Citation

Hammond, D., Fong, G.T., McDonald, P., Brown, K.S., Cameron, R. (2004). Graphic Canadian cigarette warning labels and adverse outcomes: Evidence from Canadian smokers. American Journal of Public Health, 94(8), 1442-1445.

Abstract

Objectives: We assessed the impact of graphic Canadian cigarette warning labels.

Methods: We used a longitudinal telephone survey of 616 adult smokers.

Results: Approximately one fifth of participants reported smoking less as a result of the labels; only 1% reported smoking more. Although participants reported negative emotional responses to the warnings including fear (44%) and disgust (58%), smokers who reported greater negative emotion were more likely to have quit, attempted to quit, or reduced their smoking 3 months later. Participants who attempted to avoid the warnings (30%) were no less likely to think about the warnings or engage in cessation behavior at follow-up.

Conclusions: Policymakers should not be reluctant to introduce vivid or graphic warnings for fear of adverse outcomes.

Citation

Giovino, G.A., Sidney, S., Gfroerer, J.C., O'Malley, P.M., Allen, J.A., Richter, P.A., Cummings, K.M. (2004). Epidemiology of menthol cigarette use. Nicotine and Tobacco Research, 6(Suppl1), 67-81.

Abstract

Approximately one-fourth of all cigarettes sold in the United States are mentholated. An understanding of the consequences, patterns, and correlates of menthol cigarette use can guide the development and implementation of strategies to reduce smoking prevalence and smoking-attributable morbidity and mortality. This paper summarizes the literature on the health effects of mentholated cigarettes and describes various patterns of use as indicated by consumption and survey data from the United States and other nations. The epidemiological literature on menthol cigarettes and cancer risk is inconclusive regarding whether these cigarettes confer a risk for cancer above that of nonmentholated varieties. Available data indicate that mentholated cigarettes are at least as dangerous as their nonmentholated counterparts. In addition, because mentholation improves the taste of cigarettes for a substantial segment of the smoking population and appears to mask disease symptoms, this additive may facilitate initiation or inhibit quitting. Menthol market share is high in the Philippines (60%), Cameroon (35%–40%), Hong Kong (26%), the United States (26%), and Singapore (22%). Newport has become the leading menthol brand in the United States. Surveys from four nations indicate that menthol use among adult smokers is more common among females than males. Among U.S. smokers, 68.9% of Blacks, 29.2% of Hispanics, and 22.4% of Whites reported smoking mentholated variety. Research is needed to better explain factors that may influence menthol preference, such as marketing, risk perceptions, brand formulation, and taste preferences. Such research would guide the development of potentially more effective programs and policies.

Citation

Borland, R., Yong, H.H., King, B., Cummings, K.M., Fong, G.T., Elton-Marshall, T., Hammond, D., McNeill, A. (2004). Use of and beliefs about light cigarettes in four countries: Findings from the International Tobacco Control Policy Evaluation Survey. Nicotine & Tobacco Research, 6(Suppl 3), S311-321.

Abstract

This study examined reported use of, and beliefs about, so-called light cigarettes among adult smokers in four countries: Australia (Aus), Canada (Can), the United Kingdom (U.K.) and the United States (U.S.). The method used was parallel telephone surveys among 9,046 smokers across the four countries. The results indicated that more than half of all smokers in each country except the U.K. reported smoking light cigarette brands. A majority of smokers surveyed in each country except Canada continue to believe that light cigarettes offer some health benefit compared to regular cigarettes (Canada 43%, U.S. 51%, Australia 55%, U.K. 70%). A majority of smokers in all four countries believed that light cigarettes are smoother on the throat and chest than regular cigarettes. Predictors of use of light cigarettes and beliefs about possible benefits were very similar in the four countries. These results demonstrate an ongoing need for public education about why light cigarettes do not reduce harm and do not make quitting easier. The results provide further evidence for the need for regulatory measures in all four countries to prohibit the use of misleading light and mild descriptors including package imagery in product marketing (as prescribed in Article 11 of the Framework Convention on Tobacco Control), abandon the use of standard FTC/ISO tar and nicotine yields as consumer information, and adopt policies to regulate deceptive design features of cigarettes, such as ventilated filters.

Citation

Fong, G.T., Hammond, D., Laux, F., Zanna, M.P., Cummings, K.M., Borland, R., Ross, H. (2004). The near-universal experience of regret among smokers in four countries: Findings from the International Tobacco Control Policy Evaluation Survey. Nicotine & Tobacco Research, 6(Suppl 3), S341-351.

Abstract

Regret may be a key variable in understanding the experience of smokers, the vast majority of whom continue to smoke while desiring to quit. We present data from the baseline wave (October-December 2002) of the International Tobacco Control Policy Evaluation Survey, a random-digit-dialed telephone survey of a cohort of over 8,000 adult smokers across four countries--Canada, the United States, the United Kingdom, and Australia--to estimate the prevalence of regret and to identify its predictors. The proportion of smokers who agreed or agreed strongly with the statement "If you had to do it over again, you would not have started smoking" was extremely high--about 90%--and nearly identical across the four countries. Regret was more likely to be experienced by older smokers, women, those who had tried to quit more often, those who perceived quitting as conferring benefits, those with higher levels of perceived addiction, those who worried about future damage to health, those who perceived smoking as lowering their quality of life, those who perceived higher monetary costs of smoking, and those who believed that smoking is not socially acceptable. This predictive model was the same in all four countries. Regret is thus a near-universal experience among smokers in all four countries, and the factors that predict regret are universal across these four countries. Among other implications for cessation treatment and smoking prevention, this near universality of regret casts doubt on the view of some policy analysts and economists that the decisions to take up and continue smoking are welfare-maximizing for the consumer.

Citation

Hammond, D., McDonald, P., Fong, G.T., Borland, R. (2004). Do smokers know how to quit? Knowledge and perceived effectiveness of cessation assistance as predictors of cessation behaviour. Addiction, 99(8), 1042-1048.

Abstract

Aims: Despite the existence of effective cessation methods, the vast majority of smokers attempt to quit on their own. To date, there is little evidence to explain the low adoption rates for effective forms of cessation assistance, including pharmaceutical aids. This study sought to assess smokers' awareness and perceived effectiveness of cessation methods and to examine the relationship of this knowledge to cessation behaviour.

Design: A random-digit-dial telephone survey (response rate = 76%) with 3-month follow-up was conducted with 616 adult daily smokers in South-Western Ontario, Canada.

Measurements: A baseline survey assessed smoking behaviour, as well as smokers' awareness and perceived effectiveness of cessation assistance. A follow-up survey measured changes in smoking behaviour and adoption of cessation assistance at 3 months.

Findings: Participants demonstrated a poor recall of cessation methods: 45% of participants did not recall nicotine gum, 33% did not recall the nicotine patch and 57% did not recall bupropion. Also, many participants did not believe that the following cessation methods would increase their likelihood of quitting: nicotine replacement therapies (36%), bupropion (35%), counselling from a health professional (66%) and group counselling/quit programmes (50%). In addition, 78% of smokers indicated that they were just as likely to quit on their own as they were with assistance. Most important, participants who perceived cessation methods to be effective at baseline, were more likely to intend to quit (OR = 1.80, 95% CI: 1.12-2.90), make a quit attempt at follow-up (OR = 1.80, 95% CI: 1.03-3.16) and to adopt cessation assistance when doing so (OR = 3.62, 95% CI: 1.04-12.58).

Conclusions: This research suggests that many smokers may be unaware of effective cessation methods and most underestimate their benefit. Further, this lack of knowledge may represent a significant barrier to treatment adoption.

Citation

Hammond, D., Fong, G.T., McDonald, P., Cameron, R., Brown, K.S. (2003). Impact of the graphic Canadian warning labels on adult smoking behaviour. Tobacco Control, 12(4), 291-395.

Abstract

Objective: To assess the impact of graphic Canadian cigarette warning labels on current adult smokers.

Design: A random-digit-dial telephone survey was conducted with 616 adult smokers in south western Ontario, Canada in October/November 2001, with three month follow up.

Main outcome measures: Smoking behaviour (quitting, quit attempts, and reduced smoking), intentions to quit, and salience of the warning labels.

Results: Virtually all smokers (91%) reported having read the warning labels and smokers demonstrated a thorough knowledge of their content. A strong positive relation was observed between a measure of cognitive processing—the extent to which smokers reported reading, thinking about, and discussing the new labels—and smokers’ intentions to quit (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.16; p < 0.001). Most important, cognitive processing predicted cessation behaviour at follow up. Smokers who had read, thought about, and discussed the new labels at baseline were more likely to have quit, made a quit attempt, or reduced their smoking three months later, after adjusting for intentions to quit and smoking status at baseline (OR 1.07, 95% CI 1.03 to 1.12; p < 0.001).

Conclusions: Graphic cigarette warning labels serve as an effective population based smoking cessation intervention. The findings add to the growing literature on health warnings and provide strong support for the effectiveness of Canada’s tobacco labelling policy.

Citation

Siahpush, M., Borland, R., Scollo, M. (2003). Factors associated with smoking cessation in a national sample of Australians. Nicotine and Tobacco Research, 5(4), 597-602.

Abstract

The association of sociodemographic and selected behavioral and social environmental factors with successful smoking cessation was examined using cross-sectional data from the 1998 Australian National Drug Strategy Household Survey, which used an area multistage stratified design. Data collection involved a mixture of interviews and self-administered questionnaires. We used a subsample of 2,526 Australians aged 14 years and older. The outcome measure distinguished between current smokers and those who had stopped smoking in the past 2 years and had not smoked for at least 1 month prior to the survey. Knowing that environmental tobacco smoke is harmful and having first smoked at age 14 or younger were associated with a higher likelihood of cessation. The odds of having quit smoking were 4.5 times greater for respondents who lived in households where smoking was not permitted than for those in households with no smoking restrictions. The odds of having quit were 3.2 times greater for respondents who reported that few or none of their friends smoked than for those who said most or all of their friends smoked. After including social environmental variables, associations of education and cessation disappeared. The study confirmed the difficulty of quitting if the proximal social environment is filled with smokers. Results call for an integrated approach in which smoking cessation interventions target the social environment as well as the individual. Efforts to intervene in smoking behavior will have limited effectiveness unless they take into account the social contexts in which smoking behavior takes place.