Bhutan: the world's most advanced tobacco control nation?

Significant achievements in the area of tobacco control have been made in the kingdom of Bhutan in the Eastern Himalayas, following the initiation of several tobacco control activities     

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.     

Corporate social responsibility and the tobacco industry: hope or hype?

Corporate social responsibility (CSR) emerged from a realisation among transnational corporations of the need to account for and redress their adverse impact on society: specifically, on human rights, labour practices, and the environment. Two transnational tobacco companies have recently adopted CSR: Philip Morris, and British American Tobacco. This report explains the origins and theory behind CSR; examines internal company documents from Philip Morris showing the company's deliberations on the matter, and the company's perspective on its own behaviour; and reflects on whether marketing tobacco is antithetical to social responsibility.     

Out of the smokescreen II: will an advertisement targeting the tobacco industry affect young people's perception of smoking in movies and their intention to smoke?

Objective

To evaluate the effect of an antismoking advertisement on young people''s perceptions of smoking in movies and their intention to smoke.

Subjects/setting

3091 cinema patrons aged 12–24 years in three Australian states; 18.6% of the sample (n = 575) were current smokers.

Design/intervention

Quasi‐experimental study of patrons, surveyed after having viewed a movie. The control group was surveyed in week 1, and the intervention group in weeks 2 and 3. Before seeing the movie in weeks 2 and 3, a 30 s antismoking advertisement was shown, shot in the style of a movie trailer that warned patrons not to be sucked in by the smoking in the movie they were about to see.

Outcomes

Attitude of current smokers and non‐smokers to smoking in the movies; intention of current smokers and non‐smokers to smoke in 12 months.

Results

Among non‐smokers, 47.8% of the intervention subjects thought that the smoking in the viewed movie was not OK compared with 43.8% of the control subjects (p = 0.04). However, there was no significant difference among smokers in the intervention (16.5%) and control (14.5%) groups (p = 0.4). A higher percentage of smokers in the intervention group indicated that they were likely to be smoking in 12 months time (38.6%) than smokers in the control group (25.6%; p<0.001). For non‐smokers, there was no significant difference in smoking intentions between groups, with 1.2% of intervention subjects and 1.6% of controls saying that they would probably be smoking in 12 months time (p = 0.54).

Conclusions

This real‐world study suggests that placing an antismoking advertisement before movies containing smoking scenes can help to immunise non‐smokers against the influences of film stars'' smoking. Caution must be exercised in the type of advertisement screened as some types of advertising may reinforce smokers'' intentions to smoke.In the past decade, tobacco companies have devised increasingly innovative and aggressive strategies for attracting consumers.^1,2 Product placement in films popular with young people has been the focus of comment and criticism by numerous international health groups.Depictions of smoking are common in films³ and have decreased in recent decades.⁴ Sargent et al⁵ documented an overall increase in the depiction of smoking in films in the 1990s that seemed to coincide with restrictions in advertising.⁶ Lead characters portrayed as smokers are often likeable, rebellious, attractive and/or successful.⁷ Role models with such characteristics are often used in tobacco advertising.⁸ Escamilla et al⁹ analysed the portrayal of smoking in Hollywood films and found that smoking was highly prevalent in films featuring popular actresses.¹⁰ McIntosh et al¹¹ compared Hollywood''s depiction of smokers to real‐world demographics on smoking and found that smoking scenes in movies tend to ignore the negative consequences of smoking, a finding confirmed by Dalton et al¹² in 2002.There is mounting evidence linking Hollywood''s depiction of smoking in movies and adolescents'' attitudes to smoking and their smoking behaviour. Tickle et al¹³ showed that adolescents whose favourite movie stars use tobacco on screen are significantly more likely to be at a more advanced stage of smoking uptake and to have more favourable attitudes towards smoking than adolescents who choose non‐smoking stars. Studies^{14,15,16,17,18} provide even stronger evidence that viewing smoking in movies promotes smoking initiation among adolescents. A cohort study by Dalton et al¹⁹ in 2003 suggests that viewing smoking in movies strongly predicts whether or not adolescents initiate smoking and the effect increases significantly with greater exposure.Prominent researchers and public health advocates have called for action to reduce the impact of positive depictions of smoking in the media, including feature films screened in cinemas.²⁰A Californian study²¹ suggested that young people can be immunised against the influences of film stars smoking by showing a strong antismoking advertisement before those films that contain smoking scenes. A 2004 Australian study²² supported these findings. The findings of Pechmann and Shih²¹ and Edwards et al²² support the psychological Theory of Reasoned Action,^23,24 which states that the strength of a person''s intention to behave in a certain way is a function of attitudes towards the behaviour and the influence of general subjective norms on the behaviour. According to this theory, an antismoking advertisement may alter the positive attitudes towards smoking that are portrayed in movies and elicit more realistic normative perceptions of the practice of smoking. This should theoretically alter the viewer''s intention to smoke and subsequently reduce their likelihood of smoking in the future. The Elaboration Likelihood Model of Persuasion²⁵ suggests that attitude change can be either via the central route that utilises deliberate information processing to assess an issue or via the peripheral route that takes less effort and may even be subliminal. This model predicts that smoking scenes in movies influence young people via the peripheral route. An antismoking advertisement attempts to change attitudes through the central route that, according to the theory, is more enduring and more likely to lead to long‐term behavioural change.Cinema attendance and viewing films rated R under the US classification system increases exposure to onscreen depictions of smoking.²⁶ The majority of young people, including those of varied cultural background, attend the cinema on a regular basis.^27,28 A significant advantage in using this medium for an antismoking campaign is the potential to reach a large number of young people in a cost‐effective manner.^{21, 29}This paper evaluates the use of this approach in an intervention conducted in a real‐world cinema setting in Australia. The objective of the study was to evaluate the effect of an antismoking advertisement on young people''s perceptions of smoking in the following movie and their intention to smoke. It was hypothesised that when an antismoking advertisement is shown before a movie containing smoking scenes, viewers will be (1) less likely to approve of the smoking and (2) less likely to report an intention to smoke in the future. This study expands on the first real‐world cinema study of the effect of an antismoking advertisement on attitudes to smoking in movies and intention to smoke conducted by Edwards et al in 2004. It samples a larger, more geographically and culturally diverse population of both males and females with a broader age range. It also evaluates a very different type of antismoking advertisement that does not include the health effects of smoking or a quit message.     

What are the elements of the tobacco endgame?

The available literature on tobacco endgames tends to be limited to discussing means, targets and difficulties. This article offers additional ideas on the key elements of endgame strategies and the circumstances in which these are likely to be adopted and implemented. We suggest such strategies will include explicit plans, will define the nature of `the end of tobacco use/sale' and have target dates within 20 years. The likely circumstances for endgame strategy development include low (probably under 15% adult smoking) prevalence and/or rapid prevalence reductions, wide support and strong political leadership. Even with some or all these circumstances, opposition from business, internal government forces and international factors may influence results.     

Reducing social inequalities in smoking: can evidence inform policy? A pilot study

Data source: The Cochrane Library (2002/4).

Study selection: Systematic reviews of the effectiveness of community based tobacco control interventions, and all the primary studies included in one of these reviews.

Data extraction: Reviews and primary studies were assessed for intent to assess the social distribution of intervention effects, information about the social inclusiveness or targeting of interventions, baseline sociodemographic data collected on participants, and estimates of effect size stratified by sociodemographic variables.

Data synthesis: Only one review aimed to examine outcomes stratified by sex, age or socioeconomic status, and these aims were only achieved with respect to sex. Sociodemographic data about participants were frequently collected in primary studies, but not used to compare intervention effects between social groups.

Conclusions: There may be scope for using existing research more effectively to contribute to evidence based policy to reduce social inequalities in smoking—by explicitly seeking stratified outcome data in new systematic reviews, by re-analysing original datasets, and/or by meta-analysis of individual participant data.

     

Is smoking a communicable disease? Effect of exposure to ever smokers in school tutor groups on the risk of incident smoking in the first year of secondary school

OBJECTIVE: To estimate the effect of joining a first year secondary school tutor group with a high prevalence of ever smoking on the risk of incident smoking in schoolchildren. DESIGN: Cross-sectional questionnaire survey. SETTING: 10 randomly selected secondary schools in Nottinghamshire, UK. PARTICIPANTS: Pupils in years (grades) 7-11 (aged 11-16 years). MAIN OUTCOME MEASURE: Incident smoking in the first year of secondary education, defined as pupils who reported smoking their first cigarette during year 7. RESULTS: Of 6522 pupils (75% of those eligible) who completed the questionnaire, 17% were current smokers and 49% had ever smoked, of whom 23% had started smoking in year 7. Incident smoking in year 7 was more common in girls, in children with parents or siblings who smoke, and in more deprived children, and was independently increased in relation to the proportion of ever smokers in the year 7 tutor group joined by the child (adjusted odds ratio of incident smoking for a child joining a year 7 tutor group in the highest relative to the lowest quartile of ever smoking prevalence 1.45, 95% confidence interval (CI) 1.11 to 1.89). Exposure to ever smokers in year 7 tutor groups also accounted for most of the increased risk of incident smoking associated with socioeconomic deprivation. CONCLUSIONS: The risk of incident smoking in children entering secondary education is independently increased by exposure to other ever smokers in school tutor groups. Incident smoking in adolescents is thus to some extent a communicable disorder, and may be partly preventable by policies that reduce exposure to smoking at school.     

What contributed to the major decline in per capita cigarette consumption during California's comprehensive tobacco control programme?

Objectives

California experienced a notable decline in per capita cigarette consumption during its comprehensive tobacco control programme. This study examines what proportion of the decline occurred from: (1) fewer ever smokers in the population, (2) more ever smokers quitting, and (3) current smokers smoking less.

Design, subjects

Per capita cigarette consumption computed from cigarette sales and from adult respondents to the large, cross‐sectional, population‐based California Tobacco Surveys of 1990 (n  =  24 296), 1996 (n  =  18 616) and 2002 (n  =  20 525) were examined for similar trends.

Main outcome measure

Changes (period 1: 1990–1996; period 2: 1996–2002) in per capita cigarette consumption from self‐reported survey data were partitioned for the entire population and for demographic subgroups into the three components mentioned above.

Results

In periods 1 and 2, most of the decline in per capita cigarette consumption for the population as a whole was from current smokers smoking less followed by a reduction in ever smokers. The decline from smokers smoking less was particularly evident among young adults (18–29 years) in period 1. While the portion of the decline due to quitting in the entire population in period 1 was negligible, in period 2 it accounted for 22% of the total per capita decline. The decline from quitting in period 2 was mostly observed among women.

Conclusions

Rather than near‐term benefits from smokers quitting, population health benefits from reduced per capita cigarette consumption will likely occur over the longer term from fewer people becoming ever smokers, and more less‐addicted smokers eventually quitting successfully.     

"Pack year" smoking histories: what about patients who use loose tobacco?

Life time smoking of ready made cigarettes can be readily quantified as "pack years" smoked, but methods for measuring loose tobacco use are less well established. In this study the frequency of loose tobacco use by 247 hospital in-patients was determined; 64% were current or ex-smokers, 41.3% of whom (25.9% of participants) had smoked loose tobacco. A formula was developed for converting loose tobacco use to pack years smoked, based on the weight of tobacco in ready made cigarettes; 12.5 g or half an ounce of loose tobacco was approximately equivalent to one packet of 20 cigarettes. Using a questionnaire it was found that hospital physicians of all grades were able to convert smoking histories of ready made cigarettes, but not loose tobacco, into number of "pack years" smoked.