The Association of Southeast Asian Nations (ASEAN) has made tobacco use prevention a primary health issue. All ASEAN countries except Indonesia have ratified the World Health Organization Framework Convention on Tobacco Control (WHO FCTC), the world’s first public health treaty on tobacco control.
Global Youth Tobacco Survey (GYTS) data were collected from representative samples of students in school grades associated with ages 13–15 in Cambodia, Indonesia, Laos (Vientiane), Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam (Hanoi).
Current cigarette smoking ranged from less than 5% (Vietnam and Cambodia) to 20.2% in Malaysia. Current use of tobacco products other than cigarettes was less than 10% in all countries. Boys were significantly more likely than girls to smoke cigarettes or use other tobacco products. Exposure to second-hand smoke in public places was greater than 50%, direct pro-tobacco advertising exposure was greater than 75% and over 10% of students were exposed to indirect advertising. Over 60% of students who currently smoked cigarettes wanted to stop, but 80% who tried to quit in the year prior to the survey failed.
Efforts to reduce the current and projected harm caused by tobacco use in the ASEAN countries are urgently needed. ASEAN countries need to expand their national comprehensive tobacco prevention and control programs and enforce those laws already passed. Without this effort little reduction can be expected in the burden of chronic diseases and tobacco-related mortality.
The Australian National Tobacco Campaign (NTC) was an intensive mass media anti-smoking campaign, the first phase of which commenced in 1997, cost around $A9 million, and reduced smoking prevalence by 1.4%.
To assess the cost-effectiveness of phase one of the NTC, which ran from June to November 1997.
The quit benefits model (QBM), a Markov-cycle simulation model was used to predict the benefits of smoking cessation for the estimated 190 000 quitters from the time of quitting until death, censored at age 85 years. Measures of effectiveness were cases of lung cancer, acute myocardial infarction (AMI), stroke and chronic obstructive pulmonary disease (COPD) avoided; deaths prevented, and life-years and quality-adjusted life-years (QALYs) gained. The savings in healthcare costs through prevention of the four specified smoking-associated diseases were estimated. Future costs, life-years and QALYS were discounted at 3% per year.
The QBM predicted that the NTC avoided over 32 000 cases of COPD, 11 000 cases of AMI, 10 000 cases of lung cancer, and 2500 cases of stroke. Prevention of around 55 000 deaths, gains of 323 000 life-years and 407 000 QALYs, and healthcare cost savings of $A740.6 million were predicted. The NTC was therefore both cost saving and effective.
As well as reducing smoking prevalence, the NTC was unequivocally cost-effective.
Tobacco industry documents have revealed marketing plans specifically to reach lesbian, gay and bisexual (LGB) populations. Research supports a causal linkage between receptivity and exposure to tobacco industry marketing and tobacco use uptake among adolescents. Pro-tobacco messages may diminish the effectiveness of tobacco control activities and contribute to the high smoking prevalence among LGB populations.
To compare receptivity and exposure to tobacco industry marketing between LGB and heterosexual populations.
Nearly 400 gay or bisexual men and more than 600 lesbian or bisexual women were identified in the 2003–2006 Washington State Behavioral Risk Factor Surveillance System (BRFSS), a state-wide, population-based telephone survey of adults. The BRFSS included questions measuring receptivity and exposure to tobacco industry marketing. Multiple logistic regression models stratified by gender were used to assess differences for lesbians, gays and bisexuals separately, in comparison to their heterosexual counterparts.
As expected, smoking prevalence was higher among LGB populations than among heterosexuals. After adjustment for demographic differences and smoking status, gay and bisexual men reported more exposure to tobacco industry marketing (free sample distribution) than straight men, but were equally receptive to it. Lesbian and bisexual women were more receptive to and reported more exposure to tobacco industry marketing than straight women.
LGB communities, especially lesbian and bisexual women, appear to be effectively targeted by tobacco industry marketing activities. Strategies to limit tobacco industry marketing, and increase individuals’ resistance to marketing, may be critical to reducing smoking among LGB populations.
A key element of Philip Morris’s (PM’s) corporate social responsibility initiatives is "societal alignment", defined as "strategies and programs to meet society’s expectations of a responsible tobacco company". This study explored the genesis and implementation of Philip Morris' (PM) societal alignment efforts.
The study retrieved and analysed approximately 375 previously undisclosed PM documents now available electronically. Using an iterative process, the study categorised themes and prepared a case analysis.
Beginning in 1999, PM sought to become "societally aligned" by identifying expectations of a responsible tobacco company through public opinion research and developing and publicising programs to meet those expectations. Societal alignment was undertaken within the US and globally to ensure an environment favourable to PM’s business objectives. Despite PM’s claims to be "changing", however, societal alignment in practice was highly selective. PM responded to public "expectations" largely by retooling existing positions and programs, while entirely ignoring other expectations that might have interfered with its business goals. It also appears that convincing employees of the value and authenticity of societal alignment was difficult.
As implementation of the Framework Convention on Tobacco Control proceeds, tobacco control advocates should closely monitor development of such "alignment" initiatives and expose the motivations and contradictions they reveal.
The illicit tobacco trade results in huge losses of revenue to governments, estimated at $US40–50 billion in 2006, and in increased consumption and thus health problems because it makes tobacco available more cheaply. On 20 October 2008 the second meeting of the International Negotiating Body (INB2) on the illicit trade protocol of WHO’s Framework Convention on Tobacco Control (FCTC) will discuss measures to tackle the illicit trade in tobacco products.
This paper presents the experience over the last decade of three countries, Italy, Spain and the United Kingdom, which shows that tobacco smuggling can be successfully tackled.
The evidence strongly suggests that the key to controlling smuggling is controlling the supply chain, and that the supply chain is controlled to a great extent by the tobacco industry.
Research on human emotion shows that pictures drive the activity of specialised brain networks affecting attitude and behaviour. Pictorial warnings on cigarette packages are considered one of the most effective ways to convey information on the health consequences of smoking. However, few studies have evaluated the effectiveness of warning labels to elicit avoidance of smoking.
To investigate the impact of pictorial health warnings conveyed by the Brazilian tobacco control programme through a well-established psychometric tool designed for studies on emotion and behaviour.
Graphic Brazilian cigarette warnings labels were evaluated. They consisted of the two sets of warning pictures displayed in 2002–4 (n = 9) and 2004–8 (n = 10). Pleasant, unpleasant and neutral pictures selected from a standard catalogue were used as controls. Undergraduate students (n = 212, 18% smokers) evaluated the emotional content of each picture in two affective dimensions: hedonic valence and arousal. Participants were not provided with the sources of distinction between control and warning pictures.
The judgements of hedonic content of the warning pictures ranged from neutral to very unpleasant. None was classified as highly arousing. Smokers judged warning pictures representing people smoking significantly more pleasant than pictures without smoking scenes, and significantly more so than non-smokers. No significant differences between smokers and non-smokers were found for warning pictures without these smoking scenes.
Previous studies have shown that the most threatening and arousing pictures prompt the greatest evidence of defensive activation. Emotional ratings of Brazilian warning pictures described them as unpleasant but moderately arousing. To intensify avoidance of the packages, future graphic warnings should therefore generate more arousal. The ratings for the Brazilian warning pictures indicated that, except for those depicting people smoking, judgements by smokers and non-smokers were similar, suggesting a potential applicability in both prevention and cessation. Smoking cues, however, should be avoided.
Reasons for quitting smoking and triggers that finally precipitate a quit attempt are not necessarily the same thing. We sought to assess variation in reported triggers of attempts to stop smoking as a function of age, gender and socioeconomic status.
Cross-sectional household survey in England. A total of 2441 smokers and ex-smokers aged 16 and over, who reported making at least one serious quit attempt in the last 12 months, were recruited. The main outcome measure was participants’ responses to the question "What finally triggered your most recent quit attempt?". Respondents selected from a list of options or specified a trigger not on the list.
In the event, smokers typically reported as triggers similar factors as have previously been reported as "reasons". "A concern about future health problems" (28.5%) was the most commonly cited trigger followed by "health problems I had at the time" (18%) and then "a decision that smoking was too expensive" (12.2%). The most common external trigger was advice from a health professional (5.6%). Future health concern was more common in smokers with higher socioeconomic status (SES), whereas cost and current health problems were more often cited by lower SES smokers. Younger smokers were more likely to report their quit attempt being triggered by a TV advertisement while older smokers were more likely to cite advice from a health professional. Concern about future health problems was cited less often by 16 to 24 year olds and those aged 65+ than those aged 25 to 64 years.
There are significant differences in reported triggers for quit attempts as a function of sociodemographic factors. Most notably, smokers with higher SES are more likely to report concern about future health whereas those from lower SES are more likely to cite cost and current health problems.
Cigarette packaging is a key marketing strategy for promoting brand image. Plain packaging has been proposed to limit brand image, but tobacco companies would resist removal of branding design elements.
A 3 (brand types) x 4 (degree of plain packaging) between-subject experimental design was used, using an internet online method, to expose 813 adult Australian smokers to one randomly selected cigarette pack, after which respondents completed ratings of the pack.
Compared with current cigarette packs with full branding, cigarette packs that displayed progressively fewer branding design elements were perceived increasingly unfavourably in terms of smokers’ appraisals of the packs, the smokers who might smoke such packs, and the inferred experience of smoking a cigarette from these packs. For example, cardboard brown packs with the number of enclosed cigarettes displayed on the front of the pack and featuring only the brand name in small standard font at the bottom of the pack face were rated as significantly less attractive and popular than original branded packs. Smokers of these plain packs were rated as significantly less trendy/stylish, less sociable/outgoing and less mature than smokers of the original pack. Compared with original packs, smokers inferred that cigarettes from these plain packs would be less rich in tobacco, less satisfying and of lower quality tobacco.
Plain packaging policies that remove most brand design elements are likely to be most successful in removing cigarette brand image associations.
The public receives mixed messages about the harmfulness of alternative tobacco products to cigarettes, and little is known about what present and potential users of these products actually think about their relative harmfulness.
In a nationally representative survey of 2415 Norwegian adolescents aged 16–20 years, participants were asked to rate the harmfulness of various available tobacco products and their own use of snus and cigarettes. A study was undertaken to examine how adolescents rate the relative harm of tobacco products in general, and snus and cigarettes in particular, and how this varies with age, gender and their own use of snus and smoking.
Cigarettes were generally rated as more harmful than snus, but 41% still rated snus as equally or more harmful than cigarettes. Male participants reported lower harm from all products than females. Being a snus user was associated with lower ratings of harm for snus, but being a smoker was not associated with reporting of harm for cigarettes.
Compared with the current scientific consensus, the participants overrated the harmfulness of snus and, as such, our results suggest a potential for changing peoples’ perceptions of the relative health risks of various tobacco products. To the extent that health information affects consumption, accurate information on relative risks may lead more people to choose snus over cigarettes.