How Tobacco Companies are Perceived Within the United Kingdom: An Online Panel

Association between tobacco industry denormalisation beliefs and support for tobacco endgame policies: a population-based study in Hong Kong

OBJECTIVES

To examine the associations between tobacco industry denormalisation (TID) beliefs and support for tobacco endgame policies.

METHODS

A total of 2810 randomly selected adult respondents of population-based tobacco policy-related surveys (2018-2019) were included. TID beliefs (agree vs disagree/unsure) were measured by seven items: tobacco manufacturers ignore health, induce addiction, hide harm, spread false information, lure smoking, interfere with tobacco control policies and should be responsible for health problems. Score of each item was summed up and dichotomised (median=5, >5 strong beliefs; ≤5 weak beliefs). Support for tobacco endgame policies on total bans of tobacco sales (yes/no) and use (yes/no) was reported. Associations between TID beliefs and tobacco endgame policies support across various smoking status were analysed, adjusting for sociodemographics.

RESULTS

Fewer smokers (23.3%) had strong beliefs of TID than ex-smokers (48.4%) and never smokers (48.5%) (p<0.001). Support for total bans on tobacco sales (74.6%) and use (76.9%) was lower in smokers (33.3% and 35.3%) than ex-smokers (74.3% and 77.9%) and never smokers (76.0% and 78.3%) (all p values<0.001). An increase in the number of TID beliefs supported was positively associated with support for a total ban on sales (adjusted risk ratio 1.06, 95% CI 1.05 to 1.08, p<0.001) and use (1.06, 95% CI 1.05 to 1.07, p<0.001). The corresponding associations were stronger in smokers than non-smokers (sales: 1.87 vs 1.25, p value for interaction=0.03; use: 1.78 vs 1.21, p value for interaction=0.03).

CONCLUSION

Stronger TID belief was associated with greater support for total bans on tobacco sales and use. TID intervention may increase support for tobacco endgame, especially in current smokers.

Content analysis of Dutch newspaper coverage of three tobacco control policies, 2017-2019

OBJECTIVES

News media coverage can influence support for and implementation of tobacco control policies. This research aims to analyse and compare newspaper coverage of newly implemented policies: a substantial tobacco tax increase, point-of-sale display ban and plain packaging.

DESIGN

We conducted a content analysis of articles covering the three policies from ten national Dutch newspapers. Articles published between November 2017 and November 2019 were coded for type and tone. The policy dystopia model was used to code arguments opposing the policies. Tobacco industry appearances in news articles were also analysed for frequency and type.

RESULTS

A total of 134 news articles were analysed, of which the industry appeared in 28%. The majority of coverage was neutral in tone, although among articles that were coded as expressing a positive or negative tone, plain packaging and the point-of-sale ban were portrayed more negatively than positively. Negative coverage was predominantly accounted for by industry presence. Arguments opposing the policies focused on negative economic consequences, challenging the need for policy and adverse consequences for retailers for tax, plain packaging and the point-of-sale display ban, respectively. We identified six specific new arguments that fit within existing domains of the policy dystopia model.

CONCLUSIONS

The tobacco industry and its allies still appear in a substantial proportion of news articles in relation to tobacco policy. This study identifies contemporary industry arguments against tobacco control policies in Europe which, alongside the policy dystopia model, can be used to predict and counter the tobacco industry's future attempts to oppose policies.

Adapting Inhaled Medication Practice in COPD and Asthma to Avoid Funding the Tobacco Industry

The takeover of Vectura, a healthcare company specialising in inhaled medication, by Philip Morris International raises serious ethical concerns. The European Respiratory Society notes that "health professionals will avoid prescribing drugs from any company that enriches the tobacco industry due to the ethical implications". People with chronic obstructive pulmonary disease (COPD) and asthma will also be reluctant to use medications which profit a company that is estimated to kill at least one million people every year. We discuss the practicalities involved in switching people with lung disease to inhaled medications that are not tobacco industry linked. Potential alternative inhaled medications are set out, which are likely to be equally effective for most patients. A consideration of beneficence, non-maleficence, autonomy, and distributive justice demonstrates strong ethical reasons to support switching away from the prescription of tobacco industry linked products.

Tobacco Industry Denormalization Beliefs in Hong Kong Adolescents

BACKGROUND

Tobacco industry denormalization (TID) seeks to expose the industry's misconducts. Research on TID beliefs, meaning negative attitudes toward the tobacco industry (TI), may inform TID programs, but was limited to western populations. We investigated TID beliefs and their association with smoking and sociodemographic characteristics in Hong Kong adolescents.

METHODS

In a school-based cross-sectional survey of 14214 students (mean age 15.0 years, 51.5% boys), TID beliefs were assessed by two questions: (1) whether the TI was respectable and (2) whether the TI tried to get youth to smoke, each with four options from "definitely no" to "definitely yes." Smoking susceptibility and behaviors were also assessed. Sociodemographic characteristics included age, sex, perceived family affluence, highest parental education, numbers of co-residing smokers, and school-level smoking prevalence.

RESULTS

Of all students, 77.6% considered the TI not respectable and 56.6% believed that the TI tried to get youth to smoke. Stronger TID beliefs were inversely associated with smoking susceptibility and behaviors. For example, students considering the TI definitely not respectable (vs. definitely yes) were 56% (95% confidence intervals [CI] = 45% to 66%), 49% (95% CI = 41% to 56%), and 53% (95% CI = 36% to 65%) less likely to be susceptible to smoking (among never-smokers) and be ever- and current smokers, respectively. Of all correlates examined, only younger age and having no co-residing smoker were associated with TID beliefs.

CONCLUSIONS

Substantial proportions of Hong Kong adolescents did not hold TID beliefs, but those who did were less likely to smoke. Our results suggest that TID programs may help reduce adolescent smoking.

IMPLICATIONS

The TI's misconducts and responsibility for the tobacco epidemic were not well known by Hong Kong adolescents. TID beliefs in this population were inversely associated with smoking. These findings suggest that TID programs in local adolescents may be of value. The investigation into the correlates of TID beliefs found that socioeconomic status and school-level smoking prevalence were not associated with TID beliefs. This suggests that local TID programs targeting adolescents in general, for example, mass-media campaigns, may be more appropriate than those targeting particular schools or selected groups of adolescents.

Adolescent Support for Tobacco Control Policies and Associations with Tobacco Denormalization Beliefs and Harm Perceptions

Public support is crucial for advancing tobacco control policies. We investigated adolescent support for such policies, and its association with potential factors of social denormalization (SD) beliefs of smoking, tobacco industry denormalization (TID) beliefs (negative perceptions of the industry), and harm perceptions of smoking. In a cross-sectional survey in Hong Kong, 13,964 secondary school students (mean age 15.0 years, 51.3% boys) reported their support (yes/no) for each of 14 tobacco control policies (e.g., further increase tobacco tax). Tobacco-related beliefs and perceptions, and smoking status were also measured. Support for the 14 tobacco control policies ranged from 17.6% to 54.1%. In current non-smokers, SD beliefs, TID beliefs, and harm perceptions were all associated with support for all tobacco control policies. In current smokers, the study factors were each associated with support for two to three policies. To conclude, support for tobacco control policies was weak to moderate in Hong Kong adolescents. SD beliefs, TID beliefs, and harm perceptions of smoking were associated with policy support in current non-smokers. In current smokers, the corresponding associations were less consistent or weaker.

Perceptions of cigarette pack inserts promoting cessation and dissuasive cigarettes among young adult smokers in the UK: a cross-sectional online survey

OBJECTIVES

To explore young adult smokers' perceptions of cigarette pack inserts promoting cessation and cigarettes designed to be dissuasive.

DESIGN

Cross-sectional online survey.

SETTING

UK.

PARTICIPANTS

The final sample was 1766 young adult smokers, with 50.3% male and 71.6% white British. To meet the inclusion criteria, participants had to be 16-34 years old and smoke factory-made cigarettes.

PRIMARY AND SECONDARY OUTCOME MEASURES

Salience of inserts, perceptions of inserts as information provision, perceptions of inserts on quitting, support for inserts and perceived appeal, harm and trial of three cigarettes (a standard cigarette, a standard cigarette displaying the warning 'Smoking kills' and a green cigarette).

RESULTS

Half the sample indicated that they would read inserts with three-fifths indicating that they are a good way to provide information about quitting (61%). Just over half indicated that inserts would make them think more about quitting (53%), help if they decided to quit (52%), are an effective way of encouraging smokers to quit (53%) and supported having them in all packs (55%). Participants who smoked factory-made cigarettes and other tobacco products (compared with exclusive factory-made cigarette smokers), had made a quit attempt within the last 6 months (compared with those that had never made a quit attempt) or were likely to make a successful quit attempt in the next 6 months (compared with those unlikely to make a quit attempt in the next 6 months) were more likely to indicate that inserts could assist with cessation. Multivariable logistic regression modelling suggested that compared with the standard cigarette, the cigarette with warning (adjusted OR=17.71; 95% CI 13.75 to 22.80) and green cigarette (adjusted OR=30.88; 95% CI 23.98 to 39.76) were much less desirable (less appealing, more harmful and less likely to be tried).

CONCLUSIONS

Inserts and dissuasive cigarettes offer policy makers additional ways of using the pack to reduce smoking.