Adolescents' responses to cigarette advertisements: links between exposure,liking, and the appeal of smoking

OBJECTIVE—To evaluate adolescents'' responses to cigarette advertisements for different brands.DESIGN—Adolescents were shown one print advertisement for each of five cigarette brands (Camel, Marlboro, Kool, Benson & Hedges, and Lucky Strike). They indicated on a structured questionnaire how many times they had seen the advertisement (or one almost like it), how much they liked it, whether or not they thought it made smoking more appealing, and whether or not it made them want to smoke cigarettes of that brand.SETTING—Middle school and high school classrooms, seven schools in four states in the United States (New York, Pennsylvania, Ohio, and Texas). The classrooms were selected randomly within each school.PARTICIPANTS—534 adolescents in grades 6-12 (ages 11-18 years) from seven schools in four states, 54% female, 76% white.RESULTS—The advertisements for Camel and Marlboro were more likely than the advertisements for the other brands to be seen, to be liked, to be viewed as making smoking appealing, and to influence adolescents to want to smoke cigarettes of that brand. More than 95% of the adolescents had seen an advertisement featuring Joe Camel or the Marlboro Man at least once, and more than 50% had seen these advertisements six or more times. Nearly half believed that the Joe Camel advertisement makes smoking more appealing, and 40% believed that the Marlboro Man advertisement makes smoking more appealing. Adolescent smokers were more likely than non-smokers to believe that the advertisements for Camel and Marlboro make smoking more appealing.CONCLUSIONS—The advertisements most popular among adolescents are for two of the brands they are most likely to smoke—Marlboro and Camel. The results of the study are consistent with the view that certain cigarette advertisements enhance the appeal of smoking to many adolescents.     

Trends in adolescent smoking initiation in the United States: is tobacco marketing an influence?

OBJECTIVE: To compare recent trends in smoking initiation by adolescents with trends in inflation-adjusted cigarette pricing and tobacco marketing expenditures. DESIGN: We examined smoking initiation trends in demographic subgroups of adolescents aged 14-17 years during the decade 1979-1989. Data on cigarette pricing and tobacco marketing expenditures were adjusted for inflation and plotted over this same period. SETTING: Large population surveys, United States. SUBJECTS: 140,975 ever-smokers aged 17-38 when surveyed in 1992 or 1993, who reported on age of smoking initiation during the decade 1979-1989. MAIN OUTCOME MEASURE: Initiation rate was calculated as the number in an age group who reported starting to smoke regularly in a year, divided by the number of never-smokers at the start of the year. Trends were evaluated by linear and quadratic models. RESULTS: From 1979 to 1984, adolescent initiation rates decreased, but increased thereafter, particularly among males, whites, and those who, as adults, reported never having graduated from high school. Cigarette price increased throughout the decade as did tobacco marketing expenditures, especially for coupons, value-added items, and promotional allowances. CONCLUSION: Availability of cheaper cigarettes is not likely to be a cause of increased smoking initiation by adolescents. Although other influences cannot be ruled out, we suspect that the expanded tobacco marketing budget, with its increased emphasis on tactics that may be particularly pertinent to young people, affected adolescent initiation rates.


     

Industry sponsored anti-smoking ads and adolescent reactance: test of a boomerang effect

Objective

To examine whether adolescents'' exposure to youth smoking prevention ads sponsored by tobacco companies promotes intentions to smoke, curiosity about smoking, and positive attitudes toward the tobacco industry.

Design

A randomised controlled experiment compared adolescents'' responses to five smoking prevention ads sponsored by a tobacco company (Philip Morris or Lorillard), or to five smoking prevention ads sponsored by a non‐profit organisation (the American Legacy Foundation), or to five ads about preventing drunk driving.

Setting

A large public high school in California''s central valley.

Subjects

A convenience sample of 9th and 10th graders (n  =  832) ages 14–17 years.

Main outcome measures

Perceptions of ad effectiveness, intention to smoke, and attitudes toward tobacco companies measured immediately after exposure.

Results

As predicted, adolescents rated Philip Morris and Lorillard ads less favourably than the other youth smoking prevention ads. Adolescents'' intention to smoke did not differ as a function of ad exposure. However, exposure to Philip Morris and Lorillard ads engendered more favourable attitudes toward tobacco companies.

Conclusions

This study demonstrates that industry sponsored anti‐smoking ads do more to promote corporate image than to prevent youth smoking. By cultivating public opinion that is more sympathetic toward tobacco companies, the effect of such advertising is likely to be more harmful than helpful to youth.     

Impact of smoking images in magazines on the smoking attitudes and intentions of youth: an experimental investigation

Objective

To determine the effect of magazine incidental smoking imagery on youths'' smoking intentions.

Methods

A magazine was developed incorporating photographs of smokers (Smoking Magazine). A second version of the magazine (Non‐smoking Magazine) included these photographs with the tobacco paraphernalia digitally erased. Equal numbers of smokers and non‐smokers aged 14–17 years (n = 357) were randomly assigned to look through one version of the magazine and then asked a series of questions.

Results

Smokers made more unprompted mention of smoking imagery than non‐smokers after viewing Smoking Magazine (52% vs 34%; p<0.05). Smokers viewing Smoking Magazine were more likely to report an urge to smoke (54% vs 40%; p<0.05). Female non‐smokers who viewed Smoking Magazine were more likely than those who viewed Non‐smoking Magazine to state a future intention to smoke (13% vs 0%; p<0.05). Female smokers were more attracted to the male models appearing in Smoking Magazine than Non‐smoking Magazine (49% vs 24%; p<0.05) and the opposite was true for female non‐smokers (28% vs 52%; p<0.05). Female smokers were also marginally more likely to desire looking like the female models in Smoking Magazine (64% vs 46%; p = 0.06) but no difference was observed in the non‐smoking females (46% vs 46%). Male smokers and non‐smokers did not differ in their responses by magazine type.

Conclusions

Incidental positive smoking imagery in magazines can generate the same sorts of consumer effects attributed to advertising in general, including tobacco advertising. Sex specific results of our study may be explained by the choice of smoking images used.With a view to reducing tobacco related harm, a number of countries around the world have implemented comprehensive advertising and sponsorship bans of tobacco in accordance with the World Health Organization''s Framework Convention on Tobacco Control (FCTC). Even with comprehensive tobacco control legislation, loopholes remain that can be exploited by the tobacco industry to circumvent comprehensive advertising restrictions. For example, product placements in movies and television programmes popular with adolescents are a noted tactic of the tobacco industry.¹ Furthermore, incidental depictions of tobacco in popular media, although not necessarily instigated by the tobacco industry, can serve to counter restrictions on advertising. Smoking depictions within youth oriented advertisements for non‐tobacco products are common, being used as a device by advertisers to focus on the lifestyle and image of the user, rather than on the intrinsic value or merits of the product itself.² Incidental images of smoking are also common in editorial and feature components of youth oriented entertainment media, including movies, television, magazines and the internet. Although social determinants such as having parents, older siblings and peers who smoke are the best predictors of smoking initiation in youth,³ portrayals of smoking in popular media appear to contribute by presenting socially attractive images and inflating the perception of smoking prevalence.^2,4,5Studies consistently suggest that incidental smoking is depicted far more commonly than is normal within the actual population, and that the majority of depictions are associated with popular and desirable role models with positive attributes such as fame, attractiveness, sexiness, sophistication and glamour.^6,7,8 For instance an analysis of popular Hollywood movies in the late 1990s suggested that one in two heroes smoke, including 80% of leading male characters.⁸ In the early 1990s an audit of Australian youth oriented magazines suggested that photographs featuring smoking were “infrequent” (one depiction per 147 pages). An increase of 12% in smoking depictions was noted between 1990 and 1993 in the period after the introduction of the complete tobacco advertising ban but, as this increase was non‐significant, natural variation could not be discounted.⁹ However, a similar audit of magazines conducted a decade later suggested that far from being infrequent, depictions of smoking were commonplace: 96% of a sample of youth oriented magazines included at least one depiction of incidental smoking (average 3.5 per magazine; one per 50.3 pages), with 97% of these depictions being favourable.¹⁰ Although the methodologies differed between the two studies, it appears that the tobacco advertising ban in Australia was followed by an increase rather than decrease in prevalence of smoking portrayals in magazines.There is clear evidence that exposure to positive portrayals of smoking in movies and on television increases adolescents'' positive attitudes towards smoking, the likelihood of smoking initiation, and imitation of modelled smoking actions.^11,12 However, research investigating the impact of incidental portrayals of tobacco use in magazines is sparse. Amos and colleagues¹³ assessed adolescents'' perceptions of photographs of models using tobacco products and compared these to adolescents'' perceptions of identical photographs but with the tobacco paraphernalia digitally removed. They found that the presence of a cigarette affected how the model in a photograph was perceived: when tobacco products were present, models were associated with “drug taking,” “wildness” and being “depressed,” and to a lesser extent being “vain,” “tarty” and “posers.” Without the smoking paraphernalia the same models were perceived as being more “healthy,” “rich,” “nice,” “fashionable,” “slim” and “attractive.” Although traits such as “druggy,” “wild” and “tarty” may appear to be negative associations, smokers sampled in the study were found to be more drawn to such traits than non‐smokers, and were found to rate themselves less negatively in terms of these traits than non‐smokers. The authors concluded that although young smokers and non‐smokers associated the same attributes to the smoking models, smokers identified more strongly with these attributes than did non‐smokers, and hence the smoking imagery served to positively reinforce the self identity of young smokers. In a later complementary study,¹⁴ Amos and her colleagues conducted focus groups with young smokers and found that smoking imagery in magazines helped reinforce positive perceptions of smoking as attractive, sociable and reassuring thereby reinforcing young smokers'' own identities. Furthermore the lack of obvious vested interests in incidental smoking portrayals meant that such were potentially more powerful than tobacco advertising imagery.The present study aims to extend the studies of Amos and colleagues by using a randomised controlled trial to assess the impact of smoking images in magazines on smoking and non‐smoking youth, and particularly their intentions for future smoking. We hypothesised that positive smoking imagery in a youth oriented magazine would:

• lessen young smokers'' future intentions to quit;
• increase non‐smokers'' future intentions to take up smoking;
• increase young people''s perceptions of the prevalence of smoking;
• increase young smokers'' urge to smoke while reading the magazine; and
• increase young smokers'' positive perceptions of the depicted models but decrease young non‐smokers'' positive perceptions of the depicted models.

     

Tobacco interests or the public interest: 20 years of industry strategies to undermine airline smoking restrictions

Objectives

To understand the evolution of 20 years of tobacco industry strategies to undermine federal restrictions of smoking on aircraft in the United States.

Design

We searched and analysed internal tobacco industry records, public documents, and other related research.

Results

The industry viewed these restrictions as a serious threat to the social acceptability of smoking. Its initial efforts included covert letter‐writing campaigns and lobbying of the airline industry, but with the emergence of proposals to ban smoking, the tobacco companies engaged in ever increasing efforts to forestall further restrictions. Tactics to dominate the public record became especially rigorous. The industry launched an aggressive public relations campaign that began with the promotion of industry sponsored petition drives and public opinion surveys. Results from polling research that produced findings contrary to the industry''s position were suppressed. In order to demonstrate smoker outrage against a ban, later efforts included the sponsorship of smokers'' rights and other front groups. Congressional allies and industry consultants sought to discredit the science underlying proposals to ban smoking and individual tobacco companies conducted their own cabin air quality research. Faced with the potential of a ban on all domestic flights, the industry sought to intimidate an air carrier and a prominent policymaker. Despite the intensification of tactics over time, including mobilisation of an army of lobbyists and Congressional allies, the tobacco industry was ultimately defeated.

Conclusions

Our longitudinal analysis provides insights into how and when the industry changed its plans and provides public health advocates with potential counterstrategies.     

Tobacco industry litigation strategies to oppose tobacco control media campaigns

Objective

To document the tobacco industry''s litigation strategy to impede tobacco control media campaigns.

Methods

Data were collected from news and reports, tobacco industry documents, and interviews with health advocates and media campaign staff.

Results

RJ Reynolds and Lorillard attempted to halt California''s Media Campaign alleging that the campaign polluted jury pools and violated First Amendment rights because they were compelled to pay for anti‐industry ads. The American Legacy Foundation was accused of violating the Master Settlement Agreement''s vilification clause because its ads attacked the tobacco industry. The tobacco companies lost these legal challenges.

Conclusion

The tobacco industry has expanded its efforts to oppose tobacco control media campaigns through litigation strategies. While litigation is a part of tobacco industry business, it imposes a financial burden and impediment to media campaigns'' productivity. Tobacco control professionals need to anticipate these challenges and be prepared to defend against them.     

Reaching youth at the point of sale: cigarette marketing is more prevalent in stores where adolescents shop frequently

Objective: Although numerous studies describe the quantity and nature of tobacco marketing in stores, fewer studies examine the industry''s attempts to reach youth at the point of sale. This study examines whether cigarette marketing is more prevalent in stores where adolescents shop frequently. Design, setting, and participants: Trained coders counted cigarette ads, products, and other marketing materials in a census of stores that sell tobacco in Tracy, California (n = 50). A combination of data from focus groups and in-class surveys of middle school students (n = 2125) determined which of the stores adolescents visited most frequently. Main outcome measures: Amount of marketing materials and shelf space measured separately for the three cigarette brands most popular with adolescent smokers and for other brands combined. Results: Compared to other stores in the same community, stores where adolescents shopped frequently contained almost three times more marketing materials for Marlboro, Camel, and Newport, and significantly more shelf space devoted to these brands. Conclusions: Regardless of whether tobacco companies intentionally target youth at the point of sale, these findings underscore the importance of strategies to reduce the quantity and impact of cigarette marketing materials in this venue.     

Tobacco industry use of judicial seminars to influence rulings in products liability litigation

Objectives

This paper examines the tobacco industry''s efforts to influence litigation by sponsoring judicial seminars.

Methods

Thousands of internal tobacco documents were examined, including memos, reports, presentations, and newsletters. Connections to outside organisations were corroborated by examining tobacco industry financial records, budgets, and letters pledging funds. Facts about outside organisations were triangulated through examining their websites and publicly‐filed financial records, and verifying facts through their representatives'' statements in newspaper and law review articles.

Results

There are direct financial ties between the tobacco industry and groups that organise judicial seminars in an effort to influence jurisprudence, and judges who attend these seminars may be breaching judicial ethics either by not inquiring about the source of funding or by ignoring funding by potential litigants.

Conclusions

The tobacco industry''s attempts to clandestinely influence judges'' decisions in cases to which they are a party endangers the integrity of the judiciary.     

Patterns of smoking, risk factors for smoking, and smoking cessation among Vietnamese men in Massachusetts (United States)

OBJECTIVES—To measure the prevalence and patterns of, and risk factors for, smoking and other tobacco use among Vietnamese men in Massachusetts (United States).
METHODS—Data were obtained via a telephone interview of 774 Vietnamese men in 1994.
DESIGN—Cross-sectional survey administered via telephone in 1994.
SETTING—Massachusetts, United States.
SUBJECTS—Randomly selected Vietnamese men (n = 774).
MAIN OUTCOME MEASURES—Present and past use of tobacco products, knowledge and attitudes regarding tobacco, and risk factors for tobacco use. Results were compared with data from the Massachusetts general population.
RESULTS—Vietnamese men smoked at a rate 1.9 times that of the Massachusetts general men's rate (43% vs 24%). The smoking rate did not decrease with increasing length of residence in the United States. In a logistic regression, risk factors for current smoking were: age in the thirties; history of parental smoking; lower educational level; higher depression score; low level of exercise; lack of health insurance; and geographical origin from the south coast of Vietnam. Smoking cessation declined with increasing depression score. Most smokers (76%) had no plans to quit smoking.
CONCLUSIONS—Vietnamese men smoke at much higher rates than the general population, and are much less likely to be planning cessation. High rates of depression and sociocultural barriers to smoking cessation must be addressed in efforts to reduce tobacco use among this high-risk population.


Keywords: smoking cessation; tobacco use; Vietnamese     

Cigarette advertising in Mumbai, India: targeting different socioeconomic groups, women, and youth

Background: Despite a recent surge in tobacco advertising and the recent advertising ban (pending enforcement at the time of this study), there are few studies describing current cigarette marketing in India. This study sought to assess cigarette companies' marketing strategies in Mumbai, India.

Methods: A two week field study was conducted in Mumbai in September 2003, observing, documenting, and collecting cigarette advertising on billboards, storefronts and at point of sale along two major thoroughfares, and performing a content analysis of news, film industry, and women's magazines and three newspapers.

Results: Cigarette advertising was ubiquitous in the environment, present in news and in film magazines, but not in women's magazines or the newspapers. The four major advertising campaigns all associated smoking with aspiration; the premium brands targeting the higher socioeconomic status market utilised tangible images of westernisation and affluence whereas the "bingo" (low priced) segment advertisements invited smokers to belong to a league of their own and "rise to the taste" using intangible images. Women were not depicted smoking, but were present in cigarette advertisements—for example, a woman almost always accompanied a man in "the man with the smooth edge" Four Square campaign. Advertisements and product placements at low heights and next to candies at point of sale were easily accessible by children. In view of the iminent enforcement of the ban on tobacco advertisements, cigarette companies are increasing advertising for the existing brand images, launching brand extensions, and brand stretching.

Conclusion: Cigarette companies have developed sophisticated campaigns targeting men, women, and children in different socioeconomic groups. Many of these strategies circumvent the Indian tobacco advertising ban. Understanding these marketing strategies is critical to mimimise the exploitation of loopholes in tobacco control legislation.

     

Smoking,social class,and gender: what can public health learn from the tobacco industry about disparities in smoking?

Objective: To discover how the tobacco industry considers social class and gender in its efforts to market cigarettes in the USA, particularly to socially disadvantaged young women. Methods: A systematic on-line search of tobacco industry documents using selected keywords was conducted, and epidemiological data on smoking rates reviewed. Results: The two largest cigarette manufacturers in the USA consider "working class" young adults to be a critical market segment to promote growth of key brands. Through their own market research, these companies discovered that socially disadvantaged young women do not necessarily desire a "feminine" cigarette brand. Conclusions: Considering the tobacco industry''s efforts, alongside the persistent and growing disparities in cigarette smoking by social class, and the narrowing of differences in smoking by gender, it is concluded that additional tobacco control resources ought to be directed toward working class women.     

To what extent do parents strive to protect their children from environmental tobacco smoke in the Nordic countries? A population-based study

OBJECTIVE—To assess to what extent Nordic parents strive to protect their children from environmental tobacco smoke (ETS) at home.
DESIGN—A cross-sectional study using an anonymous questionnaire.
SUBJECTS AND SETTING—A stratified, random sample of 5500 households containing a child born during 1992, including 1500 households in Denmark and 1000 households in each of the countries of Finland, Iceland, Norway, and Sweden.
MAIN OUTCOME MEASURES—Smoking status of parents, prevalence and magnitude of weekly ETS exposure, rules regarding smoking in the home.
RESULTS—82% of current smokers reported having tried to change their smoking behaviour for the sake of their children. Of all parents who answered the questionnaire, 75% reported having introduced some rules to limit ETS in their home. In households where at least one parent smoked, 57% reported that children were exposed to ETS at home. Child exposure to ETS was most prevalent in single-parent households and in households in which parents had lower levels of education. However, these parents were not less likely than other smoking parents to report having tried to change their smoking behaviour for the sake of their children.
CONCLUSION—Environmental tobacco smoke at home is still a problem for many children in the Nordic countries. However, most smoking parents reported having made efforts to change their smoking behaviour for the sake of their children; and in approximately half of all households containing at least one daily smoker, parents reported protecting their children from ETS exposure in the home. Although actual exposure may be higher owing to possible under-reporting of ETS, our results indicate a general awareness in the Nordic countries of the potential negative effects of ETS on children.


Keywords: children; environmental tobacco smoke; homes     

Teen penalties for tobacco possession,use, and purchase: evidence and issues

A handful of empirical studies have related changes in youth smoking to popular laws that penalise tobacco possession, use, and purchase (PUP). In this paper, we review the literature and outline reasons why PUP laws may be unlikely to reduce youth smoking significantly at the population level. In theoretical terms, we argue that PUP laws lack important features required for punishment to be effective in changing behaviour. In practical terms, PUP transgressions seem difficult to detect. Conceptually, there is potential for PUP laws to undermine conventional avenues of discipline, such as the parent-child relationship and the school environment. Strategically, PUP laws may divert policy attention from effective tobacco control strategies, relieve the tobacco industry of responsibility for its marketing practices, and reinforce the tobacco industry's espoused position that smoking is for adults only. To assist further debate and discussion, we identify research issues requiring attention.     

Preferences and practices among renters regarding smoking restrictions in apartment buildings

Objective: This study assessed renters' preferences for official smoking policies in their buildings and their practices concerning restricting tobacco smoking in their apartments.

Design: Renters (n = 301) living in large apartment complexes in a suburb of Minneapolis, Minnesota, completed a mail survey.

Main outcome measures: The survey asked about the official smoking policies in place in their apartment buildings, their preferences for policies, whether they had smelled tobacco smoke coming into their apartments from without, and, if so, what they had done about it.

Results: The majority of non-smokers (79%) preferred that their building be smoke-free. When asked to identify the current smoking policy in their buildings, residents disagreed substantially. Most renters (60%) reported smoke-free policies in their own apartments and another significant proportion (23%) restricted smoking to certain areas or occasions or persons. 75% thought that enforcing a smoke-free policy for guests would not be difficult. 53% of those in non-smoking households had smelled tobacco smoke in their apartments; most of these reported being bothered by it. However, very few complained to the building owner or manager (15.5%) or to the smoker (6.9%).

Conclusions: The majority of non-smokers preferred that their buildings be smoke-free. A failure to report problems to apartment managers might be an impediment to instituting smoke-free policies in apartment buildings. The considerable disagreement among residents within apartment complexes about the current official smoking policy in their buildings suggests that policies are lacking or are not well communicated.

     

Philip Morris's website and television commercials use new language to mislead the public into believing it has changed its stance on smoking and disease

Objectives

This paper analyses Philip Morris''s evolving website and the legal strategies employed in its creation and dissemination.

Methods

Internal tobacco documents were searched and examined and their substance verified and triangulated using media accounts, legal and public health research papers, and visits to Philip Morris''s website. Various drafts of website language, as well as informal discussion of the website''s creation, were located in internal Philip Morris documents. I compared website statements pertaining to Philip Morris''s stance on cigarette smoking and disease with statements made in tobacco trials.

Results

Philip Morris created and disseminated its website''s message that it agreed that smoking causes disease and is addictive in an effort to sway public opinion, while maintaining in a litigation setting its former position that it cannot be proved that smoking causes disease or is addictive.

Conclusions

Philip Morris has not changed its position on smoking and health or addiction in the one arena where it has the most to lose—in the courtroom, under oath.     

Marketing to the marginalised: tobacco industry targeting of the homeless and mentally ill

Objectives: To describe the tobacco industry''s relationships with and influence on homeless and mentally ill smokers and organisations providing services to them. Methods: Analysis of internal tobacco industry documents and journal articles. Results: The tobacco industry has marketed cigarettes to the homeless and seriously mentally ill, part of its "downscale" market, and has developed relationships with homeless shelters and advocacy groups, gaining positive media coverage and political support. Discussion: Tobacco control advocates and public health organisations should consider how to target programmes to homeless and seriously mentally ill individuals. Education of service providers about tobacco industry efforts to cultivate this market may help in reducing smoking in these populations.     

The effectiveness of tobacco sales ban to minors: the case of Finland

Objective: To evaluate the effects of the 1977 and 1995 tobacco sales bans on tobacco acquisition of minors. Design: Biennial nationwide postal surveys (adolescent health and lifestyle survey, AHLS) in 1977–2003; annual classroom surveys (school health promotion survey, SHPS) in 1996–2003. Setting and participants: Entire Finland—12, 14, 16, and 18 year olds (AHLS, n = 80 282); eighth and ninth graders (14–16 year olds) (SHPS, n = 226 681). Main outcome measures: Purchase of tobacco from commercial sources during the past month, purchase from different commercial (shop, kiosk, other outlet) and social sources, ease of buying tobacco, overall acquisition of tobacco products, daily smoking, tobacco experimenting. Results: Decrease in tobacco purchase from commercial sources was small and short term after 1977 but large and permanent after 1995: purchase rate among 14 year old smokers diminished from 90% to 67% in 2003, 16 year olds from 94% to 62%. Purchases in shops decreased most (14 year olds: from 39% to 14%; 16 year olds: from 76% to 27%); purchases in kiosks less. An increase was observed in obtaining tobacco from other outlets and friends (social sources). Only 2–3% of 14–16 year old smokers used commercial sources exclusively when obtaining tobacco. Daily smoking began to decrease after 2001, following an earlier decrease in those experimenting. No changes were observed among age groups not targeted by the ban. Conclusions: Legislation appears to have permanently changed tobacco sales practices and decreased purchases from commercial sources. Social sources need to be taken into account when controlling access to tobacco. Sales bans should be accompanied by other health promotion measures.     

Youth preferences for cigar brands: rates of use and characteristics of users

Objective: Youth use of cigars has increased in the USA. Understanding brand preference among youth could help explain the attraction to cigars, and develop prevention strategies. This study reports on youth characteristics associated with preferences for cigar brands. Design: Data are presented on 5006 students in grades 7–12 (ages 12–18 years) in classrooms administered the cigar use reasons evaluation (CURE), a questionnaire assessing alternative tobacco use (cigars, bidis, and kreteks). Setting: Twelve middle and high schools across Massachusetts. Main outcome measures: Preferred brands of cigars. Results: Cigar smoking was reported by 16.4% of the sample. The brands preferred by over 5% of cigar users were Phillies (overall prevalence: 31.0%, 95% confidence interval (CI) 27.9% to 34.3%), Black & Mild (12.3%, 95% CI 9.8% to 15.4%), Garcia y Vega (11.4%, 95% CI 9.3% to 13.8%), Swisher Sweets (9.6%, 95% CI 7.6% to 12.2%), Backwoods (6.1%, 95% CI 4.6% to 8.1%), and non-listed brands (16.4%, 95% CI 14.0% to 19.0%). Male cigar smokers were significantly more likely than females to prefer five brands: Backwoods, Dutch Masters, Garcia y Vega, Phillies, and Swisher Sweets, while females were more likely to prefer Black & Mild and non-listed brands. Brand preferences were also distinguished by self, friends'' and siblings'' tobacco use, race/ethnicity, parents'' education and cigar use, GPA (grade point average), college plans, and community type. Urban students were more likely to prefer Black & Mild; students whose parents smoke cigars preferred non-listed brands. Conclusions: Youth prefer certain brands, most notably Phillies. Particular brands are preferred by particular youth subgroups, raising the possibility of selective marketing toward these groups.     

An ethnographic study of tobacco control in hospital settings

Background

Tobacco control in hospital settings is characterised by a focus on protection strategies and an increasing expectation that health practitioners provide cessation support to patients. While practitioners claim to have positive attitudes toward supporting patient cessation efforts, missed opportunities are the practice norm.

Objective

To study hospital workplace culture relevant to tobacco use and control as part of a mixed‐methods research project that investigated hospital‐based registered nurses'' integration of cessation interventions.

Design

The study was conducted at two hospitals situated in British Columbia, Canada. Data collection included 135 hours of field work including observations of ward activities and designated smoking areas, 85 unstructured conversations with nurses, and the collection of patient‐care documents on 16 adult in‐patient wards.

Results

The findings demonstrate that protection strategies (for example, smoking restrictions) were relatively well integrated into organisational culture and practice activities but the same was not true for cessation strategies. An analysis of resources and documentation relevant to tobacco revealed an absence of support for addressing tobacco use and cessation. Nurses framed patients'' tobacco use as a relational issue, a risk to patient safety, and a burden. Furthermore, conversations revealed that nurses tended to possess only a vague awareness of nicotine dependence.

Conclusion

Overcoming challenges to extending tobacco control within hospitals could be enhanced by emphasising the value of addressing patients'' tobacco use, raising awareness of nicotine dependence, and improving the availability of resources to address addiction issues.