The social context of smoking: the next frontier in tobacco control?

A better understanding of the social context of smoking may help to enhance tobacco control research and practice     

Whose standard is it,anyway? How the tobacco industry determines the International Organization for Standardization (ISO) standards for tobacco and tobacco products

OBJECTIVE: To describe the extent of the tobacco industry involvement in establishing international standards for tobacco and tobacco products and the industry influence on the International Organization for Standardization (ISO). METHODS: Analysis of tobacco industry documents made public as part of the settlement of the Minnesota Tobacco Trial and the Master Settlement Agreement. Search words included "ISO", "CORESTA", "Barclay", "compensation and machine smoking", "tar and nicotine deliveries", and the name of key players, in different combinations. RESULTS: It is clear that the tobacco industry, through the Cooperation Centre for Scientific Research Relative to Tobacco (CORESTA), play a major role in determining the scientific evidence and suggesting the standards that are eventually adopted as international standards for tobacco and tobacco products in several areas, including the measurement of cigarette tar and nicotine yield. CONCLUSIONS: ISO's tobacco and tobacco products standards are not adequate to guide tobacco products regulatory policies, and no health claims can be made based on ISO's tobacco products standards. There is an urgent need for tobacco control advocates and groups worldwide to be more involved with the work of the ISO, both directly and through their national standardisation organisations.     

How effective are tobacco industry bar and club marketing efforts in reaching young adults?

Objective: Recently, the tobacco industry has focused marketing efforts on young adults through bar and club promotions, such as advertising and distribution of free cigarettes in these settings. This study estimates the fraction of the California young adult population that might be exposed and potentially influenced by these efforts.

Design and participants: Data were from 9364 young adult (18–29 years) respondents to the cross sectional population based 2002 California Tobacco Survey. As background, we analysed social smoking (only smoke with other smokers), and enjoyment of smoking while drinking. Our main focus was on bar and club attendance, what was observed in bars and clubs, and how this might differ according to respondents' risk for future smoking.

Results: Social smokers comprised 30.0 (2.2)% of all current smokers, including experimenters. Nearly three quarters (74.5 (2.3)%) of current smokers/experimenters said they enjoyed smoking while drinking. About one third (33.8 (1.2)%) of all young adults said they attended bars and clubs at least sometimes; attendance was significantly higher among smokers and those at risk for future smoking. Close to 60% (57.9 (2.2)%) of bar and club attenders reported seeing cigarette advertising and promotions in these settings. Again, smokers and those at risk were more likely to report seeing such advertising and promotions in these settings.

Conclusions: About 20% of all young adults and about 30% of those at risk for future smoking (including current smokers) were exposed to tobacco advertising and promotions in bars and clubs. These California results may be conservative, but nonetheless indicate that the group potentially influenced is sizable.

     

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.     

Which smokers use the smoking cessation Quitline in Hong Kong,and how effective is the Quitline?

Objective: To describe the characteristics of the Chinese subjects who utilised the first telephone smoking cessation service in Hong Kong, and to evaluate its effectiveness.

Methods: The Quitline provided Hong Kong residents with free telephone smoking cessation services which was publicised through a press conference, media reports, pamphlets, and posters at public and private hospitals and clinics. Callers who completed an initial interview from 13 December 2000 to 31 May 2002 were included. Smokers were interviewed using a structured record sheet and provided with stage matched counselling. A follow up interview was carried out after six months. Analysis was conducted by intention-to-treat.

Results: Of the 1120 callers who completed initial assessments, 1047 were current smokers and 872 consented to follow ups. Compared to the general smoking population, the Quitline attracted more of those who were female, younger, single, unemployed, higher educated, smoking more than 20 cigarettes per day, and those with quitting experience. At six months, 12% (95% confidence interval 10% to 15%) of the participants reported that they had not smoked a cigarette for the past seven days. A stepwise logistic regression model showed that the use of nicotine replacement therapy at the present attempt to quit, having made one or more serious attempts to quit in the past, perceiving less difficulties in quitting, and smoking the first cigarette at age 15 years or above were significant predictors of quitting.

Conclusion: This first Quitline in Asia appears to be acceptable to Chinese smokers, with quit rate comparable to those of better funded Quitlines in the West. A low cost Quitline is a promising model for smoking cessation services in the East.

     

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.     

"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.     

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     

State of the art in the validation of screening methods for the control of antibiotic residues: is there a need for further development?

ABSTRACT

Screening methods are used as a first-line approach to detect the presence of antibiotic residues in food of animal origin. The validation process guarantees that the method is fit-for-purpose, suited to regulatory requirements, and provides evidence of its performance. This article is focused on intra-laboratory validation. The first step in validation is characterisation of performance, and the second step is the validation itself with regard to pre-established criteria. The validation approaches can be absolute (a single method) or relative (comparison of methods), overall (combination of several characteristics in one) or criterion-by-criterion. Various approaches to validation, in the form of regulations, guidelines or standards, are presented and discussed to draw conclusions on their potential application for different residue screening methods, and to determine whether or not they reach the same conclusions. The approach by comparison of methods is not suitable for screening methods for antibiotic residues. The overall approaches, such as probability of detection (POD) and accuracy profile, are increasingly used in other fields of application. They may be of interest for screening methods for antibiotic residues. Finally, the criterion-by-criterion approach (Decision 2002/657/EC and of European guideline for the validation of screening methods), usually applied to the screening methods for antibiotic residues, introduced a major characteristic and an improvement in the validation, i.e. the detection capability (CCβ).

In conclusion, screening methods are constantly evolving, thanks to the development of new biosensors or liquid chromatography coupled to tandem-mass spectrometry (LC-MS/MS) methods. There have been clear changes in validation approaches these last 20 years. Continued progress is required and perspectives for future development of guidelines, regulations and standards for validation are presented here.