Public health measures to reduce smoking prevalence in the UK: how many lives could be saved?

Objective: To estimate the number of deaths that could be prevented in the UK by implementing population strategies to reduce smoking prevalence. Design: A prospective analysis of future mortality using recent national smoking prevalence data and relative risks of mortality in current smokers, ex-smokers, and never-smokers. Population: Smokers in the UK. Interventions: Population measures of proven effectiveness assumed to reduce smoking prevalence by 1 percentage point per year for 10 years, or alternatively by 13% over 19 years (1 percentage point per annum for seven years, 0.5 percentage point per annum for 12 years) as considered to be achievable in a recent report to the UK Chancellor of the Exchequer. Main outcome measure: Estimated deaths from smoking prevented in the 35–75 year age group. Results: Reducing the prevalence of smoking by 1 percentage point each year for 10 years would prevent 69 049 deaths at ages between 35 and 74 years during that period. The model of reduction by 13% over 19 years would prevent 54 308 and 194 493 deaths in 10 and 19 years, respectively. Continued prevalence reductions at the current rate of 0.4 percentage points each year will prevent 23 192 deaths over 10 years. Conclusions: Full implementation of simple population measures to encourage smoking cessation could prevent substantial numbers of deaths in the UK.     

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     

What public health strategies are needed to reduce smoking initiation?

Smoking initiation is a key behaviour that determines the future health consequences of smoking in a society. There is a marked difference in smoking patterns around the world, driven by initiation rates. While a number of high-income countries have seen smoking prevalence decline markedly from peak, many low-income and middle-income countries appear to still be on an upward trend. Unlike cessation where changes are limited by nicotine dependence, rates of smoking initiation can change rapidly over a short time span. Interventions that can be effective in achieving this include increases in the price of tobacco products, mass media anti-smoking advertising, smoke-free policies, smoking curricula in schools, restrictions on marketing opportunities for the tobacco industry as well as social norms that lead to restrictions on adolescents' ability to purchase cigarettes. Comprehensive tobacco control programmes that aim to denormalise smoking behaviour in the community contain all of these interventions. Rapid reductions in smoking initiation in adolescents have been documented in two case studies of comprehensive tobacco control programmes in California and Australia. Consistent and inescapable messages from multiple sources appear to be key to success. However, the California experience indicates that the rapid decline in adolescent smoking will not continue if tobacco control expenditures and the relative price of cigarettes are reduced. These case studies provide strong additional evidence of the importance of countries implementing the provisions of the Framework Treaty on Tobacco Control.     

Which insect species can best be proposed for human consumption?

Edible insects have become popular in the past few years not only in the scientific literature but in other media as well. One of the major advantages of entomophagy (eating insects) is said to be the great nutritional composition. Many sources report that insects (generally) have better nutritional characteristics than traditional protein sources. In our research, we aim to give a complete picture of the nutritional profile of insects using a multicriteria optimization method, sum of ranking differences. The materials we used are published results of different authors from the past few years. The proximate analysis tells that insects generally have a better nutritional profile than other meats. The situation is a bit different in the case of mineral content; hence some vegetables have excellent mineral sources but waxworm larvae were ranked in the first three. Additionally, waxworm larvae have the most similar amino acid pattern to the FAO recommendation for adults. Earthworm, house cricket, and mealworm larvae showed the most promising vitamin content; however, huge differences were observed between the developmental stages of insects. A detailed analysis of these differences on the example of mealworms showed that adults may present a better option from the nutritional point of view. Same measurements conducted by different authors on the same species show considerable differences; hence the comparison of the results of different publications is dubious and should be handled with care. Based on our results, insects have a promising nutritional profile and may become part of many food products in the future. Present status of knowledge allows to conclude; which insect is best suitable for human consumption.     

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.     

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.     

Is the standard compliance check protocol a valid measure of the accessibility of tobacco to underage smokers?

OBJECTIVE: To determine if the standard compliance check protocol is a valid measure of the experience of underage smokers when purchasing tobacco in unfamiliar communities. SETTING: 160 tobacco outlets in eight Massachusetts communities where underage tobacco sales laws are vigorously enforced. PROCEDURE: Completed purchase rates were compared between underage smokers who behaved normally and inexperienced non-smoking youths who were not allowed to lie or present proof of age (ID). RESULTS: The "smoker protocol" increased the likelihood of a sale nearly sixfold over that for the non-smokers (odds ratio (OR) 5.7, 95% confidence interval (CI) 1.5 to 22). When the youths presented an ID with an underage birth date, the odds of a completed sale increased dramatically (OR 27, 95% CI 3.4 to 212). Clerks judged to be under 21 years of age were seven times more likely to make an illegal sale (OR 7.6, 95% CI 2.4 to 24.0). CONCLUSIONS: Commonly used compliance check protocols are too artificial to reflect accurately the experience of underage smokers. The validity of compliance checks might be improved by having youths present ID, and by employing either tobacco users, or non-tobacco users who are sufficiently experienced to mimic the self confidence exhibited by tobacco users in this situation. Consideration should be given to prohibiting the sale of tobacco by individuals under 21 years of age.     

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.     

How much of enzyme can be saved in the process with the optimal temperature control?

A simple process of biotransformation carried out in a batch reactor in the presence of native enzyme undergoing deactivation independent of substrate concentration has been analyzed. An analytical expression has been derived enabling answering the question how much of enzyme can be saved if instead of commonly applied isothermal conditions an optimal temperature control without its limitations were used. An effect of the quotient of the activation energy on the magnitude of such benefits has also been considered. It has also been proved that the reaction kinetics has no influence on the derived expression. Based on an example of sucrose hydrolysis by immobilized invertase the obtained result has been verified.     

Salty taste in dairy foods: can we reduce the salt?

Sodium can be found in many sources of the US diet. Dietary guidelines currently suggest a maximum intake of 2,300 mg of sodium (6 g of sodium chloride) per day, whereas the average consumer intake is 3,600 mg of sodium (9 g of sodium chloride) per day. The main health concern with high consumption of sodium is hypertension. The objectives of this study were to identify the salty taste intensity of sodium chloride in water and various dairy food matrices, and to identify the just-noticeable difference in concentration at which consumers noticed a decrease in salty taste in these food products. Solutions and food products (water, cheese sauce, cottage cheese, and milk-based soup) were prepared with sodium chloride ranging in concentration from 0.008 to 0.06 M. Seventeen panelists evaluated the salty intensity of each product in triplicate using a magnitude estimation scale. In subsequent tests, panelists (n = 50) evaluated salty intensity of these food products in separate sessions using an ascending force choice method to determine the just-noticeable difference. Consumer acceptance tests (n = 75 consumers) were conducted with cottage cheeses with and without sodium reductions and under conditions with and without health benefits of sodium reduction. The magnitude estimation scale data were log-transformed, and all data were analyzed by ANOVA with Fisher's least significant difference for means separation. The linear proportion of the power function in the salty taste intensity curve for sodium chloride solutions and the 3 foods was between 0.03 and 0.20 M. Consumers were able to notice and correctly identify reductions in salt concentration of less than 20% in all products. When consumers were informed of sodium reduction and its health benefits before tasting cottage cheese with lower sodium (4-12%), overall liking scores for the lower sodium cottage cheeses were not different from higher sodium cottage cheeses. These results suggest that reducing sodium in cheese sauce, cottage cheese, and milk-based soups may be challenging and that exploration of sodium chloride alternatives in these foods is warranted. Appropriate product positioning or advertising may be beneficial to consumer acceptance of lower sodium types of products.     

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.     

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.