Pushing secondhand smoke and the tobacco industry outside the social norm to reduce adolescent smoking

New Zealand Smokers' Perceptions of Tobacco Endgame Measures: A Qualitative Analysis

INTRODUCTION

New Zealand's equity-focused endgame goal (Smokefree 2025) aims to reduce smoking prevalence to minimal levels (ie, <5%) in all population groups by 2025. Inadequate progress has stimulated discussion of innovative measures to reduce prevalence; because few studies have explored how marginalized groups perceive these measures, we addressed this knowledge gap.

AIMS AND METHODS

In November and December 2020, we conducted 20 in-depth interviews with people who smoked daily, were aged between 21 and 53, earned less than the median income (NZD33 900), and had marginal or inadequate income sufficiency. We explored participants' smoking history and used an elicitation exercise to probe their views on smokefree policies, including potential endgame measures. We used qualitative descriptive analysis and reflexive thematic analysis to interpret the data.

RESULTS

Participants favored increasing personal support to quit and reducing nicotine levels in cigarettes, but generally opposed tobacco excise tax increases and paying people to quit. While many privileged their right to "choose," some recognized that stronger policies could restore the loss of agency addiction caused. Participants felt smoking's powerful addictiveness remained poorly understood, and called for smoking to be recognized and treated as an addiction.

CONCLUSIONS

Several participants supported intensifying existing measures or introducing new measures. However, their use of tobacco industry rhetoric to frame smoking as a choice they had made could inadvertently reinforce the stigma they experienced. Reframing cigarettes as an addictive product engineered by a deceptive industry, may make it easier for participants to access the expanded support and compassion they sought.

IMPLICATIONS

Policy measures, such as reducing the nicotine level in cigarettes, could support endgame goals; however, greater public understanding of addiction is needed to reduce stigma, support self-efficacy, and foster smoking cessation. Industry denormalization campaigns could challenge views of smoking as a personal choice, decrease self-blame among people who smoke, and present endgame goals as likely to enhance agency.

Do health warnings on cigarette sticks dissuade smokers and non-smokers? A focus group and interview study of Australian university students

Introduction: Young adults are a vulnerable population for experimentation with tobacco, which can lead to lifelong addiction. In an effort to ensure reductions in tobacco use through improved health promotion materials, we explored young adults' perceptions of current Australian packaging warnings, and novel health warnings on individual cigarette sticks. Methods: Focus groups and interviews were conducted with smoking and non-smoking first-year undergraduate university students at a regional Australian university. Semi-structured questions were used to gather participant perceptions. Sixteen students participated across three focus groups, and eleven students participated in the phone interviews. Data were analyzed using thematic analysis in NVivo. Results: Six emergent themes were identified. Current cigarette packaging warnings were seen as ineffective, being disregarded by current smokers (theme 1), and seen as irrelevant by young adult smokers and non-smokers (theme 2). Several cigarette stick warnings were perceived as engaging and effective, due to the novelty of the cigarette stick as a medium (theme 3), and the proximal nature of the warnings used (theme 4). The warning depicting the financial consequences of smoking was considered the most effective, followed by the impact of smoking on personal appearance, and the "minutes of life lost" warning. Social media (theme 5), and the use of more supportive messages to assist smokers (theme 6) were considered the best next steps as tobacco control interventions. Conclusions: Supplementing packaging warnings which were seen as minimally effective in this study, using cigarette stick warnings and social media may lead to further reductions in tobacco use. New and relatable warnings such as the financial consequences of smoking and impact on personal appearance may be the most effective in dissuading young adults from smoking, particularly within the university environment.

Trends in the ease of cigarette purchase among Korean adolescents: evidence from the Korea youth risk behavior web-based survey 2005-2016

Background

According to the Juvenile Protection Act in Korea, no one is allowed to sell, rent, or distribute tobacco products to adolescents. Furthermore, the Framework Convention on Tobacco Control Article 16 prohibits the sale of tobacco products to minors. In this study, we investigated the trends in and associated factors of the ease of cigarette purchase among Korean adolescents from 2005 to 2016.

Methods

The analyses were based on the data of the Korea Youth Risk Behavior Web-based Survey. We estimated the trends in the ease of cigarette purchase from 2005 to 2016 and evaluated associated factors. Ease of cigarette purchase was defined as the proportion of adolescents who were able to purchase cigarettes from among those who had tried to purchase cigarettes in the past 30 days.

Results

The ease of cigarette purchase began decreasing since 2008 (81.3%) compared to 2005 (83.9%). It decreased to 76.5% in 2013 and further decreased to 71.4% in 2016. The ease of cigarette purchase increased for adolescents who were in higher grades, smoked larger amounts of cigarettes per day, lived in metropolitan cities, had problematic drinking in the past year, and had close friends who smoked. It decreased in adolescents who had current smokers among their family members.

Conclusions

Although the proportion of adolescents who were able to purchase cigarettes significantly decreased starting in 2008, more than 70% of Korean adolescents can still purchase cigarettes. Enforcement of the Juvenile Protection Act must be strengthened in order to prevent cigarette use among adolescents.

Electronic supplementary material

The online version of this article (10.1186/s12889-018-6151-9) contains supplementary material, which is available to authorized users.

A qualitative exploration of young adult smokers' responses to novel tobacco warnings

Background

Despite reduced smoking among adolescents, smoking prevalence peaks among young adults aged 18–30, many of whom believe themselves exempt from the health risks of smoking shown in warning labels. We explored how young adult smokers perceived warnings featuring proximal risks, and whether these encouraged cessation more effectively than traditional health messages.

Methods

We conducted in-depth interviews with 17 young adult smokers and explored their perceptions of current warnings as well as novel warnings representing short-term health consequences; immediate social risks, and tobacco’s toxicity (denormalizing tobacco as an everyday product). We used a thematic analysis approach to explore how participants rationalized existing warnings and interpreted the novel messages.

Results

Participants considered the immediate social and physiological benefits they gained from smoking outweighed the distal risks shown in health warnings, which they regarded as improbable and irrelevant. Of the novel warnings, those presenting immediate social risks altered the balance of gains and losses young adults associated with smoking; however, those presenting short-term health risks or depicting tobacco as a toxin were less effective.

Conclusions

Participants regarded warnings featuring proximal social risks as more salient and they were less likely to rationalise these as irrelevant. Social risk messages merit further investigation to examine their potential as a complement to traditional health warnings.

Through tobacco industry eyes: civil society and the FCTC process from Philip Morris and British American Tobacco's perspectives

OBJECTIVE

To analyse the models Philip Morris (PM) and British American Tobacco (BAT) used internally to understand tobacco control non-governmental organizations (NGOs) and their relationship to the global tobacco control policy-making process that resulted in the Framework Convention for Tobacco Control (FCTC).

METHODS

Analysis of internal tobacco industry documents in the Legacy Tobacco Document Library.

RESULTS

PM contracted with Mongoven, Biscoe, and Duchin, Inc. (MBD, a consulting firm specialising in NGO surveillance) as advisors. MBD argued that because NGOs are increasingly linked to epistemic communities, NGOs could insert themselves into the global policy-making process and influence the discourse surrounding the treaty-making process. MBD advised PM to insert itself into the policy-making process, mimicking NGO behaviour. BAT's Consumer and Regulatory Affairs (CORA) department argued that global regulation emerged from the perception (by NGOs and governments) that the industry could not regulate itself, leading to BAT advocating social alignment and self-regulation to minimise the impact of the FCTC. Most efforts to block or redirect the FCTC failed.

CONCLUSIONS

PM and BAT articulated a global policy-making environment in which NGOs are key, non-state stakeholders, and as a result, internationalised some of their previous national-level strategies. After both companies failed to prevent the FCTC, their strategies began to align. Multinational corporations have continued to successfully employ some of the strategies outlined in this paper at the local and national level while being formally excluded from ongoing FCTC negotiations at the global level.

Peers, tobacco advertising, and secondhand smoke exposure influences smoking initiation in diverse adolescents

PURPOSE

Identify demographic, social, and environmental factors associated with smoking initiation in a large, racially and ethnically diverse sample of underage youth participating in the 2006 Maryland Youth Tobacco Survey.

DESIGN

Cross-sectional, multistage, probability sample survey.

SETTING

Schools (308 middle and high schools) in Maryland.

SUBJECTS

Subjects were 12- to 17-year-old adolescents participating in a school-based survey. New smokers and nonsmokers were included in the analysis (n  =  57,072).

MEASURES

Social and media influence, secondhand smoke exposure, tobacco product use, and demographic information including age, race/ethnicity, and geographic region.

ANALYSIS

Chi-square and multiple logistic regression analyses controlling for clustering.

RESULTS

Hispanic and Hawaiian/Pacific Islander youth were most likely and Asian and Black youth were least likely to be new smokers. Smoking initiation was positively associated with higher age, living with a current smoker, secondhand smoke exposure, exposure to advertisements for tobacco products, having more friends that smoke, tobacco products offered by friends, risk perceptions, and use of other tobacco products such as smokeless tobacco and cigars. Multivariate logistic regression results suggested that composite measures of peer influence, advertising exposure, and secondhand smoke exposure were independently associated with smoking initiation.

CONCLUSIONS

Media, peer influence, and secondhand smoke exposure were the most important factors influencing smoking initiation and were common to all racial/ethnic groups in this study. Interventions combining targeted public awareness, education, and media campaigns directed at parents/guardians should be investigated.

'Acceptable rebellion': marketing hipster aesthetics to sell Camel cigarettes in the US

OBJECTIVE

The aim of the present work was to understand why and how RJ Reynolds and other tobacco companies have marketed tobacco products to young adult social trendsetting consumers (termed 'hipsters') to recruit trendsetters and average consumers to smoke.

METHODS

Analysis of tobacco industry documents and industry marketing materials.

RESULTS

Since 1995, RJ Reynolds developed its marketing campaigns to better suit the lifestyle, image identity and attitudes of hip trendsetters (so-called 'hipsters'), and Camel's brand identity actively shifted to more closely convey the hipster persona. Camel emphasised in-venue events such as promotional music tours to link the brand and smoking to activities and symbols appealing to hipsters and their emulating masses.

CONCLUSIONS

To reach this targeted and socially valuable trend-setting population, public health advocates must tap into hipster psychology and expose to the targeted community the tobacco company's efforts to infiltrate the hipster community to turn hipsters into tobacco-using role models.