Citation

Caleyachetty, A., Lewis, S., McNeill, A., Leonardi-Bee, J. (2012). Struggling to make ends meet: Exploring pathways to understand why smokers in financial difficulties are less likely to quit successfully. European Journal of Public Health, 22(Suppl 1), 41-48.

Abstract

Background: In high-income countries, those with low-to-middle incomes have been observing stagnating median wages and marginal improvements in their living standards. Smokers in financial difficulties appear to be less likely to quit smoking. Understanding the reasons for this is essential to intervening to improve cessation outcomes in this population, and reduce smoking-related health inequalities.

Methods: We used longitudinal data from Waves 4 to 7 of the ITC Four Country Survey (ITC-4), and included those with data from at least two consecutive waves. Associations between financial difficulties and making a quit attempt, and quit success were analysed using generalised estimating equations, with adjustment for confounders. Mediation analysis was conducted to identify potential mediators of the observed effects of financial difficulties on cessation outcomes.

Results: Having financial difficulties had little impact on making quit attempts (adjusted OR 0.84, 95% CI 0.70-1.01). Smokers with financial difficulties were substantially less likely to succeed at quitting (adjusted OR 0.55, 95% CI 0.39-0.76); an effect which was consistent over the survey years. Among the potential mediators examined, those relating to cognition of health-related and quality of life-related consequences of smoking were the most important mediators, though the proportion of the effect mediated by the largest mediator was small (6.8%).

Conclusion: Having financial difficulties remains an important barrier to smokers achieving quit success. This effect does not appear to be due to anticipated factors such as reduced use of cessation services or treatment. Further research is required to determine strong mediators of the financial difficulties effect on quit success and to tailor more effective cessation programmes.

Citation

Mons, U., Nagelhout, G.E., Guignard, R., McNeill, A., van den Putte, B., Willemsen, M.C., Brenner, H., Pötschke-Langer, M., Breitling, L.P. (2012). Comprehensive smoke-free policies attract more support from smokers in Europe than partial policies. European Journal of Public Health, 22(Suppl 1), 10-16.

Abstract

Objectives: To measure changes in prevalence and predictors of home smoking bans (HSBs) among smokers in four European countries after the implementation of national smoke-free legislation.

Design: Two waves of the International Tobacco Control Policy Evaluation Project Europe Surveys, which is a prospective panel study. Pre- and post-legislation data were used from Ireland, France, Germany and the Netherlands. Two pre-legislation waves from the UK were used as control. Participants: 4634 respondents from the intervention countries and 1080 from the control country completed both baseline and follow-up and were included in the present analyses.

Methods: Multiple logistic regression models to identify predictors of having or of adopting a total HSB, and Generalised Estimating Equation models to compare patterns of change after implementation of smoke-free legislation to a control country without such legislation.

Results: Most smokers had at least partial smoking restrictions in their home, but the proportions varied significantly between countries. After implementation of national smoke-free legislation, the proportion of smokers with a total HSB increased significantly in all four countries. Among continuing smokers, the number of cigarettes smoked per day either remained stable or decreased significantly. Multiple logistic regression models indicated that having a young child in the household and supporting smoking bans in bars were important correlates of having a pre-legislation HSB. Prospective predictors of imposing a HSB between survey waves were planning to quit smoking, supporting a total smoking ban in bars and the birth of a child. Generalised Estimating Equation models indicated that the change in total HSB in the intervention countries was greater than that in the control country.

Conclusions: The findings suggest that smoke-free legislation does not lead to more smoking in smokers' homes. On the contrary, our findings demonstrate that smoke-free legislation may stimulate smokers to establish total smoking bans in their homes.

Citation

McNeill, A., Craig, L., Willemsen, M.C., Fong, G.T. (2012). Tobacco control in Europe: A deadly lack of progress. European Journal of Public Health, 22(Suppl 1), 1-3.

Abstract

Cigarettes are uniquely dangerous, killing half of all those who regularly use them and damaging the health of those who breathe in users’ smoke, particularly children. Just under a third of European adults currently smoke, and smoking has become increasingly associated with poverty, contributing significantly to widening health inequalities across the EU. In 2004, the ASPECT report, a comprehensive review of tobacco use and tobacco control policies in the EU, found that tobacco use caused well over half a million deaths in Europe annually and on top of that constituted a huge economic burden, estimated conservatively at €98-130 billion a year.1 This review also identified that whilst some European countries were observing declines in tobacco use and mortality, in other countries tobacco use was still increasing, particularly among women. The ASPECT report identified 43 recommendations to combat the epidemic, covering tobacco control policy, interventions and research. Yet to date, few of these recommendations have been implemented, and as a result, future prospects for curbing the smoking epidemic across Europe are currently very bleak.

Citation

Arnott, D., Berteletti, F., Britton, J., Cardone, A., Clancy, L., Craig, L., Fong, G.T., Glantz, S.A., Joossens, L., Rudolphie, M.T., Rutgers, M.R., Smith, S.C., Stam, H., West, R., Willemsen, M.C. (2012). Can the Dutch government really be abandoning smokers to their fate? The Lancet, 379(9811), 121-122.

Abstract

There is no abstract available for this publication.

Citation

Myung, S.K., Seo, H.G., Cheong, Y., Park, S., Lee, E.S., Fong, G.T. (2012). Association of socio-demographic factors, smoking-related beliefs, and smoking restrictions with intention to quit smoking in Korean adults: Findings from the ITC Korea Survey. Journal of Epidemiology, 22(1), 21-27.

Abstract

Background: Few studies have reported the factors associated with intention to quit smoking among
Korean adult smokers. This study aimed to examine sociodemographic characteristics, smoking-related
beliefs, and smoking restriction variables associated with intention to quit smoking among Korean adult
smokers.

Methods: We used data from the International Tobacco Control Korea Survey, which was conducted
from November through December 2005 by using random-digit dialing and computer-assisted telephone
interviewing of male and female smokers aged 19 years or older in 16 metropolitan areas and provinces
of Korea. We performed univariate analysis and multiple logistic regression analysis to identify predictors
of intention to quit.

Results: A total of 995 respondents were included in the final analysis. Of those, 74.9% (n = 745)
intended to quit smoking. In univariate analyses, smokers with an intention to quit were younger, smoked
fewer cigarettes per day, had a higher annual income, were more educated, were more likely to have a
religious affiliation, drank less alcohol per week, were less likely to have self-exempting beliefs, and were
more likely to have self-efficacy beliefs regarding quitting, to believe that smoking had damaged their
health, and to report that smoking was never allowed anywhere in their home. In multiple logistic
regression analysis, higher education level, having a religious affiliation, and a higher self-efficacy
regarding quitting were significantly associated with intention to quit.

Conclusion: Sociodemographic factors, smoking-related beliefs, and smoking restrictions at home were
associated with intention to quit smoking among Korean adults.

Citation

Fotuhi, O., Fong, G.T., Zanna, M.P., Borland, R., Yong, H.H., Cummings, K.M. (2013). Patterns of cognitive dissonance-reducing beliefs among smokers: A longitudinal analysis from the International Tobacco Control (ITC) Four Country Survey. Tobacco Control, 22(1), 52-58.

Abstract

Objective: The purpose of this paper is to assess whether smokers adjust their beliefs in a pattern that is consistent with Cognitive Dissonance Theory. This is accomplished by examining the longitudinal pattern of belief change among smokers as their smoking behaviours change.

Methods: A telephone survey was conducted of nationally representative samples of adult smokers from Canada, the USA, the UK and Australia from the International Tobacco Control Four Country Survey. Smokers were followed across three waves (October 2002 to December 2004), during which they were asked to report on their smoking-related beliefs and their quitting behaviour.

Findings: Smokers with no history of quitting across the three waves exhibited the highest levels of rationalisations for smoking. When smokers quit smoking, they reported having fewer rationalisations for smoking compared with when they had previously been smoking. However, among those who attempted to quit but then relapsed, there was once again a renewed tendency to rationalise their smoking. This rebound in the use of rationalisations was higher for functional beliefs than for risk-minimising beliefs, as predicted by social psychological theory.

Conclusions: Smokers are motivated to rationalise their behaviour through the endorsement of more positive beliefs about smoking, and these beliefs change systematically with changes in smoking status. More work is needed to determine if this cognitive dissonance-reducing function has an inhibiting effect on any subsequent intentions to quit.

Citation

Brown, A., Boudreau, C., Moodie, C., Fong, G.T., Li, Q., McNeill, A., Thompson, M.E., Hassan, L.M., Hyland, A., Thrasher, J.F., Yong, H.H., Borland, R., Hastings, G., Hammond, D. (2012). Support for removal of point-of-purchase tobacco advertising and displays: Findings from the International Tobacco Control (ITC) Canada Survey. Tobacco Control, 21(6), 555-559.

Abstract

Background: Although most countries now have at least some restrictions on tobacco marketing, the tobacco industry meet these restrictions by re-allocating expenditure to unregulated channels, such as at point-of-purchase.

Methods: Longitudinal data from 10 Canadian provinces in the International Tobacco Control Survey was analysed to examine adult smokers' support for a ban on tobacco advertising and displays in stores and whether this support is associated with noticing either advertising or displays in stores, and quit intentions, over time. In total, there were 4580 respondents in wave 5 (October 2006 to February 2007), wave 6 (September 2007 to February 2008) and wave 7 (October 2008 to June 2009). The surveys were conducted before, during and in some cases after the implementation of display bans in most Canadian provinces and territories.

Results: Smokers in all provinces showed strong support for a ban on tobacco displays over the study period. Levels of support for an advertising and display ban were comparable between Canadian provinces over time, irrespective of whether they had been banned or not. Noticing tobacco displays and signs in-store was demonstrably less likely to predict support for display (OR=0.73, p=0.005) and advertising (OR=0.78, p=0.02) ban, respectively. Smokers intending to quit were more likely to support advertising and display bans over time.

Conclusion: This study serves as a timely reminder that the implementation of tobacco control measures, such as the removal of tobacco displays, appear to sustain support among smokers, those most likely to oppose such measures.

Citation

Hitchman, S.C., Mons, U., Nagelhout, G.E., Guignard, R., McNeill, A., Willemsen, M.C., Driezen, P., Wilquin, J.L., Beck, F., Du-Roscoat, E., Pötschke-Langer, M., Hammond, D., Fong, G.T. (2012). Effectiveness of the European Union text-only cigarette health warnings: Findings from four countries. European Journal of Public Health, 22(5), 693-699.

Abstract

Background: The European Commission requires tobacco products sold in the European Union to display standardized text health warnings. This article examines the effectiveness of the text health warnings among daily cigarette smokers in four Member States.

Methods: Data were drawn from nationally representative samples of smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), the Netherlands (2008) and the UK (2006). We examined: (i) smokers' ratings of the health warnings on warning salience, thoughts of harm and quitting and forgoing of cigarettes; (ii) impact of the warnings using a Labels Impact Index (LII), with higher scores signifying greater impact; and (iii) differences on the LII by demographic characteristics and smoking behaviour.

Results: Scores on the LII differed significantly across countries. Scores were highest in France, lower in the UK, and lowest in Germany and the Netherlands. Across all countries, scores were significantly higher among low-income smokers, smokers who had made a quit attempt in the past year and smokers who smoked fewer cigarettes per day.

Conclusion: The impact of the health warnings varies greatly across countries. Impact tended to be highest in countries with more comprehensive tobacco control programmes. Because the impact of the warnings was highest among smokers with the lowest socioeconomic status (SES), this research suggests that health warnings could be more effective among smokers from lower SES groups. Differences in warning label impact by SES should be further investigated.

Citation

Borland, R., Partos, T.R., Cummings, K.M. (2012). Systematic biases in cross-sectional community studies may underestimate the effectiveness of stop-smoking medications. Nicotine & Tobacco Research, 14(12), 1483-1487.

Abstract

Introduction: Randomized, controlled trials typically indicate stop-smoking medications (SSMs: e.g., Varenicline, Bupropion, and over-the-counter nicotine replacement therapies) to be effective, whereas cross-sectional community-based studies have found them to be less effective, ineffective, or even associated with higher risk of relapse. Consequently, some critics have suggested SSMs have no useful applications in “real-world” settings. This discrepancy may, however, be due to systematic biases affecting cross-sectional survey outcomes. Namely, failed quit attempts where SSMs were used may be better recalled than failed unassisted attempts. Moreover, smokers who choose to quit using SSMs may be more addicted and thus less likely to succeed. Either of these factors would lead to an overrepresentation of failed quit attempts among SSM users in cross-sectional surveys even if there were real benefits.

Methods: We report on data from the International Tobacco Control 4-country cohort study to examine the relationship between SSM use, level of nicotine addiction, and the reported date since the start of participants’ (N = 1,101) most recent quit attempt.

Results: The last quit attempt was reported to have begun longer ago among participants who used SSMs than those who did not. Scores on the Heaviness of Smoking Index, measuring addiction severity, were also higher among SSM users, with no interactions.

Conclusion: Better recall of quit attempts and stronger addiction to nicotine are two characteristics found more often among smokers using SSMs compared with self-quitters, which could potentially bias the assessed effects of SSMs on cessation outcomes in cross-sectional surveys.

Citation

Brown, A., McNeill, A., Mons, U., Guignard, R. (2012). Do smokers in Europe think all cigarettes are equally harmful? European Journal of Public Health, 22(Suppl 1), 35-40.

Abstract

Background: Despite the ban on misleading descriptors such as light or mild cigarettes in Europe, there are still widespread misperceptions of the relative harmfulness of different brands of cigarettes among smokers. This study examined the extent to which smokers in three European countries believed that some cigarette brands are less harmful and why, using data from the International Tobacco Control (ITC) Europe surveys.

Methods: Cross-sectional analyses were completed among nationally representative samples of 4,956 current smokers (aged_18) from Germany (n = 1,515), France (n = 1,735) and the United Kingdom (n = 1,706) conducted between September 2006 and November 2007. Logistic regression models examined whether outcomes, including beliefs that some cigarettes could be less harmful than others, varied by socio-demographic and country of residence.

Findings: Around a quarter of smokers in the UK and France, and a third in Germany believed some cigarettes are less harmful than others. Overall, of smokers who falsely believed that some cigarettes are less harmful, 86.3% thought that tar/ nicotine yields, 48.7% taste, and 40.4% terms on packs such as ‘smooth’ or ‘ultra’ indicated less harmful brands. About a fifth of smokers across all countries chose their brand based on health reasons, and a similar proportion gave tar yields as a reason for choosing brands.

Conclusions: Our research suggests that the current European Tobacco Products Directive is inadequate in eliminating misperceptions about the relative risk of brand descriptors on cigarettes. There is therefore an urgent need to protect smokers in Europe from these misperceptions via stronger measures such as plain packaging regulations.

Citation

Hitchman, S.C., Guignard, R., Nagelhout, G.E., Mons, U., Beck, F., van den Putte, B., Crone, M.R., de Vries, H., Hyland, A., Fong, G.T. (2012). Predictors of car smoking rules among smokers in France, Germany, and the Netherlands. European Journal of Public Health, 22(Suppl 1), 17-22.

Abstract

Background: As exposure to tobacco smoke pollution (TSP) has been identified as a cause of premature death and disease in non-smokers, and studies have demonstrated that smoking in cars produces high levels of TSP, this study will investigate smokers’ rules for smoking in their cars, and predictors of car smoking rules, including potentially modifiable correlates.

Methods: Data were drawn from nationally representative samples of current smokers from the International Tobacco Control Policy Evaluation Project surveys in France (2007), Germany (2007), and the Netherlands (2008). Smokers in France and Germany were asked about smoking rules in their cars, and smokers in the Netherlands were asked about smoking rules in cars carrying children.

Results: In France and Germany, 59% and 52% of smokers respectively, allowed smoking in their cars. In the Netherlands, 36% of smokers allowed smoking in cars carrying children. Predictors of allowing smoking in cars included: being a daily vs. non-daily smoker, being younger vs. older age, having no (young) children in the home, being a heavier smoker, and allowing smoking in the home. In the Netherlands, smokers who agreed that TSP is dangerous to nonsmokers were less likely to allow smoking in cars carrying children.

Conclusion: Overall, a sizeable proportion of smokers allowed smoking in their cars across the three countries. Media campaigns with information about the dangers of TSP may increase the adoption of smoke-free cars. These media campaigns could target smokers who are most likely to allow smoking in cars.

Citation

Kennedy, R.D., Behm, I., Craig, L., Thompson, M.E., Fong, G.T., Guignard, R., Beck, F. (2012). Outdoor smoking behaviour and support for outdoor smoking restrictions before and after France's national smoking ban. European Journal of Public Health, 22(Suppl 1), 29-34.

Abstract

Background: On January 1, 2008, the French government implemented a national ban on indoor smoking in hospitality venues. Survey results indicate the indoor ban has been successful at dramatically reducing indoor smoking; however, there are reports of an increased number of outdoor hospitality spaces (patios) where smoking can take place. This study sought to understand if the indoor ban simply moved smoking to the outdoors, and to assess levels of support for smoking restrictions in outdoor hospitality settings after the smoke-free law.

Methods: Telephone interviews were conducted among 1067 adult smokers before and after the 2008 indoor ban as part of the International Tobacco Control (ITC) France Survey. Among other topics, this survey measures how the smoking ban has influenced smoking behaviour relevant to outdoor sections of hospitality venues. In addition, 414 non-smoking adults and 164 respondents who had quit smoking between waves were also asked about support for outdoor smoking restrictions.

Results: Reported smoking outdoors at cafes/pubs/bars increased from 33.6% of smokers at Wave 1 to 75.9% at Wave 2. At restaurants, smoking outdoors increased from 28.9% to 59.0%. There was also an increase in reported non-smoking for both visits to cafe´ s/pubs/bars, and restaurants from 13.4% to 24.7%, and 30.4% to 40.8% respectively. The majority of smokers (74.5%), non-smokers (89.4%) and quitters (74.0%) support a partial or complete ban on smoking in outdoor areas of restaurants.

Conclusion: The indoor smoking ban moved smoking to outdoor spaces; however, the ban is also associated with increased non-smoking behaviour. The majority of respondents support outdoor smoking restrictions in patio environments.

Citation

Kennedy, R.D., Behm, I., Craig, L., Thompson, M.E., Fong, G.T., Guignard, R., Beck, F. (2012). Smoking cessation interventions from health care providers before and after the national smoke-free law in France. European Journal of Public Health, 22(Suppl 1), 23-28.

Abstract

Background: Smoking cessation advice from health care providers (HCP) is well-known to be associated with increased quitting. This study sought to understand the extent to which smokers in France who visited a HCP around the time of the implementation of the national ban on smoking received encouragement to quit from a HCP and what kinds of intervention were provided. HCP may have a unique opportunity during the implementation phase of smoke-free laws to address their patients’ smoking behaviours to increase the likelihood of success at a time when smokers’ readiness and interest in quitting may be higher.

Methods: Telephone interviews were conducted among adult smokers (n = 1067) before and after the two-phase 2007 and 2008) national ban on indoor smoking as part of the International Tobacco Control (ITC) France Survey. In the survey, smokers were asked whether they had visited a HCP in the past 6 months and, if so, whether they had received cessation encouragement, and/or other interventions to support quitting such as prescriptions for stop-smoking medication.

Results: Most smokers (61%) reported visiting a HCP in the 6 months prior to the first phase of the national smoke-free ban, and 58% after the time of the hospitality ban. Of these, most reported they did not receive any assistance from a HCP before (54%) or after (64%) the smoke-free law. Among those who reported an intervention, the most common were only encouragement to quit (58% in Wave 1 and 49% in Wave 2), or receiving both encouragement and a pamphlet (31% in both Wave 1 and 2). The combination of prescriptions for stop-smoking medicine and encouragement to quit increased from 8% in 2007 to 22% in 2008. The smokers who received an intervention were more likely (OR 1.9, 95% CI: 1.2–2.9) to report that they were thinking about quitting.

Discussion: This study demonstrates that HCP in France are well positioned to provide smoking cessation encouragement and other interventions to a majority of smokers and thus the importance of taking measures to increase their involvement, particularly when populationlevel tobacco control policies, such as smoke-free laws, are being implemented.

Citation

King, B., White, V., Balmford, J., Cooper, J., Borland, R. (2012). The decline of menthol cigarette smoking in Australia, 1980-2008. Nicotine & Tobacco Research, 14(10), 1213-1220.

Abstract

Introduction: Concerns have been expressed that menthol cigarettes are highly conducive to uptake and hence function as “starter cigarettes” for adolescents. There is strong evidence for this in the United States. If menthol cigarettes are critical to uptake for some adolescents, they might be expected to remain popular among adolescents independent of promotional activity. We analyzed trends in the market share of menthol brands in Australia among both adolescents and adults to provide further insights into the determinants of menthol cigarette smoking.

Methods: We used the Australian Secondary Students Alcohol and Drug Survey (1984–2008), the Smoking and Health Survey (1980–1998), and the International Tobacco Control Four Nations Survey (2002–2008) to estimate market share of brands. Measures were reported use of all menthol brands for adults and use of the Alpine brand for adolescents.

Results: Menthol smoking was much more popular among female smokers of all age groups in the early 1980s. During the 1980s and 1990s, use declined markedly in the 18–29 age groups, while remaining relatively stable among older smokers. Use of Alpine declined markedly among adolescents in the 1980s and 1990s. However, during this period, Alpine remained more popular among experimenting than regular smokers.

Conclusions: Both Alpine and other menthol brands are now primarily “older women’s cigarettes” in Australia. The trends in declining popularity among younger smokers suggest that targeted marketing plays a major role in determining menthol brand market share. Alpine has played a role as a “starter” cigarette in Australia but that role has decreased markedly since the 1980s. Within the Australian context, “light/mild” brands may have taken over the role of easier-to-smoke cigarettes that attract experimenting smokers.

Citation

Borland, R., Partos, T.R., Yong, H.H., Cummings, K.M., Hyland, A. (2012). How much unsuccessful quitting activity is going on among adult smokers? Data from the International Tobacco Control 4-Country Cohort Survey. Addiction, 107(3), 673-682.

Abstract

Aims: To document accurately the amount of quitting, length of quit attempts and prevalence of plans and serious thought about quitting among smokers.

Design: We used longitudinal data from 7 waves of the International Tobacco Control Policy Evaluation Four Country Survey (ITC-4). We considered point-prevalence data and cumulative prevalence over the 7 years of the study. We also derived annual estimates of quit activity from reports of quit attempts starting only within more recent time-frames, to control for biased recall.

Setting: Australia, Canada, the United Kingdom and the United States.

Participants: A total of 21 613 smokers recruited across seven waves.

Measurements: Reported life-time quit attempts, annual quit attempts, length of attempts, time since last attempt started, frequency of aborted attempts, plans to quit and serious thought about quitting.

Findings: Around 40.1% (95% CI: 39.6–40.6) of smokers report attempts to quit in a given year and report an average of 2.1 attempts. Based on free recall, this translates to an average annual quit attempt rate of 0.82 attempts per smoker. Estimates derived only from the preceding month to adjust for recall bias indicate an annual rate of approximately one attempt per smoker. There is a high prevalence of quitrelated activity, with more than a third of smokers reporting thoughts or actions related to quitting in a given month. More than half the surveyed smokers eventually succeeded in quitting for at least 1 month, and a majority of these for over 6 months.

Conclusions: Smokers think a great deal about stopping and make many unsuccessful quit attempts. Many have been able to last for extended periods and yet they still relapsed. More attention needs to be focused on translating quit-related activity into long-term abstinence.

Citation

Nagelhout, G.E., de Vries, H., Boudreau, C., Allwright, S., McNeill, A., van den Putte, B., Fong, G.T., Willemsen, M.C. (2012). Comparative impact of smoke-free legislation on smoking cessation in three European countries. European Journal of Public Health, 22(Suppl 1), 4-9.

Abstract

Background: Little is known about the differential impact of comprehensive and partial smoke-free legislation on smoking cessation. This study aimed to examine the impact of comprehensive smoke-free workplace legislation in Ireland and England, and partial hospitality industry legislation in the Netherlands on quit attempts and quit success.

Methods: Nationally representative samples of 2,219 adult smokers were interviewed in three countries as part of the International Tobacco Control (ITC) Europe Surveys. Quit attempts and quit success were compared between period 1 (in which smoke-free legislation was implemented in Ireland and the Netherlands) and period 2 (in which smoke-free legislation was implemented in England).

Results: In Ireland, significantly more smokers attempted to quit smoking in period 1 (50.5%) than in period 2 (36.4%) (p < 0.001). Percentages of quit attempts and quit success did not change significantly between periods in the Netherlands. English smokers were significantly more often successful in their quit attempt in period 2 (47.3%) than in period 1 (26.4%) (p = 0.011). In the first period there were more quit attempts in Ireland than in England and fewer in the Netherlands than in Ireland. Fewer smokers quitted successfully in the second period in both Ireland and the Netherlands than in England.

Conclusion: The comprehensive smoke-free legislation in Ireland and England may have had positive effects on quit attempts and quit success respectively. The partial smoke-free legislation in the Netherlands probably had no effect on quit attempts

Citation

Sansone, G., Raute, L.J., Fong, G.T., Pednekar, M.S., Quah, A.C.K., Bansal-Travers, M., Gupta, P.C., Sinha, D.N. (2012). Knowledge of health effects and intentions to quit among smokers in India: Findings from the Tobacco Control Policy (TCP) India Pilot Survey. International Journal of Environmental Research and Public Health, 9(2), 564-578.

Abstract

Awareness of the health risks of smoking is an important factor in predicting smoking-related behaviour; however, little is known about the knowledge of health risks in low-income countries such as India. The present study examined beliefs about the harms of smoking and the impact of health knowledge on intentions to quit among a sample of 249 current smokers in both urban and rural areas in two states (Maharashtra and Bihar) from the 2006 TCP India Pilot Survey, conducted by the ITC Project. The overall awareness among smokers in India of the specific health risks of smoking was very low compared to other ITC countries, and only 10% of respondents reported that they had plans to quit in the next six months. In addition, smokers with higher knowledge were significantly more likely to have plans to quit smoking. For example, 26.2% of respondents who believed that smoking cause CHD and only 5.5% who did not believe that smoking causes CHD had intentions to quit (χ2 = 16.348, p < 0.001). Important differences were also found according to socioeconomic factors and state: higher levels of knowledge were found in Maharashtra than in Bihar, in urban compared to rural areas, among males, and among smokers with higher education. These findings highlight the need to increase awareness about the health risks of smoking in India, particularly in rural areas, where levels of education and health knowledge are lower.

Citation

Siahpush, M., Borland, R., Yong, H.H., Cummings, K.M., Fong, G.T. (2012). Tobacco expenditure, smoking-induced deprivation and financial stress: Results from the International Tobacco Control (ITC) Four-Country Survey. Drug and Alcohol Review, 31(5), 664-671.

Abstract

Introduction and Aims: While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS).

Design and Methods: We used data from wave 7 (2008–2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS.

Results: In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS.

Conclusions: Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.

Citation

Yong, H.H., Borland, R., Thrasher, J.F., Thompson, M.E. (2012). Stability of cigarette consumption over time among continuing smokers: A latent growth curve analysis. Nicotine & Tobacco Research, 14(5), 531-539.

Abstract

Objectives: This paper examined the stability over time of daily cigarette consumption of continuing smokers and explored factors that might account for the patterns of change in consumption using a latent growth curve (LGC) analytic approach.

Methods: Data come from the first 5 waves of the International Tobacco Control Four-Country Survey, conducted in Canada, the United States, the United Kingdom, and Australia where a cohort of over 2,000 smokers from each country were recruited and followed up annually with replenishment.

Results: Raw data revealed that continuing smokers showed a marked steep decline in cigarettes per day during the first 2 waves followed by a gentler linear decline in consumption over the remaining waves of the study period. This pattern of change in cigarette consumption was best modelled using a piecewise linear LGC model. Baseline consumption level was highest in Australia and lowest in the United Kingdom, although the rate of decline was similar across the 4 countries. Being older than 55 years and having made at least 1 quit attempt were related to greater rate of decline in consumption.

Conclusion: Continuing smokers who are unwilling or unable to quit smoking can and do attempt to reduce their daily cigarette consumption over time. Factors such as making a quit attempt even if unsuccessful and experiencing smoking bans at work and at homes can contribute to reduced smoking among this group, which suggests that interventions focusing in on these factors, along with providing cessation help, may greatly improve their chances of quitting smoking altogether.

Citation

Young, D., Yong, H.H., Borland, R., Shahab, L., Hammond, D., Cummings, K.M., Wilson, N. (2012). Trends in roll your own smoking: Findings from the ITC Four Country Survey (2002-2008). Journal of Environmental and Public Health, 2012, 1-7.

Abstract

Objective: To establish the trends in prevalence, and correlates, of roll-your-own (RYO) use in Canada, USA, UK and Australia, 2002–2008.

Methods: Participants were 19,456 cigarette smokers interviewed during the longitudinal International Tobacco Control (ITC) Four-Country Survey in Canada, USA, UK, and Australia.

Results: “Predominant” RYO use (i.e., >50% of cigarettes smoked) increased significantly in the UK and USA as a proportion of all cigarette use (both P < .001) and in all countries as a proportion of any RYO use (all P < .010). Younger, financially stressed smokers are disproportionately contributing to “some” use (i.e., ≤50% of cigarettes smoked). Relative cost was the major reason given for using RYO, and predominant RYO use is consistently and significantly associated with low income.

Conclusion: RYO market trends reflect the price advantages accruing to RYO (a product of favourable taxation regimes in some jurisdictions reinforced by the enhanced control over the amount of tobacco used), especially following the impact of the Global Financial Crisis; the availability of competing low-cost alternatives to RYO; accessibility of duty-free RYO tobacco; and tobacco industry niche marketing strategies. If policy makers want to ensure that the RYO option does not inhibit the fight to end the tobacco epidemic, especially amongst the disadvantaged, they need to reduce the price advantage, target additional health messages at (young) RYO users, and challenge niche marketing of RYO by the industry.

Citation

Hall, P.A., Fong, G.T., Yong, H.H., Sansone, G.C., Borland, R., Siahpush, M. (2012). Do time perspective and sensation-seeking predict quitting activity among smokers? Findings from the International Tobacco Control (ITC) Four Country Survey. Addictive Behaviours, 37(12), 1307-1313.

Abstract

Personality factors such as time perspective and sensation-seeking have been shown to predict smoking uptake. However, little is known about the influences of these variables on quitting behavior, and no prior studies have examined the association cross-nationally in a large probability sample. In the current study it was hypothesized that future time perspective would enhance – while sensation-seeking would inhibit – quitting activity among smokers. It was anticipated that the effects would be similar across English speaking countries. Using a prospective cohort design, this cross-national study of adult smokers (N=8845) examined the associations among time perspective, sensation-seeking and quitting activity using the first three waves of data gathered from the International Tobacco Control Four Country Survey (ITC-4), a random digit dialed telephone survey of adult smokers from the United Kingdom, United States, Canada and Australia. Findings revealed that future time perspective (but not sensation-seeking) was a significant predictor of quitting attempts over the 8-month follow-up after adjusting for socio-demographic variables, factors known to inhibit quitting (e.g., perceived addiction, enjoyment of smoking, and perceived value of smoking), and factors known to enhance quitting (e.g., quit intention strength, perceived benefit of quitting, concerns about health effects of smoking). The latter, particularly intention, were significant mediators of the effect of time perspective on quitting activity. The effects of time perspective on quitting activity were similar across all four English speaking countries sampled. If these associations are causal in nature, it may be the case that interventions and health communications that enhance future-orientation may foster more quit attempts among current smokers.

Citation

Borland, R., Li, L., Driezen, P., Wilson, N., Hammond, D., Thompson, M.E., Fong, G.T., Mons, U., Willemsen, M.C., McNeill, A., Thrasher, J.F., Cummings, K.M. (2012). Cessation assistance reported by smokers in 15 countries participating in the International Tobacco Control (ITC) Policy Evaluation Survey. Addiction, 107(1), 197-205.

Abstract

Aims: To describe some of the variability across the world in levels of quit smoking attempts and use of various forms of cessation support.

Design: Use of the International Tobacco Control Policy Evaluation Project surveys of smokers, using the 2007 survey wave (or later, where necessary).

Settings: Australia, Canada, China, France, Germany, Ireland, Malaysia, Mexico, the Netherlands, New Zealand, South Korea, Thailand, United Kingdom, Uruguay and United States.

Participants: Samples of smokers from 15 countries.

Measurements: Self-report on use of cessation aids and on visits to health professionals and provision of cessation advice during the visits.

Findings: Prevalence of quit attempts in the last year varied from less than 20% to more than 50% across countries. Similarly, smokers varied greatly in reporting visiting health professionals in the last year (<20% to over 70%), and among those who did, provision of advice to quit also varied greatly. There was also marked variability in the levels and types of help reported. Use of medication was generally more common than use of behavioural support, except where medications are not readily available.

Conclusions: There is wide variation across countries in rates of attempts to stop smoking and use of assistance with higher overall use of medication than behavioural support. There is also wide variation in the provision of brief advice to stop by health professionals.

Citation

Li, L., Borland, R., Yong, H.H., Hitchman, S.C., Wakefield, M.A., Kasza, K.A., Fong, G.T. (2012). The association between exposure to point-of-sale anti-smoking warnings and smokers' interest in quitting and quit attempts: Findings from the International Tobacco Control Four Country Survey. Addiction, 107(2), 425-433.

Abstract

Aims: This study aimed to examine the associations between reported exposure to anti-smoking warnings at the point-of-sale (POS) and smokers’ interest in quitting and their subsequent quit attempts by comparing reactions in Australia where warnings are prominent to smokers in other countries.

Design: A prospective multi-country cohort design was employed.

Setting: Australia, Canada, the United Kingdom and the United States.

Participants: A total of 21 613 adult smokers who completed at least one of the seven waves (2002–08) of the International Tobacco Control Four Country Survey were included in the analysis.

Measurements: Reported exposure to POS anti-smoking warnings and smokers’ interest in quitting at the same wave and quit attempts over the following year.

Findings: Compared to smokers in Canada, the United Kingdom and the United States, Australian smokers reported higher levels of awareness of POS anti-smoking warnings, and this difference was consistent over the study period. Over waves in Australia (but not in the other three countries) there was a significantly positive association between reported exposure to POS anti-smoking warnings and interest in quitting [adjusted odds ratio = 1.139, 95% confidence interval (CI) 1.039–1.249, P < 0.01] and prospective quit attempts (adjusted odds ratio = 1.216, 95% CI 1.114–1.327, P < 0.001) when controlling for demographics, smoking characteristics, overall salience of anti-smoking information and awareness of anti-smoking material from channels other than POS.

Conclusions: Point-of-sale health warnings about tobacco are more prominent in Australia than the United Kingdom, the United States or Canada and appear to act as a prompt to quitting.

Citation

Wilson, N., Weerasekera, D., Kahler, C.W., Borland, R., Edwards, R. (2012). Hazardous patterns of alcohol use are relatively common in smokers: ITC Project (New Zealand). New Zealand Medical Journal, 125(1348), 34-41.

Abstract

Aims: To describe patterns of alcohol use in a nationally-representative sample of New Zealand smokers.

Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) derives its sample from a national survey: the NZ Health Survey (NZHS). From this sample we surveyed adult smokers (n=1376).

Results: A third (33.1%) of these smokers had a drinking pattern that was considered hazardous (i.e., AUDIT scores greater than and equal to 8). These figures were much higher than for non-smokers in the NZHS (at 13.1%). In both the univariate and multivariate analyses, hazardous drinking patterns were significantly more common among: younger smokers, male smokers, and Māori smokers (e.g., adjusted odds ratio for the latter: 1.43, 95%CI: 1.05-1.95). The same pattern of more hazardous drinking was also seen (but in the univariate analysis only), for smokers with financial stress and for moderate individuallevel deprivation.

Conclusions: These findings provide additional evidence that hazardous drinking patterns are elevated in New Zealand smokers overall and particularly in some groups of smokers. Given the international evidence that hazardous drinking may impede quitting, policy makers could consider the potential benefits of improved alcohol control as part of the national strategy to curtail the tobacco epidemic and achieve the government's "Smokefree Nation 2025" goal. Such an approach could also reduce this country's high levels of alcohol-related harm and reduce gender and ethnic health inequalities.

Citation

Nagelhout, G.E., Willemsen, M.C., Gebhardt, W.A., van den Putte, B., Hitchman, S.C., Crone, M.R., Fong, G.T., van der Heiden, S., de Vries, H. (2012). Does smoke-free legislation and smoking outside bars increase feelings of stigmatization among smokers? Findings from the International Tobacco Control (ITC) Netherlands Survey. Health & Place, 18(6), 1436-1440.

Abstract

This study examined whether smokers’ perceived level of stigmatization changed after the implementation of smoke-free hospitality industry legislation and whether smokers who smoked outside bars reported more perceived stigmatization. Longitudinal data from the International Tobacco Control (ITC) Netherlands Survey was used, involving a nationally representative sample of 1447 smokers aged 15 years and older. Whether smoke-free legislation increases smokers’ perceived stigmatization depends on how smokers feel about smoking outside. The level of perceived stigmatization did not change after the implementation of smoke-free hospitality industry legislation in the Netherlands, possibly because most Dutch smokers do not feel negatively judged when smoking outside.