Citation

Hyland, A., Higbee, C., Borland, R., Travers, M.J., Hastings, G., Fong, G.T., Cummings, K.M. (2009). Attitudes and beliefs about secondhand smoke and smoke-free policies in four countries: Findings from the International Tobacco Control Four Country Survey. Nicotine & Tobacco Research, 11(6), 642-649.

Abstract

Introduction: This paper describes the varying levels of smoking policies in nationally representative samples of smokers in four countries and examines how these policies are associated with changes in attitudes and beliefs about secondhand smoke over time.

Methods: We report data on 5,788 respondents to Wave 1 of the International Tobacco Control Four Country Survey who were employed at the time of the survey. A cohort of these respondents was followed up with two additional survey waves approximately 12 months apart. Respondents ’ attitudes and beliefs about secondhand smoke as well as self-reported policies in their workplace and in bars and restaurants in their community were assessed at all waves.

Results: The level of comprehensive smoke-free policies in workplaces, restaurants, and bars increased over the study period for all countries combined and was highest in Canada (30%) and lowest in the United Kingdom (0%) in 2004. In both crosssectional and longitudinal analyses, stronger secondhand smoke policies were associated with more favorable attitudes and support for comprehensive regulations. The associations were the strongest for smokers who reported comprehensive policies in restaurants, bars, and their workplace for all three survey waves.

Discussion: Comprehensive smoke-free policies are increasing over time, and stronger policies and the public education opportunities surrounding their passage are associated with more favorable attitudes toward secondhand smoke regulations. The implication for policy makers is that, although the initial debate over smoke-free policies may be tumultuous, once people understand the rationale for implementing smoke-free policies and experience their benefits, public support increases even among smokers, and compliance with smoke-free regulations increases over time.

Citation

Li, Z., Jiang, H., Jiao, S., Zhao, J., Zhu, G., Luo, B., Li, X., Li, Q., Feng, G., Yang, Y. (2008). Cross-sectional study on nicotine dependence of adult smokers in six cities. Practical Preventive Medicine, 15(6), 1691-1694.

Abstract

Objective: To collect the information on nicotine dependence of Chinese adult smokers and understand the related factors of high nicotine dependence in adult smokers.

Methods: Used 4800 adult smokers, interviewed in Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan 1,800 smokers in each city were selected with multiple stages sampling method.

Results: The level of HIS was 215 ±117 in adult smokers in China, 215 ±117 for male and 119 ±117 for female, which were lower than that of smokers in developed countries1 The result of logistic regressions for predicting the probability of high nicotine dependence showed that gender, age, education, years after becoming a regular smoker, health consciousness and p rice per pack of last purchase could enter the equation1 Male (OR = 21352) and lower education had significant associations with high nicotine dependence. The lower education the smokers had, the higher nicotine dependence they were (the high education as contrasted, the OR of the medium education was 11417; the OR of low education was 11853) People who had smoked more than 10 years had high nicotine dependence (OR = 41519) People who regarded smoking was neither good nor bad for their own health (OR = 11345) , regarded smoking was good for their own health (OR = 21419) and purchased below 4 yuan per pack (OR = 11635) had high nicotine dependence.

Conclusion: Compared with developed countries, the HSI level was lower in China Male, higher age, lower education, smoking more than 10 years, failing to understand smoking damage, and purchasing cheap cigarettes were associated with high nicotine dependence.

Citation

Wilson, N., Weerasekera, D., Peace, J., Edwards, R., Thomson, G., Devlin, M. (2009). Misperceptions of “light” cigarettes abound: National survey data. BioMed Central Public Health, 9(1), 126.

Abstract

Background: Many smokers believe that "light" cigarettes are less harmful than regular cigarettes, which is at variance with the scientific evidence. The Framework Convention on Tobacco Control (FCTC) aims to address this problem in Article 11 which deals with misleading labelling of tobacco products. In this study we aimed to determine smokers' use and beliefs concerning "light" and "mild" cigarettes ("lights"), including in relation to ethnicity, deprivation and other socio-demographic characteristics.

Methods: The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey (ITC Project) uses as its sampling frame the NZ Health Survey. This is a national sample with boosted sampling of Maori, Pacific peoples and Asians. From this sample we surveyed adult smokers (n = 1376) about use and beliefs relating to "light" cigarettes. We assessed the associations with smoking "lights" after adjusting for socio-demographic variables, and smoking-related behaviours and beliefs.

Results: Many smokers of "lights" believed that smoking "lights" made it easier to quit smoking (25%), that "lights" are less harmful (42%), and that smokers of "lights" take in less tar (43%). Overall most "lights" smokers (60%) had at least one of these three beliefs, a proportion significantly higher than for smokers of "regular" cigarettes at 45% (adjusted odds ratio (aOR) = 1.96, 95% CI = 1.29 – 2.96). While "lights" smokers had significantly lower tobacco consumption and were more aware of smoking harms, they were no more likely to be intending to quit or have made a previous quit attempt. By ethnicity, both Maori and Pacific people were less likely to smoke "lights" than Europeans (aOR = 0.53, 95% CI = 0.35 – 0.80 and aOR = 0.14, 95% CI = 0.05 – 0.40 respectively). In contrast there was no significant difference by level of deprivation. Roll-your-own (RYO) tobacco smokers were less likely to smoke "light" forms of RYO tobacco while both older and women smokers were more likely to smoke "lights".

Conclusion: Most "lights" smokers have one or more misperceptions about the product they use, and were no more likely to intend to quit or to have made a quit attempt. In response to such misperceptions, governments could act further to eliminate all misleading tobacco marketing. Ideally, they could not only adopt FCTC requirements, but go further by requiring plain packaging for all tobacco products.

Citation

Li, L., Yong, H.H., Borland, R., Fong, G.T., Thompson, M.E., Jiang, Y., Yang, Y., Sirirassamee, B., Hastings, G., Harris, F. (2009). Reported awareness of tobacco advertising and promotion in China compared to Thailand, Australia and the USA. Tobacco Control, 18(3), 222-227.

Abstract

Background: China currently does not have comprehensive laws or regulations on tobacco advertising and promotion, although it ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in October 2005 and promised to ban all tobacco advertising by January 2011. Much effort is needed to monitor the current situation of tobacco advertising and promotion in China.

Objective: This study aims to examine levels of awareness of tobacco advertising and promotion among smokers in China as compared to other countries with different levels of restrictions.

Methods: One developing country (Thailand) and two developed countries (Australia and the USA) were selected for comparison. All four countries are part of the International Tobacco Control (ITC) Policy Evaluation Survey project. Between 2005 and 2006, parallel ITC surveys were conducted among adult smokers (at least smoked weekly) in China (n=4763), Thailand (n=2000), Australia (n=1767) and the USA (n=1780). Unprompted and prompted recall of noticing tobacco advertising and promotion were measured.

Results: Chinese respondents reported noticing tobacco advertisements in a range of channels and venues, with highest exposure levels on television (34.5%), billboards (33.4%) and in stores (29.2%). A quarter of respondents noticed tobacco sponsorships, and a high level of awareness of promotion was reported. Cross-country comparison reveals that overall reported awareness was significantly higher in China than in Thailand (particularly) and Australia, but lower than in the USA.

Conclusions: There is a big gap between China and the better-performing countries such as Thailand and Australia regarding tobacco promotion restrictions. China needs to do more, including enhanced policy and more robust enforcement.

Citation

Brown, A., Moodie, C., Hastings, G. (2009). A longitudinal study of policy effect (smoke-free legislation) on smoking norms: ITC Scotland/United Kingdom. Nicotine & Tobacco Research, 11(8), 924-932.

Abstract

Introduction: The longitudinal ITC Scotland/U.K. survey was used to investigate adult smokers ’ support for smoke-free legislation and whether this support was associated with higher quit intentions at follow-up, either directly or indirectly, via the mediation of perceived social unacceptability of smoking.

Methods: Structural equation modeling was employed to compare differences between the two samples (507 adult smokers from Scotland and 507 from the rest of the United Kingdom) across two waves (February/March 2006 and March 2007). During these two waves, a smoking ban was introduced in Scotland but not the rest of the United Kingdom.

Results: For smokers in both samples, support for smoke-free legislation at baseline significantly heightened perceived unacceptability of smoking, although perceptions of unacceptability were somewhat stronger in Scotland than the rest of the United Kingdom post ban. Unlike the rest of the United Kingdom, support for a ban at baseline among smokers in Scotland was associated with higher quit intentions at follow-up. For both samples, quit intentions were significantly associated with heightened perceived unacceptability at follow-up. The overall variance explained in quit intentions was greater in Scotland than in the rest of the United Kingdom but not significantly so.

Discussion: Support for smoke-free legislation at baseline significantly increased support at follow-up for both samples. However, this did not independently increase quit intentions among smokers from both Scotland and the rest of the United Kingdom. The findings suggest that normative influences are one of the mechanisms through which comprehensive smokefree legislation influences quit intentions.

Citation

Fathelrahman, A., Omar, M., Awang, R., Borland, R., Fong, G.T., Hammond, D., Zain, Z. (2009). Smokers' responses toward cigarette pack warning labels in predicting quit intention, stage of change, and self-efficacy. Nicotine & Tobacco Research, 11(3), 248-253.

Abstract

Introduction: This paper is concerned with the effects of cigarette pack warning labels on quitting intentions. We examined whether different responses among smokers toward cigarette pack warning labels could predict quit intentions and self-efficacy in quitting. Variables studied were “noticing warning labels during last month,” “reading or looking closely at warning labels,” “avoiding looking at labels during last month,” “thinking about health risks of smoking because of the warning labels, “more likely to quit because of the warning labels,” and “stopping from having a cigarette when about to smoke one because of the labels.”

Methods: A total of 2,006 adult smokers in Malaysia were surveyed in face-to-face interviews using a standardized questionnaire. Of those, 1,919 male smokers were included in the analyses.

Results: The responses “more likely to quit because of the warning labels” and “stopped from having a cigarette when about to smoke one ” significantly predicted all stages of change and self-efficacy, independent of the other measures. In addition, thinking about the health risks and reading the warnings more often added extra predictive capacity but only in the early stages of contemplating change.

Discussion: Less intense processing of the information may be important in initiating thoughts, but cognitions about quitting and foregoing cigarettes are the key mechanisms by which warnings stimulate quitting intentions and help smokers feel capable of succeeding. Malaysian smokers appear to respond to warnings in ways comparable with those from developed countries.

Citation

Cummings, K.M., Fong, G.T., Borland, R. (2009). Environmental influences on tobacco use: Evidence from societal and community influences on tobacco use and dependence. Annual Review of Clinical Psychology, 5, 433-458.

Abstract

There is little doubt that nicotine addiction sustains tobacco use in most people and that individual variation in response to tobacco has a strong biological basis. However, the great diversity in tobacco use behaviors observed between countries and within countries over time suggests that biology alone cannot fully explain these variations. This review examines the role of the social environment in understanding tobacco use behaviors and efforts to curb tobacco use at the population level. We conclude that the social environment plays a critical role in determining how innate biological factors involved in nicotine dependency actually get expressed at the population level. Tobacco use as reflected in population trends is seen as the product of the interaction of agent, host, and environmental factors. Government policies are seen as an important modifiable environmental influence that can alter how tobacco products are designed and marketed (agent factors) and how consumers perceive the risks and benefits of smoking (host factors). Evidence suggests that synergy is gained when tobacco control interventions directed at agent, host, and environmental factors are implemented together.

Citation

Hammond, D., Kin, F., Prohmmo, A., Kungskulniti, N., Lian, T.Y., Sharma, S.K., Sirirassamee, B., Borland, R., Fong, G.T. (2008). Patterns of smoking among adolescents in Malaysia and Thailand: Findings from the International Tobacco Control Southeast Asia Survey. Asia-Pacific Journal of Public Health, 20(3), 193-203.

Abstract

At present, 70% of the world's 1.1 billion smokers are in developing countries, with over 50% in Asia alone. The current study examined patterns of youth smoking in Thailand and Malaysia. Respondents were 2002 youths between the ages of 13 and 17 from Thailand (n = 1000) and Malaysia (n = 1002). Respondents were selected using a multistage cluster sampling design and surveyed between January 2005 and March 2005. Approximately 3% of youth between the ages of 13 and 17 were current smokers, with an additional 10% to 12% reporting experimental smoking. Males were between 7 and 15 times more likely to report smoking behavior than females. Less than 1% of females respondents in either country met the criteria for current smoking, and less than 5% met the criteria for experimental smoking. In contrast, more than 50% Thai males and approximately one-third of Malaysian males aged 17 met the criteria for either experimental or current smoking.

Citation

Borland, R., Yong, H.H., Balmford, J., Fong, G.T., Zanna, M.P., Hastings, G. (2009). Do risk-minimizing beliefs about smoking inhibit quitting? Findings from the International Tobacco Control (ITC) Four Country Survey. Preventive Medicine, 19(2-3), 219-223.

Abstract

Objective: To replicate findings that risk-minimizing and self-exempting beliefs lower quit intentions, and to extend this by testing their capacity to prospectively predict smoking cessation.

Method: 13,324 adult (≥ 18 years) cigarette smokers from the USA, Canada, UK, and Australia from one of the first three waves (2002-2004) of the International Tobacco Control 4-Country survey were employed for the predictive analysis where beliefs measured in one wave (1-3) of a cohort were used to predict cessation outcomes in the next wave (2-4).

Results: Both types of belief were negatively associated with both intention to quit in the same wave and making a quit attempt at the next wave. When taken together and controlling for demographic factors, the risk-minimizing beliefs continued to be predictive, but the self-exempting belief was not. Some of the effects of risk-minimizing beliefs on quit attempts seem to be independent of intentions, but not consistently independent of other known predictors. There were no consistent predictive effects on sustained cessation among those who made attempts to quit for either measure.

Conclusions: Countering risk-minimizing beliefs may facilitate increased quitting, but this may not be so important for self-exempting beliefs.

Citation

Borland, R., Yong, H.H., Wilson, N., Fong, G.T., Hammond, D., Cummings, K.M., Hosking, W., McNeill, A. (2009). How reactions to cigarette packet health warnings influence quitting: Findings from the ITC Four Country Survey. Addiction, 104(4), 669-675.

Abstract

Objectives: To examine prospectively the impact of health warnings on quitting activity.

Design: Five waves (2002–06) of a cohort survey where reactions to health warnings at one survey wave are used to predict cessation activity at the next wave, controlling for country (proxy for warning differences) and other factors. These analyses were replicated on four wave-to-wave transitions.

Setting and participants: Smokers from Australia, Canada, the United Kingdom and the United States. Samples were waves 1–2: n = 6525; waves 2–3: n = 5257; waves 3–4: n = 4439; and waves 4–5: n = 3993.

Measures: Warning salience, cognitive responses (thoughts of harm and of quitting), forgoing of cigarettes and avoidance of warnings were examined as predictors of quit attempts, and of quitting success among those who tried (1 month sustained abstinence), replicated across four wave-to-wave transitions.

Results: All four responses to warnings were independently predictive of quitting activity in bivariate analyses. In multivariate analyses, both forgoing cigarettes and cognitive responses to the warnings predicted prospectively making quit attempts in all replications. However, avoiding warnings did not add predictive value consistently, and there was no consistent pattern for warning salience. There were no interactions by country. Some, but not all, the effects were mediated by quitting intentions. There were no consistent effects on quit success.

Conclusions: This study adds to the evidence that forgoing cigarettes as a result of noticing warnings and quit-related cognitive reactions to warnings are consistent prospective predictors of making quit attempts. This work strengthens the evidence base for governments to go beyond the Framework Convention on Tobacco Control to mandate health warnings on tobacco products that stimulate the highest possible levels of these reactions.

Citation

Borland, R., Wilson, N., Fong, G.T., Hammond, D., Cummings, K.M., Yong, H.H., Hosking, W., Hastings, G., Thrasher, J.F., McNeill, A. (2009). Impact of graphic and text warnings on cigarette packs: Findings from four countries over five years. Tobacco Control, 18(5), 358-364.

Abstract

Objectives: To examine the impact of health warnings on smokers by comparing the short-term impact of new graphic (2006) Australian warnings with: (i) earlier (2003) United Kingdom larger text-based warnings; (ii) and Canadian graphic warnings (late 2000); and also to extend our understanding of warning wear-out.

Methods: The International Tobacco Control Policy Evaluation Survey (ITC Project) follows prospective cohorts (with replenishment) of adult smokers annually (five waves: 2002–2006), in Canada, United States, UK and Australia (around 2000 per country per wave; total n=17 773). Measures were of pack warning salience (reading and noticing); cognitive responses (thoughts of harm and quitting); and two behavioural responses: forgoing cigarettes and avoiding the warnings.

Results: All four indicators of impact increased markedly among Australian smokers following the introduction of graphic warnings. Controlling for date of introduction, they stimulated more cognitive responses than the UK (textonly) changes, and were avoided more, did not significantly increase forgoing cigarettes, but were read and noticed less. The findings also extend previous work showing partial wear-out of both graphic and text-only warnings, but the Canadian warnings have more sustained effects than UK ones.

Conclusions: Australia’s new health warnings increased reactions that are prospectively predictive of cessation activity. Warning size increases warning effectiveness and graphic warnings may be superior to text-based warnings. While there is partial wear-out in the initial impact associated with all warnings, stronger warnings tend to sustain their effects for longer. These findings support arguments for governments to exceed minimum FCTC requirements on warnings.

Citation

Jiang, Y., Fong, G.T., Li, Q., Hammond, D., Quah, A.C.K., Yang, Y., Driezen, P., Yan, M. (2009). Evaluation of the effectiveness of health warnings on cigarette packs in China, 2008 (Language: Chinese). Chinese Journal of Health Education, 25(6), 411-430.

Abstract

Objective: To evaluate the effectiveness of health warnings on cigarette packs among Chinese residents.

Methods: 1169 individuals, including adult smokers, adult non-smokers and youth, balanced on gender, were selected from Bejing, Shanghai, Kunming, Yinchuan cities. The participants rated and ranked 10 real-size photographs of cigarette packs with a health warning. In addition to the two Chinese text warnings (one old and one new), there were 4 Chinese versions health warnings from foreign countries and the same 4 warnings with the picture removed.

Results: Regarding the effectiveness of motivating smokers to quit and convincing youth not to start smoking, the picture warnings were consistently ranked or rated in the top positions, followed by the 4 foreign text-only warnings. The old Chinese text warnings were consistently ranked or rated in the bottom. Results were very consistent across subject groups, cities and gender.

Conclusions: The new Chinese warning gained a small enhancement in term of effectiveness. It is necessary to use powerful health warnings on cigarette packs following the Article 11 of Framework Convention on Tobacco Control to improve the effectiveness of the communication of health harm knowledge to the publics.

Keywords: Cigarette package; Health warning; Health knowledge

Citation

Feng, G., Jiying, X., Liang, B., Jiang, Y., Yang, Y., Li, Q. (2009). Analysis on factors associated with intention to quit smoking of adult smokers in six cities of China (Language: Chinese). Chinese Journal of Prevention and Control of Chronic Diseases, 17(5), 476-478.

Abstract

Background: Over 350 million smokers live in China, and this represents nearly one-third of the smoking population of the world. Smoking cessation is critically needed to help reduce the harms and burden caused by smoking-related diseases. It is therefore important to identify the determinants of quitting and of quit intentions among smokers in China. Such knowledge would have potential to guide future tobacco control policies and programs that could increase quit rates in China.

Objective: To identify the correlates of intentions to quit smoking among a representative sample of adult smokers in six cities in China.

Methods: Data from wave 1 (2006) of the International Tobacco Control (ITC) Policy Evaluation Project China Survey, a face-to-face survey of adult Chinese smokers in six cities: Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan, was analysed. Households were sampled using a stratified multistage design. About 800 smokers were surveyed in each selected city (total n=4815).

Results: Past quit attempts, duration of past attempts, Heaviness of Smoking Index (HSI), outcome expectancy of quitting, worry about future health and overall opinion of smoking were found to be independently associated with intentions to quit smoking, but demographic characteristics were not.

Conclusions: The determinants of quit intentions among smokers in China are fairly similar to those found among smokers in Western countries, despite the fact that interest in quitting is considerably lower among Chinese smokers. Identifying the determinants of quit intentions provides possibilities for shaping effective policies and programs for increasing quitting among smokers in China.

Citation

Fong, G.T., Hammond, D., Hitchman, S.C. (2009). The impact of pictures on the effectiveness of tobacco warnings. Bulletin of the World Health Organization, 87(8), 640-643.

Abstract

Cigarette packages in most countries carry a health warning; however, the position, size and general strength of these warnings vary considerably across jurisdictions.1 Article 11 of the WHO Framework Convention on Tobacco Control (FCTC) and the Article 11 Guidelines adopted at the Third Conference of the Parties in November 2008 have put the spotlight on the inclusion of pictures on tobacco package health warnings. Beginning with Canada in 2001, 28 countries have introduced pictorial warnings and many other countries are in the process of drafting regulations for pictorial warnings (Box 1 and Box 2). This paper presents a brief review of the research studies that support pictorial warnings, reviewed in greater depth by Hammond and by the International Tobacco Control (ITC) Policy Evaluation Project.

Citation

Herd, N., Borland, R. (2009). The natural history of quitting smoking: Findings from the International Tobacco Control (ITC) Four Country Survey. Addiction, 104 (12), 2075-2087.

Abstract

Aims: To describe the long-term natural history of a range of potential determinants of relapse from quitting smoking.

Design setting and participants: A survey of 2502 ex-smokers of varying lengths of time quit recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, United Kingdom, United States) across five annual waves of surveying.

Measurements: Quitters were interviewed by telephone at varying durations of abstinence, ranging from 1 to 1472 days (about 4 years) post-quitting. Smoking-related beliefs and experiences (i.e. urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) were included in the survey.

Findings: Most theorized determinants of relapse changed over time in a manner theoretically associated with reduced risk of relapse, except most notably the belief that smoking controls weight, which strengthened. Change in these determinants changed at different rates: from a rapidly asymptoting log function to a less rapidly asymptoting square-root function.

Conclusions: Variation in patterns of change across time suggests that the relative importance of each factor to maintaining abstinence may similarly vary.

Citation

Herd, N., Borland, R., Hyland, A. (2009). Predictors of smoking relapse by duration of abstinence: Findings from the International Tobacco Control (ITC) Four Country Survey. Addiction, 104(12), 2088-2099.

Abstract

Aim: To explore predictors of smoking relapse and how predictors vary according to duration of abstinence.

Design, setting and participants: A longitudinal survey of 1296 ex-smokers recruited as part of the International Tobacco Control (ITC) Four Country Survey (Australia, Canada, United Kingdom and United States).

Measurements: Quitters were interviewed by telephone at varying durations of abstinence (from 1 day to approximately 3 years) and then followed-up approximately 1 year later. Theorized predictors of relapse (i.e. urges to smoke; outcome expectancies of smoking and quitting; and abstinence self-efficacy) and nicotine dependence were measured in the survey.

Findings: Relapse was associated with lower abstinence self-efficacy and a higher frequency of urges to smoke, but only after the first month or so of quitting. Both these measures mediated relationships between perceived benefits of smoking and relapse. Perceived costs of smoking and benefits of quitting were unrelated to relapse.

Conclusions: Challenging perceived benefits of smoking may be an effective way to increase abstinence self-efficacy and reduce frequency of urges to smoke (particularly after the initial weeks of quitting), in order to reduce subsequent relapse risk.

Citation

Hosking, W., Borland, R., Yong, H.H., Fong, G.T., Zanna, M.P., Laux, F., Thrasher, J.F., Lee, W.B., Sirirassamee, B., Omar, M. (2009). The effects of smoking norms and attitudes on quitting intentions in Malaysia, Thailand and four western nations: A cross-cultural comparison. Psychology & Health, 24(1), 95-107.

Abstract

This research investigated the influence of smoking attitudes and norms on quitting intentions in two predominantly collectivistic countries (Malaysia and Thailand) and four predominantly individualistic Western countries (Canada, USA,UK and Australia). Data from the International Tobacco Control Project (N¼13,062) revealed that higher odds of intending to quit were associated with negative personal attitudes in Thailand and the Western countries, but not in Malaysia; with norms against smoking from significant others in Malaysia and the Western countries, but not in Thailand; and with societal norms against smoking in all countries. Our findings indicate that normative factors are important determinants of intentions, but they play a different role in different cultural and/or tobacco control contexts. Interventions may be more effective if they are designed with these different patterns of social influence in mind.

Citation

Hyland, A., Hassan, L.M., Higbee, C., Boudreau, C., Fong, G.T., Borland, R., Cummings, K.M., Yan, M., Thompson, M.E., Hastings, G. (2009). The impact of smokefree legislation in Scotland: Results from the Scottish ITC Scotland/UK longitudinal surveys. European Journal of Public Health, 19(2), 198-205.

Abstract

Background: To evaluate how Scotland's smokefree law impacted self-reported secondhand smoke (SHS) exposure in hospitality venues, workplaces and in people's homes. In addition, we examine changes in support for the law, pub and restaurant patronage, smoking cessation indicators and whether any observed changes varied by socioeconomic status.

Methods: A quasi-experimental longitudinal telephone survey of nationally representative samples of smokers and non-smokers interviewed before the Scottish law (February to March 2006) and 1 year later after the law (March 2007) in Scotland (n = 705 smokers and n = 417 non-smokers) and the rest of the UK (n = 1027 smokers and n = 447 non-smokers) where smoking in public places was not regulated at the time.

Results: Dramatic declines in the observance of smoking in pubs, restaurants and workplaces were found in Scotland relative to the rest of the UK. The change in the percent of smokers reporting a smokefree home and number of cigarettes smoked inside the home in the evening was comparable in Scotland and the rest of the UK. Support for smokefree policies increased to a greater extent in Scotland than in the rest of the UK. Self-reported frequency of going to pubs and restaurants was generally comparable between Scotland and the rest of the UK; however, non-smokers in Scotland were more likely to frequent pubs more often. No differences in smoking cessation indicators were observed between countries.

Conclusion: The Scottish smokefree law has been successful in decreasing secondhand smoke exposure while causing none of the hypothesized negative outcomes.

Citation

Kahler, C.W., Borland, R., Hyland, A., McKee, S., Thompson, M.E., Cummings, K.M. (2009). Alcohol consumption and quitting smoking in the International Tobacco Control (ITC) Four Country Survey. Drug and Alcohol Dependence, 100(3), 214-220.

Abstract

Although greater alcohol consumption has been associated with decreased odds of quitting smoking in prospective studies, the aspects of drinking most strongly associated with quitting have not been fully explored and examination of potential confounder variables has been limited. Further studies are needed to inform efforts to enhance smoking cessation among the substantial portion of smokers who drink alcohol. The present study examines (a) drinking frequency, average weekly quantity of alcohol consumption, and frequency of heavy drinking as prospective predictors of quit smoking behaviors, (b) difference across countries in this prediction, and (c) third variables that might account for the association between alcohol consumption and quitting smoking. Data were drawn from the International Tobacco Control Four Country Survey, a prospective cohort study of smokers in Australia, Canada, the UK, and the US. A total of 4,831 participants provided alcohol data at one study wave and were re-interviewed 1 year later. Individuals who drank heavily (4+/5+ drinks for women and men, respectively) more than once a week had significantly lower rates of quitting smoking than all other participants, in part due to the fact that a significantly lower proportion of those making a quit attempt remained quit for more than one month at follow-up. The role of frequent heavy drinking did not differ by country or sex and was not accounted for by demographics, smoking dependence, or attitudes regarding quitting smoking. Neither drinking frequency nor weekly quantity of consumption showed robust associations with quitting behaviors. Results indicate further study of interventions to address heavy drinking among smokers is warranted.

Citation

McKee, S., Higbee, C., O'Malley, P.M., Hassan, L.M., Borland, R., Cummings, K.M., Hastings, G., Fong, G.T., Hyland, A. (2009). Longitudinal evaluation of smoke-free Scotland on pub and home drinking behavior: Findings from the International Tobacco Control Policy Evaluation Project. Nicotine & Tobacco Research, 11(6), 619-626

Abstract

Introduction: On 26 March 2006, Scotland implemented a smoke-free policy prohibiting smoking in indoor public venues, including bars and pubs. Drinking and smoking are highly associated behaviors, so we evaluated whether the regulations would decrease drinking behavior among smokers in public venues. We further assessed whether this effect would be more pronounced in heavier drinkers and whether decreases in drinking behavior in pubs would be offset by increased drinking in the home.

Methods: Participants (N = 1,059) were adult smokers and nonsmokers from Scotland and from the rest of the United Kingdom, which did not have comprehensive smoke-free policies during the study period. Data were collected using a random-digit-dialed telephone survey from February to March 2006, just prior to the policy implementation in Scotland. Follow-up surveys were conducted in March 2007. Using baseline data, we categorized participants as abstainers, moderate drinkers, or heavy drinkers.

Results: Overall, results demonstrated that drinking behavior did not change significantly in Scotland compared with the rest of the United Kingdom following implementation of the smoke-free policy in Scotland. However, planned comparisons examining mean changes in drinks consumed in pubs or bars following the legislation demonstrated that the smoke-free legislation was associated with reduced drinking behavior in pubs and bars among moderate- and heavy-drinking smokers in Scotland. These moderate- and heavy-drinking Scottish smokers also reduced their pub attendance following policy implementation.

Discussion: The smoke-free Scottish law did not increase drinking in the home. These findings suggest that smoke-free policies may have additional public health benefits for those at greater risk for alcohol-related health problems.

Citation

Ross, H., Driezen, P., Sirirassamee, B., & Kin, F. (2009). Cigarette purchasing behaviour in Thailand and Malaysia: comparative analysis of a semi-monopolistic and a free-market structure. Global public health, 4(6), 588–599. https://doi.org/10.1080/17441690903072204

Abstract

A wide range of cigarette prices can undermine the impact of tobacco tax policy when smokers switch to cheaper cigarettes instead of quitting. In order to better understand this behaviour, we study socio-economic determinants of price/brand choices in two different markets: a semimonopolistic market in Thailand and a competitive market in Malaysia. The hypothesis that the factors affecting the price/brand choice are different in these two markets is analysed by employing a 2005 survey among smokers. This survey provides a unique perspective on market characteristics usually described only in business reports by the tobacco industry. We found that smokers in Thailand have fewer opportunities to trade down to save money on cigarettes, but pay lower prices than smokers in Malaysia, despite Thailand’s higher tax rate. The Malaysian market, on the other hand, offers many possibilities to shop around for cheaper cigarettes. Higher income and education increase the price paid per cigarette in both countries, but the impact of these factors is larger in Malaysia. This has implications for sensitivity to cigarette prices. Using tax policy alone should be a more effective tobacco control measure in Thailand as compared to Malaysia. The effectiveness of a tax increase in Malaysia can be improved by adding programmes focusing on smoking cessation among low-income/low-educated smokers.

Citation

Shahab, L., Cummings, K.M., Hammond, D., Borland, R., West, R., McNeill, A. (2009). The impact of changing nicotine replacement therapy licensing laws in the United Kingdom: Findings from the International Tobacco Control Four Country Survey. Addiction, 104(8), 1420-1427.

Abstract

Aim: To evaluate the impact of a new licence for some nicotine replacement therapy products (NRT) for cutting down to stop (CDTS) on changes in the pattern of NRT use.

Design: Quasi-experimental design comparing changes in NRT use across two waves of a population-based, replenished-panel, telephone survey conducted before and after the introduction of new licensing laws in the United Kingdom with changes in NRT use in three comparison countries (Australia, Canada and United States) without a licensing change.

Participants: A total of 7386 and 7013 smokers and recent ex-smokers participating in the 2004 and/or 2006/7 survey.

Measurements: Data were collected on demographic and smoking characteristics as well as NRT use and access. In order to account for interdependence resulting from some participants being present in both waves, generalized estimation equations with an exchangeable correlation matrix were used to assess within-country changes and linear and logistic regressions to assess betweencountry differences in adjusted analyses.

Findings: NRT use was more prevalent in the United Kingdom and increased across waves in all countries but nowave x country interaction was observed. There was no evidence that the licensing change increased the prevalence of CDTS or the use of NRT (irrespective of how it was accessed) for CDTS in the United Kingdom relative to comparison countries. There was also no evidence for a change in concurrent smoking and NRT use among smokers not attempting to stop in the United Kingdom relative to comparison countries.

Conclusion: The addition of the CDTS licence for some NRT products in the United Kingdom appears to have had very limited, if any, impact on NRT use in the first year after the licence change.

Citation

Sirirassamee, T., Sirirassamee, B., Jampaklay, A., Borland, R., Fong, G.T. (2009). Risk factors of tobacco use among Thai adolescents: Finding from International Tobacco Control Policy Survey Southeast Asia (ICT-SEA). Journal of the Medical Association of Thailand, 92(3), 4-8.

Abstract

To determine the risk factors of tobacco use among Thai adolescents. A cross-sectional study was conducted among 706 adolescents sampled from 5 regions of Thailand using stratified multistage sampling. Participants were asked to complete self-administered questionnaires about tobacco use and psychosocial factors. A logistic regression model of risk factors for tobacco use was estimated using backward stepping. The prevalence of smoking in Thai adolescent was 15 percent (27.8% in males, 2.3% in females). Older age (OR = 1.25, 95% CI = 1.02-1.51), number of close friend smoking (OR = 1.61, 95% CI = 1.35-1.93), number of older sibling smoking (OR = 1.44, 95% CI = 1.01-2.04), heavy alcoholic consumption (OR = 3.99, 95% CI = 1.87-8.49), low self-worth (OR = 3.16, 95% CI = 1.71-5.84) were risk factors of smoking in Thai adolescents. Females (OR = 0.10, 95% CI = 0.04-0.24), currently studying in school (OR = 0.33, 95% CI = 0.18-0.59) and religious beliefs guide actions (OR = 0.41, 95% CI = 0.22-0.77) were protective factors against smoking. Male adolescents are target group for tobacco control in Thailand. The strong correlation between smoking and alcoholic consumption indicate that anti-smoking campaign should be done in parallel with anti-alcohol campaign.

Citation

Thomson, G., Wilson, N. (2009). Public attitudes to laws for smoke-free private vehicles: A brief review. Tobacco Control, 18(4), 256-261.

Abstract

As smoke-free car policy is a frontier domain for tobacco control, attitudes to smoke-free private car laws are briefly reviewed. Medline and Google Scholar searches for the period up to midNovember 2008, from English language sources, were undertaken. Studies were included that contained data from national and subnational populations (eg, in states and provinces), but not for smaller administrative units, eg, cities or councils. Jurisdiction, sample size and survey questions were assessed. One reviewer conducted the data extraction and both authors conducted assessments. A total of 15 relevant studies (from 1988) were identified, set in North America, the UK and Australasia. The available data indicates that, for the jurisdictions with data, there is majority public support for laws requiring cars that contain children to be smoke free. There appears to be an increase over time in this support. In five surveys in 2005 or since (in California, New Zealand and Australia), the support from smokers was 77% or more. The high levels of public (and smoker) support for smokefree car laws found in the studies to date suggest that this can be a relatively non-controversial tobacco control intervention. Survey series on attitudes to such laws are needed, and surveys in jurisdictions where the issue has not been investigated to date.

Citation

Thrasher, J.F., Villalobos, V., Dorantes-Alonso, A., Arillo-Santillán, E., Cummings, K.M., O’Connor, R.J., Fong, G.T. (2009). Does the availability of single cigarettes promote or inhibit cigarette consumption? Perceptions, prevalence and correlates of single cigarette use among adult Mexican smokers. Tobacco Control, 18(6), 431-437.

Abstract

Background: Single cigarette use and its implications have rarely been studied among adults.

Objective: To assess perceptions, prevalence and correlates of single cigarette purchase behaviour and its relation to harm reduction.

Design: Focus group transcripts and cross-sectional data were analysed.

Setting and participants: Focus groups among convenience samples of adult smokers in two Mexican cities and a population-based sample of 1079 adult smokers from the International Tobacco Control Policy Evaluation Project in four Mexican cities.

Main outcome measures: Purchase of single cigarettes last time cigarettes were bought, frequency of purchasing single cigarettes in the previous month and intention to quit in the next 6 months.

Results: Focus group data indicated that smokers bought single cigarettes as a harm reduction strategy. Survey data indicated that 38% of participants purchased single cigarettes in the last month and 10% purchased them the last time they bought cigarettes, with more frequent consumption among young adults and those with lower income. Purchasing single cigarettes was independently associated with the frequency of using single cigarettes to reduce consumption and, less consistently, with the frequency of being cued to smoke after seeing single cigarettes for sale. Using single cigarettes to reduce consumption was positively associated with quit intention, whereas being cued to smoke by single cigarettes was negatively associated with quit intention.

Conclusions: Study results suggest that some adult Mexican smokers purchase single cigarettes as a method to limit, cut down on and even quit smoking. Nevertheless, promotion of the availability of single cigarettes as a harm reduction strategy could provide additional smoking cues that undermine quit attempts and promote youth smoking.