Scientific Journal Articles
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Publication written in Chinese. Please visit link to view article.[download PDF]
Li, et al. 2009. Risk factors associated with smoking behaviour in recreational venues: Findings from the International Tobacco Control (ITC) China Survey [access full article]
Objective: To explore the determinants of smoking behaviour in recreational venues and to provide scientific bases for establishing smoke-free measures applying to these locations.
Methods: The International Tobacco Control (ITC) China Survey—a face-to-face cross-sectional survey of representative adult smokers from six cities (Shenyang, Beijing, Shanghai, Guangzhou, Changsha and Yinchuan) was conducted between April and August 2006. A total of 4815 smokers were selected using multistage sampling methods, and final analyses were conducted on 2875 smokers who reported patronising recreational venues at least once in the last six months. Multivariate logistic regression models were used to identify factors influencing the smoking behaviour within recreational settings.
Outcome Measure: Whether a smoker reported smoking in recreational venues during the last 6 months.
Results: 84% of subjects reported smoking in recreational venues. 32.0% of patrons reported partial The following factors were significant predicators of smoking in recreational venues: absence of bans on smoking, support for non-bans, being aged 18–24 years, positive smoking-related attitudes, low number of health effects reported and not living in Beijing.
Conclusions: The findings point to the importance of informing Chinese smokers about the active smoking and passive smoking harmfulness in both building support for smoke-free laws and in reducing smokers’ desire to smoke within recreational venues. They also point to the importance of good enforcement of smoke-free laws when implemented. Such strategies could also serve to de-normalise smoking in China.[download PDF]
Li, et al. 2009. Cross-sectional study on nicotine dependence of adult smokers in six cities [access full article]
Objective: To collect the information on nicotine dependence of Chinese adult smokers and understand the related factors of high nicotine dependence in adult smokers.
Methods: Used 4800 adult smokers, interviewed in Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan 1,800 smokers in each city were selected with multiple stages sampling method.
Results: The level of HIS was 215 ±117 in adult smokers in China, 215 ±117 for male and 119 ±117 for female, which were lower than that of smokers in developed countries1 The result of logistic regressions for predicting the probability of high nicotine dependence showed that gender, age, education, years after becoming a regular smoker, health consciousness and p rice per pack of last purchase could enter the equation1 Male (OR = 21352) and lower education had significant associations with high nicotine dependence. The lower education the smokers had, the higher nicotine dependence they were (the high education as contrasted, the OR of the medium education was 11417; the OR of low education was 11853) People who had smoked more than 10 years had high nicotine dependence (OR = 41519) People who regarded smoking was neither good nor bad for their own health (OR = 11345) , regarded smoking was good for their own health (OR = 21419) and purchased below 4 yuan per pack (OR = 11635) had high nicotine dependence.
Conclusion: Compared with developed countries, the HSI level was lower in China Male, higher age, lower education, smoking more than 10 years, failing to understand smoking damage, and purchasing cheap cigarettes were associated with high nicotine dependence.[download PDF]
Li, et al. 2009. Reported awareness of tobacco advertising and promotion in China compared to Thailand, Australia and the USA [access full article]
Background: China currently does not have comprehensive laws or regulations on tobacco advertising and promotion, although it ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in October 2005 and promised to ban all tobacco advertising by January 2011. Much effort is needed to monitor the current situation of tobacco advertising and promotion in China.
Objective: This study aims to examine levels of awareness of tobacco advertising and promotion among smokers in China as compared to other countries with different levels of restrictions.
Methods: One developing country (Thailand) and two developed countries (Australia and the USA) were selected for comparison. All four countries are part of the International Tobacco Control (ITC) Policy Evaluation Survey project. Between 2005 and 2006, parallel ITC surveys were conducted among adult smokers (at least smoked weekly) in China (n=4763), Thailand (n=2000), Australia (n=1767) and the USA (n=1780). Unprompted and prompted recall of noticing tobacco advertising and promotion were measured.
Results: Chinese respondents reported noticing tobacco advertisements in a range of channels and venues, with highest exposure levels on television (34.5%), billboards (33.4%) and in stores (29.2%). A quarter of respondents noticed tobacco sponsorships, and a high level of awareness of promotion was reported. Cross-country comparison reveals that overall reported awareness was significantly higher in China than in Thailand (particularly) and Australia, but lower than in the USA.
Conclusions: There is a big gap between China and the better-performing countries such as Thailand and Australia regarding tobacco promotion restrictions. China needs to do more, including enhanced policy and more robust enforcement.[download PDF]
Li, et al. 2009. Tobacco advertising on the street in Kunming, China
There is no abstract available for this publication.[download PDF]
Li, et al. 2009. Warning effects of health labeling on cigarette packet on smokers in six cities (Language: Chinese)
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.[download PDF]
Li, et al. 2009. Notice on health warning labeling on the cigarette packet in smokers of six cities [access full article]
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.[download PDF]
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.[download PDF]
Li, et al. 2009. Support for smoke-free policies among smokers and non-smokers in six cities in China: ITC China Survey (Language: Chinese)
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.[download PDF]
Zhao, et al. 2009. Prevalence study of anti-tobacco media campaign in six cities of China (Language: Chinese) [access full article]
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.[download PDF]
Jiang, et al. 2009. Evaluation of the effectiveness of health warnings on cigarette packs in China
Objective: To evaluate the effectiveness of health warnings on cigarette packs among Chinese residents.
Methods: 1169 individuals, including adult smokers, adult non-smokers and youth, balanced on gender, were selected from Bejing, Shanghai, Kunming, Yinchuan cities. The participants rated and ranked 10 real-size photographs of cigarette packs with a health warning. In addition to the two Chinese text warnings (one old and one new), there were 4 Chinese versions health warnings from foreign countries and the same 4 warnings with the picture removed.
Results: Regarding the effectiveness of motivating smokers to quit and convincing youth not to start smoking, the picture warnings were consistently ranked or rated in the top positions, followed by the 4 foreign text-only warnings. The old Chinese text warnings were consistently ranked or rated in the bottom. Results were very consistent across subject groups, cities and gender.
Conclusions: The new Chinese warning gained a small enhancement in term of effectiveness. It is necessary to use powerful health warnings on cigarette packs following the Article 11 of Framework Convention on Tobacco Control to improve the effectiveness of the communication of health harm knowledge to the publics.
Keywords: Cigarette package; Health warning; Health knowledge[download PDF]
Fong, et al. 2009. The impact of pictures on the effectiveness of tobacco warnings
Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions.1 Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) and the Article 11 Guidelines adopted at the Third Conference of the Parties in November 2008 have put the spotlight on the inclusion of pictures on tobacco package health warnings. Beginning with Canada in 2001, 28 countries have introduced pictorial warnings and many other countries are in the process of drafting regulations for pictorial warnings (Box 1 and Box 2). This paper presents a brief review of the research studies that support pictorial warnings, reviewed in greater depth by Hammond and by the International Tobacco Control (ITC) Policy Evaluation Project.[download PDF]
Feng, et al. 2009. Analysis on factors associated with intention to quit smoking of adult smokers in six cities of China
Background: Over 350 million smokers live in China, and this represents nearly one-third of the smoking population of the world. Smoking cessation is critically needed to help reduce the harms and burden caused by smoking-related diseases. It is therefore important to identify the determinants of quitting and of quit intentions among smokers in China. Such knowledge would have potential to guide future tobacco control policies and programs that could increase quit rates in China.
Objective: To identify the correlates of intentions to quit smoking among a representative sample of adult smokers in six cities in China.
Methods: Data from wave 1 (2006) of the International Tobacco Control (ITC) Policy Evaluation Project China Survey, a face-to-face survey of adult Chinese smokers in six cities: Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan, was analysed. Households were sampled using a stratified multistage design. About 800 smokers were surveyed in each selected city (total n=4815).
Results: Past quit attempts, duration of past attempts, Heaviness of Smoking Index (HSI), outcome expectancy of quitting, worry about future health and overall opinion of smoking were found to be independently associated with intentions to quit smoking, but demographic characteristics were not.
Conclusions: The determinants of quit intentions among smokers in China are fairly similar to those found among smokers in Western countries, despite the fact that interest in quitting is considerably lower among Chinese smokers. Identifying the determinants of quit intentions provides possibilities for shaping effective policies and programs for increasing quitting among smokers in China.[download PDF]
Thompson, et al. 2008. Simulation-based randomized systematic PPS sampling under substitution of units [access full article]
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.[download PDF]
Zhu, et al. 2008. Comparison of smoking characteristics between smokers in Changsha and five other cities in China (Language: Chinese)
Objective: To approach the features about smoking behavior, quit pattern, and tobacco control policies in Changsha, and to provide a scientific basis for tobacco control in Changsha.
Methods: Multiple stage sampling method was used to sample 800 smokers in each of the six cities Face to face interviews were conducted.
Conclusions: As compared with the other five cities, smokers in Changsha tend to smoke higher number of cigarettes per day to be more addicted to cigarettes, to smoke local cigarette brand to relapse after quitting to have weaker desire to quit smoking, and to be less confident to quit smoking In addition, the tobacco control policies in Changsha are not as strong as the other five cities.[download PDF]
Jiang, et al. 2008. Knowledge about the adverse health effects of tobacco among smokers in six cities in China (Language: Chinese) [access full article]
Written in Chinese - please access link to see full article.
Thrasher, et al. 2006. Evaluación de las políticas contra el tabaquismo en países latinoamericanos en la era del Convenio Marco para el Control del Tabaco (in Spanish) [access full article]
Objective: The Framework Convention on Tobacco Control (FCTC) aims to coordinate tobacco control policies around the world that reduce tobacco consumption. The FCTC's recommended policies are likely to be effective in low- and middle-income countries. Nevertheless, policy evaluation studies are needed to determine policy impact and potential synergies across policies.
Materials and methods: The International Tobacco Control Policy Evaluation Project (ITC) is an international collaboration to assess the psychosocial and behavioral impact of the FCTC's policies among adult smokers in nine countries. The ITC evaluation framework utilizes multiple country controls, a longitudinal design, and a theory-driven conceptual model to test hypotheses about the anticipated effects of given policies.
Results: ITC Project results generally confirm previous studies that form the evidence base for FCTC policy recommendations, in particular: the use of graphic warning labels; banning of "light" and "mild" descriptors; smoking bans; increasing tax and price; banning advertising; and using new cigarette product testing methods.
Conclusions: Initial findings from the ITC Project suggest that Latin American countries could use similar methods to monitor and evaluate their own tobacco control policies while contributing to the evidence base for policy interventions in other countries.[download PDF]