Citation

Yang, J., Hammond, D., Driezen, P., Fong, G.T., Jiang, Y. (2010). Health knowledge and perception of risks among Chinese smokers and non-smokers: Findings from ITC China Survey. Tobacco Control, 19(Suppl 2), i18-i23.

Abstract

Background: Awareness of health risks of smoking is strongly associated with smoking behaviour. However, there are no population-based studies of smoking-related health knowledge in China.

Objective: The aim of current study was to use a population-based sample from the International Tobacco Control China Wave 1 survey to examine variations between current, former and never smokers' health knowledge about smoking and the impact of health knowledge awareness on smokers' intention to quit.

Methods: A face-to-face interview was conducted with 5986 adult smokers and non-smokers from six cities in China. Respondents were asked whether they believed smoking causes heart disease, stroke, impotence, lung cancer, emphysema, stained teeth, premature ageing in smokers and lung cancer in non-smokers. Current smokers were also asked additional questions on how smoking affects their current and future health as well as whether they had plans to quit smoking and if they believe they would have health benefit from quitting.

Findings: The overall awareness of health risks of smoking in China was low compared to developed countries. Current smokers in China were less likely than non-smokers and former smokers to acknowledge the consequences of smoking. Current smokers who were more aware of the health consequences of smoking were more likely to intend to quit smoking.

Conclusion: These findings highlight the need to increase awareness about the health effects of smoking in China, particularly among current smokers to increase quitting.

Citation

Yang, Y., Li, L., Yong, H.H., Borland, R., Wu, X., Li, Q., Wu, C., Kin, F. (2010). Regional differences in awareness of tobacco advertising and promotion in China: Findings from the ITC China Survey. Tobacco Control, 19(2), 117-124.

Abstract

Objective: To examine whether levels of, and factors related to, awareness of tobacco advertising and promotion differ across six cities in China.

Methods: Data from wave 1 of the International Tobacco Control (ITC) China Survey (April to August 2006) were analysed. The ITC China Survey employed a multistage sampling design in Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan. Face-to-face interviews were conducted with a total of 4763 smokers and 1259 non-smokers. Multivariate logistic regression models were used to identify factors associated with awareness of tobacco advertising and promotion.

Results: The overall levels of noticing advertisements varied considerably by city. Cities reporting lower levels of advertising tended to report higher levels of point of sale activity. Noticing tobacco industry promotions was associated with more positive attitudes to tobacco companies.

Conclusion: The awareness of tobacco advertising and promotional activities was not homogeneous across the six Chinese cities, suggesting variations in the tobacco industry's activities and the diversity of implementing a central set of laws to restrict tobacco promotion. This study clearly demonstrates the need to work with the implementation agencies if national laws are to be properly enforced.

Citation

Yong, H.H., Borland, R., Cooper, J., Cummings, K.M. (2010). Postquitting experiences and expectations of adult smokers and their association with subsequent relapse: Findings from the International Tobacco Control (ITC) Four Country Survey. Nicotine & Tobacco Research, 12(Suppl 1), S12-19.

Abstract

Introduction: This paper explores postquitting experiences and expectations of adult ex-smokers and their utility as predictors of smoking relapse after prolonged abstinence.

Methods: Data are from 1,449 ex-smokers (providing 2,234 observations) recruited as smokers as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, the United Kingdom, and the United States) but surveyed after they had quit. Controlling for length of time quit, reported postquitting experiences, and expectations assessed at one of three waves were used as predictors. Smoking status (whether they had relapsed) at the next wave was used as the outcome of interest.

Results: Postquitting experiences and expectations, such as capacity to enjoy life’s simple pleasures, ability to cope with stress, ability to control negative emotions, and health concerns, changed systematically over time but at different rates. The trajectory of change for life enjoyment and health concerns followed a rapidly asymptoting logarithmic function, while that of stress and negative affect coping followed a slower asymptoting square root function. After controlling for sociodemographic and abstinence duration, only reported decline in capacity to control negative affect since quitting was associated with increased relapse risk.

Discussion: The varying patterns of change in postquitting experiences suggest that psychological gains over time following smoking cessation do not all occur at the same rate. The relative importance of each factor in maintaining abstinence is also not the same with deficits in perceived control of negative emotions being the only one predictive of subsequent relapse. Strategies to improve impulse control over negative emotions postquitting may help to reduce relapse risk.

Citation

Yong, H.H., Kin, F., Borland, R., Omar, M., Hamann, S.L., Sirirassamee, B., Fong, G.T., Fotuhi, O., Hyland, A. (2010). Support for and reported compliance among smokers with smoke-free policies in air-conditioned hospitality venues in Malaysia and Thailand: Findings from the International Tobacco Control Southeast Asia Survey. Asia-Pacific Journal of Public Health, 22(1), 98-109.

Abstract

This study examined support for and reported compliance with smoke-free policy in air-conditioned restaurants and other similar places among adult smokers in Malaysia and Thailand. Baseline data (early 2005) from the International Tobacco Control Southeast Asia Survey (ITC-SEA), conducted face-to-face in Malaysia and Thailand (n = 4005), were used. Among those attending venues, reported total smoking bans in indoor air-conditioned places such as restaurants, coffee shops, and karaoke lounges were 40% and 57% in Malaysia and Thailand, respectively. Support for a total ban in air-conditioned venues was high and similar for both countries (82% Malaysian and 90% Thai smokers who believed there was a total ban), but self-reported compliance with bans in such venues was significantly higher in Thailand than in Malaysia (95% vs 51%, P < .001). As expected, reporting a ban in air-conditioned venues was associated with a greater support for a ban in such venues in both countries.

Citation

Young, D., Wilson, N., Borland, R., Edwards, R., Weerasekera, D. (2010). Prevalence, correlates of, and reasons for using roll-your-own tobacco in a high RYO use country: Findings from the ITC New Zealand Survey. Nicotine & Tobacco Research, 12(11), 1089-1098.

Abstract

Aim: To describe the prevalence, correlates of, and reasons for use of roll-your-own (RYO) tobacco in a high RYO use and ethnically diverse country: New Zealand (NZ).

Methods: The NZ arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) is sampled from the New Zealand Health Survey, with boosted sampling of Māori, Pacific peoples, and Asian New Zealanders. We surveyed 1,376 current adult smokers using standard ITC project procedures in 2007-2008.

Results: Prevalence of regularly smoking RYOs was 53% (with 38% of all smokers being exclusive RYO smokers). RYO use was higher among disadvantaged smokers, heavier smokers, those with a relatively low intention of quitting, and those with more friends who smoke. RYO use increased more in the youngest age groups as disadvantage increased. "Lower price" dominated the reasons smokers' cited for smoking RYOs (at 83%). About one fifth cited "less health concerns" as a reason.

Conclusions: RYO smoking is particularly associated with individual deprivation and high levels of dependence. Its capacity to blunt price signals provided by tobacco taxes is accompanied by misperceptions that it is less hazardous to health and it is particularly prevalent among vulnerable disadvantaged populations (including Māori, young people, and those with mental health problems). Governments should reconsider removing any tax advantages given to RYO tobacco, ensure RYO smokers are properly informed of health risks, and supported to quit as strongly as other smokers. However, governments should also examine a broader range of options including a higher differential tax on RYO tobacco, removing flavors, and controlling all tobacco marketing.

Citation

Thrasher, J.F., Swayampakala, K., Arillo-Santillán, E., Sebrie, E.M., Walsemann, K.M., Bottai, M. (2010). Differential impact of local and federal smoke-free legislation in Mexico: A longitudinal study among adult smokers. Salud Publica de Mexico, 52(Suppl 2), S244-253.

Abstract

Objective: To assess the impact of Mexico City and federal smoke-free legislation on secondhand tobacco smoke (SHS) exposure and support for smoke-free laws.

Material and Methods: Pre- and post-law data were analyzed from a cohort of adult smokers who participated in the International Tobacco Control (ITC) Policy Evaluation Suvey in four Mexican cities. For each indicator, we estimated prevalence, changes in prevalence, and between-city differences in rates of change.

Results: Self-reported exposure to smoke-free media campaigns generally increased more dramatically in Mexico City. Support for prohibiting smoking in regulated venues increased overall, but at a greater rate in Mexico City than in other cities. In bars and restaurants/cafés, self-reported SHS exposure had significantly greater decreases in Mexico City than in other cities; however, workplace exposure decreased in Tijuana and Guadalajara, but not in Mexico City or Ciudad Juárez.

Conclusions: Although federal smoke-free legislation was associated with important changes smoke-free policy impact, the comprehensive smoke-free law in Mexico City was generally accompanied by a greater rate of change.

Citation

Borland, R., Hyland, A., Cummings, K.M., Fong, G.T. (2010). One size does not fit all when it comes to smoking cessation: Observations from the International Tobacco Control Policy Evaluation Project. Nicotine & Tobacco Research, 12(Suppl 1), S1-3.

Abstract

The global community, through the World Health Organization’s Framework Convention on Tobacco Control (FCTC), is seeking to develop Guidelines for the implementation of Article 14 of the Convention, which deals with support for smoking cessation. This development requires models of how best to develop infrastructure and measures to promote and support cessation around the world. This special issue of Nicotine & Tobacco Research provides some evidence from the International Tobacco Control (ITC) Policy Evaluation Project that is contributing to an increased understanding of the challenges associated with encouraging and supporting smoking cessation. The ITC project (of which we are all leaders) is a research collaborative of more than 80 tobacco control researchers across 20 countries of which data from 7 countries are featured in this supplement. This commentary discusses three areas where the research reported here makes a contribution: our understanding of dependence; the effects of socioeconomic factors on cessation; and the potential utility of support programs. But first, we describe the context for this research.

Citation

Hyland, A., Cummings, K.M. (2010). Using tobacco control policies to increase consumer demand for smoking cessation. American Journal of Preventive Medicine, 38(Suppl 3), S347-350.

Abstract

Population-based indicators of smoking cessation have stalled in recent years. This commentary focuses attention on tobacco control policies that can be used to stimulate renewed consumer demand for smoking cessation. Tobacco use as reflected in population trends is the product of the interaction of three broad categories of factors: agent, host, and environment. Government policies are an important, modifıable environmental influence that can directly or indirectly influence smoking behavior. For example, numerous studies have shown that a hike in tobacco taxes reduces cigarette consumption and encourages smokers to quit.

Citation

Li, X., Dong, L., Sun, B., Liang, H., Chen, J., Zhang, L., Jiang, Y., Lv, Y. (2010). The willingness of smoking cessation and its determinants. Chinese Journal of Preventive Medicine, 11(7), 663-667.

Abstract

Objective: To explore the determinants of willingness to quit smoking among regular smokers, and to provide a scientific basis for establishing smoking cessation strategies for adult smokers.

Methods: The study was conducted between April to August 2006. A stratified multistage cluster sampling design was used to select residents from 10 streets in Shenyang. Households were then randomly selected from the communities of the selected streets. The average of 40 adult smokers were selected from each of 20 communities. The information of age, gender and smoking status was collected from 801 participants.

Results: The rate of voluntary cessation of smoking was 30.7%(29.8% in male and 46.7%in female). The government employees had the highest proportion of voluntary cessation of smoking (47.5%), followed by retired population (36.7%) and technical professionals (21.4%). The associated factors of smoking cessation include objection from relatives, public opinion, the advocacy efforts and measures of tobacco control.

Conclusion: The proportion of voluntary smoking cessation was low in Shenyang. Additional advocacy efforts and control measures should be taken to encourage the cessation of smoking.

Citation

O'Connor, R. J., Fix, B. V., Hammond, D., Giovino, G. A., Hyland, A., Fong, G. T., & Cummings, K. M. (2010). The impact of reduced ignition propensity cigarette regulation on smoking behaviour in a cohort of Ontario smokers. Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention, 16(6), 420–422. https://doi.org/10.1136/ip.2009.025114

Abstract

This study examined the degree to which legislation intended to reduce the incidence of cigarette-caused fires influenced the behaviours of a cohort of smokers in Ontario. A random digit dialled telephone survey of adult smokers residing in Ontario was conducted in 2005, ending 1 month prior to the reduced ignition propensity (RIP) regulation's implementation date. A follow-up survey was conducted one year later. Of the baseline participants, 73.0% (n=435) completed the follow-up survey. The frequency of fire risk behaviours was similar across both surveys. At baseline, only 3.7% of smokers interviewed reported that their cigarettes went out on their own 'often' while smoking. Following the implementation of the reduced ignition propensity legislation, this increased significantly to 14.7%. Results suggest that the proportion of Ontario smokers who reported engaging in behaviour such as leaving a cigarette burning unattended and smoking in bed actually declined, although these declines were not statistically significant across all measures of fire risk.

Citation

Thrasher, J.F., Villalobos, V., Szklo, A.S., Fong, G.T., Perez, C., Sebrie, E.M., Sansone, N., Figueiredo, V., Boado Martinez, M., Arillo-Santillán, E., Bianco, E. (2010). Assessing the impact of cigarette package health warning labels: A cross-country comparison in Brazil, Uruguay and Mexico. Salud Publica de Mexico, 52(Suppl 2), S206-215.

Abstract

Objective: To assess the impact of different health warning labels (HWL).

Material and Methods: Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact.

Results: HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment.

Conclusions: This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking.

Citation

Xu, J., Liang, B., Li, X., Xie, F., Yao, H., Li, Q., Jiang, Y., Yang, Y., Feng, G., Jiao, S., Li, X., Zhu, G. (2010). Health consciousness and its influential factors among low tar cigarette smokers in six cities of China (Language: Chinese). Chinese Journal of Public Health, 25(10).

Abstract

Publication written in Chinese. Please visit link to view article.

Citation

Wilson, N., Edwards, R., Thomson, G., Weerasekera, D., Talemaitoga, A. (2010). High support for a tobacco endgame by Pacific peoples who smoke: National survey data. New Zealand Medical Journal, 123(1316), 131-134.

Abstract

The attitudes of smokers to tobacco control interventions is highly topical in New Zealand given the current inquiry by the Maori Affairs Select Committee into tobacco issues. Presenters to this Committee have raised the need for a tobacco endgame strategy (e.g.), and this idea has currency among Maori leadership, nongovernmental organisations, and amongst other researchers. In the 2006 Census 30.3% of adult Pacific peoples in New Zealand reported being smokers, compared to 19.4% of the European population.7 Tobacco use is a substantial burden on the health of Pacific peoples and is likely to be contributing significantly to the health inequalities between Pacific peoples and other New Zealanders (e.g. see the emerging differences in lung cancer mortality rates). Harm to health and expenditure on tobacco is also likely to be holding back the social and economic development of Pacific communities. Pacific peoples support improved tobacco control, and in a 2008 national survey (smokers and nonsmokers) there was much stronger support than average for tobacco regulation. This high level of support contrasts somewhat to that of Pacific policymakers—at least for extending smokefree regulations. Here we describe the results of another national survey that considered attitudes of Pacific smokers to a range of tobacco control policy options.

Citation

Wilson, N., Edwards, R., Thomson, G., Weerasekera, D., Gifford, H., Hoek, J. (2010). High and increased support by Maori and non-Maori smokers for a ban on point-of-sale tobacco displays: National survey data. New Zealand Medical Journal, 123(1317), 84-86.

Abstract

Considerations around advancing tobacco control are particularly relevant to New Zealand at present, given the current Inquiry by the Māori Affairs Select Committee into the tobacco industry. While there are good arguments for a rapid endgame solution to the tobacco epidemic (involving a phase out of tobacco sales over 10 years) other supplementary measures should also be considered to help lower demand for tobacco – regardless of the adoption of endgame policies. There is international evidence, and evidence from New Zealand, that point of-sale (PoS) tobacco displays encourage tobacco uptake among children and undermine cessation among smokers wishing to quit and who have recently quit. Other New Zealand research has identified that the arguments for tobacco displays are contradictory and flawed and that there is poor compliance with the current (albeit relatively weak) law on tobacco displays. New Zealand data indicate majority public support for additional marketing restrictions on tobacco. Around half (53.4%) of respondents to a national survey agreed that “tobacco companies should not be allowed to promote cigarettes by having different brand names and packaging” (22.6% disagreed), and 65.6% wanted fewer tobacco retailers. We have previously reported that a majority (62.5%) of Māori smokers support a ban on PoS tobacco displays. Here we draw on additional survey data to examine this issue further.

Citation

Elkin, L., Wilson, N., Thomson, G. (2010). Connecting world youth with tobacco brands: YouTube and the internet policy vacuum on Web 2.0. Tobacco Control, 5, 361-366.

Abstract

Background: The internet is an ideal forum for tobacco marketing, as it is largely unregulated and there is no global governing body for controlling content. Nevertheless, tobacco companies deny advertising on the internet.

Objective: To assess the extent and nature of English language videos available on the Web 2.0 domain 'YouTube' that contain tobacco brand images or words.

Methods: The authors conducted a YouTube search using five leading non-Chinese cigarette brands worldwide. The themes and content of up to 40 of the most viewed videos returned for each search were analysed: a total of 163 videos.

Results: A majority of the 163 tobacco brand-related videos analysed (71.2%, 95% CI 63.9 to 77.7) had pro-tobacco content, versus a small minority (3.7%) having anti-tobacco content (95% CI 1.4 to 7.8). Most of these videos contained tobacco brand content (70.6%), the brand name in the title (71.2%) or smoking imagery content (50.9%). One pro-smoking music video had been viewed over 2 million times. The four most prominent themes of the videos were celebrity/movies, sports, music and 'archive', the first three of which represent themes of interest to a youth audience.

Conclusions: Pro-tobacco videos have a significant presence on YouTube, consistent with indirect marketing activity by tobacco companies or their proxies. Since content may be removed from YouTube if it is found to breach copyright or if it contains offensive material, there is scope for the public and health organisations to request the removal of pro-tobacco content containing copyright or offensive material. Governments should also consider implementing Framework Convention on Tobacco Control requirements on the internet, to further reduce such pro-tobacco content.

Citation

Wilson, N., Peace, J., Edwards, R., Hoek, J. (2010). Long-term benefit of increasing the prominence of a quitline number on cigarette packaging: 3 years of Quitline call data. New Zealand Medical Journal, 123(1321), 109-111.

Abstract

In 2008 the law required tobacco packaging in New Zealand to include pictorial health warnings (PHWs) and the national Quitline number. Previously, text-only health warnings provided a telephone number, but did not explicitly link this to the “Quitline”. Research indicated that New Zealand smokers became more aware of the Quitline number on packs since PHWs were introduced, and there was an immediate increase in the proportion of new callers who registered with the Quitline following the introduction of PHWs. We investigated whether Quitline callers’ use of packaging to source the Quitline number continued beyond the initial introduction of PHWs.

Methods: The national free-phone Quitline service in New Zealand routinely collects data on where new callers sourced the Quitline number (i.e., a standardised question asked of all new callers). The Quitline service provided us with data on the proportion of new callers who reported obtaining the Quitline number from cigarettes packaging before and after the introduction of PHWs (i.e. for the three-year period March 2007 to February 2010). These data were compared to the proportion of callers who cited television advertising as the source of this number (which was the major source at the start of the study period). We reviewed monthly “target audience rating points” (TARPs) data on the reach and frequency of television advertising for smoking cessation advertisements (most of them showed the Quitline number).

Results and Discussion: During the 12-month pre-PHWs period (March 2007 to February 2008), 7.5% and 34.9% of new callers (out of n=19,558 total callers), cited tobacco packaging and television advertising respectively as their source for the Quitline number (Figure 1). However, in the first full year of the new PHWs (March 2008 to February 2009), the proportions reporting tobacco packaging as the source increased to 26.4% and television advertising declined to 27.1% (out of n=20,152 total callers). The same pattern was still evident in the subsequent 12-month period at 22.9% and 23.3% respectively (n=18,309 for the period March 2009 to February 2010).

Citation

Wilson, N., Weerasekera, D., Edwards, R., Blakely, T. (2009). Smoker support for increased (if dedicated) tobacco tax by individual deprivation level: National survey data. Tobacco Control, 18(6), 512-512.

Abstract

Increasing the price of tobacco products through tobacco taxation is one of the most effective tobacco control interventions. An additional benefit is that a “dedicated tobacco tax” (where some or all of the revenue raised is earmarked for specific spending or programmes) can generate revenue for funding other tobacco control and health programmes. Should dedicated tobacco taxes be introduced, it will be useful for decision makers to know whether there is support from all sociodemographic categories of smokers. Accordingly, we aimed to examine smoker support for tobacco taxes by an individual level measure of deprivation.

Citation

Li, Y., He, L., Wang, H., Zhou, Y. (2009). The current status and the related factors of smoking in the recreational venues in Beijing, China. (Language: Chinese). Chinese Journal of Health Education, 43(12), 1136-1138.

Abstract

Publication written in Chinese. Please visit link to view article.

Citation

Wilson, N., Thomson, G., Weerasekera, D., Blakely, T., Edwards, R., Peace, J., Young, D., Gifford, H. (2009). Smoker misperceptions around tobacco: National survey data of particular relevance to protecting Maori health. New Zealand Medical Journal, 122(1306), 123-127.

Abstract

To evaluate relevant issues around smoker knowledge and misperceptions about tobacco smoking, a cohort group of 1376 New Zealand smoking adults aged >18 years and 607 Maori respondents were surveyed between March 2007 and February 2008. Specific questions relevant to possible misinformation included perceptions related to light/mild cigarettes/tobacco, to menthols, and to RYO tobacco. Overall results indicated that sizeable minorities of both Maori and European/other smokers had various misperceptions about tobacco products. Regarding light and mild cigarettes, nearly half (48%) of Maori smokers have at least one of three misperceptions which suggest (erroneously) that these cigarettes have health benefits compared to “regular” cigarettes. Also, New Zealand smokers have misperceptions about mentholated cigarettes (“menthols”) being less harmful relative to “non-mentholated” cigarettes. This misperception was significantly more common (13% vs 7%) among Maori smokers. In addition, a minority (up to 10%) of Maori smokers also have specific misperceptions about the adverse health effects of second-hand smoke. Around a fifth of Maori and European/other smokers gave health reasons for smoking RYO cigarettes. Smokers also have high levels of knowledge deficits and misperceptions around smokeless tobacco products. Finally, a substantial group of smokers agree or strongly agree that “tobacco companies have done everything they can to reduce the harm caused by smoking,” and Maori smokers were significantly more likely to have this view (24%) compared to 18% of European/other. In conclusion, these data on smoker misperceptions are likely to be associated with tobacco industry messages on packaging.

Citation

Peace, J., Wilson, N., Hoek, J., Edwards, R., Thomson, G. (2009). Survey of descriptors on cigarette packs: Still misleading consumers? New Zealand Medical Journal, 122(1303), 90-96.

Abstract

Aim: In September 2008, the New Zealand (NZ) Commerce Commission issued a warning to the major tobacco companies to remove “light” and “mild” descriptors from cigarette packaging. Despite published evidence that suggested tobacco companies had started colour-coding their packs in anticipation of the Commission's decision, the investigation did not consider more general misleading packaging. This study explored changes in tobacco packaging that had been introduced to the New Zealand market, by surveying descriptors used on cigarette packs after the Commerce Commission's warning.

Method: A convenience sample of discarded cigarette packs were collected in four cities and six towns/rural areas between November 2008 and January 2009. The majority of packs (93%) were collected in the capital city (Wellington). Information on the descriptors and pack colours was analysed.

Results: Four percent of the 1208 packs collected still included the terms “light” and “mild”. Almost half the packs (42%) used a colour word (e.g. red, blue, gold) as a descriptor to indicate mildness or strength. A further 18% used other words that suggested mildness/strength (e.g. “subtle”, “mellow”). A quarter of packs used a descriptor that did not connote either mildness or strength; however, the majority of these packs still appeared to be colour-coded.

Conclusion: Although the words “light” and “mild” have been largely removed from tobacco packaging in the New Zealand market, these words have been replaced with associated colours or other words that may continue to communicate “reduced harm” messages to consumers. Further research to test how smokers interpret the new words and colours, and how these influence their behaviour, is desirable. However, government-mandated generic (plain) packaging would remove the opportunity to communicate misleading claims and so would afford the highest level of consumer protection.

Citation

Li, X., Li, Q., Dong, L., Sun, B., Chen, J., Jiang, J., Yang, Y., Zhou, B., Fong, G.T. (2010). Risk factors associated with smoking behaviour in recreational venues: Findings from the International Tobacco Control (ITC) China Survey. Tobacco Control, 19(Suppl 2), i30-i39.

Abstract

Objective: To explore the determinants of smoking behaviour in recreational venues and to provide scientific bases for establishing smoke-free measures applying to these locations.

Methods: The International Tobacco Control (ITC) China Survey—a face-to-face cross-sectional survey of representative adult smokers from six cities (Shenyang, Beijing, Shanghai, Guangzhou, Changsha and Yinchuan) was conducted between April and August 2006. A total of 4815 smokers were selected using multistage sampling methods, and final analyses were conducted on 2875 smokers who reported patronising recreational venues at least once in the last six months. Multivariate logistic regression models were used to identify factors influencing the smoking behaviour within recreational settings.

Outcome Measure: Whether a smoker reported smoking in recreational venues during the last 6 months.

Results: 84% of subjects reported smoking in recreational venues. 32.0% of patrons reported partial The following factors were significant predicators of smoking in recreational venues: absence of bans on smoking, support for non-bans, being aged 18–24 years, positive smoking-related attitudes, low number of health effects reported and not living in Beijing.

Conclusions: The findings point to the importance of informing Chinese smokers about the active smoking and passive smoking harmfulness in both building support for smoke-free laws and in reducing smokers’ desire to smoke within recreational venues. They also point to the importance of good enforcement of smoke-free laws when implemented. Such strategies could also serve to de-normalise smoking in China.

Citation

Thomson, G., Weerasekera, D., Peace, J., Wilson, N. (2009). New Zealand smokers' attitudes to smokefree cars containing preschool children: Very high support across all sociodemographic groups. New Zealand Medical Journal, 122(1300), 84-86.

Abstract

In 2008 we published the overall support by New Zealand smokers for smokefree cars containing preschool children (96%).1 To provide further detail on the support by different groups, we examined the support by age-groups, gender, ethnicity, level of socioeconomic deprivation, and level of financial stress. The data came from the wave 1 of the New Zealand arm of the International Tobacco Control Policy Evaluation Survey (NZ ITC Project). This wave involved surveying a national sample of 1376 New Zealand adult (18+ years) smokers in 2007–2008. We asked: Do you think smoking should be allowed in cars with preschool children in them? Further detail on the survey methods is available elsewhere.2 We found that smokers in all age-groups, both men and women, those in the four ethnic groups considered, and those in all small area deprivation quintiles, disagreed with the statement at a level of 92%+ (Table 1). Of those smokers who reported suffering from two different types of smoking-related financial stress (those unable to pay any important bills on time due to a shortage of money, and those not spending on household essentials due to spending on smoking) over 92% also disagreed (see Table 1). The key finding is that New Zealand smokers from different socio-demographic groups appear to give very high support for not allowing smoking in cars carrying preschool children. These data are further supported by results from a 2008 national survey of the New Zealand public, which found 91% (82% for smokers) agreeing with the statement ‘that smoking should not be allowed in cars with children under the age of 14 in them’.3 These results indicate that there is strong support across a very wide range of smokers (and from the public) for active government intervention to protect New Zealand children from tobacco smoke pollution in cars. We need to consider why New Zealand is lagging behind 11 states and provinces in Australia, Canada, and the USA, which have all passed laws to protect their children from smoking in cars.4 While further social marketing campaigns on this theme are desirable, we suggest that smokefree car legislation is an appropriate use of the law, and would provide a strong signal on the priority of child protection from tobacco smoke. If the New Zealand Parliament is going to consider banning cell phone use while car driving, they could consider smokefree cars at the same time.

Citation

Lee, W.B., Fong, G.T., Zanna, M.P., Omar, M., Sirirassamee, B., Borland, R. (2009). Regret and rationalization among smokers in Thailand and Malaysia: Findings from the International Tobacco Control Southeast Asia Survey. Health Psychology, 28(4), 457-464.

Abstract

Objective: To test whether differences of history and strength in tobacco control policies will influence social norms, which, in turn, will influence quit intentions, by influencing smokers’ regret and rationalization.

Design: The data were from the International Tobacco Control (ITC) Policy Evaluation Southeast Asia Survey, a cohort survey of representative samples of adult smokers in Thailand (N _2,000) and Malaysia (N _ 2,006). The survey used a stratified multistage sampling design.

Main Outcome Measures: Measures included regret, rationalization, social norms, and quit intention.

Results: Thai smokers were more likely to have quit intentions than Malaysian smokers. This difference in quit intentions was, in part, explained by the country differences in social norms, regret, and rationalization. Reflecting Thailand’s history of stronger tobacco control policies, Thai smokers, compared with Malaysian smokers, perceived more negative social norms toward smoking, were more likely to regret, and less likely to rationalize smoking. Mediational analyses revealed that these differences in social norms, accounted, in part, for the country-quit intention relation and that regret and rationalization accounted, in part, for the social norm-quit intention relation.

Conclusion: The results suggest that social norms toward smoking, which are shaped by tobacco control policies, and smokers’ regret and rationalization influence quit intentions.

Citation

Siahpush, M., Yong, H.H., Borland, R., Reid, J., Hammond, D. (2009). Smokers with financial stress are more likely to want to quit but less likely to try or succeed: Findings from the International Tobacco Control (ITC) Four Country Survey. Addiction, 104(8), 1382-1390.

Abstract

Objective: To examine the association of financial stress with interest in quitting smoking, making a quit attempt and quit success.

Design and participants: The analysis used data from 4984 smokers who participated in waves 4 and 5 (2005–07) of the International Tobacco Control (ITC) Four Country Survey, a prospective study of a cohort of smokers in the United States, Canada, the United Kingdom and Australia.

Measurement: The outcomes were interest in quitting at wave 4, making a quit attempt and quit success at wave 5. The main predictor was financial stress at wave 4: ‘. . . because of a shortage of money, were you unable to pay any important bills on time, such as electricity, telephone or rent bills?’. Additional socio-demographic and smoking-related covariates were also examined.

Findings: Smokers with financial stress were more likely than others to have an interest in quitting at baseline [odds ratio (OR): 1.63; 95% confidence interval (CI): 1.22–2.19], but were less likely to have made a quit attempt at follow-up (OR: 0.74; 95% CI: 0.57–0.96). Among those who made a quit attempt, financial stress was associated with a lower probability of abstinence at follow-up (OR: 0.53; 95% CI: 0.33–0.87).

Conclusions: Cessation treatment efforts should consider assessing routinely the financial stress of their clients and providing additional counseling and resources for smokers who experience financial stress. Social policies that provide a safety net for people who might otherwise face severe financial problems, such as not being able to pay for rent or food, may have a favorable impact on cessation rates.

Citation

Parkinson, C., Hammond, D., Fong, G.T., Borland, R., Omar, M., Sirirassamee, B., Awang, R., Driezen, P., Thompson, M.E. (2009). Smoking beliefs and behavior among youth in Malaysia and Thailand. American Journal of Health Behavior, 33(4), 366-375.

Abstract

Objective: To characterize smoking beliefs among Thai and Malaysian youth and to examine associations with gender, antismoking media exposure, and smoking status.

Methods: Nationally representative samples of youth completed self-administered questionnaires.

Results: A substantial proportion of youth reported positive beliefs about smoking. Those reporting positive beliefs were more likely to be susceptible to smoking. Youth who noticed antismoking media were less likely to report positive beliefs about smoking.

Conclusions: As in Western countries, beliefs about smoking held by youth in Southeast Asia are associated with smoking status. Antismoking media may be an important means of targeting beliefs about smoking among youth.