross, H. [2004]. The near-universal experience of regret among smokers in four countries: Findings from the International Tobacco Control Policy Evaluation Survey. Nicotine and Tobacco Research, 6, S341–S351. doi:10.1080/14622200412331320743), but no research to date has examined the prevalence of regret among smokers in non-Western, low- and middle-income countries.

Methods: Data were from the International Tobacco Control (ITC) Surveys of smokers in 4 Asian countries (China, Malaysia, South Korea, and Thailand); N = 9,738. Regret was measured with the statement: “If you had to do it over again, you would not have started smoking.”

Results: Prevalence of regret in 3 countries (South Korea = 87%, Malaysia = 77%, and China = 74%) was lower than that found by Fong et al. in the United States, Australia, Canada, and the United Kingdom (89%–90%); but was higher in Thailand (93%). These significant country differences in regret corresponded with differences in tobacco control and norms regarding smoking. The predictors of regret in the Asian countries were very similar to those in the 4 Western countries: Regret was more likely to be experienced by smokers who smoked fewer cigarettes per day, perceived greater benefits of quitting and higher financial costs of smoking, had more prior quit attempts, worried that smoking would damage their health, and felt that their loved ones and society disapproved of smoking. Regret was also positively associated with intentions to quit (r = 0.23, p < .001).

Conclusions: Across the Asian countries and high-income Western countries, the prevalence of regret varies, but the factors predicting regret are quite consistent. Regret may be an important indicator of tobacco control and is related to factors associated with future quitting.

Citation

Sansone, G., Fong, G.T., Hall, P.A., Guignard, R., Beck, F., Mons, U., Pötschke-Langer, M., Yong, H.H., Thompson, M.E., Omar, M., Jiang, Y. (2013). Time perspective as a predictor of smoking status: Findings from the International Tobacco Control (ITC) Surveys in Scotland, France, Germany, China, and Malaysia. BioMed Central Public Health, 13(1), 346.

Abstract

Background: Prior studies have demonstrated that time perspective—the propensity to consider shortversus long-term consequences of one’s actions—is a potentially important predictor of health-related behaviors, including smoking. However, most prior studies have been conducted within single highincome countries. The aim of this study was to examine whether time perspective was associated with the likelihood of being a smoker or non-smoker across five countries that vary in smoking behavior and strength of tobacco control policies.

Methods: The data were from the International Tobacco Control (ITC) Surveys in five countries with large probability samples of both smokers (N=10,341) and non-smokers (N=4,955): Scotland, France, Germany, China, and Malaysia. The surveys were conducted between 2005 and 2008. Survey respondents indicated their smoking status (smoker vs. non-smoker) and time perspective (future oriented vs. not future-oriented) and provided demographic information.

Results: Across all five countries, non-smokers were significantly more likely to be future-oriented (66%) than were smokers (57%), χ2 (1, N = 15,244) = 120.64, p < .001. This bivariate relationship between time perspective and smoking status held in a multivariate analysis. After controlling for country, age, sex, income, education, and ethnicity (language in France), those who were future-oriented had 36% greater odds of being a non-smoker than a smoker (95% CI: 1.22 to 1.51, p<.001).

Conclusion: These findings establish time perspective as an important predictor of smoking status across multiple countries and suggest the potential value of incorporating material to enhance future orientation in smoking cessation interventions.

Citation

Fong, G.T., Craig, L., Guignard, R., Nagelhout, G.E., Tait, M., Driezen, P., Kennedy, R.D., Boudreau, C., Wilquin, J.L., Deutsch, A., Beck, F. (2013). Évaluation de l’interdiction de fumer dans les lieux publics en France un an et cinq ans après sa mise en œuvre: Résultats de l’enquête ITC France. Bulletin Epidémiologique Hebdomadaire, 20(21), 217-223.

Abstract

France implemented a comprehensive smoke-free policy in public places in February 2007 for workplaces, shopping centres, airports, train stations, hospitals and schools. On January 2008, it was extended to meeting places (bars, restaurants, hotels, casinos, nightclubs). This paper evaluates France’s smoke-free law based on the International Tobacco Control Policy Evaluation Project in France (the ITC France Project), which conducted a cohort survey of approximately 1,500 smokers and 500 non-smokers before the implementation of the laws (Wave 1, conducted December 2006 to February 2007) and two waves after the implementation (Wave 2, conducted between September-November 2008; and Wave 3, conducted between September-December 2012). Results show that the smoke-free law led to a very significant and near total elimination of indoor smoking in key venues such as bars (from 95.9% to 3.7%) and restaurants (from 64.7% to 2.3%) at Wave 2, which was sustained four years later at Wave 3 (1.4% in restaurants; 6.6% in bars). Smoking in workplaces declined significantly after the law (from 42.6% to 19.3%), which continued to decline at Wave 3 (to 12.8%). Support for the smoke-free law increased significantly after their implementation and continued to increase at Wave 3 (among smokers for bars and restaurants; among smokers and non-smokers for workplaces). The findings demonstrate that smoke-free policies that are implemented in ways consistent with the Guidelines for Article 8 of the WHO Framework Convention on Tobacco Control (WHO FCTC) lead to substantial and sustained reductions in tobacco smoke in public places while also leading to high levels of support by the public.

En France, l’interdiction de fumer dans les lieux publics a été mise en œuvre en février 2007 pour les lieux de travail, les centres commerciaux, les aéroports, les gares, les hôpitaux et les écoles. En janvier 2008, elle a été étendue aux lieux de convivialité (bars, restaurants, hôtels, casinos, discothèques). L’évaluation proposée dans cet article s’inscrit dans le cadre du volet français d’International Tobacco Control (ITC), projet d’évaluation des politiques publiques de lutte antitabac. Une enquête de cohorte d’environ 1 500 fumeurs et 500 non-fumeurs a été mise en place avant la mise en œuvre de la loi (vague 1, de décembre 2006 à février 2007); la vague 2 a eu lieu entre septembre et novembre 2008, et la vague 3, entre septembre et décembre 2012. Les résultats de la vague 2 montrent que la législation antitabac a conduit, dès la fin 2008, à une élimination quasi totale du tabagisme à l’intérieur d’endroits clés tels que les bars (de 95,9% à 3,7%) et les restaurants (de 64,7% à 2,3%), persistant quatre ans plus tard (1,4% dans les restaurants, 6,6% dans les bars à la vague 3). Le tabagisme sur le lieu de travail a diminué de façon significative après la loi (de 42,6% à 19,3%) et a continué de baisser (12,8%) à la vague 3. Le soutien à l’interdiction de fumer dans les lieux publics a augmenté de façon significative après sa mise en œuvre et a continué d’augmenter à la vague 3 (parmi les fumeurs concernant les bars et restaurants, parmi les fumeurs et les non-fumeurs concernant les lieux de travail). Les résultats démontrent que les politiques antitabac mises en œuvre de manière cohérente avec les lignes directrices relatives à l’article 8 de la Convention-cadre de l’OMS pour la lutte antitabac (CCLAT) conduisent à des réductions substantielles et durables du tabagisme passif dans les lieux publics, ainsi qu’à des niveaux de soutien élevés par la population.

Citation

Adkison, S., O’Connor, R.J., Borland, R., Yong, H.H., Cummings, K.M., Hammond, D., Fong, G.T. (2013). Impact of reduced ignition propensity cigarette regulation on consumer smoking behavior and quit intentions: Evidence from 6 waves (2004–11) of the ITC Four Country Survey. Tobacco Induced Diseases, 11(1), 26.

Abstract

Background: Although on the decline, smoking-related fires remain a leading cause of fire death in the United States and United Kingdom and account for over 10% of fire-related deaths worldwide. This has prompted lawmakers to enact legislation requiring manufacturers to implement reduced ignition propensity (RIP) safety standards for cigarettes. The current research evaluates how implementation of RIP safety standards in different countries influenced smokers’ perceptions of cigarette selfextinguishment, frequency of extinguishment, and the impact on consumer smoking behaviors, including cigarettes smoked per day and planning to quit.

Methods: Participants for this research come from Waves 3 through 8 of the International Tobacco Control (ITC) Four Country Survey conducted longitudinally from 2004 through 2011 in the United States, United Kingdom, Australia, and Canada.

Results: Perceptions of cigarette self-extinguishment and frequency of extinguishment increased concurrently with an increase in the prevalence of RIP safety standards for cigarettes. Presence of RIP safety standards was also associated with a greater intention to quit smoking, but was not associated with the number of cigarettes smoked per day. Intention to quit was higher among those who were more likely to report that their cigarettes self-extinguish sometimes and often, but we found no evidence of an interaction between frequency of extinguishment and RIP safety standards on quit intentions.

Conclusions: Overall, because these standards largely do not influence consumer smoking behavior, RIP implementation may significantly reduce the number of cigarette-related fires and the associated death and damages. Further research should assess how implementation of RIP safety standards has influenced smoking-related fire incidence, deaths, and other costs associated with smoking-related fires.

Citation

Mutti, S., Hammond, D., Reid, J., Thrasher, J.F. (2013). The efficacy of cigarette warning labels on health beliefs in the United States and Mexico. Journal of Health Communication, 18(10), 1180-1192.

Abstract

Concern over health risks is the most common motivation for quitting smoking. Health warnings on tobacco packages are among the most prominent interventions to convey the health risks of smoking. Face-to-face surveys were conducted in Mexico (n = 1,072), and a web-based survey was conducted in the US (n = 1,449) to examine the efficacy of health warning labels on health beliefs. Respondents were randomly assigned to view two sets of health warnings (each with one text-only warning and 5–6 pictorial warnings) for two different health effects. Respondents were asked whether they believed smoking caused 12 different health effects. Overall, the findings indicate high levels of health knowledge in both countries for some health effects, although significant knowledge gaps remained; for example, less than half of respondents agreed that smoking causes impotence and less than one third agreed that smoking causes gangrene. Mexican respondents endorsed a greater number of correct beliefs about the health effects of smoking than did the U.S. sample. In both countries, viewing related health warning labels increased beliefs about the health risks of smoking, particularly for less well-known health effects such as gangrene, impotence, and stroke.

Citation

Fathelrahman, A., Li, L., Borland, R., Yong, H.H., Omar, M., Awang, R., Sirirassamee, B., Fong, G.T., Hammond, D. (2013). Stronger pack warnings predict quitting more than weaker ones: Findings from the ITC Malaysia and Thailand Surveys. Tobacco Induced Diseases, 11(1), 20-27.

Abstract

Background: We examined the impact of cigarette pack warning labels on interest in quitting and subsequent quit attempts among adult smokers in Malaysia and Thailand.

Methods: Two overlapping cohorts of adults who reported smoking factory- made cigarettes from Malaysia and Thailand were interviewed face-to-face (3189 were surveyed at baseline and 1781 recontacted at Wave 2; 2361 current smokers were surveyed at Wave 2 and 1586 re-contacted at Wave 3). In Thailand at baseline, large text only warnings were assessed, while at Wave 2 new large graphic warnings were assessed. In Malaysia, during both waves small text only warnings were in effect. Reactions were used to predict interest in quitting, and to predict making quit attempts over the following inter-wave interval.

Results: Multivariate predictors of “interest in quitting” were comparable across countries, but predictors of quit attempts varied. In both countries, cognitive reactions to warnings (adjusted ORs; 1.57 & 1.69 for Malaysia at wave 1 and wave 2 respectively and 1.29 & 1.19 for Thailand at wave 1 and wave 2 respectively), forgoing a cigarette (except Wave 2 in Malaysia) (adjusted ORs; 1.77 for Malaysia at wave 1 and 1.54 & 2.32 for Thailand at wave 1 and wave 2 respectively), and baseline knowledge (except wave 2 in both countries) (adjusted ORs; 1.71 & 1.51 for Malaysia and Thailand respectively) were positively associated with interest in quitting at that wave. In Thailand only, “cognitive reactions to warnings” (adjusted ORs; 1.12 & 1.23 at wave 1 and wave 2 respectively), “forgoing a cigarette” (adjusted OR = 1.55 at wave 2 only) and “an interest in quitting” (adjusted ORs; 1.61 & 2.85 at wave 1 and wave 2 respectively) were positively associated with quit attempts over the following inter-wave interval. Salience was negatively associated with subsequent quit attempts in both Malaysia and Thailand, but at Wave 2 only (adjusted ORs; 0.89 & 0.88 for Malaysia and Thailand respectively).

Conclusion: Warnings appear to have common mechanisms for influencing quitting regardless of warning strength. The larger and more informative Thai warnings were associated with higher levels of reactions predictive of quitting and stronger associations with subsequent quitting, demonstrating their greater potency.

Citation

O’Connor, R.J., Caruso, R., Borland, R., Cummings, K.M., Bansal-Travers, M., Fix, B.V., King, B., Hammond, D., Fong, G.T. (2013). Relationship of cigarette-related perceptions to cigarette design features: Findings from the 2009 ITC U.S. Survey. Nicotine & Tobacco Research, 15(11), 1943-1947.

Abstract

Introduction: Many governments around the world have banned the use of misleading cigarette descriptors such as “light” and “mild” because the cigarettes so labeled were found not to reduce smokers' health risks. However, underlying cigarette design features, which are retained in many brands, likely contribute to ongoing belief that these cigarettes are less harmful by producing perceptions of lightness/smoothness through lighter taste and reduced harshness and irritation.

Methods: Participants (N = 320) were recruited from the International Tobacco Control U.S. Survey conducted in 2009 and 2010, when they answered questions about smoking behavior, attitudes and beliefs about tobacco products, and key mediators and moderators of tobacco use behaviors. Participants also submitted an unopened pack of their usual brand of cigarettes for analysis using established methods.

Results: Own-brand filter ventilation level (M 29%, range 0%-71%) was consistently associated with perceived lightness (p < .001) and smoothness (p = .005) of own brand. Those whose brand bore a light/mild label (55% of participants) were more likely to report their cigarettes were lighter [71.9% vs. 41.9%; χ(2)(2) = 38.1, p < .001] and smoother than other brands [75.5% vs. 68.7%; χ(2)(2) = 7.8, p = .020].

Conclusion: Product design features, particularly filter ventilation, influence smokers' beliefs about product attributes such as lightness and smoothness, independent of package labels. Regulation of cigarette design features such as filter ventilation should be considered as a complement to removal of misleading terms in order to reduce smokers' misperceptions regarding product risks.

Citation

Nagelhout, G.E., Crone, M.R., van den Putte, B., Willemsen, M.C., Fong, G.T., de Vries, H. (2013). Age and educational inequalities in smoking cessation due to three population-level tobacco control interventions: Findings from the International Tobacco Control (ITC) Netherlands Survey. Health Education Research, 28(1), 83-91.

Abstract

This study aimed to examine age and educational inequalities in smoking cessation due to the implementation of a tobacco tax increase, smoke-free legislation and a cessation campaign. Longitudinal data from 962 smokers aged 15 years and older were used from three survey waves of the International Tobacco Control (ITC) Netherlands Survey. The 2008 survey was performed before the implementation of the interventions and the 2009 and 2010 surveys were performed after the implementation. No significant age and educational differences in successful smoking cessation were found after the implementation of the three tobacco control interventions, although smokers aged 15–39 years were more likely to attempt to quit. Of the three population-level tobacco control interventions that were implemented simultaneously in the Netherlands, only the smoke-free legislation seemed to have increased quit attempts. The price increase of cigarettes may have been only effective in stimulating smoking cessation among younger smokers. Larger tax increases, stronger smoke-free legislation and media campaigns about the dangers of (second-hand) smoking are needed in the Netherlands.

Citation

Yong, H.H., Fong, G.T., Driezen, P., Borland, R., Quah, A.C.K., Sirirassamee, B., Hamann, S.L., Omar, M. (2013). Adult smokers’ reactions to pictorial health warning labels on cigarette packs in Thailand and moderating effects of type of cigarette smoked: Findings from the International Tobacco Control Southeast Asia Survey. Nicotine & Tobacco Research, 15(8), 1339-1347.

Abstract

Introduction: In this study, we aimed to examine, in Thailand, the impact on smokers’ reported awareness of and their cognitive and behavioral reactions following the change from text-only to pictorial warnings printed on cigarette packs. We also sought to explore differences by type of cigarette smoked (roll-your-own [RYO] vs. factory-made [FM] cigarettes).

Methods: Data came from the International Tobacco Control Southeast Asia Survey, conducted in Thailand and Malaysia, where a representative sample of 2,000 adult smokers from each country were recruited and followed up. We analyzed data from one wave before (Wave 1) and two waves after the implementation of the new pictorial warnings (two sets introduced at Waves 2 and 3, respectively) in Thailand, with Malaysia, having text-only warnings, serving as a control.

Results: Following the warning label change in Thailand, smokers’ reported awareness and their cognitive and behavioral reactions increased markedly, with the cognitive and behavioral effects sustained at the next follow-up. By contrast, no significant change was observed in Malaysia over the same period. Compared to smokers who smoke any FM cigarettes, smokers of only RYO cigarettes reported a lower salience but greater cognitive reactions to the new pictorial warnings.

Conclusions: The new Thai pictorial health warning labels have led to a greater impact than the text-only warning labels, and refreshing the pictorial images may have helped sustain effects. This finding provides strong support for introducing pictorial warning labels in low- and middle-income countries, where the benefits may be even greater, given the lower literacy rates and generally lower levels of readily available health information on the risks of smoking.

Citation

Wakefield, M.A., Bowe, S.J., Durkin, S.J., Yong, H.H., Spittal, M.J., Simpson, J.A., Borland, R. (2013). Does tobacco-control mass media campaign exposure prevent relapse among recent quitters? Nicotine & Tobacco Research, 15(2), 385-392.

Abstract

Objective:To determine whether greater mass media campaign exposure may assist recent quitters to avoid relapse.

Method: Using date of data collection and postcode, media market estimates of televised tobacco-control advertising exposure measured by gross ratings points (GRPs) were merged with a replenished cohort study of 443 Australians who had quit in the past year. Participants' demographic and smoking characteristics prior to quitting, and advertising exposure in the period after quitting, were used to predict relapse 1 year later.

Results: In multivariate analysis, each increase in exposure of 100 GRPs (i.e., 1 anti-smoking advertisement) in the three-month period after the baseline quit was associated with a 5% increase in the odds of not smoking at follow-up (OR = 1.05, 95% CI 1.02-1.07, p < 0.001). This relationship was linear and unmodified by length of time quit prior to the baseline interview. At the mean value of 1081 GRPs in the 3 months after the baseline-quit interview, the predicted probability of being quit at follow-up was 52%, whereas it was 41% for the minimum (0) and 74% for the maximum (3,541) GRPs.

Conclusion: Greater exposure to tobacco-control mass media campaigns may reduce the likelihood of relapse among recent quitters.

Citation

Siahpush, M., Thrasher, J.F., Yong, H.H., Cummings, K.M., Fong, G.T., Saenz-de-Miera Juarez, B., Borland, R. (2013). Cigarette prices, cigarette expenditure and smoking-induced deprivation: Findings from the International Tobacco Control Mexico Survey. Tobacco Control, 22(4), 223-226.

Abstract

Aim: Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income.

Methods: We used data (n=2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID ('In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?').

Results: Price paid per cigarette increased from Mex$1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex$6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income.

Conclusion: Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected.

Citation

Nagelhout, G.E., van den Putte, B., de Vries, H., Crone, M.R., Fong, G.T., Willemsen, M.C. (2012). The influence of newspaper coverage and a media campaign on smokers' support for smoke-free bars and restaurants and on secondhand smoke harm awareness: Findings from the International Tobacco Control (ITC) Netherlands Survey. Tobacco Control, 21(1), 24-29.

Abstract

Objective: To assess the influence of newspaper coverage and a media campaign about Dutch smoke-free legislation on smokers’ support for smoke-free bars and restaurants and on secondhand smoke (SHS) harm awareness.

Design and main outcome measures: A content analysis was conducted of 1041 newspaper articles on the smoke-free legislation published in six Dutch newspapers from March 2008 to April 2009. Smokers who were regular readers of at least one of these newspapers (n¼677) were selected from the pre-ban and post-ban waves of the International Tobacco Control Netherlands Survey. Exposure to newspaper coverage and the implementation campaign was correlated with changes in smokers’ support for smoke-free bars and restaurants and SHS harm awareness.

Results: Most newspaper coverage was found to be negative towards the smoking ban (57%) and focused on economic aspects (59%) rather than health aspects (22%). Exposure to this coverage had a small but significantly negative effect on support for smoke-free bars and restaurants (b¼_0.09, p¼0.013). Among higher educated smokers, exposure to positive newspaper coverage had a more positive effect on support for smoke-free bars and restaurants. In addition, exposure to the implementation campaign had a small but significantly positive effect on SHS harm awareness (b¼0.11, p¼0.001).

Conclusion: Media attention on smoke-free legislation can influence smokers’ support for the legislation and SHS harm awareness. Tobacco control advocates should aim to establish positive media attention that puts forward the health arguments for the legislation.

Citation

Partos, T.R., Borland, R., Siahpush, M. (2012). Socio-economic disadvantage at the area level poses few direct barriers to smoking cessation for Australian smokers: Findings from the International Tobacco Control Australian Cohort Survey. Drug and Alcohol Review, 31(5), 653-663.

Abstract

Introduction: Area-level indicators of socio-economic variation are frequently included in models of individual health outcomes. Area disadvantage is linearly related to smoking prevalence, but its relation to cessation outcomes is less well understood.

Aims: To explore the relationship between area-level disadvantage and prospective data on smoking cessation.

Design and Methods: The Australian cohort of the International Tobacco Control Four-Country Survey (N = 3503) was used to prospectively examine the contribution of area-level socio-economic disadvantage to predicting three important smoking-cessation outcomes: making a quit attempt, achieving 1 month abstinence and achieving 6 month abstinence from smoking, while controlling for individual-level socio-economic indicators and other individual-level covariates related to smoking cessation.

Results: Only two independent associations were observed between socio-economic disadvantage and cessation outcomes. Area-level disadvantage was related to 1 month abstinence in a non-linear fashion, and the individual experience of smoking-induced deprivation was associated with a lower likelihood of making quit attempts.

Discussion: Despite the documented higher prevalence of smoking among the more disadvantaged and in more disadvantaged areas, socio-economic disadvantage was not consistently related to making quit attempts, nor to medium-term success. Nevertheless, indirect effects of disadvantage, like its impact on psychological distress, cannot be ruled out, and considering smokers’ individual psychosocial circumstances is likely to aid cessation efforts.

Conclusion: Socio-economic disadvantage, particularly at the area level, poses few direct barriers to smoking cessation

Citation

Nagelhout, G.E., de Vries, H., Fong, G.T., Candel, M.J.J.M., Thrasher, J.F., van den Putte, B., Thompson, M.E., Cummings, K.M., Willemsen, M.C. (2012). Pathways of change explaining the effect of smoke-free legislation on smoking cessation in the Netherlands. An application of the International Tobacco Control (ITC) Conceptual Model. Nicotine & Tobacco Research, 14(12), 1474-1482.

Abstract

Introduction: This study aims to test the pathways of change from individual exposure to smoke-free legislation on smoking cessation, as hypothesized in the International Tobacco Control (ITC) Conceptual Model.

Methods: A nationally representative sample of Dutch smokers aged 15 years and older was surveyed during 4 consecutive annual surveys. Of the 1,820 baseline smokers, 1,012 participated in the fourth survey. Structural Equation Modeling was employed to test a model of the effects of individual exposure to smoke-free legislation through policy-specific variables (support for smoke-free legislation and awareness of the harm of [secondhand] smoking) and psychosocial mediators (attitudes, subjective norm, self-efficacy, and intention to quit) on quit attempts and quit success.

Results: The effect of individual exposure to smoke-free legislation on smoking cessation was mediated by 1 pathway via support for smoke-free legislation, attitudes about quitting, and intention to quit smoking. Exposure to smoke-free legislation also influenced awareness of the harm of (secondhand) smoking, which in turn influenced the subjective norm about quitting. However, only attitudes about quitting were significantly associated with intention to quit smoking, whereas subjective norm and self-efficacy for quitting were not. Intention to quit predicted quit attempts and quit success, and self-efficacy for quitting predicted quit success.

Conclusion: Our findings support the ITC Conceptual Model, which hypothesized that policies influence smoking cessation through policy-specific variables and psychosocial mediators. Smoke-free legislation may increase smoking cessation, provided that it succeeds in influencing support for the legislation.

Citation

Caleyachetty, A., Lewis, S., McNeill, A., Leonardi-Bee, J. (2012). Struggling to make ends meet: Exploring pathways to understand why smokers in financial difficulties are less likely to quit successfully. European Journal of Public Health, 22(Suppl 1), 41-48.

Abstract

Background: This paper prospectively examined two kinds of social normative beliefs about smoking, secular versus religious norms.

Purpose: The purpose of this paper is to determine the relative importance of these beliefs in influencing quitting behaviour among Muslim Malaysian and Buddhist Thai smokers.

Methods: Data come from 2,166 Muslim Malaysian and 2,463 Buddhist Thai adult smokers who participated in the first three waves of the International Tobacco Control Southeast Asia project. Respondents were followed up about 18 months later with replenishment. Respondents were asked at baseline about whether their society disapproved of smoking and whether their religion discouraged smoking, and those recontacted at follow-up were asked about their quitting activity.

Results: Majority of both religious groups perceived that their religion discouraged smoking (78% Muslim Malaysians and 86% Buddhist Thais) but considerably more Buddhist Thais than Muslim Malaysians perceived that their society disapproved of smoking (80% versus 25%). Among Muslim Malaysians, religious, but not societal, norms had an independent effect on quit attempts. By contrast, among the Buddhist Thais, while both normative beliefs had an independent positive effect on quit attempts, the effect was greater for societal norms. The two kinds of normative beliefs, however, were unrelated to quit success among those who tried.

Conclusions: The findings suggest that religious norms about smoking may play a greater role than secular norms in driving behaviour change in an environment, like Malaysia where tobacco control has been relatively weak until more recently, but, in the context of a strong tobacco control environment like Thailand, secular norms about smoking become the dominant force.

Citation

Caleyachetty, A., Lewis, S., McNeill, A., Leonardi-Bee, J. (2012). Struggling to make ends meet: Exploring pathways to understand why smokers in financial difficulties are less likely to quit successfully. European Journal of Public Health, 22(Suppl 1), 41-48.

Abstract

Background: In high-income countries, those with low-to-middle incomes have been observing stagnating median wages and marginal improvements in their living standards. Smokers in financial difficulties appear to be less likely to quit smoking. Understanding the reasons for this is essential to intervening to improve cessation outcomes in this population, and reduce smoking-related health inequalities.

Methods: We used longitudinal data from Waves 4 to 7 of the ITC Four Country Survey (ITC-4), and included those with data from at least two consecutive waves. Associations between financial difficulties and making a quit attempt, and quit success were analysed using generalised estimating equations, with adjustment for confounders. Mediation analysis was conducted to identify potential mediators of the observed effects of financial difficulties on cessation outcomes.

Results: Having financial difficulties had little impact on making quit attempts (adjusted OR 0.84, 95% CI 0.70-1.01). Smokers with financial difficulties were substantially less likely to succeed at quitting (adjusted OR 0.55, 95% CI 0.39-0.76); an effect which was consistent over the survey years. Among the potential mediators examined, those relating to cognition of health-related and quality of life-related consequences of smoking were the most important mediators, though the proportion of the effect mediated by the largest mediator was small (6.8%).

Conclusion: Having financial difficulties remains an important barrier to smokers achieving quit success. This effect does not appear to be due to anticipated factors such as reduced use of cessation services or treatment. Further research is required to determine strong mediators of the financial difficulties effect on quit success and to tailor more effective cessation programmes.

Citation

Mons, U., Nagelhout, G.E., Guignard, R., McNeill, A., van den Putte, B., Willemsen, M.C., Brenner, H., Pötschke-Langer, M., Breitling, L.P. (2012). Comprehensive smoke-free policies attract more support from smokers in Europe than partial policies. European Journal of Public Health, 22(Suppl 1), 10-16.

Abstract

Objectives: To measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation.

Design: Two waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control. Participants: 4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses.

Methods: Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation.

Results: Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country.

Conclusions: The findings suggest that smoke-free legislation does not lead to more smoking in smokers' homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in their homes.

Citation

McNeill, A., Craig, L., Willemsen, M.C., Fong, G.T. (2012). Tobacco control in Europe: A deadly lack of progress. European Journal of Public Health, 22(Suppl 1), 1-3.

Abstract

Cigarettes are uniquely dangerous, killing half of all those who regularly use them and damaging the health of those who breathe in users’ smoke, particularly children. Just under a third of European adults currently smoke, and smoking has become increasingly associated with poverty, contributing significantly to widening health inequalities across the EU. In 2004, the ASPECT report, a comprehensive review of tobacco use and tobacco control policies in the EU, found that tobacco use caused well over half a million deaths in Europe annually and on top of that constituted a huge economic burden, estimated conservatively at €98-130 billion a year.1 This review also identified that whilst some European countries were observing declines in tobacco use and mortality, in other countries tobacco use was still increasing, particularly among women. The ASPECT report identified 43 recommendations to combat the epidemic, covering tobacco control policy, interventions and research. Yet to date, few of these recommendations have been implemented, and as a result, future prospects for curbing the smoking epidemic across Europe are currently very bleak.

Citation

Arnott, D., Berteletti, F., Britton, J., Cardone, A., Clancy, L., Craig, L., Fong, G.T., Glantz, S.A., Joossens, L., Rudolphie, M.T., Rutgers, M.R., Smith, S.C., Stam, H., West, R., Willemsen, M.C. (2012). Can the Dutch government really be abandoning smokers to their fate? The Lancet, 379(9811), 121-122.

Abstract

There is no abstract available for this publication.

Citation

Myung, S.K., Seo, H.G., Cheong, Y., Park, S., Lee, E.S., Fong, G.T. (2012). Association of socio-demographic factors, smoking-related beliefs, and smoking restrictions with intention to quit smoking in Korean adults: Findings from the ITC Korea Survey. Journal of Epidemiology, 22(1), 21-27.

Abstract

Background: Few studies have reported the factors associated with intention to quit smoking among
Korean adult smokers. This study aimed to examine sociodemographic characteristics, smoking-related
beliefs, and smoking restriction variables associated with intention to quit smoking among Korean adult
smokers.

Methods: We used data from the International Tobacco Control Korea Survey, which was conducted
from November through December 2005 by using random-digit dialing and computer-assisted telephone
interviewing of male and female smokers aged 19 years or older in 16 metropolitan areas and provinces
of Korea. We performed univariate analysis and multiple logistic regression analysis to identify predictors
of intention to quit.

Results: A total of 995 respondents were included in the final analysis. Of those, 74.9% (n = 745)
intended to quit smoking. In univariate analyses, smokers with an intention to quit were younger, smoked
fewer cigarettes per day, had a higher annual income, were more educated, were more likely to have a
religious affiliation, drank less alcohol per week, were less likely to have self-exempting beliefs, and were
more likely to have self-efficacy beliefs regarding quitting, to believe that smoking had damaged their
health, and to report that smoking was never allowed anywhere in their home. In multiple logistic
regression analysis, higher education level, having a religious affiliation, and a higher self-efficacy
regarding quitting were significantly associated with intention to quit.

Conclusion: Sociodemographic factors, smoking-related beliefs, and smoking restrictions at home were
associated with intention to quit smoking among Korean adults.

Citation

Fotuhi, O., Fong, G.T., Zanna, M.P., Borland, R., Yong, H.H., Cummings, K.M. (2013). Patterns of cognitive dissonance-reducing beliefs among smokers: A longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 22(1), 52-58.

Abstract

Objective: The purpose of this paper is to assess whether smokers adjust their beliefs in a pattern that is consistent with Cognitive Dissonance Theory. This is accomplished by examining the longitudinal pattern of belief change among smokers as their smoking behaviours change.

Methods: A telephone survey was conducted of nationally representative samples of adult smokers from Canada, the USA, the UK and Australia from the International Tobacco Control Four Country Survey. Smokers were followed across three waves (October 2002 to December 2004), during which they were asked to report on their smoking-related beliefs and their quitting behaviour.

Findings: Smokers with no history of quitting across the three waves exhibited the highest levels of rationalisations for smoking. When smokers quit smoking, they reported having fewer rationalisations for smoking compared with when they had previously been smoking. However, among those who attempted to quit but then relapsed, there was once again a renewed tendency to rationalise their smoking. This rebound in the use of rationalisations was higher for functional beliefs than for risk-minimising beliefs, as predicted by social psychological theory.

Conclusions: Smokers are motivated to rationalise their behaviour through the endorsement of more positive beliefs about smoking, and these beliefs change systematically with changes in smoking status. More work is needed to determine if this cognitive dissonance-reducing function has an inhibiting effect on any subsequent intentions to quit.

Citation

Brown, A., Boudreau, C., Moodie, C., Fong, G.T., Li, Q., McNeill, A., Thompson, M.E., Hassan, L.M., Hyland, A., Thrasher, J.F., Yong, H.H., Borland, R., Hastings, G., Hammond, D. (2012). Support for removal of point-of-purchase tobacco advertising and displays: Findings from the International Tobacco Control (ITC) Canada Survey. Tobacco Control, 21(6), 555-559.

Abstract

Background: Although most countries now have at least some restrictions on tobacco marketing, the tobacco industry meet these restrictions by re-allocating expenditure to unregulated channels, such as at point-of-purchase.

Methods: Longitudinal data from 10 Canadian provinces in the International Tobacco Control Survey was analysed to examine adult smokers' support for a ban on tobacco advertising and displays in stores and whether this support is associated with noticing either advertising or displays in stores, and quit intentions, over time. In total, there were 4580 respondents in wave 5 (October 2006 to February 2007), wave 6 (September 2007 to February 2008) and wave 7 (October 2008 to June 2009). The surveys were conducted before, during and in some cases after the implementation of display bans in most Canadian provinces and territories.

Results: Smokers in all provinces showed strong support for a ban on tobacco displays over the study period. Levels of support for an advertising and display ban were comparable between Canadian provinces over time, irrespective of whether they had been banned or not. Noticing tobacco displays and signs in-store was demonstrably less likely to predict support for display (OR=0.73, p=0.005) and advertising (OR=0.78, p=0.02) ban, respectively. Smokers intending to quit were more likely to support advertising and display bans over time.

Conclusion: This study serves as a timely reminder that the implementation of tobacco control measures, such as the removal of tobacco displays, appear to sustain support among smokers, those most likely to oppose such measures.

Citation

Hitchman, S.C., Mons, U., Nagelhout, G.E., Guignard, R., McNeill, A., Willemsen, M.C., Driezen, P., Wilquin, J.L., Beck, F., Du-Roscoat, E., Pötschke-Langer, M., Hammond, D., Fong, G.T. (2012). Effectiveness of the European Union text-only cigarette health warnings: Findings from four countries. European Journal of Public Health, 22(5), 693-699.

Abstract

Background: The European Commission requires tobacco products sold in the European Union to display standardized text health warnings. This article examines the effectiveness of the text health warnings among daily cigarette smokers in four Member States.

Methods: Data were drawn from nationally representative samples of smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), the Netherlands (2008) and the UK (2006). We examined: (i) smokers' ratings of the health warnings on warning salience, thoughts of harm and quitting and forgoing of cigarettes; (ii) impact of the warnings using a Labels Impact Index (LII), with higher scores signifying greater impact; and (iii) differences on the LII by demographic characteristics and smoking behaviour.

Results: Scores on the LII differed significantly across countries. Scores were highest in France, lower in the UK, and lowest in Germany and the Netherlands. Across all countries, scores were significantly higher among low-income smokers, smokers who had made a quit attempt in the past year and smokers who smoked fewer cigarettes per day.

Conclusion: The impact of the health warnings varies greatly across countries. Impact tended to be highest in countries with more comprehensive tobacco control programmes. Because the impact of the warnings was highest among smokers with the lowest socioeconomic status (SES), this research suggests that health warnings could be more effective among smokers from lower SES groups. Differences in warning label impact by SES should be further investigated.