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.

Citation

Yong, H.H., Borland, R. (2008). Functional beliefs about smoking and quitting activity among adult smokers in four countries: Findings from the International Tobacco Control Four Country Survey. Health Psychology, 27(Suppl 3), S216-223.

Abstract

Objective: To examine the psychometric properties, distributions, and predictive utility for quitting behavior of six functional beliefs about smoking among adult smokers.

Design: Data was from the first three waves of the International Tobacco Control Four-Country Survey (ITC-4), a random-digit dialed telephone survey of a cohort of over 8,000 adult current smokers from the United Kingdom, United States, Canada, and Australia followed up annually.

Main Outcome Measures: Quitting attempts and the success of such attempts at the next wave.

Results: The six functional belief measures are modestly correlated with each other and are moderately stable over time. Smoking for enjoyment and life enhancement were significantly negatively related to quitting attempts, at least partly mediated by quitting intention and dependence. Smoking for stress management appeared to reduce quit success among those who tried, an effect mediated by quitting self-efficacy and dependence. Smoking for weight control, social facilitation, and as an aid to concentration were not independently associated with cessation.

Conclusion: Positive reasons for smoking may discourage quitting, but stress management is the only function that appears to prospectively predict quit success. Interventions should target those beliefs, and review the value of intervening on beliefs that are unrelated to cessation outcomes.

Citation

O’Connor, R.J., Hyland, A., Giovino, G.A., Fong, G.T., Cummings, K.M. (2005). Smoker awareness of and beliefs about supposedly less-harmful tobacco products. American Journal of Preventive Medicine, 29(2), 85-90.

Abstract

Background: Cigarette manufacturers in the United States have begun marketing cigarette brands claiming to reduce smokers' exposure to selected toxins in tobacco smoke. Little data exist on smokers' awareness, use, and beliefs about these products.

Methods: Data from the U.S. arm of the International Tobacco Control Policy Four-Country Survey (ITC-4), a telephone survey of 2028 adult current cigarette smokers in the United States conducted between May and September 2003, were analyzed. Respondents were asked to report their awareness, beliefs, and use of products marketed as less harmful than traditional cigarettes and of smokeless tobacco (SLT) products.

Results: Close to 39% of smokers were aware of "less-harmful" cigarettes, but only 27% of them could name a specific brand of such cigarettes. The brand named most often was Quest (25.7%), followed by Eclipse (7.6%), Winston (5.7%), herbal cigarettes (3.3%), "smoke-free" cigarettes (2.9%), Marlboro Blend #27 (1.9%), and Omni (1.9%). Of those who named a brand, 25% believed such products were less harmful than "ordinary cigarettes." In contrast, 82% of cigarette smokers were aware of SLT products, but only 10.7% of these believed that SLTs were less harmful than ordinary cigarettes.

Conclusions: Smokers hold beliefs about the relative safety of supposedly less-harmful tobacco products that are opposite to existing scientific evidence. These results highlight the need to educate smokers about the risks of alternatives to conventional cigarettes, and the need to regulate the advertising and promotion of such alternatives.

Citation

Borland, R., Fong, G.T., Yong, H.H., Cummings, K.M., Hammond, D., King, B., Siahpush, M., McNeill, A., Hastings, G., O’Connor, R.J., Elton-Marshall, T., Zanna, M.P. (2008). What happened to smokers' beliefs about light cigarettes when "light/mild" brand descriptors were banned in the UK? Findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 17(4), 256-262.

Abstract

Aim: This paper examines how beliefs of smokers in the UK were affected by the removal of “light” and “mild” brand descriptors, which came into effect on 30 September 2003 for Member States of the European Union (EU).

Participants: The data come from the first four waves (2002–2005) of the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey, an annual cohort telephone survey of adult smokers in Canada, USA, UK and Australia (15 450 individual cases).

Design: The UK ban on misleading descriptors occurred around the second wave of data collection in the ITC survey, permitting us to compare beliefs about light cigarettes among adult smokers in the UK before and after the ban, with beliefs in the three other ITC countries unaffected by the ban.

Results: There was a substantial decline in reported beliefs about the benefits of light cigarettes in the UK following the policy change and an associated public information campaign, but by 2005 (ie, wave 4), these beliefs rebounded slightly and the change in beliefs was no greater than in the USA, where there was no policy change.

Conclusions: The findings reveal that high levels of misperceptions about light cigarettes existed among smokers in all four countries before and after the EU ban took effect. We cannot conclude that the policy of removing some aspects of misleading labels has been effective in changing beliefs about light cigarettes. Efforts to correct decades of consumer misperceptions about light cigarettes must extend beyond simply removing “light” and “mild” brand descriptors.

Citation

Hammond, D., Reid, J., Driezen, P., Cummings, K.M., Borland, R., Fong, G.T., McNeill, A. (2008). Smokers' use of nicotine replacement therapy for reasons other than stopping smoking: Findings from the ITC Four Country Survey. Addiction, 103(10), 1696-1703.

Abstract

Aims: To measure the prevalence and correlates of nicotine replacement therapy (NRT) use for reasons other than quitting smoking among smokers in four countries.

Design and setting: Population-based, cross-sectional telephone survey with nationally representative samples of adult smokers in Canada, the United States, the United Kingdom and Australia, conducted in 2005.

Participants: A total of 6532 adult daily smokers in Canada (n = 1660), the United States (n = 1664), the United Kingdom (n = 1617) and Australia (n = 1591).

Measurements: Survey questions included demographics, smoking behaviour, use of NRT and reasons for NRT use, as well as access and availability of NRT.

Findings: Approximately 17% of smokers surveyed had used NRT in the past year. Among NRT users, approximately one-third used NRT for a reason other than quitting smoking, including temporary abstinence or reducing the number of cigarettes smoked. The prevalence of non-standard NRT use was remarkably consistent across countries. Using NRT for reasons other than quitting was associated with higher education level, heavier smoking, having no quit intentions, having no past-year quit attempts, the type of NRT product used and accessing NRT without a prescription.

Conclusions: The use of NRT for purposes other than quitting smoking is fairly common and may help to explain the difficulty in detecting significant quitting benefits associated with NRT use in population studies. Tobacco control policies, including the accessibility of NRT, may have important implications for patterns of NRT use.

Citation

Hassan, L.M., Shiu, E., Thrasher, J.F., Fong, G.T., Hastings, G. (2008). Exploring the effectiveness of cigarette warning labels: Findings from the United States and United Kingdom arms of the International Tobacco Control (ITC) Four Country Survey. International Journal of Nonprofit and Voluntary Sector Marketing, 13(3), 263-274.

Abstract

This paper explores the effectiveness of cigarette warning labels across two countries, one (the UK) with new and stricter legislation where text based labels have been made more prominent and one (the USA) with less stringent regulation, where labels are less visible. Using longitudinal data from the two countries, the research seeks to investigate the impact of the different types of warning labels on the information processing by consumers. This paper assesses the effectiveness of warning labels in terms of: consumer attention, elaboration, contemplation on quitting and behavioural compliance. This study provides a comprehensive examination of these key factors in a fixed causal sequence. Structural equation modelling was used to test this model based on longitudinal panel survey data from the International Tobacco Control (ITC) Four Country Survey. Analysis of a sample of 901 US smokers and 1459 UK smokers yielded results in full support of all hypothesised relationships in the model proposed for both countries. Findings suggest that the new European Union policy of more prominent warning labels has a direct effect on influencing behavioural compliance by smokers.

Citation

Hyland, A., Higbee, C., Hassan, L.M., Fong, G.T., Borland, R., Cummings, K.M., Hastings, G. (2008). Does smoke-free Ireland have more smoking inside the home and less in pubs than the United Kingdom? Findings from the International Tobacco Control Policy Evaluation Project. European Journal of Public Health, 18(1), 63-65.

Abstract

Background: In March 2004, Ireland implemented comprehensive smoke-free regulations. Some were concerned this would cause pub patrons to move their smoking and drinking from inside pubs to inside homes. This article aims to assess whether nationwide smoke-free policies are associated with more smoking or drinking inside the home.

Methods: Participants were 1917 adult smokers (> 18-years old) from Ireland (n = 582), Scotland (n = 507) and the rest of the United Kingdom (n = 828), which did not have smoke-free laws at the time of the interview, who completed a random digit-dialed telephone survey in February to March 2006. The percentage of alcoholic drinks consumed in the home versus pubs was compared by country as well as the percentage of daily cigarette consumption occurring in the home after work.

Results: Irish respondents reported a significantly lower percentage of alcoholic drinks consumed in the home compared to Scotland and the rest of the United Kingdom, and cigarette consumption in the home was comparable in all three regions.

Conclusions: Smoking and drinking in the home was not greater in smoke-free Ireland than in the United Kingdom, where there was not a smoke-free law at the time of the survey. These findings add further support to the enactment of comprehensive smoke-free laws, as called for in the Framework Convention on Tobacco Control.

Citation

Shahab, L., Hammond, D., O’Connor, R.J., Cummings, K.M., Borland, R., King, B., McNeill, A. (2008). The reliability and validity of self-reported puffing behavior: Evidence from a cross-national study. Nicotine & Tobacco Research,10(5), 867-874.

Abstract

Self-reported puffing behavior has considerable potential as an indicator of smoking intensity, particularly in survey research evaluating population-based changes in smoking patterns. However, little is known about the reliability and validity of self-reported puffing behavior. This study compared smokers’ perceptions of their puffing behavior with measures of both machinedetermined puffing behavior and nicotine uptake to assess the utility of self-report. We assessed self-reported puffing behavior as well as demographic and smoking characteristics of 118 smokers from Australia, Canada, the United Kingdom, and the United States. At two visits, participants were asked to provide a saliva sample and to smoke a cigarette through a portable smoking topography device, the CReSSmicro, to measure puffing behavior. Saliva samples were assayed for cotinine, a measure of nicotine uptake, to provide estimates of smoke exposure. Intraclass coefficients for all measures of self-reported general puffing behavior were above .6, indicating that self-reported measures had fair-to-good test–retest reliability. Self-report, in particular of interpuff interval and number of cigarette puffs, was correlated only moderately with machine-determined puffing measures (.2<r<.4), and no self-report measure related to smoke exposure as measured by cotinine. Self-reported measures of puffing behavior appear to be fairly reliable but are correlated only weakly with objective measures of smoking topography. Results suggest that smokers have a better perception of the time spent between puffs and of the number of puffs taken than of the intensity and depth of each puff or their actual smoke exposure.

Citation

Siahpush, M., Borland, R., Yong, H.H., Kin, F., Sirirassamee, B. (2008). Socio-economic variations in tobacco consumption, intention to quit and self-efficacy to quit among male smokers in Thailand and Malaysia: Results from the International Tobacco Control-South-East Asia (ITC-SEA) Survey. Addiction, 103(3), 502-508.

Abstract

Aim: To examine the association of socio-economic position (education, income and employment status) with cigarette consumption, intention to quit and self-efficacy to quit among male smokers in Thailand and Malaysia.

Design and setting: The data were based on a survey of adult smokers conducted in early 2005 in Thailand and Malaysia as part of the International Tobacco Control–South-East Asia (ITC– SEA) project.

Participants: A total of 1846 men in Thailand and 1906 men in Malaysia.

Measurement: Participants were asked questions on daily cigarette consumption, intention to quit and self-efficacy to quit in face-to-face interviews.

Findings: Analyses were based on multivariate regression models that adjusted for all three socio-economic indicators. In Thailand, higher level of education was associated strongly with not having self-efficacy, associated weakly with having an intention to quit and was not associated with cigarette consumption. Higher income was associated strongly with having self-efficacy, associated weakly with high cigarette consumption and was not associated with having an intention to quit. Being employed was associated strongly with having an intention to quit and was not associated with cigarette consumption or self-efficacy. In Malaysia, higher level of education was not associated with any of the outcomes. Higher income was associated strongly with having self-efficacy, and was not associated with the other outcomes. Being employed was associated moderately with higher cigarette consumption and was not associated with the other outcomes.

Conclusion: Socio-economic and cultural conditions, as well as tobacco control policies and tobacco industry activities, shape the determinants of smoking behaviour and beliefs. Existing knowledge from high-income countries about disparities in smoking should not be generalized readily to other countries.

Citation

Yong, H.H., Borland, R., Hyland, A., Siahpush, M. (2008). How does a failed quit attempt among regular smokers affect their cigarette consumption? Findings from the International Tobacco Control Four Country Survey (ITC-4). Nicotine & Tobacco Research, 10(5), 897-905.

Abstract

Recent cross-sectional data suggests that smokers tend to reduce smoking following a failed selfinitiated quit attempt, possibly motivated by the need to reduce harms or to facilitate future quitting or both. This study prospectively examined changes in cigarette consumption among adult smokers who relapsed from a quit attempt. It uses data from the first three waves of the International Tobacco Control Four-Country Survey (ITC-4), a random digit-dialed telephone survey of a cohort of over 9,000 adult smokers from the United Kingdom, United States, Canada, and Australia, followed up annually. Compared with those who did not make a quit attempt, relapsers were more likely to reduce consumption (average reduction of 0.7 vs. 3.4, respectively) over a mean period of 7 months between waves 1 and 2. Of the relapsers, 52% reduced their consumption by 5% or more, but 22% increased it. Smokers who smoked heavily at baseline, whose last quit attempt ended more recently, was of longer duration, and quit via a gradual cutdown method were all independently associated with reducing smoking following a failed attempt. These findings were similar across all four countries and were successfully replicated using waves 2–3 data. Change in consumption between waves 1 and 2 (whether increase or decrease) was maintained by a substantial number a year later (wave 3), but change did not undermine nor promote quitting between waves 2 and 3.

Citation

Yong, H.H., Borland, R., Hammond, D., Sirirassamee, B., Ritthiphakdee, B., Awang, R., Omar, M., Kin, F., Zain, Z., Lee, W.B., Siahpush, M., Fong, G.T. (2008). Levels and correlates of awareness of tobacco promotional activities among adult smokers in Malaysia and Thailand: Findings from the International Tobacco Control Southeast Asia (ITC-SEA) Survey. Tobacco Control, 17(1), 46-52.

Abstract

Aim: To examine the impact of tobacco advertising policy on adult smokers’ awareness of tobacco promotion in two developing countries—Malaysia and Thailand.

Methods: Data from 2004 Malaysian and 2000 Thai adult smokers who participated in the baseline wave of the International Tobacco Control Southeast Asia survey (ITCSEA). Respondents were asked in a face-to-face interview conducted between January and March 2005 to indicate their levels of awareness of tobacco advertising and promotional activities in the last six months.

Results: Unprompted awareness of any tobacco marketing activities was very low in Thailand (20%) but significantly higher in Malaysia (53%; OR=5.6, 95% CI: 3.5 to 8.9, p<0.001). When prompted about specific locations, Thai adult smokers reported very low recall of tobacco advertising where it was banned, being highest around point of sale, particularly street vendors (7.5%). In contrast, Malaysian adult smokers reported significantly higher levels of awareness of tobacco advertising in all locations (range=17.7% noticing in disco lounges to 59.3% on posters) including where they are nationally banned (for example, billboards).

Conclusions: These findings demonstrate that comprehensive tobacco advertising legislation when well implemented can lead to dramatic decline in awareness of tobacco promotion, thus supporting strong implementation of Article 13 of the Framework Convention on Tobacco Control.