Citation

Fong, G.T., Ratte, S., Craig, L., Driezen, P., Wilquin, J.L., Beck, F., Guignard, R., Kennedy, R.D., Arwidson, P. (2008). Évaluation des politiques de lutte contre le tabagisme en France: Résultats de la premiere vague de l'enquete ITC France. Bulletin Epidémiologique Hebdomadaire, 22(27), 182-187.

Abstract

In recent years, countries throughout the world have made policy advancements in recognition of the threat that tobacco use poses to public health. The Framework Convention on Tobacco Control (FCTC), the first-ever treaty on health, has been ratified by over 150 countries, including France. The FCTC identifies tobacco control policy domains in which the parties must implement policies (e.g., enhanced warning labels, protection from tobacco smoke in public places, bans/restrictions on advertising/promotion/sponsorship, higher taxes). Rigorous and comprehensive evaluation of FCTC policies is essential in increasing the likelihood that the actual policies implemented will meet the objectives of the FCTC in significantly reducing the toll of tobacco throughout the world. The International Tobacco Control Policy Evaluation Project (the ITC Project) is an international collaborative effort to conduct rigorous evaluation of the FCTC. The ITC Project consists of prospective cohort surveys of representative samples of adult smokers in 15 countries, inhabited by over half of the world’s smokers. The ITC France Survey was created as a system for comprehensive surveillance and evaluation of tobacco control initiatives in France, including the two-phase smoke-free initiative. This paper presents selected findings from the initial wave (2006) of the ITC France Survey in three areas: a) smoking behaviour and cessation, b) smoke-free laws, and c) warning labels. Comparisons are made with other ITC countries in Europe. Findings lead to the prediction of a successful implementation of the smoke-free law in France and to the potential benefits of graphic warnings. They also suggest challenges for tobacco control in France, including the need to engage health professionals as agents for assisting smokers to quit.

Citation

Thomson, G., Wilson, N., Weerasekera, D., Edwards, R. (2008). Ninety-six percent of New Zealand smokers support smokefree cars containing preschool children. New Zealand Medical Journal, 121(1285), 139-140.

Abstract

New Zealand and international research shows that smoking in cars, even with the windows down, produces dangerous levels of pollutants.1,2 These levels are far higher than World Health Organization air quality guidelines for particulates in ambient air.3 While at least 10 Australian and North American jurisdictions (including California) have banned smoking in cars carrying children,4–13 New Zealand officials have been reported as hesitant about considering such a move.14 Perceived questions about public support appear to have contributed to lack of progress on this issue in New Zealand.14 In a number of areas of Australia and North America, support from smokers (85% or over) and non smokers (90% or over) has been reported for banning smoking in cars with children inside.15–18 In a 1997 Wellington area survey, 94% agreed that cars with children in them should be smokefree (86% of smokers).15 In a 2004 New Zealand wide survey, 76% disagreed that it is “okay” to smoke around non smokers inside cars even when there are windows down.16

Citation

Jiang, Y., Li, X., Zhao, G., Yang, Y., Feng, G., Jiao, S., Zhao, J., Zhu, G., Luo, B., Li, X., Li, Q. (2008). Knowledge about the adverse health effects of tobacco among smokers in six cities in China (Language: Chinese). Chinese Journal of Health Education, 24(9), 665-668.

Abstract

Written in Chinese - please access link to see full article.

Citation

Seo, H.G., Cheong, Y., Myung, S.K., Kim, Y., Lee, W.B., Fong, G.T. (2008). Smoking-related characteristics in Korean adult smokers: Findings from the 2005 International Tobacco Control Policy Evaluation Survey-Korea (Language: Korean). Journal of Korean Academy of Family Medicine, 29(11), 844-853.

Abstract

Background: This study reports findings from the ITC Korea Survey, which was conducted to evaluate the characteristics in Korean adult smokers as part of the ITC Project.

Methods: Adult male and female smokers were randomly selected using telephone survey from November to December 2005. The ITC Korea Survey contained a wide range of questions on smoking behavior and smoking history. The data reported are weighted on the basis of age and gender, and they are nationally representative of smokers in Korea.

Results: A total of 1,002 smokers among the selected 1,402 subjects (71.5%) were interviewed; 96.2% were males. Daily smokers comprised 94.5% of the sample. The mean of cigarettes per day was 17.9. The average minutes after waking before the first cigarette was smoked was lower (50.6 minutes) than it was in other countries of the ITC Project. Over 90% considered themselves addicted to cigarettes and 86.5% expressed regret over smoking. Smokers reported that the norms against smoking in Korea were very strong both personal norms (89.4%) and perceived norms in Korean society (86.3%). Among the smokers, 80.8% had tried to quit smoking, and 76.1% were planning to quit. Only 5.8% of the Korean smokers indicated that the warning labels made them a lot more likely to quit smoking. When the price of cigarettes increased by 500 won (25%) in December 2004, 34.3% reported trying to quit smoking. Only 17.7% supported a complete workplace ban and 15.8% supported a complete ban in restaurants. Although knowledge of the harms of smoking was high, nearly 80% of the Koreans wrongly believed that “nicotine causes most of the cancer in smokers.” Finally, the great majority (85.2%) of smokers in Korea believed that “the government should do more to tackle the harm done by smoking” and 62.5% believed that “tobacco products should be more tightly regulated.”

Conclusion: The results from the baseline wave of the ITC Korea Survey have identified where tobacco control in Korea has been done. Future waves of the ITC Korea Survey will be able to evaluate the impact of important tobacco control policies that Korea will be required to implement over the next few years, as a party to the FCTC.

Citation

Thrasher, J.F., Reynales-Shigematsu, L.M., Baezconde-Garbanati, L., Villalobos, V., Tellez-Giron, P., Arillo-Santillán, E., Dorantes-Alonso, A., Valdes-Salgado, R., Lazcano-Ponce, E. (2008). Promoting the effective translation of the framework convention on tobacco control: A case study of challenges and opportunities for strategic communications in Mexico. Evaluation & the Health Professions, 31(2), 145-166.

Abstract

The World Health Organization Framework Convention on Tobacco Control (WHO-FCTC) promotes the implementation of best-practices tobacco control policies at a global scale. This article describes features of the sociocultural and political-economic context of Mexico that pose challenges and opportunities to the effective translation of WHO-FCTC policies there. It also considers how strategic communication efforts may advance these policies by framing their arguments in ways that resonate with prevalent values, understandings, and concerns. A focus on a smoke-free policy illustrates barriers to policy compliance, including how similar issues have been overcome among Latino populations in California. Overall, this article aims to lay the foundation for comparative research from policy uptake to impact so that the scientific evidence base on tobacco control policies includes examination of how context moderates this process.

Citation

Wilson, N., Thomson, G., Edwards, R., Weerasekera, D., Laugesen, M. (2008). Most New Zealand smokers support having fire-safe cigarettes: National survey data. New Zealand Medical Journal, 121(1286), 134-135.

Abstract

A recent New Zealand study on cigarette fires and burns among New Zealand smokers,1 has highlighted again yet another adverse consequence of nicotine addiction. The obvious long-term solution to this problem is to lower smoking prevalence by advancing comprehensive tobacco control measures (as previously advocated by injury researchers in New Zealand2). However, a more direct and supplementary option is for governments to mandate for fire safe (or “reduced ignition propensity”) cigarettes as per Canada and various US states (including New York and California).3,4

Citation

Zhu, G., Jiang, Y., Li, Q., Hu, L., Hu, J., Zhao, G., Yin, L., Jiao, S., Li, Z., Li, Z., Luo, B., Zhao, J. (2008). Comparison of smoking characteristics between smokers in Changsha and five other cities in China (Language: Chinese). Practical Preventive Medicine, 15(6), 1691-1694.

Abstract

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.

Citation

Ding, X., Bedingfield, S., Yeh, C.H., Borland, R., Young, D., Zhang, J.Y., Petrovic-Lazarevic, S, Coghill, K. (2008). A decision tree approach for predicting smokers’ quit intentions. Journal of Electronic Science and Technology of China, 6(3), 220-224.

Abstract

This paper presents a decision tree approach for predicting smokerspsila quit intentions using the data from the International Tobacco Control Four Country Survey. Three rule-based classification models are generated from three data sets using attributes in relation to demographics, warning labels, and smokerspsila beliefs. Both demographic attributes and warning label attributes are important in predicting smokerspsila quit intentions. The modelpsilas ability to predict smokerspsila quit intentions is enhanced, if the attributes regarding smokerspsila internal motivation and beliefs about quitting are included.

Citation

Thomson, G., Wilson, N., Weerasekera, D., Edwards, R. (2008). Ninety-six percent of New Zealand smokers support smokefree cars containing preschool children. New Zealand Medical Journal, 121(1285), 139-140.

Abstract

New Zealand and international research shows that smoking in cars, even with the windows down, produces dangerous levels of pollutants. These levels are far higher than World Health Organization air quality guidelines for particulates in ambient air. While at least 10 Australian and North American jurisdictions (including California) have banned smoking in cars carrying children, New Zealand officials have been reported as hesitant about considering such a move. Perceived questions about public support appear to have contributed to lack of progress on this issue in New Zealand. In a number of areas of Australia and North America, support from smokers (85% or over) and non smokers (90% or over) has been reported for banning smoking in cars with children inside. In a 1997 Wellington area survey, 94% agreed that cars with children in them should be smokefree (86% of smokers). In a 2004 New Zealand wide survey, 76% disagreed that it is “okay” to smoke around non smokers inside cars even when there are windows down.

Citation

Thomson, G., Wilson, N., Bushell, L., Al Matar, W., Ball, B., Chiu, J., Culliford, N., Gibson, K., Hudson, J., Hunt, P., Rangamuwa, K., Tapp, D., Wickramaratne, H., Young, V. (2008). Butt lengths differ by area deprivation level: A field study to explore intensive smoking. Nicotine & Tobacco Research, 10(5), 927-931.

Abstract

We collected cigarette butts in a range of residential areas, to assess differences in the length of unburnt tobacco in the butts, and in proportions of roll-your-own (RYO) cigarettes. Two high, two medium, and two low deprivation areas, as classified by deciles of the New Zealand Deprivation Index, were selected for the Wellington region. Collected butts were systematically classified and measured. A mixed model of analysis, treating location clusters nested within deprivation level areas as a random effect, was used to assess differences in mean length of unburnt tobacco in the butts. A total of 6,262 cigarette butts and separate filters were collected, of which 3,509 (56.0%) were measurable manufactured cigarette butts, 1,069 were unmeasurable manufactured butts, 1,450 were RYO butts, and 236 were RYO filters. The RYO butts were not measured because of the extent of their degradation. The unburnt tobacco lengths in manufactured cigarette butts were significantly shorter in the most deprived areas, relative to the least deprived areas (p = .035). Deformed manufactured cigarette butts (i.e., that potentially were stubbed out) showed the same pattern (p = .011 between the most and least deprived areas). We found no significant difference between deprivation areas in the proportion of RYO material found. The shorter mean unburnt tobacco length in the most deprived areas is consistent with more intensive smoking among smokers in those areas. This finding is consistent with other evidence of increased price sensitivity among poorer smokers, and with basic economic theory. Further evidence on observed smoking behavior in the field is necessary to better interpret these preliminary findings.

Citation

Norton, K.J., Wilkins, K., O’Connor, R.J., Wilson, N., Edwards, R., Peace, J. (2008). Properties of “light” cigarettes sold in New Zealand. New Zealand Medical Journal, 121(1281), 107-117.

Abstract

“Light” or “mild” cigarettes have historically been marketed to appeal to health concerned smokers, and positioned as an alternative to quitting.1 But despite this marketing strategy, there is evidence that “light” cigarettes often deliver as much tar as regular cigarettes.2 Furthermore, there is epidemiological evidence that suggests no significant health benefit in terms of lung cancer, heart disease or chronic lung disease for smoking “light” versus other cigarettes.2,3

Citation

Hyland, A., Cummings, K.M., Higbee, C., Dresler, C., Travers, M. (2008). A 32-country comparison of tobacco smoke derived particle levels in indoor public places. Tobacco Control, 17(3), 159-165.

Abstract

Objective: To compare tobacco smoke derived particulate levels in transportation and hospitality venues with and without smoking in 32 countries using a standardised measurement protocol.

Methods: The TSI SidePak AM510 Personal Aerosol Monitor was used to measure the concentration of particulate matter less than 2.5 microns in diameter (PM(2.5)) in 1822 bars, restaurants, retail outlets, airports and other workplaces in 32 geographically dispersed countries between 2003 and 2007.

Results: Geometric mean PM(2.5) levels were highest in Syria (372 microg/m(3)), Romania (366 microg/m(3)) and Lebanon (346 microg/m(3)), while they were lowest in the three countries that have nationwide laws prohibiting smoking in indoor public places (Ireland at 22 microg/m(3), Uruguay at 18 microg/m(3) and New Zealand at 8 microg/m(3)). On average, the PM(2.5) levels in places where smoking was observed was 8.9 times greater (95% CI 8.0 to 10) than levels in places where smoking was not observed.

Conclusions: Levels of indoor fine particle air pollution in places where smoking is observed are typically greater than levels that the World Health Organization and US Environmental Protection Agency have concluded are harmful to human health.

Citation

Wilson, N., Edwards, R., Thomson, G. (2008). Use of four major tobacco control interventions in New Zealand: a review. New Zealand Medical Journal, 121(1276), 71-86.

Abstract

Aims: To identify the extent to which four major population-level tobacco control interventions were used in New Zealand from January 2000 to June 2007.

Methods: We selected the four population-based tobacco control interventions with the strongest evidence base. For each intervention, we undertook literature searches to identify the extent of their use in New Zealand during the study period and made comparisons with the other 29 OECD countries.

Results: Increasing the unit price of tobacco: New Zealand has high tobacco prices, but the policy on tax has several limitations relative to best practice within OECD countries. In particular, the high price appears to be shifting many smokers from factory-made cigarettes to loose tobacco, rather than stimulating quitting.

Controls on marketing: While New Zealand compares favourably with most other OECD countries for tobacco marketing controls, some jurisdictions have made more progress in specific areas (e.g. eliminating point-of-sale product displays and removing misleading descriptors on packaging).

Mass media campaigns: The country routinely invests in these campaigns, but the budget is only around $1.2 per capita per year. Some design aspects of the campaigns are progressive, but comparisons with other countries indicate potential for improvements (e.g. learning from counter-industry campaigns in the USA).

Smokefree environments regulations: New Zealand was one of the first OECD countries to implement comprehensive smokefree workplaces legislation (including restaurants and bars) and it still compares well. But gaps remain when compared to some other OECD jurisdictions (e.g. no smokefree car laws).

Conclusions: There is still substantial scope for New Zealand to catch up to OECD leaders in these key tobacco control areas. In particular, there needs to be higher tax levels for loose tobacco (relative to factory-made cigarettes) and the elimination of residual marketing. There are also important gaps in exploiting synergies between interventions in this country.

Citation

Thompson, M.E. (2008). International surveys: motives and methodologies. Survey Methodology, 34, 131-141.

Abstract

The context of the discussion is the increasing incidence of international surveys, of which one is the International Tobacco Control (ITC) Policy Evaluation Project, which began in 2002. The ITC country surveys are longitudinal, and their aim is to evaluate the effects of policy measures being introduced in various countries under the WHO Framework Convention on Tobacco Control. The challenges of organization, data collection and analysis in international surveys are reviewed and illustrated. Analysis is an increasingly important part of the motivation for large scale cross-cultural surveys. The fundamental challenge for analysis is to discern the real response (or lack of response) to policy change, separating it from the effects of data collection mode, differential non-response, external events, time-in-sample, culture, and language. Two problems relevant to statistical analysis are discussed. The first problem is the question of when and how to analyze pooled data from several countries, in order to strengthen conclusions which might be generally valid. While in some cases this seems to be straightforward, there are differing opinions on the extent to which pooling is possible and reasonable. It is suggested that for formal comparisons, random effects models are of conceptual use. The second problem is to find models of measurement across cultures and data collection modes which will enable calibration of continuous, binary and ordinal responses, and produce comparisons from which extraneous effects have been removed. It is noted that hierarchical models provide a natural way of relaxing requirements of model invariance across groups.

Citation

King, B., Borland, R., Fowles, J. (2007). Mainstream smoke emissions of Australian and Canadian cigarettes. Nicotine & Tobacco Research, 9(8), 835-844.

Abstract

We investigated how mainstream smoke emissions vary and interrelate in 15 Australian and 21 Canadian brands,using public emissions disclosures from 2001. These disclosures provided emission data for 40 hazardous agents under both standard and intensive ISO testing conditions. Our analyses focused on ‘‘adjusted emissions’’ (i.e., emissions per milligram of nicotine yield) for 13 selected agents. Adjusted emissions differed significantly by ISO testing condition for 9 of the 13 selected agents. Intensive condition adjusted emissions were strongly negatively correlated for several agent pairs. Country and manufacturer variables were the strongest predictors of intensive condition adjusted emissions for 8 of the 13 selected agents and significant predictors for all of them. Taken together, these results suggest potential for the intent of emission limits to be undermined by risk swapping (in which one specific exposure is reduced within a group at the cost of another’s exposure increasing) and risk shifting (in which a specific exposure is reduced within a group at the cost of that exposure’s increasing within another group).

Citation

Baker, T.B., Piper, M.E., McCarthy, D.E., Bolt, D.M., Smith, S.S., Kim, S.Y., Colby, S., Conti, D., Giovino, G.A., Hatsukami, D., Hyland, A., Krishnan-Sarin, S., Perkins, K.A., Niaura, R., Toll, B.A. (2007). Time to first cigarette in the morning as an index of ability to quit smoking: Implications for nicotine dependence. Nicotine & Tobacco Research, 9(Suppl 4), S555-570.

Abstract

An inability to maintain abstinence is a key indicator of tobacco dependence. Unfortunately, little evidence exists regarding the ability of the major tobacco dependence measures to predict smoking cessation outcome. This paper used data from four placebo-controlled smoking cessation trials and one international epidemiological study to determine relations between cessation success and the Fagerstrom Test for Nicotine Dependence (FTND), the Heaviness of Smoking Index, the Nicotine Dependence Syndrome Scale, and the Wisconsin Inventory of Smoking Dependence Motives. Results showed that much of the predictive validity of the FTND could be attributed to its first item, time to first cigarette in the morning, and this item had greater validity than any other single measure. Thus the time-to-first-cigarette item appears to tap a pattern of heavy, uninterrupted, and automatic smoking and may be a good single-item measure of nicotine dependence.

Citation

Hammond, D., Fong, G.T., Borland, R., Cummings, K.M., McNeill, A., Driezen, P. (2007). Communicating risk to smokers: The impact of health warnings on cigarette packages. American Journal of Preventive Medicine, 32(3), 202-209.

Abstract

Background: Health warnings on cigarette packages provide smokers with universal access to information on the risks of smoking. However, warnings vary considerably among countries, ranging from graphic depictions of disease on Canadian packages to obscure text warnings in the U.S. The current study examined the effectiveness of health warnings on cigarette packages in four countries.

Methods: Quasi-experimental design. Telephone surveys were conducted with representative cohorts of adult smokers (N= 14,975): Canada (n =3687); the U.S. (n =4273); the UK (n= 3634); and Australia (n =3381). Surveys were conducted between 2002 and 2005, before and at three time points following new warnings on UK packages.

Results: At Wave 1, Canadian smokers reported the highest levels of awareness and impact for health warnings among the four countries, followed by Australian smokers. Following the implementation of new UK warnings at Wave 2, UK smokers reported greater levels of awareness and impact, although Canadian smokers continued to report higher levels of impact after adjusting for the implementation date. U.S. smokers reported the lowest levels of effectiveness for almost every measure recorded at each survey wave.

Conclusions: Large, comprehensive warnings on cigarette packages are more likely to be noticed and rated as effective by smokers. Changes in health warnings are also associated with increased effectiveness. Health warnings on U.S. packages, which were last updated in 1984, were associated with the least effectiveness.

Citation

Young, D., Borland, R., Siahpush, M., Hastings, G., Fong, G.T., Cummings, K.M. (2007). Australian smokers support stronger regulatory controls on tobacco: Findings from the ITC Four-Country Survey. Australian and New Zealand Journal of Public Health, 31(2), 164-169.

Abstract

Objective: To examine Australian smokers’ attitudes towards regulation of the tobacco industry and to compare their attitudes with those of three similar countries – the United Kingdom (UK), the United States (US), and Canada

Method: A telephone survey of 2,056 adult Australian smokers and 6,166 Canadian, US, and UK smokers was conducted in 2004 as the third wave of the International Tobacco Control Policy Evaluation Four- Country Survey.

Results: Australian smokers display the strongest support for regulation. Only 16% believe that tobacco companies should be allowed to advertise/promote cigarettes as they please, 70% agree that tobacco products should be more tightly regulated, and 64% agree that governments should do more to tackle the harms of smoking. Smokers see government failure to do so in cynical terms – 77% agree that governments do not really care about smoking because of money from tobacco taxes. Opposition comes largely from smokers who hold self-exempting beliefs about smoking’s risks, have a positive attitude to smoking, do not accept that smoking is socially denormalised, and do not hold tobacco companies responsible for harms caused by smoking.

Conclusions and Implications: The majority of Australian smokers believe that the tobacco industry is partly responsible for the predicament they find themselves in and want governments to act more strongly in their real interests. The strong relationship between support for regulation and cynicism about government inaction should stimulate governments into action.

Citation

Cheong, Y., Yong, H.H., Borland, R. (2007). Does how you quit affect success? A comparison between abrupt and gradual methods using data from the International Tobacco Control Policy Evaluation Study. Nicotine & Tobacco Research, 9(8), 801-810.

Abstract

Two recommended quit methods in standard cessation programs involve either gradual reduction of smoking prior to complete abstinence ("cut down") or abrupt abstinence from cigarettes ("cold turkey"). This study examined the reported use, characteristics of users, and the impact of self-selected strategy choice on quitting success and relapse of adult smokers who reported quitting on their own. Data came from the first three waves of the International Tobacco Control Policy Evaluation 4-Country Survey (ITC-4). The ITC-4 is a random-digit-dialed telephone survey of a cohort of more than 8,000 adult smokers from the United Kingdom, the United States, Canada, and Australia, with a 75% follow-up rate. The results indicated that 68.5% of the smokers who had made a quit attempt between waves reported using the cold-turkey method. Of those who used the cold turkey method, 22% and 27% succeeded at Waves 2 and 3, respectively, compared with the 12% and 16%, respectively, who used the cut-down method. Multivariate analyses revealed that cold-turkey users were more likely to be aged 25-39 years, male, from the United Kingdom, and smoking heavily, and had lower perceived dependence. Controlling for sociodemographic and known predictors of quitting including use of medications, we found that smokers who used the cold-turkey method to quit were almost twice as likely to abstain for a month or more in their attempt. Overall, we cautiously conclude that cold turkey should be the recommended strategy for smokers who want to quit on their own.

Citation

O’Connor, R.J., McNeill, A., Borland, R., Hammond, D., King, B., Boudreau, C., Cummings, K.M. (2007). Smokers' beliefs about the relative safety of other tobacco products: Findings from the ITC collaboration.Nicotine & Tobacco Research, 9(10), 1033-1042.

Abstract

Most tobacco control efforts in western countries focus on the factory-made, mass-produced (FM) cigarette, whereas other tobacco products receive relatively little attention. Noncombusted tobacco products (i.e., referred to as smokeless tobacco), particularly Swedish-style snus, carry lower disease risks, compared with combusted tobacco products such as cigarettes. In this context, it is important to know what tobacco users believe about the relative harmfulness of various types of tobacco products. Data for this study came from random-digit-dialed telephone surveys of current smokers aged 18 or older in Australia, Canada, the United Kingdom, and the United States. Three waves of data, totaling 13,322 individuals, were assessed. Items assessed use of and beliefs about the relative harms of cigars, pipes, smokeless tobacco, and FM and roll-your-own cigarettes, as well as sociodemographics and smoking behaviors. Cigars (2.8%-12.7%) were the other tobacco products most commonly used by current cigarette smokers, followed by pipes (0.3%-2.1%) and smokeless tobacco (0.0%-2.3%). A significant minority of smokers (12%-21%) used roll-your-own cigarettes at least some of the time. About one-quarter of smokers believed that pipes, cigars, or roll-your-own cigarettes were safer than FM cigarettes, whereas only about 13% responded correctly that smokeless tobacco was less hazardous than cigarettes. Multivariate analyses showed that use of other tobacco products was most strongly related to beliefs about the reduced harm of these other products. Use of other tobacco products was low but may be growing among smokers in the four countries studied. Smokers are confused about the relative harms of tobacco products. Health education efforts are needed to correct smoker misperceptions.

Citation

Siahpush, M., Borland, R., Yong, H.H. (2007). Sociodemographic and psychosocial correlates of smoking-induced deprivation and its effect on quitting: Findings from the International Tobacco Control Policy Evaluation Survey. Tobacco Control, 16(2), 106-113.

Abstract

Aims: To determine the prevalence and characteristics of smokers who experience smoking-induced deprivation (SID), and to examine its effect on quit attempts, relapse and cessation.

Methods: Waves 2 and 3 (2003-5) of the International Tobacco Control Policy Evaluation Survey were used, which is a prospective study of a cohort of smokers in the US, Canada, UK and Australia. SID was measured with the question "In the last six months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?" A total of 7802 smokers participated in the survey in wave 2, of whom 5408 were also interviewed in wave 3.

Findings: The proportion of smokers who reported SID was highest in Australia (33%) and lowest in the UK (20%). Younger age, minority status and low income were associated with a higher probability of SID. Some of the other factors related to a higher probability of SID were higher level of nicotine dependence, having an intention to quit, and smoking to help one socialise or control weight. The relationship between SID and quit attempt was mediated by having an intention to quit and worrying that smoking would damage health and reduce the quality of life. The relationship between SID and relapse was mediated by perceived stress. SID was not associated with successful cessation.

Conclusions: Many smokers experience deprivation that is the result of their smoking. Strategies to reduce the prevalence of smoking probably effect a general improvement in standards of living and reduction in deprivation.

Citation

Thrasher, J.F., Hammond, D., Fong, G.T., Arillo-Santillán, E. (2007). Smokers' reactions to cigarette package warnings with graphic imagery and with only text: A comparison between Mexico and Canada. Salud Publica de Mexico, 49(Suppl 2), S233-240.

Abstract

Objective: This comparison of population-based representative samples of adult smokers in Canada (n=1 751) and Mexico (n=1 081) aimed to determine whether cigarette packages with graphic warning labels in Canada had a stronger impact than the text-only warning labels in Mexico.

Materials and methods: Bivariate and multivariate adjusted models were used in this study. Results. Canadian smokers reported higher warning label salience (i.e., noticing labels & processing label messages) than Mexican smokers, and warning label salience independently predicted intention to quit. Moreover, Canadians had higher levels of knowledge about smoking-related health outcomes that were included as content on Canadian, but not Mexican, warning labels. Finally, a majority of Mexican smokers want their cigarette packs to contain more information than they currently contain.

Discussion: These results are consistent with other studies that indicate that cigarette packages whose warning labels contain prominent graphic imagery are more likely than text-only warning labels to promote smoking-related knowledge and smoking cessation.

Citation

Wilson, N., Jalali, R., Nathe, J., Maher, A., Edwards, R., Wilson, N. (2007). National smokefree law in New Zealand improves air quality inside bars, pubs and restaurants. BioMed Central Public Health, 7, 85.

Abstract

Background: We aimed to: (i) assess compliance with a new smokefree law in a range of hospitality settings; and (ii) to assess the impact of the new law by measuring air quality and making comparisons with air quality in outdoor smoking areas and with international data from hospitality settings.

Methods: We included 34 pubs, restaurants and bars, 10 transportation settings, nine other indoor settings, six outdoor smoking areas of bars and restaurants, and six other outdoor settings. These were selected using a mix of random, convenience and purposeful sampling. The number of lit cigarettes among occupants at defined time points in each venue was observed and a portable real-time aerosol monitor was used to measure fine particulate levels (PM2.5).

Results: No smoking was observed during the data collection periods among over 3785 people present in the indoor venues, nor in any of the transportation settings. The levels of fine particulates were relatively low inside the bars, pubs and restaurants in the urban and rural settings (mean 30-minute level = 16 μg/m3 for 34 venues; range of mean levels for each category: 13 μg/m3 to 22 μg/m3). The results for other smokefree indoor settings (shops, offices etc) and for smokefree transportation settings (eg, buses, trains, etc) were even lower. However, some “outdoor” smoking areas attached to bars/restaurants had high levels of fine particulates, especially those that were partly enclosed (eg, up to a 30-minute mean value of 182 μg/m3 and a peak of maximum value of 284 μg/m3). The latter are far above WHO guideline levels for 24 hour exposure (ie, 25μg/m3).

Conclusion: There was very high compliance with the new national smokefree law and this was also reflected by the relatively good indoor air quality in hospitality settings (compared to the “outdoor” smoking areas and the comparable settings in countries that permit indoor smoking). Nevertheless, adopting enhanced regulations (as used in various US and Canadian jurisdictions) may be needed to address hazardous air quality in relatively enclosed “outdoor” smoking areas.

Citation

O’Connor, R.J., Kozlowski, L.T., Borland, R., Hammond, D., McNeill, A. (2006). Relationship between constituent labelling and reporting of tar yields among smokers in four countries. Journal of Public Health, 28(4), 324-329.

Abstract

Countries have adopted different approaches to disseminating cigarette tar, nicotine, and carbon monoxide (CO) levels to consumers, with some (e.g. EU member states, Canada, Australia, but not the United States) requiring disclosure of results from the International Organization for Standardization (ISO) test method on packs. Cross-country comparisons can provide insight into how smokers use yields when information is presented differently. We examined whether smokers in four different countries could recall the tar yield of their brand of cigarettes, using data from the third wave of the International Tobacco Control Four Country Survey (ITC-4). Of current smokers in the United States, Canada, Australia and the United Kingdom, 33.6% gave a numeric response when asked to report the tar yield of their brand, whereas 66.4% responded ‘I don’t know.’ American participants (9.2%) were less likely than Canadian (28.0%), UK (36.5%) or Australian (68.2%) smokers to give an answer, even after controlling for sociodemographic and smoking behaviour factors. Constituent labelling policies can affect whether smokers report a tar yield for their cigarette brand. Pack labelling appears to be useful for conveying information about cigarettes to smokers; however, there is an urgent need to develop more meaningful information on toxic constituents of cigarette smoke.

Citation

Hyland, A., Laux, F., Higbee, C., Hastings, G., Ross, H., Chaloupka, F., Fong, G.T., Cummings, K.M. (2006). Cigarette purchase patterns in four countries and the relationship with cessation: Findings from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 15(Suppl 3), iii59-iii64.

Abstract

Background: Higher cigarette prices result in decreased cigarette consumption, but some smokers may seek lower-taxed cigarette sources. This price avoidance behaviour likely dampens the health impact of higher cigarette prices although it has not been thoroughly studied.

Objective: To describe the characteristics of smokers who purchase low/untaxed cigarettes and to examine how this behaviour is associated with subsequent changes in smoking behaviours.

Methods: Telephone survey data from 8930 smokers from the International Tobacco Control (ITC) Four Country Survey (ITC-4) were used to assess cigarette purchase patterns and smoking behaviours in Wave 1 conducted from October to December 2002 and subsequently followed seven months later in Wave 2. Respondents’ smoking status, attempts to quit, amount smoked, and cigarette purchase patterns were assessed in both waves.

Results: Rates of purchase from a low/untaxed source at the respondents’ last cigarette purchase differed notably between countries at Wave 1, from less than 1% in Australia to 15% in the United Kingdom. In the UK, but not the other countries, this increased significantly to 20% at Wave 2. Smokers who were older, white/English speakers, had higher incomes, and had higher levels of education were more likely to report purchasing cigarettes from a low/untaxed source on their last purchase. Those who reported purchasing from a low/untaxed source on their last purchase at Wave 1 were less likely to have tried to quit smoking quit smoking by Wave 2 (relative risk 0.70, p , 0.01), while no overall significant association with smoking cessation was observed.

Conclusion: Data from this study indicate that there are lower levels of making a quit attempt among purchasers of low/untaxed cigarettes compared to purchasers of full-priced cigarettes. The availability of low/untaxed cigarettes may mitigate the influence of increases in cigarette prices.