Print media coverage of research on passive smoking

OBJECTIVE: To assess the extent and content of newspaper and magazine coverage of research on passive smoking. DESIGN: Content analysis of newspaper and magazine articles. SUBJECTS: Articles reporting on passive smoking research published in newspapers (n = 180) or magazines (n = 92) between January 1981 and December 1994. MAIN OUTCOME MEASURES: Numbers of articles, conclusions of articles, sources quoted, numbers and characteristics of research studies cited, presence of tobacco advertising. RESULTS: The number of newspaper and magazine articles reporting on passive smoking research increased from four in 1981 to 57 in 1992 and 32 in 1994. Sixty-two per cent (168/272) of articles concluded that the research on passive smoking is controversial. Tobacco industry representatives were quoted significantly more often in newspaper articles (52%, 94/180) than magazine articles (12%, 11/92) (p<0.0001). Of 121 different research studies cited in the lay press articles, only 15 were from tobacco-industry sponsored projects or publications. In magazines, acceptance of tobacco industry advertising was associated with the conclusion that research on passive smoking is controversial (p<0.0001). CONCLUSIONS: Although research on the harmful effects of passive smoking accumulated between 1981 and 1994, lay press coverage of the research maintained that the science was controversial. Few research studies were cited to support the industry's claim that passive smoking is not harmful to health. However, tobacco industry representatives who were critical of the research methods used to study the health effects of passive smoking were frequently quoted.     

Youth smoking prevention and tobacco industry revenue

Objectives

Epidemiological surveys make it clear that youth smoking contributes to both current and future tobacco industry revenue: over 80% of adult smokers reportedly began smoking before age 18. This paper estimates annual and lifetime revenue from youth smoking, and highlights the association between declines in youth smoking and declines in tobacco industry revenue.

Main outcome measures

This paper reports the amount of tobacco industry revenue generated by youth smoking at two points in time (1997 and 2002), and describes the distribution of youth generated tobacco income among the major tobacco companies. The authors project the amount of tobacco industry revenue that will be generated by members of two cohorts (the high school senior classes of 1997 and 2002) over the course of their lifetimes.

Results

In 1997, youth consumed 890 million cigarette packs, generating $737 million in annual industry revenue. By 2002, consumption dropped to 541 million packs and revenue increased to nearly $1.2 billion. Fifty eight per cent of youth generated revenue goes to Philip Morris USA, 18% to Lorillard, and 12% to RJ Reynolds. The authors project that, over the course of their lives, the 1997 high school senior class will smoke 12.4 billion packs of cigarettes, generating $27.3 billion in revenue. The 2002 high school senior class is projected to smoke 10.4 billion packs, generating $22.9 billion in revenue over the course of their lives.

Conclusions

Cigarette price increases from 1997 to 2002 have resulted in greater revenue for the tobacco industry, despite declines in youth smoking prevalence. However, in the absence of further cigarette price increases, declines in youth smoking are projected to lead ultimately to a loss of approximately $4 billion in future tobacco industry revenue from a single high school cohort.     

Investing in youth tobacco control: a review of smoking prevention and control strategies

OBJECTIVE: To provide a comprehensive review of interventions and policies aimed at reducing youth cigarette smoking in the United States, including strategies that have undergone evaluation and emerging innovations that have not yet been assessed for efficacy. DATA SOURCES: Medline literature searches, books, reports, electronic list servers, and interviews with tobacco control advocates. DATA SYNTHESIS: Interventions and policy approaches that have been assessed or evaluated were categorised using a typology with seven categories (school based, community interventions, mass media/public education, advertising restrictions, youth access restrictions, tobacco excise taxes, and direct restrictions on smoking). Novel and largely untested interventions were described using nine categories. CONCLUSIONS: Youth smoking prevention and control efforts have had mixed results. However, this review suggests a number of prevention strategies that are promising, especially if conducted in a coordinated way to take advantage of potential synergies across interventions. Several types of strategies warrant additional attention and evaluation, including aggressive media campaigns, teen smoking cessation programmes, social environment changes, community interventions, and increasing cigarette prices. A significant proportion of the resources obtained from the recent settlement between 46 US states and the tobacco industry should be devoted to expanding, improving and evaluating "youth centred" tobacco prevention and control activities.     

What should be the elements of any settlement with the tobacco industry?

Litigation and regulatory assaults on the tobacco companies may create a willingness among tobacco manufacturers to bargain resources and acceptance of public policy changes for limitations of liability, as has been seen by the recent settlement with the Liggett Group. Two elements absolutely critical to any plan are the elimination of tobacco advertising and promotion and the removal of addiction as a reason for tobacco use. Minimal components of any settlement should include: (a) acceptance by the tobacco manufacturers of the causal relationship between tobacco use and disease, and the addictive nature of nicotine; (b) a total ban on tobacco advertising and promotion; (c) FDA jurisdiction over tobacco products and their nicotine content, with the intent of removing nicotine as soon as acceptable nicotine substitution products are available; (d) reimbursement to the states for Medicaid and other state expenditures attributable to smoking, to the maximum extent feasible; (e) funding for local, state, and federal programmes and research in tobacco control; (f) acceptance of legislation and regulations protecting the right of non-smokers to breathe air free of tobacco smoke; (g) funding for a large, national, media-led, anti- tobacco campaign; and (h) cessation assistance for addicted smokers. If negotiations toward a settlement proceed, it is essential that the public health community participate in defining the elements of any agreement to ensure that whatever agreement develops is focused on reducing tobacco-related disease rather than continuing the profitability of American tobacco companies. That participation requires articulation of the core elements essential to an acceptable agreement. If resolution of the public health issues surrounding continued sale of tobacco products can be reached in the United States, it may provide a model for similar resolution in other countries.


     

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.     

Smoking on the rise among young adults: implications for research and policy

This paper investigates hypotheses regarding the cause of the recent apparent increase in young adult smoking, compares trends in smoking among young adults with trends in the use of other substances, and considers the implications for youth tobacco control research and policy. Time series analyses of national data suggest that the recent observed increase in smoking among young adults is primarily an artefact of the almost simultaneous increase in smoking among high school students. In addition, however, it also appears that there have been real changes in smoking patterns among young adults. While many questions remain regarding recent trends in tobacco and other drug use among adolescents and young adults, what is known leads to a clarion call for increased intervention and policy action for the prevention and control of tobacco use among young adults in the USA.     

Media advocacy and newspaper coverage of tobacco issues: a comparative analysis of 1 year's print news in the United States and Australia.

Tobacco control advocates now recognize the value of influencing news coverage of tobacco; news coverage influences attitudes and behavior as well as policy progression. It is, however, difficult to assess the progress of such efforts within a single national and temporal context. Our data represent the first systematic international comparison of press coverage of tobacco issues. Tobacco articles from major daily newspapers in Australia (12 newspapers; 1,188 articles) and the United States (30 newspapers; 1,317 articles) were collected over 1 year (2001). The analysis shows that coverage in the two countries was similarly apportioned between hard news (>70%) and opinion pieces. Similarly, stories in both countries were most likely to recount positive events. The substantive focus of coverage, however, differed, as did the expression of hostile opinion toward tobacco control efforts (United States, 4%; Australia, 7.1%). Although secondhand smoke and education, cessation, and prevention efforts were covered widely in both settings, these topics dominated coverage in Australia (29.2%) more than in the United States (17.6%), where a more diffuse set of tobacco topics gained relative prominence. The difference in policy conditions seems to offer contrasting opportunities for advocates in the two countries to use newspapers to promote helpful tobacco control messages for both behavior and policy change.     

Effect of policies directed at youth access to smoking: results from the SimSmoke computer simulation model

OBJECTIVES: To develop a simulation model to predict the effects of youth access policies on retail compliance, smoking rates, and smoking attributable deaths. METHODS: A model of youth access policies is developed based on empirical research and a theory of perceived risk. The model incorporates substitution into other sources as retail sales are restricted, and is used to project the number of smokers and smoking related deaths. Various policies to limit youth access to cigarettes are evaluated, and we explore how efficient policies may be developed. RESULTS: The model predicts that a well designed and comprehensive policy that includes sufficient compliance checks, penalties, and community involvement has the potential to reduce the number of young smokers. Because smoking related deaths occur later in life, the effects on health are largely delayed. CONCLUSIONS: A well designed youth access policy has the ability to affect youth smoking rates in the short term, and will lead to savings in lives in future years. The ability of retail oriented policies to reduce youth smoking, however, is limited. Other tobacco control policies, including those directed at non-retail sources of cigarettes, are also needed.     

Smoking behaviour among young adults: beyond youth prevention

Objective: There is a widespread assumption that smoking behaviour is largely established by the age of 18 years. As a result, smoking prevention has focused almost exclusively upon youth. However, recent trends suggest that young adulthood may be an important—and largely overlooked—period in the development of regular smoking behaviour. The current study sought to examine patterns of tobacco use among young adults (aged 18–29 years) and to address the implications for tobacco control policy.

Design: Data are presented from the 2003 Canadian Tobacco Use Monitoring Survey, a national survey of smoking behaviour (n = 10 559, response rate 89%).

Main outcome measures: Measures of smoking behaviour, smoking initiation, susceptibility to smoking, and occupational status.

Results: A total of 1.4 million or 28% of young adults in Canada currently smoke, the highest proportion among all age groups. The prevalence of daily smoking rose from 8% among youth to 22% among young adults, and approximately one fifth of smokers tried their first cigarette after the age of 18 years. Smoking behaviour among young adults was also distinct from older smokers: young adults were more likely to be occasional smokers and reported lower daily consumption. Finally, smoking prevalence and cessation rates varied substantially within subgroups of young adults, as characterised by occupational setting.

Conclusions: Dramatic increases in the proportion and intensity of smoking occurs after the age of 18 years. Smoking behaviour among young adults is distinct from both youth and older adults, and warrants immediate attention from the public health community.

     

Effects of market liberalisation on smoking in Japan

OBJECTIVE: To document the effect of the liberalisation of the Japanese tobacco market on Japanese smoking rates and on Japanese tobacco industry practices. DATA SOURCE: Asahi Shimbun (major daily newspaper) from 1980 to 1996. STUDY SELECTION: Review of media coverage on the effects of market liberalisation following the imposition of the USA's section 301 trade sanction. DATA SYNTHESIS: The opening of Japan's tobacco market to foreign cigarette companies stalled a decline in smoking prevalence. Smoking rates among young women increased significantly, and also appear to be on the rise among adolescents. Aggressive marketing and promotional activities by US and Japanese tobacco companies in response to trade liberalisation appear responsible for these adverse trends. Steep increases in sales through vending machines were also possible contributors to the rising smoking prevalence among adolescents. On the positive side, market liberalisation indirectly promoted smoking control efforts in Japan, by causing an anti-smoking movement to coalesce. CONCLUSION: Market liberalisation in Japan played a significant role in increasing smoking prevalence among young women and adolescents while helping to transform the issue of smoking in Japan from a matter of individual choice to a public health problem.     

Press coverage of public expenditure of Master Settlement Agreement funds: how are non-tobacco control related expenditures represented?

Objective: To examine newspaper reports of Master Settlement Agreement (MSA) allocation decisions outside of tobacco control, focusing on the arguments being put forth in favour of competing claims on MSA funds. The major aims were to identify newsworthy non-tobacco control areas for which MSA funds have been applied and to examine how non-tobacco control spending has been presented through the US press.

Design: A qualitative textual analysis was performed on 94 articles taken from a sample of 322 newspapers over a 12 month period (October 2000 through September 2001) that related to the allocation of MSA funds to non-tobacco control causes. Articles were coded for general content areas of MSA allocation as well as for rhetorical and framing devices employed to explain and justify allocation decisions.

Main outcome measures: (1) Areas of non-tobacco control allocation; (2) rhetorical devices and framing techniques employed in the articles to discuss the allocation.

Results: The analysis identified a wide variety of issues for which MSA funds were being appropriated. Three main frames emerged in relation to justifying or appealing for particular spending decisions: (1) funds should be allocated to the needy and/or the deserving; (2) funds should be spent on state development; (3) funds should be put towards helping the state weather a crisis. Claims for each such issue were made using strategies such as presenting the MSA funds as a "windfall", focusing coverage on the merits of the cause rather than the issue of resource allocation, and stressing links between the particular claim and the stated objectives of the MSA.

Conclusions: Press coverage of MSA non-tobacco control spending suggests that the funds have been quickly formulated as fodder for state spending, rather than to support tobacco control efforts. Thus, caution is required in pursuing settlements with the industry where the objective is better funding for tobacco control efforts, particularly in light of the possibility that press coverage of MSA allocation may actually serve as positive publicity for the tobacco industry.

     

US news media coverage of tobacco control issues

Objective

To characterise the relative amount and type of daily newspaper, local and national TV newscast, and national news magazine coverage of tobacco control issues in the United States in 2002 and 2003.

Design

Content analysis of daily newspapers, news magazines, and TV newscasts.

Subjects

Items about tobacco in daily newspapers, local and national TV newscasts, and three national news magazines in a nationally representative sample of 56 days of news stratified by day of week and season of the year, from 2002 and 2003.

Main outcome measures

Story theme, tobacco topics, sources, story prominence, story valence (orientation), and story type.

Results

Tobacco coverage was modest over the two‐year period as estimated in our sample. Only 21 TV stories, 17 news magazine stories, and 335 daily newspaper stories were found during the two‐year sampling period. Noteworthy results for the newspaper data set include the following: (1) government topics predominated coverage; (2) government action and negative health effects topics tended not to occur together in stories; (3) tobacco stories were fairly prominently placed in newspapers; (4) opinion news items tended to favour tobacco control policies, while news and feature stories were evenly split between positive and negative stories; and (5) tobacco coverage in the southeast, which is the country''s major tobacco producing region, did not differ from the rest of the country.

Conclusion

Results suggest mixed support in news coverage for tobacco control efforts in the United States. The modest amount of news coverage of tobacco is troubling, particularly because so few news stories were found on TV, which is a more important news source for Americans than newspapers. When tobacco was covered, government themed stories, which often did not include mentions of negative health effects, were typical, suggesting that media coverage does not reinforce the reason for tobacco control efforts. However, some results were encouraging. For example, when newspapers did cover tobacco, they accorded the stories relatively high prominence, thus increasing the chance that readers would see tobacco stories when they were published.     

A comprehensive review of state laws governing Internet and other delivery sales of cigarettes in the United States.

All U.S. states regulate face-to-face tobacco sales at retail outlets. However, the recent growth of delivery sales of tobacco products by Internet and mail-order vendors has prompted new state regulations focused on preventing youth access and tax evasion. To date, there are no comprehensive and systematic analyses of these laws. The objectives of this study were to: (a) document the historical enactment of the laws; (b) assess the nature and extent of the laws; and (c) examine the relationship between the presence of laws and state tobacco control policy and other contextual variables. Between 1992 and 2006, 34 states (67%) enacted a relevant law, with 27 states' laws (45%) effective between 2003 and 2006. Five states banned direct-to-consumer shipment of cigarettes. The remaining 29 states' laws included a combination of requirements addressing minimum age/ID, payment issues, shipping, vendor licensure and related issues, tax collection/remittance, and penalties/enforcement. States with delivery sales laws have stronger youth tobacco access policies and state tobacco control environments, as well as higher state cigarette excise tax rates and revenue, past-month cigarette use rates, and perceptions of risk of use by adolescents. This paper provides the policy context for understanding Internet and other cigarette delivery sales laws in the U.S. It also provides a systematic framework for ongoing policy surveillance and will contribute to future analyses of the impact of these laws on successfully reducing youth access to cigarettes and preventing tax evasion.     

Effectiveness of comprehensive tobacco control programmes in reducing teenage smoking in the USA

OBJECTIVE: To describe the extent to which comprehensive statewide tobacco control programmes in the USA have made progress toward reducing teenage smoking. DATA SOURCES: Literature search of Medline for reviews of effectiveness of programme and policy elements, plus journal articles and personal request for copies of publicly released reports and working papers from evaluation staff in each of the state programmes of California, Massachusetts, Arizona, Oregon, and Florida. STUDY SELECTION: All studies, reports, and commentaries that provided information on aspects of programme implementation and evaluation. DATA SYNTHESIS: Statewide comprehensive programmes show high levels of advertising recall and generally positive improvement in smoking related beliefs and attitudes among teenagers. More fully funded programmes lead to increased mass media campaign advertising and community initiatives; a greater capacity to implement school based smoking prevention programmes; and an increase in the passage of local ordinances that create smoke free indoor environments and reduce cigarette sales to youth. The combination of programme activity and increased tobacco tax reduce cigarette consumption more than expected as a result of price increases alone, and these effects seem to apply to adolescents as well as adults. Programmes are associated with a decline in adult smoking prevalence, with these effects observed to date in California, Massachusetts, and Oregon. Arizona and Florida have yet to examine change in adult prevalence associated with programme exposure. California and Massachusetts have demonstrated relative beneficial effects in teenage smoking prevalence, and Florida has reported promising indications of reduced prevalence. Arizona has yet to report follow up data, and Oregon has found no change in teenage smoking, but has only two years of follow up available. One of the most critical factors in programme success is the extent of programme funding, and consequent level of programme implementation, and the degree to which this is undermined by the tobacco industry and other competitors for funding. CONCLUSIONS: Despite the different strengths and combinations of programme messages and strategies used in these comprehensive programmes, there is evidence that they lead to change in factors that influence teenage smoking, and to reductions in teenage smoking.     

Can media advocacy influence newspaper coverage of tobacco: measuring the effectiveness of the American stop smoking intervention study's (ASSIST) media advocacy strategies

OBJECTIVE: To compare the rate and slant of local tobacco control print media coverage in ASSIST (American stop smoking intervention study) states as compared with non-ASSIST states. METHODS: Local tobacco control policy articles, editorials, and letters to the editors published from 1994 to 1998 clipped from all daily local newspapers in the USA were analysed (n = 95 911). The main hypothesis tested for the existence of an interaction between ASSIST intervention and time. This interaction would represent a change in the difference between ASSIST and non-ASSIST states over the course of the intervention. RESULTS: No evidence of an ASSIST-year interaction was found. However, a main effect for ASSIST was significant for the percentage of articles with the model predicting higher rates of articles for ASSIST states. Similarly the rate of letters to the editor expressing protobacco control views was higher in ASSIST states than non-ASSIST states. No main effects or interactions were found for analyses of percentage of protobacco control editorials. Models controlled for a measure of preintervention tobacco control conditions at baseline. CONCLUSIONS: The presence of an ASSIST main effect should be interpreted with caution because of the quasi-experimental design and the lack of information on article rates before the ASSIST intervention. Nonetheless, these preliminary findings suggest some possible effects of the media advocacy activities of ASSIST when controlling for differences in states' initial tobacco control conditions.     

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.     

Tobacco use and dependence in Asian Americans: a review of the literature.

This article reports on an integrative review of literature on Asian American tobacco use and dependence, identifies gaps in the literature, and proposes studies needed in the future. Articles were retrieved from electronic health-related databases indexed for permutations of the keywords Asian Americans, smoking, tobacco use, tobacco dependence, and nicotine dependence. A manual search also was done to identify additional literature. A total of 216 articles were identified; the review includes 39 articles reporting gender- and ethnic-specific information on subgroups of Asian Americans in the following areas: Smoking prevalence, correlates of smoking, and tobacco dependence treatment. In addition, 13 articles on tobacco and nicotine metabolism were reviewed. Empirical studies have concentrated on Chinese, Korean, and Vietnamese American men. Smoking prevalence is higher among Asian American men with low acculturation than among their counterparts, but the reverse pattern is observed among Asian American women. Asian Americans tend to smoke fewer cigarettes per day than White Americans, and this difference may be explained by differences between the two groups in nicotine metabolism. More research is needed on this diverse population, especially Asian American women of all ethnic subgroups and Asian Indian, Filipino, Pakistani, and Thai American men. A need also exists for the development of specialized tobacco dependence treatments to address the cultural issues of specific Asian American ethnic subgroups, to enhance access to treatment, and to determine how treatment recommendations should reflect differences in acculturation level and tobacco and nicotine metabolism.     

How state counter-industry campaigns help prime perceptions of tobacco industry practices to promote reductions in youth smoking

Methods: Rates of youth smoking were compared in three groups of states: (1) those with long funded counter-industry campaigns (California, Florida, and Massachusetts); (2) states with more recently funded counter-industry media campaigns (Indiana, Minnesota, Mississippi, and New Jersey); and (3) other states. An analysis was performed for a series of national telephone surveys of 12–17 year olds between 1999 and 2002, controlling for differences in demographic background, the price of cigarettes, and exposure to the national truth^® campaign. Results: Between 1999 and 2002, rates of current smoking and established smoking decreased significantly faster in states with established or more newly funded counter-industry campaigns than in other states. State counter-industry campaigns appear to prime, or make more salient, negative perceptions about tobacco industry practices. Conclusion: Results highlight the value of continued state counter-industry campaigns.     

Cigarette acquisition and proof of age among US high school students who smoke

OBJECTIVE: To determine how US high school students who are under 18 years of age and who smoke obtain their cigarettes and whether they are asked for proof of age. DESIGN AND SETTING: Data from the Centers for Disease Control and Prevention's 1995, 1997, and 1999 national Youth Risk Behavior Surveys which employed national probability samples of students in grades 9-12 (ages 14-18 years). MAIN OUTCOME MEASURES: Associations of usual source of cigarettes and request for proof of age with variables such as sex, race/ethnicity, grade, and frequency of smoking. RESULTS: In 1999, among current smokers under age 18 years, 23.5% (95% confidence interval (CI), -4.5% to +4.5%) usually purchased their cigarettes in a store; among these students, 69.6% (95% CI -5.7% to +5.7%) were not asked to show proof of age. As days of past month smoking increased, reliance on buying cigarettes in a store (p < 0.001) and giving someone else money to buy cigarettes (p < 0.001) increased, and usually borrowing cigarettes decreased (p < 0.001). From 1995 to 1999, relying on store purchases significantly decreased (from 38.7% (95% CI -4.6% to + 4.6%) to 23.5% (95% CI -4.5% to +4.5%)); usually giving someone else money to buy cigarettes significantly increased (from 15.8% (95% CI -3.6% to +3.6%) to 29.9% (95% CI -4.5% to + 4.5%)). CONCLUSIONS: Stricter enforcement of tobacco access laws is needed to support other community and school efforts to reduce tobacco use among youth. Furthermore, effective interventions to reduce non-commercial sources of tobacco, including social, need to be developed and implemented.