Citation

Sirirassamee, T., Sirirassamee, B., Jampaklay, A., Borland, R., Fong, G.T. (2009). Risk factors of tobacco use among Thai adolescents: Finding from International Tobacco Control Policy Survey Southeast Asia (ICT-SEA). Journal of the Medical Association of Thailand, 92(3), 4-8.

Abstract

To determine the risk factors of tobacco use among Thai adolescents. A cross-sectional study was conducted among 706 adolescents sampled from 5 regions of Thailand using stratified multistage sampling. Participants were asked to complete self-administered questionnaires about tobacco use and psychosocial factors. A logistic regression model of risk factors for tobacco use was estimated using backward stepping. The prevalence of smoking in Thai adolescent was 15 percent (27.8% in males, 2.3% in females). Older age (OR = 1.25, 95% CI = 1.02-1.51), number of close friend smoking (OR = 1.61, 95% CI = 1.35-1.93), number of older sibling smoking (OR = 1.44, 95% CI = 1.01-2.04), heavy alcoholic consumption (OR = 3.99, 95% CI = 1.87-8.49), low self-worth (OR = 3.16, 95% CI = 1.71-5.84) were risk factors of smoking in Thai adolescents. Females (OR = 0.10, 95% CI = 0.04-0.24), currently studying in school (OR = 0.33, 95% CI = 0.18-0.59) and religious beliefs guide actions (OR = 0.41, 95% CI = 0.22-0.77) were protective factors against smoking. Male adolescents are target group for tobacco control in Thailand. The strong correlation between smoking and alcoholic consumption indicate that anti-smoking campaign should be done in parallel with anti-alcohol campaign.

Citation

Thomson, G., Wilson, N. (2009). Public attitudes to laws for smoke-free private vehicles: A brief review. Tobacco Control, 18(4), 256-261.

Abstract

As smoke-free car policy is a frontier domain for tobacco control, attitudes to smoke-free private car laws are briefly reviewed. Medline and Google Scholar searches for the period up to midNovember 2008, from English language sources, were undertaken. Studies were included that contained data from national and subnational populations (eg, in states and provinces), but not for smaller administrative units, eg, cities or councils. Jurisdiction, sample size and survey questions were assessed. One reviewer conducted the data extraction and both authors conducted assessments. A total of 15 relevant studies (from 1988) were identified, set in North America, the UK and Australasia. The available data indicates that, for the jurisdictions with data, there is majority public support for laws requiring cars that contain children to be smoke free. There appears to be an increase over time in this support. In five surveys in 2005 or since (in California, New Zealand and Australia), the support from smokers was 77% or more. The high levels of public (and smoker) support for smokefree car laws found in the studies to date suggest that this can be a relatively non-controversial tobacco control intervention. Survey series on attitudes to such laws are needed, and surveys in jurisdictions where the issue has not been investigated to date.

Citation

Thrasher, J.F., Villalobos, V., Dorantes-Alonso, A., Arillo-Santillán, E., Cummings, K.M., O’Connor, R.J., Fong, G.T. (2009). Does the availability of single cigarettes promote or inhibit cigarette consumption? Perceptions, prevalence and correlates of single cigarette use among adult Mexican smokers. Tobacco Control, 18(6), 431-437.

Abstract

Background: Single cigarette use and its implications have rarely been studied among adults.

Objective: To assess perceptions, prevalence and correlates of single cigarette purchase behaviour and its relation to harm reduction.

Design: Focus group transcripts and cross-sectional data were analysed.

Setting and participants: Focus groups among convenience samples of adult smokers in two Mexican cities and a population-based sample of 1079 adult smokers from the International Tobacco Control Policy Evaluation Project in four Mexican cities.

Main outcome measures: Purchase of single cigarettes last time cigarettes were bought, frequency of purchasing single cigarettes in the previous month and intention to quit in the next 6 months.

Results: Focus group data indicated that smokers bought single cigarettes as a harm reduction strategy. Survey data indicated that 38% of participants purchased single cigarettes in the last month and 10% purchased them the last time they bought cigarettes, with more frequent consumption among young adults and those with lower income. Purchasing single cigarettes was independently associated with the frequency of using single cigarettes to reduce consumption and, less consistently, with the frequency of being cued to smoke after seeing single cigarettes for sale. Using single cigarettes to reduce consumption was positively associated with quit intention, whereas being cued to smoke by single cigarettes was negatively associated with quit intention.

Conclusions: Study results suggest that some adult Mexican smokers purchase single cigarettes as a method to limit, cut down on and even quit smoking. Nevertheless, promotion of the availability of single cigarettes as a harm reduction strategy could provide additional smoking cues that undermine quit attempts and promote youth smoking.

Citation

Wilson, N., Borland, R., Weerasekera, D., Edwards, R., Russell, M. (2009). Smoker interest in lower harm alternatives to cigarettes: National survey data. Nicotine & Tobacco Research, 11(12), 1467-1473.

Abstract

Introduction: The aim of this study was to examine knowledge and attitudes to lower harm alternatives to cigarettes among New Zealand (NZ) smokers.

Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) utilizes the NZ Health Survey (a national sample). From this sample, we surveyed adult smokers (N = 1,376).

Results: Knowledge about smokeless tobacco was poor, with only 16% regarding such products as less harmful than ordinary cigarettes. Only 7% considered such products to be “a lot less” harmful. When participants were asked to assume that these products were much less harmful than cigarettes, 34% of smokers stated that they would be interested in trying smokeless tobacco products, with another 11% saying “maybe” or “don't know.” In the multivariate analysis, Māori smokers were significantly more interested in trying smokeless products than Europeans in all 3 models considered (e.g., Model 1: adjusted odds ratio [AOR] = 1.71, 95% CI = 1.23–2.37). There was also significantly increased interest for those concerned about the impact of smoking on health and quality of life in the future (AOR = 1.44, 95% CI = 1.17–1.78). But interest did not vary significantly by 2 measures of socioeconomic status and varied inconsistently by 2 measures of financial stress.

Discussion: The finding that one third of smokers said that they would be interested in trying smokeless products suggests that these products could have a role as part of a tobacco epidemic endgame that phases out smoked tobacco. Differences in interest level by ethnic group may be relevant to stimulating further work in this area (e.g., among those health workers concerned for smokers with the highest need to quit).

Citation

Yong, H.H., Hamann, S.L., Borland, R., Fong, G.T., Omar, M. (2009). Adult smokers' perception of the role of religion and religious leadership on smoking and association with quitting: A comparison between Thai Buddhists and Malaysian Muslims. Social Science & Medicine, 69(7), 1025-1031.

Abstract

In recent years, attempts have been made to incorporate religion into tobacco control efforts, especially in countries like Malaysia and Thailand where religion is central to the lives of people. This paper is a prospective examination of the perceived relevance and role of religion and religious authorities in influencing smoking behaviour among Muslims in Malaysia and Buddhists in Thailand. Data were collected from 1482 Muslim Malaysian and 1971 Buddhist Thai adult smokers who completed wave 1 (early 2005) of the International Tobacco Control Southeast Asia Survey (ITC-SEA). Respondents were asked about the role of religion and religious leadership on smoking at Wave 1 and among those recontacted, quitting activity at Wave 2. Results revealed that over 90% of both religious groups reported that their religion guides their day-to-day behaviour at least sometimes, but Malaysian Muslims were more likely to report that this was always the case. The majority (79% Muslims and 88% Buddhists) of both groups believed that their religion discourages smoking. About 61% of the Muslims and 58% of the Buddhists reported that their religious leaders had encouraged them to quit before and a minority (30% and 26%, respectively) said they would be an influential source to motivate them to quit. Logistic regression models suggest that these religious factors had a clear independent association with making quitting attempts in both countries and this translated to success for Malaysian Muslims but not for the Thai Buddhists. Taken together, results from this study indicate that religion and religious authorities are both relevant and important drivers of quitting, but whether this is always enough to guarantee success is less clear. Religion can be a culturally relevant vehicle to complement other tobacco control efforts.

Citation

Li, L., Yong, H.H. (2009). Tobacco advertising on the street in Kunming, China. Tobacco Control, 18(1), 63-63.

Abstract

There is no abstract available for this publication.

Citation

Hyland, A., Higbee, C., Travers, M. J., Van Deusen, A., Bansal-Travers, M., King, B., & Cummings, K. M. (2009). Smoke-free homes and smoking cessation and relapse in a longitudinal population of adults. Nicotine & tobacco research : official journal of the Society for Research on Nicotine and Tobacco, 11(6), 614–618. https://doi.org/10.1093/ntr/ntp022

Abstract

Introduction: The present study reports on the prevalence of smoke-free homes, the characteristics of participants who adopted a smoke-free home policy, and the association between smoke-free homes and subsequent predictors of smoking cessation.

Methods: Data are reported on 4,963 individuals who originally participated in the Community Intervention Trial for Smoking Cessation between 1988 and 1993 and completed follow-up surveys in 2001 and 2005. The relationship between home smoking policy and smoking behavior was examined with a multivariate regression model.

Results: Among those who were smokers at the 2001 followup, the percentage reporting that no smoking was allowed in their home increased from 29% in 2001 to 38% in 2005. Smokers most likely to adopt smoke-free home policies between 2001 and 2005 were males, former smokers, and those who had lower levels of daily cigarette consumption (among those who continued to smoke), those with higher annual household incomes, and those with no other smokers in the household. Some 28% of smokers with smoke-free homes in 2001 reported that they had quit smoking by 2005 compared with 16% of those who allowed smoking in their homes (odds ratio [ OR ] = 1.7, 95% CI = 1.4 – 2.2), and baseline quitters with smoke-free homes also were less likely to relapse ( OR = 0.6,95% CI = 0.4 – 0.8).

Discussion: Smoke-free homes are becoming more prevalent, and they are a powerful tool not only to help smokers stop smoking but also to help keep those who quit from relapsing back to smoking.

Citation

Wilson, N., Edwards, R., Weerasekera, D. (2009). High levels of smoker regret by ethnicity and socioeconomic status: National survey data. New Zealand Medical Journal, 122(1292), 99-100.

Abstract

Some previous international work has studied levels of regret among smokers. In Australia, Canada, the UK, and the US, the proportion of smokers who agreed, or agreed strongly, with the statement “If you had to do it over again, you would not have started smoking”, was very high (range: 89.2% to 91.3%).1 This study also reported significantly lower regret by higher level of education, but no significant differences by ethnicity or income.

Citation

Edwards, R., Wilson, N., Thomson, G., Weerasekera, D., Blakely, T. (2009). Majority support by Maori and non-Maori smokers for many aspects of increased tobacco control regulation: National survey data. New Zealand Medical Journal, 122(1307), 115-118.

Abstract

The Māori Affairs Select Committee is undertaking an Inquiry into “the tobacco industry in Aotearoa and the consequences of tobacco use for Maori”.1 The very high levels of smoking among Māori,2 the important contribution of smoking to poor health and disparities in health,3,4 and the substantial impact of tobacco use on Māori social and economic development, support the timeliness and importance of this Inquiry. A possible outcome of the Inquiry is to recommend substantial strengthening of the measures in place to reduce smoking prevalence by promoting and supporting smoking cessation and reducing smoking uptake. Such measures might include introducing a range of proposed new tobacco control policies, strengthening and intensification of existing interventions, or implementing more radical ‘endgame’ solutions. The latter is probably more efficient at ending the tobacco epidemic and could aim to reduce the use of smoked tobacco products such that the large-scale commercial distribution and sale of smoked tobacco product effectively ceases (e.g. in 10 years time). The aim of this study is to describe the level of support for additional tobacco control policy measures among Māori and non-Māori participants from a nationally representative sample of New Zealand smokers.

Citation

Li, Q., Jiang, Y., Zhao, G., Li, X., Du, L., Zhu, G., Hu, L., Hu, J., Jiao, S., Li, X., Zhao, J. (2009). Support for smoke-free policies among smokers and non-smokers in six cities in China: ITC China Survey (Language: Chinese). Chinese Journal of Prevention and Control of Chronic Diseases, 17(1), 8-15.

Abstract

Objective: To examine levels of support for comprehensive smoke-free policies in six large Chinese cities.

Methods: Data from Wave 1 of the International Tobacco Control (ITC) China Survey (April–August 2006) were
analysed. The ITC China Survey employed a multistage sampling design in Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan (none of which has comprehensive smokefree policies in place). Face-to-face interviews were conducted with 4815 smokers and 1270 nonsmokers.Multivariate logistic regression models were used to identify factors associated with support for comprehensive smoke-free policies.

Results: About one in two Chinese urban smokers and four in five non-smokers believed that secondhand smoke (SHS) causes lung cancer. The majority of respondents supported comprehensive smoke-free policies in hospitals, schools and public transport vehicles while support for smoke-free workplaces, restaurants and bars was lower. Levels of support were generally comparable between smokers and non-smokers. Support for comprehensive smoke-free policies was positively associated with knowledge about the harm of SHS.
Respondents who worked in a smoke-free worksite or who frequented smoke-free indoor entertainment places were more likely to support comprehensive smoking restriction in bars and restaurants.

Conclusion: Considerable support for smoke-free policies exists in these six large cities in China. Greater public education about the dangers of SHS may further increase support. Experiencing the benefits of smoke-free indoor entertainment places and/or workplaces increases support for these policies and suggests that some initial smoke-free policy implementation may hasten the diffusion of these public health policies.

Abstract

Objective: To examine the effects of health warning on cigarette package on smokers in Beijing, Shenyang, Shanghai, Changsha, Guangzhou, and Yinchuan.

Methods: Multistage sampling was used to select 4815 smokers in six cities. Face to Face interview was conducted to collect related information. Multivariate logistic regression models were used to explore factors associated with warning effects.

Results: Among the participants, 94.9% was male. Average score of warning effects was 1.38 (effective score≥2). Only 2. 15 % of respondents often stop smoking because of warning labels, and 13.31% avoided warnings during the past one month. The proportion of considering the harm of smoking and planning to quit smoking because of noticing the warning label were only 8.26% and 5.29%, respectively. Multivariate logistic regression analysis showed that different cities and smoking years were associated with warning effects of health labels on cigarette package.

Conclusion: Current health warning on cigarette package had no designed warning effects for smokers. It is necessary to renew the form of the warnings.

Citation

Li, X., Jiang, Y., Li, Q., Xu, J., Yao, H., Jiao, S., Zhao, J., Zhu, G., Luo, B., Li, X. (2009). Notice on health warning labeling on the cigarette packet in smokers of six cities (Language: Chinese). Chinese Journal of Prevention and Control of Chronic Diseases, 17(3), 231-233.

Abstract

Objective: To understand the degree of concern of cigarette smokers in 6 cities including Beijing, Shenyang, Shanghai, Changsha, Guangzhou, and Yinchuan.

Methods: A multi-stage sampling method was used to select 4,815 adult smokers in six cities for a household survey. The degree of attention to health warnings was analyzed, and the factors affecting smokers' attention to health warnings were analyzed using multi-factor Logistic regression.

Results: Among the smokers in 6 cities, 94.9% were male. In the 1 month before the survey, 50.3% of smokers often saw health warnings on cigarette boxes, but only 22.0% of smokers often read them carefully. Univariate analysis showed that older and illiterate smokers paid less attention (P <0.05); multivariate analysis also suggested that age and education were factors influencing smokers' attention to health warnings, and the 25-39 age group Smokers pay more attention to warnings than smokers over 55 years old, with an OR and 95% CI of 0.714 (0.669 to 0.972), respectively; illiterate smokers pay less attention to warnings than undergraduate degree or above (P = 0.015).

Conclusion: The health warnings on cigarette packages in China cannot attract the attention of smokers because of the single information and excessive information exposure. It is imperative to develop more eye-catching and rotating warning messages.

Citation

Thomson, G., Wilson, N., Weerasekera, D., Edwards, R. (2009). Most smokers support smokefree council-owned playgrounds: National survey data. New Zealand Medical Journal, 122(1291), 122-123.

Abstract

From an international perspective, New Zealand has been one of the world leaders in passing smokefree environment laws to protect the health of nonsmokers and advance tobacco control.1 It passed a major law in 1990 and the updated 2003 legislation (implemented during 2004) extended smokefree areas to all restaurants, bars and additional indoor workplaces that were not covered by the 1990 law. There has also been progress in terms of outdoor smokefree areas. Smoking in outdoor settings is prohibited in the grounds of all schools by the 2003 legislation. “Educative” smokefree parks policies have been currently adopted by 29% (21/73) of the city and district councils in New Zealand. These are policies which rely on signposts, media coverage and public pressure to limit smoking, rather than on legal enforcement. The grounds of some hospitals, some stadiums, and the campuses of at least one university (Massey) are also covered by smokefree policies. A 2007 survey in Upper Hutt found that 83% of adult park users thought that having a “smokefree parks policy” was a good idea.2 There was even majority support (73%) by smokers for the Upper Hutt smokefree park policy. A 2007 national survey gave options of agreeing that smoking in various settings was acceptable anywhere, in set areas, or not at all. Over a third (38%) said that it was not at all acceptable in local parks or reserves, and 76% said it was not at all acceptable in outdoor children’s playgrounds.3 Nevertheless, there has been no national survey data on what smokers think about smokefree parks – an issue we address in the results below.

Citation

Thrasher, J.F., Boado Martinez, M., Sebrie, E.M., Bianco, E. (2009). Smoke-free policies and the social acceptability of smoking in Uruguay and Mexico: Findings from the International Tobacco Control Policy Evaluation Project. Nicotine & Tobacco Research, 11(6), 591-599.

Abstract

Introduction: Little research has been conducted to determine the psychosocial and behavioral impacts of smoke-free policies in middle-income countries.

Methods: Cross-sectional data were analyzed from the 2006 waves of the International Tobacco Control Policy Evaluation. Survey comparing adult smokers in Mexico (n = 1,080), where smoke-free legislation at that time was weak, and Uruguay (n = 1,002), where comprehensive smoke-free legislation was implemented. Analyses aimed to determine whether exposure to smoke-free policies and perceived antismoking social norms were associated with smokers' receiving cues about the bothersome nature of secondhand smoke (SHS), with smokers' reactance against such cues, and with smokers' level of support for smoke-free policies in different venues.

Results: In bivariate analyses, Uruguayan smokers were more likely than Mexican smokers to experience verbal anti-SHS cues, lower reactance against anti-SHS cues, stronger antismoking societal norms, and stronger support for 100% smoke-free policies in enclosed workplaces, restaurants, and bars. In multivariate models for both countries, the strength of voluntary smoke-free policies at home was independently associated with support for smoke-free policies across all venues queried, except for in bars among Uruguayans. Perceived strength of familial antismoking norms was consistently associated with all indicators of the social acceptability of smoking in Uruguay but only with the frequency of receiving anti-SHS verbal cues in Mexico.

Discussion: These results are generally consistent with previous research indicating that comprehensive smoke-free policies are likely to increase the social unacceptability of smoking and that resistance against such policies is likely to diminish once such policies are in place.

Citation

Zhao, G., Jiang, Y., Yang, Y., Feng, G., Li, X., Jiao, S., Zhao, J., Zhu, G., Luo, B., Li, X. (2009). Prevalence study of anti-tobacco media campaign in six cities of China (Language: Chinese). Chinese Journal of Prevention and Control of Chronic Diseases, 17(5), 473-475.

Abstract

Objective: To describe the present condition of tobacco control reports in Beijing, Shenyang, Shanghai, Changsha, Guangzhou, and Yinchuan and to provide evidence to promote anti-tobacco media campaign in China.

Methods: Multistage sampling was used to sample 4 815 smokers and 1,270 non-smokers in the six cities. Face-to-face interviews were conducted to examine the exposure rate of anti-tobacco media reports. Multivariate logistic regression models were used to explore factors associated with exposure rate of anti-tobacco media campaign.

Results: 69.1% of the smokers had seen anti -tobacco media report. 64.6%, 50.5%, 45.6% and 38.1% of the respondents saw tobacco control publicity on TV, cigarette package, newspaper/magazine and broadcast. Multivariate logistic regression analysis showed that age, education background and the amount of smoking cigarette per day have significant associations with exposure rate of tobacco control media reports (P<0.05）.

Conclusion: The anti -smoke media campaigns in China has made a good progress, but is not well distributed. There should be a unitive and long-term anti-smoke media campaign strategy in China.

Citation

Yang, Y., Wu, X., Li, Q., Jiao, S., Li, X., Li, X., Zhu, G., Du, L., Zhao, J., Jiang, Y., Feng, G. (2009). Factors related to awareness on tobacco advertisement and promotion among adults in six cities in China (Language: Chinese). Chinese Journal of Epidemiology, 30(4), 313-317.

Abstract

Objective: To know the situation of tobacco advertisement, promotions and related factors in six cities in China.

METHODS: 4815 adults (above 18 years), selected form Beijing, Shanghai, Shenyang, Changsha, Guangzhou and Yinchuan through probability proportionate sampling and simple random sampling, were investigated through questionnaires.

Results: The most commonly reported channels that smokers noticed tobacco advertisements were billboards (35.6%) and television (34.4%). The most commonly reported tobacco promotional activities that were noticed by smokers were free gifts when buying cigarettes (23.1%) and free samples of cigarettes (13.9%). Smokers in Changsha were more likely to report noticing tobacco advertisement on billboards (chi2 = 562.474, P < 0.00 1), and on television (chi2 = 265.570, P <0.001). Smokers in Changsha (chi2 = 58.314, P < 0.001) were more likely to notice tobacco related news and games. A logistic regression analysis showed that the living and education level were related to awareness of tobacco advertisement and promotion.

Conclusion: It was universal to see tobacco advertisement and promotions in cities in China but the laws and regulations about tobacco-control were not uniformly executed in different cities. It is necessary to perfect and uniform related laws and regulations.

Citation

Wilson, N., Young, D., Weerasekera, D., Edwards, R., Thomson, G., Glover, M. (2009). The importance of tobacco prices to roll-your-own (RYO) smokers (national survey data): Higher tax needed on RYO. New Zealand Medical Journal, 122(1305), 92-96.

Abstract

There are strong, evidence-based, public health arguments for raising tobacco taxes based on both international,1,2 and New Zealand work.3–6 The benefits include protecting young people from smoking. A systematic review reports evidence for greater price sensitivity among low-income adults, thereby suggesting that such a tax could potentially contribute to reducing health inequalities.7 Despite this, a major report8 has highlighted the lack of a real increase in tobacco prices in New Zealand since 2001. This report also showed that the proportion of tobacco consumed as loose or roll-your-own (RYO) tobacco had increased substantially over time.

Citation

Wilson, N., Blakely, T., Edwards, R., Weerasekera, D., Thomson, G. (2009). Support by New Zealand smokers for new types of smokefree areas: National survey data. New Zealand Medical Journal, 122(1303), 80-89.

Abstract

Aims: To describe smoker support for new smokefree laws covering cars and outdoor settings, in a national sample of New Zealand (NZ) smokers.

Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) uses as its sampling frame the NZ Health Survey (a nationally-representative sample interviewed face-to-face). From this sample we surveyed by telephone adult smokers (n=1376). Along with adjustment for the complex sample design, there was weighting of the results to attempt to adjust for the non-response at various points (i.e. there was an overall response rate of 33%).

Results: A majority of this national sample of smokers supported three new smokefree areas (albeit with some potential for response bias not adequately addressed by the weighting process). That is, only a minority agreed that smoking should be allowed: in cars with pre-school children (3%), anywhere in outdoor eating areas (22%), and at council-owned playgrounds (32%) (with a more equivocal minority for “within 5 metres of the entrance to public buildings” (48%)). These attitudes were generally compatible with the findings that most of these smokers (87%) reported trying to minimise the amount that nonsmokers were exposed to their cigarette smoke, and reported never smoking in a car with non-smokers (73%). Nevertheless, there were still domains where most smokers thought smoking should be allowed-- e.g. on lifeguard-patrolled beaches (55%) and in at least some of the outdoor seating areas of restaurants/cafes (51%) and pubs (83%).

Conclusions: There was majority support by these New Zealand smokers for three new types of smokefree areas not covered by current smokefree legislation (including in cars and some outdoor areas). These findings suggest it is a reasonable option for central government and local government authorities to further study and consider new smokefree laws.

Citation

Wilson, N., Thomson, G., Edwards, R., Peace, J. (2009). Estimating missed government tax revenue from foreign tobacco: survey of discarded cigarette packs. Tobacco Control, 5, 416-418.

Abstract

Aim: To clarify the extent of use of foreign (including duty free, foreign normal retail and smuggled) tobacco, and to estimate missed government tax revenue in a geographically isolated country.

Methods: Discarded cigarette packs were collected on the streets of four cities and six New Zealand towns/rural locations between November 2008 and January 2009.

Results: Out of a total of 1310 packs collected, 42 foreign packs were identified (3.2%, 95% CI 2.4% to 4.3%). Overall, the distribution of packs by country and company was not suggestive of any clustering that might indicate smuggling. At 3.2% of packs being ‘‘foreign’’, the New Zealand government is losing around $36 million per year in tobacco-related tax relative to if all this tobacco was purchased in New Zealand. For various reasons (including that it was not possible to identify packs bought duty free within New Zealand, and other New Zealand survey data indicating duty free product use at 3.8% of packs), the figure reached is probably an underestimate of the true level.

Conclusion: The New Zealand government is missing out on revenue that could be used for improving the funding of tobacco control, and smokers are being exposed to cheaper tobacco thus increasing their risk of continuing to smoke. This government and other governments can and should act at the international and national levels to end the sales of duty free tobacco.

Citation

Lanumata, T., Thomson, G. (2009). Unequal risks, unmet needs: the tobacco burden for Pacific peoples in New Zealand. New Zealand Medical Journal, 122(1303), 39-53.

Abstract

Aim: To review the available published literature and documentary material relevant to smoking by Pacific peoples in New Zealand.

Methods: Electronic databases and websites were searched using a range of search words.

Results: Over 30% of Pacific adults in New Zealand reporting being smokers in the 2006 Census, compared to 21% of the whole adult population. Smoking by Pacific women increased from 23% in 1996 to 27% in the 2006 census. Other survey data indicates some fall in the prevalence of daily smoking from 35% in 2002/3 to 26% in 2006/7. The prevalence of smoking by Pacific Year-10 students declined sharply during 1999-2007, from 29% to 16%. Smoking inside the homes of Pacific students has declined during 2001-7, from 35% to 26%. We found little government attention to smoking by Pacific peoples, and no specific central government plan for Pacific tobacco control.

Conclusions: The threat to health from smoking and secondhand smoke exposure is higher for Pacific peoples and contributes to health inequalities in New Zealand. There is a need for tobacco control interventions specific to Pacific peoples, with some policy shortcomings needing to be urgently addressed. A central government plan for Pacific tobacco control is required. Some progress has occurred, particularly in the decrease of smoking by Pacific youth, and the increase in smokefree Pacific homes.

Citation

Wilson, N., Peace, J., Li, J., Edwards, R., Hoek, J., Stanley, J., Thomson, G. (2009). Distribution of new graphic warning labels: Are tobacco companies following regulations? BioMed Central Public Health, 5(1), 5-14.

Abstract

Objective: To test the hypothesis that tobacco companies would not follow a regulation that required seven new graphic health warnings (GHWs) to be evenly distributed on cigarette packs and that they would distribute fewer packs featuring warnings regarded by smokers as being more disturbing.

Methods: Cross-sectional survey of purchased packs (n = 168) and street-collected discarded packs (convenience sample of New Zealand cities and towns, n = 1208 packs) with statistical analysis of seven types of new GHWs. A priori warning impact was judged using three criteria, which were tested against data from depth interviews with retailers.

Results: The GHWs on the purchased packs and street-collected packs both showed a distribution pattern that was generally consistent with the hypothesis ie, there were disproportionately more packs featuring images judged as "least disturbing" and disproportionately fewer of those with warnings judged "more disturbing". The overall patterns were statistically significant, suggesting an unequal frequency of the different warnings for both purchased (p < 0.0001) and street-collected packs (p = 0.035). One of the least disturbing images (of a "corpse with toe-tag") dominated the distribution in both samples. Further analysis of the street-collected packs revealed that this image appeared disproportionately more frequently on manufactured cigarettes made by each of the three largest New Zealand tobacco companies. Although stock clustering could explain the purchase pack result, there were no obvious reasons why the same uneven warning distribution was also evident among the street-collected packs.

Conclusion: These results suggest that tobacco companies are not following the regulations, which requires even distribution of the seven different GHWs on cigarette packs; further monitoring is required to estimate the extent of this non-compliance. As an immediate measure, governments should strictly enforce all regulations applying to health warnings, particularly given that these are an effective tobacco control intervention that cost tax payers nothing.

Citation

Wilson, N., Edwards, R., Thomson, G. (2009). What’s new in tobacco tax research for New Zealand and is it time for a tax hike now? New Zealand Medical Journal, 122(1293), 89-92.

Abstract

Raising the price of cigarettes through increases in taxation and duties is the tobacco control intervention with the strongest evidence of effectiveness at reducing smoking prevalence. Despite this evidence, the rate of tobacco taxation in New Zealand has not been raised beyond the rate of Consumer Price Index inflation since 2000. To inform evidence-based decision-making, we aimed to briefly review new work on tobacco tax in New Zealand and to put this into context with selected recent international developments. We updated a previous review that covered the use and effects of tobacco tax in New Zealand up to June 20071 with further Medline and Google Scholar searches to cover the period up to the end of February 2009. Findings for all data-based articles and review articles were put in context with relevant international literature and recent developments overseas.

Citation

Thomson, G., Edwards, R., Wilson, N. (2009). At the frontier of tobacco control: A brief review of public attitudes toward smoke-free outdoor places. Nicotine and Tobacco Research, 11(6), 584-590.

Abstract

Introduction: Outdoor smoke-free areas have been adopted increasingly in North America, Britain, Ireland, Australasia, and elsewhere. Their use appears to be one of the frontier areas of tobacco control development. We briefly reviewed the available reports on public attitudes about smoke-free public outdoor areas.

Methods: We included surveys of the general population or of users of public outdoor locations, reported in English language publications to September 2008.

Results: We identified 16 relevant reports that used surveys from 1988 to 2007. Although the evidence remains limited, this research indicates that, in a number of jurisdictions, the majority of the public supports restricting smoking in various outdoor settings. Support for smoke-free outdoor public places appears to be increasing over time. Among respondents ’ reasons for support were the following: litter control, establishing positive smoke-free role models for youth, reducing youth opportunities to smoke, and avoiding exposure to secondhand smoke.

Discussion: Given the recent increase in outdoor smoking restrictions in many developed countries and the growing recognition of the importance of reducing smoking role models for children, this area needs further research related to attitudes and policy evaluation. Given the levels of public support, policy makers in some jurisdictions appear to have an opportunity to establish smoke-free outdoor public places, at least in areas frequented by children.

Citation

Shahab, L., West, R., McNeill, A. (2008). The feasibility of measuring puffing behaviour in roll-your-own cigarette smokers. Tobacco Control, 17(Suppl 1), i17-i23.

Abstract

Background/Objective: Despite the increase in roll-your-own (RYO) cigarette consumption in many countries, very little is known about RYO smokers. In order to estimate the health risks inherent in RYO use, it is important to assess exposure to tobacco toxins in this group. Exposure is determined by a number of factors, including puffing behaviour, but so far this issue has not been addressed among RYO smokers. This study sought both to determine the feasibility of measuring puffing behaviour in this group, its reliability and validity, and to characterise puffing behaviour among RYO smokers compared with smokers of factory-made (FM) cigarettes.

Methods: At two visits, 24 hours apart, 131 FM and 29 RYO cigarette smokers provided saliva samples that were assayed for cotinine, a measure of nicotine intake and thus smoke exposure. Self-reported puffing behaviour of participants, as well as their demographic and smoking characteristics were also assessed. At the end of the first visit, smokers were shown how to use a portable smoking topography machine that measures puffing behaviour, the CReSSmicro, and asked to smoke all cigarettes with this machine until the second visit, when participants were asked to provide feedback on using the device.

Results: Both RYO and FM cigarette smokers reported that the CReSSmicro was easy to use; however, RYO cigarette smokers were more likely to have missing data, to reduce cigarette consumption and to indicate a change in their puffing behaviour because of the device. Machine determined puffing behaviour was equally stable over time in both groups with similar ability to predict exposure; cotinine levels were related to machine but not to self-reported puffing parameters. Overall, RYO smokers appeared to puff cigarettes less hard but for longer than FM cigarette smokers.

Conclusion: The measurement of puffing behaviour using a topography device is feasible but less practicable for RYO than FM cigarette smokers. Puffing parameters show comparable reliability and validity for both groups of smokers and reveal some differences in smoking topography dependent on the type of cigarette smoked.

Citation

Thompson, M.E., Wu, C. (2008). Simulation-based randomized systematic PPS sampling under substitution of units. Survey Methodology, 34, 3-10.

Abstract

The International Tobacco Control (ITC) Policy Evaluation Survey of China uses a multi-stage unequal probability sampling design with upper level clusters selected by the randomized systematic PPS sampling method. A difficulty arises in the execution of the survey: several selected upper level clusters refuse to participate in the survey and have to be replaced by substitute units, selected from units not included in the initial sample and once again using the randomized systematic PPS sampling method. Under such a scenario the first order inclusion probabilities of the final selected units are very difficult to calculate and the second order inclusion probabilities become virtually intractable. In this paper we develop a simulation-based approach for computing the first and the second order inclusion probabilities when direct calculation is prohibitive or impossible. The efficiency and feasibility of the proposed approach are demonstrated through both theoretical considerations and numerical examples. Several R/SPLUS functions and codes for the proposed procedure are included. The approach can be extended to handle more complex refusal/substitution scenarios one may encounter in practice.