1
|
Ahuja N, Mahmood A, Kedia S, Dillon PJ. Predictors of U.S. Adults' Opinion Toward an R-Rating Policy for Movies With Cigarette Smoking. HEALTH EDUCATION & BEHAVIOR 2024; 51:573-582. [PMID: 38519853 DOI: 10.1177/10901981241239933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2024]
Abstract
Recently, multiple health organizations and advocacy groups have pushed for giving an R-rating for movies depicting tobacco imagery. This study examined several predictors of U.S. adults' opinion toward an R-rating policy for movies depicting cigarette smoking. We used data from the Health Information National Trends Survey (2020 cycle), for a nationally representative sample of 3,865 US adults (aged ≥ 18). The outcome variable was opinion toward an R-rating policy (support, neutral, and oppose) for movies depicting cigarette smoking. A weighted adjusted multinomial logistic regression analysis with comparisons of support versus oppose, support versus neutral, and neutral versus oppose was performed. About 48.2% of respondents were supportive of, 31.1% were neutral toward, and 20.7% were opposed to an R-rating policy. Adults aged 50 to 64 years (adjusted odds ratio [aOR] = 2.28, p = .008) and ≥65 years (aOR = 4.54, p <.001) (vs. 18-34 years) were more likely to support the R-rating policy than oppose it. Non-Hispanic Black respondents (vs. non-Hispanic Whites) were 1.74 times more likely to support than oppose the policy (aOR = 1.74, p = .04), whereas adults with a household annual income of US$75,000 or more (vs. <$20,000) and those with moderate (vs. liberal) political viewpoints were more likely to be neutral than oppose the policy. Former and current e-cigarette users (vs. never users) were less likely to support than oppose the policy. Tailored messaging addressing the rationale behind R-rating policy should be directed towards communities based on age, race/ethnicity, household income, e-cigarette usage, and political ideologies.
Collapse
Affiliation(s)
- Nikhil Ahuja
- Slippery Rock University of Pennsylvania, Slippery Rock, PA, USA
| | - Asos Mahmood
- The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Satish Kedia
- The University of Memphis School of Public Health, Memphis, TN, USA
| | | |
Collapse
|
2
|
Nunes-Rubinstein M, Leão T. Arguments used by proponents and opponents in Brazil's regulatory discussions of e-cigarettes and heated tobacco products. Tob Control 2023; 32:296-301. [PMID: 34531313 DOI: 10.1136/tobaccocontrol-2021-056628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 08/19/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify proponents and opponents of the commercialisation and marketing of e-cigarettes and heated tobacco products (HTPs), identify the arguments used on both sides and compare how the arguments have changed over time, we analysed three policy discussions occurring in 2009, 2018 and 2019. METHODS We conducted a content analysis of one document and six videos from these discussions, provided on the Brazilian Health Regulatory Agency website, or upon request. RESULTS The arguments most used by tobacco companies were related to claims that the use of e-cigarettes and HTPs is less harmful than conventional tobacco. Unions that support its commercialisation also argued that lifting the ban would prevent smuggling and guarantee their quality. On the other side, universities, medical and anti-tobacco institutions argued that such devices may have health risks, including the risk of inducing cigarette smoking. In 2009, most arguments belonged to the 'health' theme, while in 2018 and 2019 economic arguments and those related to morals and ethics were frequently used. CONCLUSIONS Those that supported the commercialisation and marketing of e-cigarettes and HTPs first focused on arguments of harm reduction, while 10 years later the right to access and potential economic consequences also became common. Public health agents and academics must gather evidence to effectively respond to these arguments and discuss these policies, and must prepare themselves to use and respond to arguments related to moral and economic themes.
Collapse
Affiliation(s)
| | - Teresa Leão
- EPI-Unit, Instituto de Saúde Pública da Universidade do Porto, Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| |
Collapse
|
3
|
Who Are the Local Policy Innovators? Cluster Analysis of Municipal Tobacco Control Policies in Massachusetts. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2023; 29:151-161. [PMID: 36214651 DOI: 10.1097/phh.0000000000001649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
CONTEXT Tobacco use is a leading cause of preventable death, yet it is challenging to establish public policy to reduce tobacco use. Massachusetts has been a national leader in tobacco control, and its policy-making patterns can be informative to the country. OBJECTIVE To identify factors associated with the adoption of tobacco policy within 351 Massachusetts municipalities. DESIGN We obtained the 2019 Massachusetts municipality-level tobacco control policy information from Massachusetts' Tobacco Automated Fact Sheet Information system and compiled it with data from American Community Survey, Massachusetts Municipal Association, and Massachusetts state government's Web sites. We used k -means clustering method to identify statistical clustering patterns and hotspot analysis (Getis-Ord Gi*) and Local Indicators of Spatial Association to identify geographic clustering patterns. We then performed multinomial logistic regression to identify factors associated with policy clusters. SETTING Massachusetts. PARTICIPANTS Three hundred fifty-one municipalities in Massachusetts. MAIN OUTCOME MEASURE Policy clusters-groups of municipalities with similar tobacco control policy behaviors. RESULTS Based on the k -means analyses, we identified 3 clusters in Massachusetts municipal tobacco control policy behaviors: 54% (N = 191) of municipalities were "Policy Leaders" with a high adoption rate of the 6 tobacco control policies; 18% (N = 63) were "Peer-Influenced Actors" focused on tobacco purchase restrictions for individuals younger than 21 years; and 28% (N = 97) were "Policy Non-Actors," with no tobacco control policies in place. Policy Leaders were geographically clustered in larger cities and the MetroWest region. Policy Non-Actors were clustered in rural areas of Western and Central Massachusetts. Larger municipal population size, higher municipal tax income, and higher percentages of residents voting Democratic were associated with higher policy adoption activities. CONCLUSIONS Local variation in the adoption of tobacco policies may exacerbate inequities in tobacco use and population health. Opportunities remain to implement additional tobacco control regulations at the local level to promote public health.
Collapse
|
4
|
Kiviniemi MT, Orom H, Hay JL, Waters EA. Prevention is political: political party affiliation predicts perceived risk and prevention behaviors for COVID-19. BMC Public Health 2022; 22:298. [PMID: 35164719 PMCID: PMC8842925 DOI: 10.1186/s12889-022-12649-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 01/18/2022] [Indexed: 11/10/2022] Open
Abstract
Background Many US politicians have provided mixed messages about the risks posed by SARS-CoV-2/COVID-19 and whether and to what extent prevention practices should be put in place to prevent transmission. This politicization of the virus and pandemic may affect individuals’ risk perceptions and willingness to take precautions. We examined how political party affiliation relates to risk perception for one’s own and other people’s likelihood of SARS-CoV-2 infection/COVID-19 illness. Methods We surveyed members of a nationally-representative, probability-sampling based survey panel (N = 410) to examine their risk perceptions, precautionary behaviors, and political party affiliation. Results The more strongly one identified as a Republican, the less risk one perceived to oneself from SARS-CoV-2/COVID-19 and the less risk one perceived other people faced. Moreover, those identifying as more strongly Republican engaged in fewer preventive behaviors. Conclusions This differential response may affect virus transmission patterns and poses a considerable challenge for health communications efforts.
Collapse
Affiliation(s)
- Marc T Kiviniemi
- University of Kentucky, 151 Washington Avenue, Lexington, KY, 40536, USA.
| | | | - Jennifer L Hay
- Memorial Sloan Kettering Cancer Center, New York City, USA
| | - Erika A Waters
- Washington University in Saint Louis School of Medicine, St. Louis, USA
| |
Collapse
|
5
|
Roberts R. Prevention pays: COVID-19 tells us it's time for a Sovereign Health Fund for disease prevention. Aust J Rural Health 2021; 29:488-491. [PMID: 34423512 PMCID: PMC8653197 DOI: 10.1111/ajr.12792] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
|
6
|
Ofori-Parku SS. Fifty years after surgeon general’s report: cultural cognition, biased assimilation, and cigarette smoking risk perceptions among college students. HEALTH, RISK & SOCIETY 2020. [DOI: 10.1080/13698575.2020.1769566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
7
|
Fischer B, Bullen C, Hall W. A call for greater policy and regulatory coherence for an expanding menu of legal psychoactive substances. Drug Alcohol Rev 2020; 39:737-742. [PMID: 32420658 DOI: 10.1111/dar.13071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 03/20/2020] [Accepted: 03/26/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Benedikt Fischer
- School of Population Health, University of Auckland, Auckland, New Zealand.,School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.,Department of Psychiatry, University of Toronto, Toronto, Canada.,Centre for Applied Research in Mental Health and Addiction, Simon Fraser University, Vancouver, Canada.,Department of Psychiatry, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Chris Bullen
- School of Population Health, University of Auckland, Auckland, New Zealand
| | - Wayne Hall
- Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Australia.,National Addiction Centre, Kings College London, London, UK
| |
Collapse
|
8
|
Astuti PAS, Assunta M, Freeman B. Why is tobacco control progress in Indonesia stalled? - a qualitative analysis of interviews with tobacco control experts. BMC Public Health 2020; 20:527. [PMID: 32306928 PMCID: PMC7168953 DOI: 10.1186/s12889-020-08640-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 04/02/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Indonesia shoulders a significant tobacco burden, with almost two million cases of tobacco-related illnesses and more than two hundred thousand tobacco-related deaths annually. Indonesian tobacco control is progressing but lags behind other countries. Our study evaluates factors that contribute to the slow progress of tobacco policy change in Indonesia from the perspective of tobacco control experts (TCEs). METHOD We conducted qualitative interviews with four international and ten national TCEs, who have been active in tobacco control for at least 5 years. Our interview guideline included questions on the current tobacco control situation in Indonesia and explored reasons why tobacco control is progressing so slowly. The interviews were conducted either in English or Bahasa Indonesia, recorded and then transcribed verbatim. We conducted a thematic analysis based on five core causal factors for policy adoption: institutions, networks, socio-economic factors, agendas and ideas. RESULTS The multistage delay of tobacco policy adoption is principally due to political structures and policy hierarchy, complex bureaucracy, unclear roles and responsibilities, and a high degree of corruption. The low bargaining position and lack of respect for the Ministry of Health also contributes. There are contrasting frames of tobacco as a strategic economic asset and tobacco control as a sovereignty threat. There is an imbalance of power and influence between well entrenched and resourced tobacco industry networks compared to relatively young and less established tobacco control networks. The policy agenda is likely influenced by the privileged position of tobacco in Indonesia as a socially acceptable product with high consumption. There are constraints on transferring ideas and evidence to successful policy adoption. CONCLUSION Tobacco companies have substantially influenced both policy decisions and public perceptions, signifying a power imbalance within the government system and broader networks. Acceding to and enforcing the World Health Organization- Framework Convention on Tobacco Control (WHO-FCTC) would enable the Indonesian government to shift the power imbalance towards public health stakeholders. Tobacco control advocates must enhance their network cohesion and embrace other community groups to improve engagement and communication with policymakers.
Collapse
Affiliation(s)
- Putu Ayu Swandewi Astuti
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Bali, Indonesia. .,School of Public Health, The University of Sydney, Sydney, NSW, Australia.
| | - Mary Assunta
- South East Asia Tobacco Control Alliance (SEATCA), Bangkok, Thailand
| | - Becky Freeman
- School of Public Health, The University of Sydney, Sydney, NSW, Australia.,Prevention Research Collaboration (PRC), Charles Perkins Center, The University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
9
|
Rhoades RR, Beebe LA, Mushtaq N. Support for Local Tobacco Policy in a Preemptive State. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3378. [PMID: 31547351 PMCID: PMC6766053 DOI: 10.3390/ijerph16183378] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 08/26/2019] [Accepted: 09/06/2019] [Indexed: 11/16/2022]
Abstract
Policy at the local level is a critical component of comprehensive tobacco control programs. This study examined the relationships of individual and social factors with support for tobacco-related public policy using cross-sectional data (n = 4461) from adults participating in a statewide survey. Weighted multivariate, multinomial logistic regression examined associations between individual and social factors and support for tobacco-free city properties and support for limiting the number of stores that sell tobacco near schools. Oklahomans were more likely to favor policies that create tobacco-free city properties than policies that limit the number of stores that sell tobacco near schools. While non-smokers were most likely to favor both policies, support for both policies was greater than 50% among current smokers. Knowledge of secondhand smoke (SHS) exposure harm and female gender were predictors of support for both policies and among current, former, and never smokers. Rural-urban status was a predictor of support among former smokers and never smokers. Tobacco use among friends and family was only a predictor among never smokers' support for limiting the sale of tobacco near schools. This study demonstrates that level of support differs by policy type, individual smoking status, as well as among subpopulations, and identifies critical elements in the theory of change for tobacco control programs.
Collapse
Affiliation(s)
- Rebekah R Rhoades
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104, USA.
| | - Laura A Beebe
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104, USA
| | - Nasir Mushtaq
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104, USA
| |
Collapse
|
10
|
Bigman CA, Mello S, Sanders-Jackson A, Tan ASL. Speaking up about Lighting up in Public: Examining Psychosocial Correlates of Smoking and Vaping Assertive Communication Intentions among U.S. Adults. HEALTH COMMUNICATION 2019; 34:500-510. [PMID: 29364737 PMCID: PMC6501571 DOI: 10.1080/10410236.2018.1428849] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Against a backdrop of increasing smoke-free policies, electronic cigarette use, and discussion about public health risks posed by smoking and vaping, this study examines psychosocial predictors of intentions to ask others not to use e-cigarettes (vape) and smoke - i.e., assertive communication intentions. A national sample of U.S. adults (n = 474) reported assertive communication intentions for public venues. Psychosocial correlates included perceived risks of exposure to secondhand smoke (SHSe) and secondhand vapor (SHVe), SHSe and SHVe attitudes, subjective norms, and perceived self-efficacy. Separate linear regression models were conducted for smoking and vaping assertive communication intention outcomes. Perceived risks and self-efficacy were associated with greater vaping and smoking assertive communication intentions; subjective norms were only significant for vaping assertive communication intentions. Although a majority of respondents indicated they were unlikely to intervene to voice objections about SHSe and SHVe in public venues, this study suggests that incidental or intentional messages and policies that influence perceptions of risk, norms, and efficacy could affect willingness to voice objections about others' vaping and smoking in public.
Collapse
Affiliation(s)
- Cabral A Bigman
- a Department of Communication , University of Illinois Urbana-Champaign
| | - Susan Mello
- b Department of Communication Studies , Northeastern University
| | | | - Andy S L Tan
- d Department of Social and Behavioral Sciences , Harvard University T.H. Chan School of Public Health and Division of Population Sciences, Center for Community-Based Research, Dana-Farber Cancer Institute
| |
Collapse
|
11
|
Kuijpers TG, Willemsen MC, Kunst AE. Public support for tobacco control policies: The role of the protection of children against tobacco. Health Policy 2018; 122:929-935. [PMID: 29859650 DOI: 10.1016/j.healthpol.2018.05.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Revised: 05/07/2018] [Accepted: 05/10/2018] [Indexed: 11/17/2022]
Abstract
INTRODUCTION In many countries, health advocates aim to increase public support for tobacco control policies by framing these policies in terms of child protection. We examined whether support for the protection of children is indeed associated with support for tobacco control policies, even among smokers, opponents of state intervention and opponents of a governmental role in tobacco control. METHODS We used a survey on a representative sample of Dutch adults of 18 years and older (n = 1631). The survey measured respondents' support for banning tobacco displays, raising the age of sale for tobacco to 21 years and limiting tobacco sales to specialized shops. Regression analyses were done to assess the association with respondents' support for the protection of children against tobacco. In further analyses, subgroup interactions were added. RESULTS Respondents' support for the protection of children against tobacco with legislation was positively related to support for all three policies. Associations were weaker for smokers (except for raising the age of sale) but similar for opponents of state intervention and opponents of a governmental role in tobacco control. CONCLUSION This is the first paper to empirically support the idea that emphasizing the need to protect children against tobacco enhances support for tobacco control policies. This 'child effect' is effective in all segments of the population, albeit somewhat weaker among smokers.
Collapse
Affiliation(s)
- Thomas G Kuijpers
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Marc C Willemsen
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands; Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
12
|
|
13
|
Exploring Support for 100% College Tobacco-Free Policies and Tobacco-Free Campuses Among College Tobacco Users. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:29-39. [PMID: 25859902 DOI: 10.1097/phh.0000000000000262] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tobacco-free campus policy is identified as an effective means to address tobacco use on college campuses; however, the prevalence of tobacco-free policies (TFPs) in the United States remains low. This study explores college tobacco users' support for a university's TFP and tobacco-free campuses (TFCs) in general. METHODS A standardized and structured questionnaire was administered to 790 college tobacco users recruited in a university located in a tobacco-growing region of the United States, during April-May 2011, to collect information on support for TFPs and TFCs and sociodemographic-political characteristics. Descriptive and multivariable logistic regression analyses were conducted to identify key factors associated with support for TFPs and TFCs. RESULTS Approximately 2 of 5 tobacco users favored TFPs and TFCs. Multivariable logistic regression models showed that demographic factors were mostly not significantly associated with attitudes of the college tobacco users. Instead, while knowledge about harmful effects of exposure to secondhand tobacco smoke significantly increased support for both TFPs and TFCs, parental and peer smoking and exposure to tobacco industry promotions significantly decreased the likelihoods of support compared with respective referent groups. CONCLUSION Study findings suggest that campus advocacy and education campaigns for campus tobacco policies to pay attention to tobacco use behavior of familial relations, tobacco industry activities, and other political determinants of tobacco users' attitudes. Thus, this study should inform national initiatives to promote TFPs nationwide such as the Tobacco-Free College Campus Initiative.
Collapse
|
14
|
Payán DD, Lewis LB, Cousineau MR, Nichol MB. Advocacy coalitions involved in California's menu labeling policy debate: Exploring coalition structure, policy beliefs, resources, and strategies. Soc Sci Med 2017; 177:78-86. [PMID: 28161674 PMCID: PMC5598761 DOI: 10.1016/j.socscimed.2017.01.036] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 12/21/2016] [Accepted: 01/22/2017] [Indexed: 11/15/2022]
Abstract
Advocacy coalitions often play an important role in the state health policymaking process, yet little is known about their structure, composition, and behavior. In 2008, California became the first state to enact a menu labeling law. Using the advocacy coalition framework, we examine different facets of the coalitions involved in California’s menu labeling policy debate. We use a qualitative research approach to identify coalition members and explore their expressed beliefs and policy arguments, resources, and strategies by analyzing legislative documents (n=87) and newspaper articles (n=78) produced between 1999 and 2009. Between 2003 and 2008, six menu labeling bills were introduced in the state’s legislature. We found the issue received increasing media attention during this period. We identified two advocacy coalitions involved in the debate—a public health (PH) coalition and an industry coalition. State organizations acted as coalition leaders and participated for a longer duration than elected officials. The structure and composition of each coalition varied. PH coalition leadership and membership notably increased compared to the industry coalition. The PH coalition, led by nonprofit PH and health organizations, promoted a clear and consistent message around informed decision making. The industry coalition, led by a state restaurant association, responded with cost and implementation arguments. Each coalition used various resources and strategies to advance desired outcomes. PH coalition leaders were particularly effective at using resources and employing advocacy strategies, which included engaging state legislators as coalition members, using public opinion polls and information, and leveraging media resources to garner support. Policy precedence and a local policy push emerged as important policymaking strategies. Areas for future research on the state health policymaking process are discussed.
Collapse
Affiliation(s)
- Denise D Payán
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA, USA; RAND Corporation, Santa Monica, CA, USA.
| | - LaVonna B Lewis
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| | - Michael R Cousineau
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Michael B Nichol
- Sol Price School of Public Policy, University of Southern California, Los Angeles, CA, USA
| |
Collapse
|
15
|
van der Eijk Y. Ethics of tobacco harm reduction from a liberal perspective. JOURNAL OF MEDICAL ETHICS 2016; 42:273-277. [PMID: 26612426 DOI: 10.1136/medethics-2015-102974] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 11/02/2015] [Indexed: 06/05/2023]
Abstract
Mixed evidence on the possible harms, benefits and usage patterns of electronic nicotine delivery systems (ENDS, or 'e-cigarettes'), has led to vigorous and ongoing debates on the issue. The ethical trade-off often represented is that, though smokers should be permitted access to ENDS as a less harmful alternative to smoking, this comes at the expense of non-smokers and children who may experiment with ENDS, become addicted to them, or experience health issues from long-term exposure to passive ENDS vapour. Lacking from many debates is a balanced analysis based on sound ethical reasoning, so this paper aims to examine the issue from a liberal perspective. More specifically, focus is on how ENDS policy can help to promote freedom in a broader sense, with 'freedom' considered as originating from having options and the necessary information and ability to autonomously choose between these options.
Collapse
|
16
|
Mello S, Bigman CA, Sanders-Jackson A, Tan ASL. Perceived Harm of Secondhand Electronic Cigarette Vapors and Policy Support to Restrict Public Vaping: Results From a National Survey of US Adults. Nicotine Tob Res 2015; 18:686-93. [PMID: 26470722 DOI: 10.1093/ntr/ntv232] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 10/01/2015] [Indexed: 12/25/2022]
Abstract
INTRODUCTION There is ongoing debate over banning electronic cigarette (e-cigarette) use (vaping) in public places. Many people perceive secondhand e-cigarette vapors (SHV) to be relatively harmless, which may affect their support for policies to restrict vaping in public places. Given that awareness of secondhand cigarette smoke risks predicts public support for clean air policies, we hypothesized that greater perceived harm of SHV to personal health would be associated with stronger support for vaping restrictions. METHODS Data from 1449 US adults in a national online panel was collected from October to December 2013. Using multiple regressions, we predict a three-item scale of support for e-cigarette restricting policies in restaurants, bars/casinos/clubs, and parks using a two-item scale measuring concern and perceptions of harm to personal health from breathing SHV. Analyses adjusted for demographic covariates, smoking status and e-cigarette use, and were weighted to represent the US adult population. RESULTS Overall, respondents considered SHV exposure to be moderately harmful to their health and tended to favor restricting vaping in public places. Perceived harm of SHV to personal health was associated with support for vaping restrictions in public spaces (unstandardized regression coefficient, B = 0.18, 95% CI = 0.16, 0.20). Current smokers (vs. nonsmokers), those who ever tried e-cigarettes (vs. never), those who directly observed others vaping, and those with some college education (vs. high school or less) demonstrated less support for such policies. IMPLICATIONS This study shows that support for banning vaping in public spaces in the United States is positively associated with perceived health harms of SHV exposure. The findings suggest that continued monitoring of public perception of SHV harm and the accuracy of e-cigarette marketing claims about reduced harm would be needed to guide clean air policy decisions. With the emergence of new scientific evidence of the potential effects of SHV exposure, these results will serve as an important baseline of public perceptions and opinion during a time when such evidence was particularly limited.
Collapse
Affiliation(s)
- Susan Mello
- Department of Communication Studies, Northeastern University, Boston, MA;
| | - Cabral A Bigman
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL
| | - Ashley Sanders-Jackson
- Department of Advertising and Public Relations, Michigan State University, East Lansing, MI
| | - Andy S L Tan
- Population Sciences Division, Center for Community Based Research, Dana-Farber Cancer Institute, Boston, MA; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA
| |
Collapse
|
17
|
Communicating program outcomes to encourage policymaker support for evidence-based state tobacco control. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12562-74. [PMID: 25485977 PMCID: PMC4276631 DOI: 10.3390/ijerph111212562] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Revised: 11/21/2014] [Accepted: 11/21/2014] [Indexed: 11/29/2022]
Abstract
Tobacco use, the leading cause of preventable death in the U.S., can be reduced through state-level tobacco prevention and cessation programs. In the absence of research about how to communicate the need for these programs to policymakers, this qualitative study aimed to understand the motivations and priorities of policymakers in North Carolina, a state that enacted a strong tobacco control program from 2003–2011, but drastically reduced funding in recent years. Six former legislators (three Democrats, three Republicans) and three lobbyists for health organizations were interviewed about their attitudes towards tobacco use, support of state-funded programs, and reactions to two policy briefs. Five themes emerged: (1) high awareness of tobacco-related health concerns but limited awareness of program impacts and funding, (2) the primacy of economic concerns in making policy decisions, (3) ideological differences in views of the state’s role in tobacco control, (4) the impact of lobbyist and constituent in-person appeals, and (5) the utility of concise, contextualized data. These findings suggest that building relationships with policymakers to communicate ongoing program outcomes, emphasizing economic data, and developing a constituent advocacy group would be valuable to encourage continued support of state tobacco control programs.
Collapse
|
18
|
Hiilamo H, Glantz SA. Old wine in new bottles: tobacco industry's submission to European Commission tobacco product directive public consultation. Health Policy 2014; 119:57-65. [PMID: 25467283 DOI: 10.1016/j.healthpol.2014.11.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 10/27/2014] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
Between September and December 2010 the European Commission Health & Consumer Protection Directorate-General (DGSANCO) held a public consultation on a possible revision of the European Union Tobacco Products Directive (2001/37/EC). We used content analysis of the tobacco industry's and related parties' 300 submissions to the public consultation to determine if tobacco industry and its allies in Europe are prepared to reduce harm of the tobacco products as their public statements assert. The industry submission resorted to traditional tobacco industry arguments where illicit trade and freedom of choice were emphasized and misrepresented the conclusions of a DGSANCO-commissioned scientific report on smokeless tobacco products. Retailers and wholesalers referred to employment and economic growth more often than respondents from other categories. The pattern of responses in the submission differed dramatically from independent public opinion polls of EU citizens' support for tobacco control policies. None of the major tobacco manufacturers or their lobbying organizations supported any of the DGSANCO's proposed evidence based interventions (pictorial health warnings, plain packaging or point-of-sale display bans) to reduce harms caused by cigarette smoking.
Collapse
Affiliation(s)
- Heikki Hiilamo
- Helsinki University, Faculty of Social Sciences, PO Box 16, 00014 Helsinki, Finland.
| | - Stanton A Glantz
- Department of Medicine Center for Tobacco Control Research & Education Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, CA 94143-1390, United States
| |
Collapse
|
19
|
Abstract
Although governments have imposed controls on tobacco company behaviour, they have not yet aligned tobacco industry goals to public health objectives. As a result, tobacco companies have delayed or diminished the impact of imposed public health measures and have not contributed to curbing the epidemic of tobacco use. Over the past decade, several regulatory innovations have been proposed as ways to better align industry actions with public health needs, but none have been put in place. These policy suggestions share the goal of providing a supply-side complement to conventional demand reduction strategies, but they differ in the assumptions they make and in the regulatory and governance approaches they take. Similarly, differing views on ideology and political context within the tobacco control community and between governments may hinder the establishment of a global consensus on the ideal supply-side intervention. A government willing to implement innovative supply-side strategies as part of a tobacco control endgame may not require such consensus if factors specific to their national public health systems or political contexts are supportive.
Collapse
Affiliation(s)
- Cynthia D Callard
- Physicians for a Smoke-Free Canada, 1226A Wellington Street, Ottawa, ON, Canada.
| | | |
Collapse
|
20
|
Fooks G, Gilmore A, Collin J, Holden C, Lee K. The Limits of Corporate Social Responsibility: Techniques of Neutralization, Stakeholder Management and Political CSR. JOURNAL OF BUSINESS ETHICS : JBE 2013; 112:283-299. [PMID: 23997379 PMCID: PMC3755635 DOI: 10.1007/s10551-012-1250-5] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2009] [Accepted: 02/15/2012] [Indexed: 05/21/2023]
Abstract
Since scholarly interest in corporate social responsibility (CSR) has primarily focused on the synergies between social and economic performance, our understanding of how (and the conditions under which) companies use CSR to produce policy outcomes that work against public welfare has remained comparatively under-developed. In particular, little is known about how corporate decision-makers privately reconcile the conflicts between public and private interests, even though this is likely to be relevant to understanding the limitations of CSR as a means of aligning business activity with the broader public interest. This study addresses this issue using internal tobacco industry documents to explore British-American Tobacco's (BAT) thinking on CSR and its effects on the company's CSR Programme. The article presents a three-stage model of CSR development, based on Sykes and Matza's theory of techniques of neutralization, which links together: how BAT managers made sense of the company's declining political authority in the mid-1990s; how they subsequently justified the use of CSR as a tool of stakeholder management aimed at diffusing the political impact of public health advocates by breaking up political constituencies working towards evidence-based tobacco regulation; and how CSR works ideologically to shape stakeholders' perceptions of the relative merits of competing approaches to tobacco control. Our analysis has three implications for research and practice. First, it underlines the importance of approaching corporate managers' public comments on CSR critically and situating them in their economic, political and historical contexts. Second, it illustrates the importance of focusing on the political aims and effects of CSR. Third, by showing how CSR practices are used to stymie evidence-based government regulation, the article underlines the importance of highlighting and developing matrices to assess the negative social impacts of CSR.
Collapse
Affiliation(s)
- Gary Fooks
- Department of Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Anna Gilmore
- Department of Health, University of Bath, Claverton Down, Bath, BA2 7AY UK
| | - Jeff Collin
- Global Health Policy, Centre for International Public Health Policy, School of Health in Social Science, University of Edinburgh, Medical Buildings, Teviot Place, Edinburgh, EH8 9AG UK
| | - Chris Holden
- Social Policy and Social Work, University of York, Heslington, York, YO10 5DD UK
| | - Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Room 11322, Blusson Hall, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
| |
Collapse
|
21
|
Moore K, Borland R, Yong HH, Siahpush M, Cummings KM, Thrasher JF, Fong GT. Support for tobacco control interventions: do country of origin and socioeconomic status make a difference? Int J Public Health 2012; 57:777-86. [PMID: 22714136 DOI: 10.1007/s00038-012-0378-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 05/15/2012] [Accepted: 06/01/2012] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To examine the attitudes to various tobacco control regulations among smokers from four different countries and explore differences by country and socioeconomic status. METHODS Questions relating to tobacco regulation were asked of adult smokers from the 2007-2008 International Tobacco Control Four Country Survey (ITC4). Measures included attitudes to tobacco industry and product regulation, and measures of socioeconomic status and economic disadvantage. RESULTS Overall smokers supported greater regulation of the tobacco industry with least supportive US smokers and most supportive Australian smokers. Reporting smoking-related deprivation and a lower income was independently associated with increased support for regulation of the tobacco industry (both p≤0.01). CONCLUSIONS Policy-makers interested in doing more to control tobacco should be reassured that, for the most part, they have the support of smokers, with greatest support in countries with the strongest regulations. Smokers economically disadvantaged by smoking were more supportive of government policies to regulate the tobacco industry suggesting that reactance against regulation is not likely to differentially contribute to lower cessation rates in this group.
Collapse
Affiliation(s)
- Karen Moore
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | | | | | | | | | | | | |
Collapse
|
22
|
Hudson S, Thomson G. Policymakers and the example of smoking to children: A qualitative study. Tob Induc Dis 2011; 9:1. [PMID: 21255457 PMCID: PMC3037299 DOI: 10.1186/1617-9625-9-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Accepted: 01/22/2011] [Indexed: 12/04/2022] Open
Abstract
Background The normality of smoking that children are exposed to is associated with increased risk of smoking uptake. To better understand policymaking that could address this issue, our aim was to identify and document the views of New Zealand policymakers regarding the example of smoking behaviour to children, and the policy responses they preferred. Method We analysed public documents for relevant statements, and conducted semi-structured anonymous interviews with 62 purposively selected policymakers. We identified views of New Zealand policymakers regarding: the example to children of adult smoking behaviour, and the policy responses they preferred. Results In both public statements and anonymous interviews, policymakers demonstrated that they perceived a clear relationship between the example of smoking and children taking up smoking. However, they showed a general unwillingness to support further smokefree legislation in areas frequented by children. Rather, they preferred to educate adults about their impact as models for youth behaviour. Conclusions Health advocates in New Zealand and elsewhere may require more evidence of the effect of relevant legislation and of public support, and wider alliances, to significantly move policies specifically to reduce the example of smoking.
Collapse
|
23
|
Rouch G, Thomson G, Wilson N, Hudson S, Edwards R, Gifford H, Lanumata T. Public, private and personal: qualitative research on policymakers' opinions on smokefree interventions to protect children in 'private' spaces. BMC Public Health 2010; 10:797. [PMID: 21194440 PMCID: PMC3022865 DOI: 10.1186/1471-2458-10-797] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2010] [Accepted: 12/31/2010] [Indexed: 11/16/2022] Open
Abstract
Background Governments use law to constrain aspects of private activities for purposes of protecting health and social wellbeing. Policymakers have a range of perceptions and beliefs about what is public or private. An understanding of the possible drivers of policymaker decisions about where government can or should intervene for health is important, as one way to better guide appropriate policy formation. Our aim was to identify obstacles to, and opportunities for, government smokefree regulation of private and public spaces to protect children. In particular, to seek policymaker opinions on the regulation of smoking in homes, cars and public parks and playgrounds in a country with incomplete smokefree laws (New Zealand). Methods Case study, using structured interviews to ask policymakers (62 politicians and senior officials) about their opinions on new smokefree legislation for public and private places. Supplementary data was obtained from the Factiva media database, on the views of New Zealand local authority councillors about policies for smokefree outdoor public places. Results Overall, interviewees thought that government regulation of smoking in private places was impractical and unwise. However, there were some differences on what was defined as 'private', particularly for cars. Even in public parks, smoking was seen by some as a 'personal' decision, and unlikely to be amenable to regulation. Most participants believed that educative, supportive and community-based measures were better and more practical means of reducing smoking in private places, compared to regulation. Conclusions The constrained view of the role of regulation of smoking in public and private domains may be in keeping with current political discourse in New Zealand and similar Anglo-American countries. Policy and advocacy options to promote additional smokefree measures include providing a better voice for childrens' views, increasing information to policymakers about the harms to children from secondhand smoke and the example of adult smoking, and changing the culture for smoking around children.
Collapse
Affiliation(s)
- Gareth Rouch
- University of Otago, Wellington, Box 7343 Wellington, New Zealand
| | | | | | | | | | | | | |
Collapse
|
24
|
Neuberger JS, Davis K, Nazir N, Dunton N, Winn K, Jacquot S, Moler D. Indoor smoking ordinances in workplaces and public places in Kansas. Nicotine Tob Res 2010; 12:828-33. [PMID: 20534777 DOI: 10.1093/ntr/ntq089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
INTRODUCTION The purpose of this study was to investigate the preferences of elected city officials regarding the need for a statewide clean indoor air law and to analyze the content of local smoking ordinances. METHODS A survey of elected officials in 57 larger Kansas cities obtained information on the perceived need for statewide legislation, venues to be covered, and motivating factors. Clean indoor air ordinances from all Kansas cities were analyzed by venue. RESULTS The survey response rate was 190 out of 377 (50.4%) for elected officials. Over 70% of the respondents favored or strongly favored greater restrictions on indoor smoking. Sixty percent favored statewide legislation. Among these, over 80% favored restrictions in health care facilities, theaters, indoor sports arenas (including bowling alleys), restaurants, shopping malls, lobbies, enclosed spaces in outdoor arenas, and hotel/motel rooms. Officials who had never smoked favored a more restrictive approach. Employee and public health concerns were cited as influential by 76%-79% of respondents. Thirty-eight ordinances, covering over half of the state's population, were examined. They varied considerably in their exemptions. DISCUSSION Official's attitudes toward smoking regulations were associated with their smoking status. The examination of existing ordinances revealed a piecemeal approach to smoking regulations.
Collapse
Affiliation(s)
- John S Neuberger
- Department of Preventive Medicine and Public Health, School of Medicine, University of Kansas Medical Center, Kansas City, KS 66160, USA.
| | | | | | | | | | | | | |
Collapse
|
25
|
Quick BL, Bates BR, Quinlan MM. The utility of anger in promoting clean indoor air policies. HEALTH COMMUNICATION 2009; 24:548-561. [PMID: 19735032 DOI: 10.1080/10410230903104939] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
This investigation examined antecedents associated with support for clean indoor air policies. Participants (N = 550) living in a Midwestern county (population = 62,223) were randomly sampled. Results suggest that beliefs in the health risks associated with secondhand smoke are positively associated with favorable attitudes toward clean indoor air policies, whereas trait reactance is negatively associated with these attitudes. Findings also indicate that risks and trait reactance are indirectly associated with support for clean indoor air policies, mediated through anger arousal toward exposure to secondhand smoke. In addition, regression analyses revealed that health risks, trait reactance, and smoking status explained a significant amount of variance regarding anger toward exposure to secondhand smoke, but only health risks and smoking status accounted for a significant amount of variance toward clean indoor air attitudes. Finally, the Smoking Status x Health Risks interaction was supported for anger toward exposure to secondhand smoke and favorable attitudes toward clean indoor air policies. Our findings suggest the incorporation of anger appeals when promoting clean indoor air policies.
Collapse
Affiliation(s)
- Brian L Quick
- Department of Communication, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
| | | | | |
Collapse
|
26
|
Apollonio DE, Bero LA. Evidence and argument in policymaking: development of workplace smoking legislation. BMC Public Health 2009; 9:189. [PMID: 19534777 PMCID: PMC2706247 DOI: 10.1186/1471-2458-9-189] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2009] [Accepted: 06/17/2009] [Indexed: 11/23/2022] Open
Abstract
Background We sought to identify factors that affect the passage of public health legislation by examining the use of arguments, particularly arguments presenting research evidence, in legislative debates regarding workplace smoking restrictions. Methods We conducted a case-study based content analysis of legislative materials used in the development of six state workplace smoking laws, including written and spoken testimony and the text of proposed and passed bills and amendments. We coded testimony given before legislators for arguments used, and identified the institutional affiliations of presenters and their position on the legislation. We compared patterns in the arguments made in testimony to the relative strength of each state's final legislation. Results Greater discussion of scientific evidence within testimony given was associated with the passage of workplace smoking legislation that provided greater protection for public health, regardless of whether supporters outnumbered opponents or vice versa. Conclusion Our findings suggest that an emphasis on scientific discourse, relative to other arguments made in legislative testimony, might help produce political outcomes that favor public health.
Collapse
Affiliation(s)
- Dorie E Apollonio
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA 94143-0613, USA.
| | | |
Collapse
|
27
|
York NL, Hahn EJ, Rayens MK, Talbert J. Community readiness for local smoke-free policy change. Am J Health Promot 2008; 23:112-20. [PMID: 19004161 DOI: 10.4278/ajhp.07021615] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE The purpose of this study was to use the Community Readiness Model to examine local smoke-free policy development. DESIGN, SETTING, AND SUBJECTS A descriptive, cross-sectional design was used to assess 64 Kentucky communities. Dimensions of readiness included a community's knowledge of the problem and existing voluntary smoke-free policies; leadership for policy development; resources for policy development; climate surrounding policy development; existing voluntary policy efforts; and political climate for policy development. Dimension scores were summed to identify one of six overall readiness stages: (1) unawareness; (2) vague awareness; (3) preplanning; (4) preparation; (5) initiation; and (6) endorsement. ANALYSES Correlations between dimensions and overall readiness scores were evaluated. One-way analysis of variance was used to evaluate regional trends, and multiple regression was used to assess the influence of sociodemographic/political variables on policy readiness. RESULTS The knowledge dimension rated highest, and community climate rated lowest. Most communities were in the lower stages of readiness. No relationship was found between overall readiness and region (F [4,59] = 1.17; p > .05); nor were there regional differences among dimension scores. Smaller communities were less ready for local policy development than larger ones (adjusted R2 = .25; p = .003). CONCLUSIONS The Community Readiness Model is appropriate for understanding local policy development, and it provides advocates with information that may prove helpful in advancing smoke-free policy.
Collapse
Affiliation(s)
- Nancy L York
- University of Nevada Las Vegas, School of Nursing, 4505 Maryland Parkway, Box 453018, Las Vegas, NV 89154-3018, USA.
| | | | | | | |
Collapse
|
28
|
Jones AS, Austin WD, Beach RH, Altman DG. Tobacco farmers and tobacco manufacturers: implications for tobacco control in tobacco-growing developing countries. J Public Health Policy 2008; 29:406-23. [PMID: 19079300 DOI: 10.1057/jphp.2008.37] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Assisting tobacco farmers to transition to non-tobacco alternatives is a key element of comprehensive tobacco control's end-game strategy and specifically required by the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC). We examine the historical relationship between tobacco manufacturers and tobacco farmers in the United States, where the duration of the relationship has been longest and use information obtained to inform possible end-game strategies for tobacco control advocates working with tobacco farmers in developing countries. Tobacco Documents obtained under the Master Settlement Agreement (MSA) provide evidence of conflicts between tobacco manufacturers and tobacco farmers. Findings support WHO FCTC articles aimed at helping developing country tobacco farmers adversely affected by tobacco control efforts and highlight difficulties in discouraging tobacco cultivation as long as it remains relatively profitable. We conclude that successful end-game strategies should take a long-term approach aimed at building alliances with tobacco farmers and at creating mechanisms for tobacco farmer investment in local infrastructure.
Collapse
Affiliation(s)
- Alison Snow Jones
- 1epartment of Social Sciences and Health Policy, Wake Forest University School of Medicine, 2000 West 1st Street, Winston-Salem, NC 27157, USA
| | | | | | | |
Collapse
|
29
|
Stevens ARA, Caan W. Gender, economics and culture: diversity and the international evolution of smoking prevalence. ACTA ACUST UNITED AC 2008; 128:113-6. [PMID: 18595626 DOI: 10.1177/1466424008089799] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
AIMS To examine whether the observed diversity between national patterns of smoking prevalence could require modification of the World Health Organization (WHO) linear model for an international 'smoking pandemic' (a worldwide epidemic) to address data from non-western countries. METHOD We conducted secondary research using current measures in three publicly available databases: Globalink, the International Labour Organization and the World Bank (all Internet-accessible). The measures we used are the separate percentage data for men and women on: smoking and employment and national income per capita (US$) and percentage growth per annum. RESULTS Regression analysis showed that women smokers were more frequent in countries with higher national income, but women were less likely to smoke in countries of rapid growth. Men were less likely to smoke in countries with higher national income, but more likely to smoke in countries of rapid growth. Two principle components together explained 62% of all the variance in the international data. The largest factor was positively correlated with the percentage of employed females, the percentage of female smokers and national income per capita, but negatively correlated with the percentage of male smokers and percentage annual. growth. The effect of female employment was not continuous, but above a threshold of 51%, was associated with a higher prevalence of female smoking. The smaller, second factor was only weakly correlated with any smoking variables. CONCLUSIONS In his 1994 model (subsequently adopted by the WHO) Lopez looked at historical trends in 'stages' of smoking prevalence. These have been associated with 'stages' of economic development. We extended this analysis to look at a dynamic change (% annual growth) and a social indicator (employment). Male and female smoking is affected differentially by economic change and by level of income. These are also strongly related to the percentage of women in employment. This has implications for workplace policies on smoking.
Collapse
Affiliation(s)
- Andy R A Stevens
- Faculty of Health and Social Care, Anglia Ruskin University Chelmsford, Essex CM1 1SQ, UK.
| | | |
Collapse
|
30
|
Breton E, Richard L, Gagnon F. The role of health education in the policy change process: Lessons from tobacco control. CRITICAL PUBLIC HEALTH 2007. [DOI: 10.1080/09581590701549527] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
31
|
Andersen PA, Buller DB, Voeks JH, Borland R, Helme D, Bettinghaus EP. Predictors of government officials' support for youth tobacco control policies. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2007; 13:621-9. [PMID: 17984717 DOI: 10.1097/01.phh.0000296139.94670.ef] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Preventing youth access to tobacco products is a crucial public health goal. This study examines support by elected city and county officials in Colorado for enacting youth tobacco control policies in the State of Colorado. Participating city and county officials (n = 684) were surveyed regarding their attitudes and opinions on tobacco-related issues and policy control efforts. The officials surveyed were generally supportive of efforts to restrict youth access to tobacco. A number of predictors of support for youth tobacco control policies were identified, including official's perceptions of community norms, their political party, the presence of citizen anti-tobacco events, educational background of the officials, and their attitudes about tobacco. Recommendations for theory and citizen action are provided.
Collapse
Affiliation(s)
- Peter A Andersen
- School of Communication, San Diego State University, San Diego, California 92182, USA.
| | | | | | | | | | | |
Collapse
|
32
|
Apollonio DE, Lopipero P, Bero LA. Participation and argument in legislative debate on statewide smoking restrictions. Health Res Policy Syst 2007; 5:12. [PMID: 17953767 PMCID: PMC2174461 DOI: 10.1186/1478-4505-5-12] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2007] [Accepted: 10/22/2007] [Indexed: 11/20/2022] Open
Abstract
Background In this paper we review the relationship between participation in legislative hearings, the use of ideological arguments, and the strength of public health legislation using a theoretical construct proposed by E. E. Schattschneider in 1960. Schattschneider argued that the breadth and types of participation in a political discussion could change political outcomes. Methods We test Schattschneider's argument empirically by reviewing the efforts of six states to pass Clean Indoor Air Acts by coding testimony given before legislators, comparing these findings to the different characteristics of each state's political process and the ultimate strength of each state's legislation. Results We find that although greater participation is associated with stronger legislation, there is no clear relationship between the use and type of ideological arguments and eventual outcomes. Conclusion These findings offer validation of a long-standing theory about the importance of political participation, and suggest strategies for public health advocates seeking to establish new legislation.
Collapse
Affiliation(s)
- Dorie E Apollonio
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, California, US.
| | | | | |
Collapse
|
33
|
Schmitt CL, Malarcher AM, Clark PI, Bombard JM, Strauss W, Stillman FA. Community guide recommendations and state level tobacco control programmes: 1999-2004. Tob Control 2007; 16:318-24. [PMID: 17897990 PMCID: PMC2598570 DOI: 10.1136/tc.2006.019372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2006] [Accepted: 05/06/2007] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To identify the level of effort state tobacco control programmes and partners have expended on interventions recommended by the community guide and how those efforts have changed over time between 1999 and 2004. DESIGN Longitudinal study. SETTING United States. PARTICIPANTS State tobacco control partners, including the state health department, voluntary agencies and tobacco control coalitions. MAIN OUTCOME MEASURE We used the Strength of Tobacco Control survey responses in 1999, 2002 and 2004 to calculate the mean proportion of state tobacco control partners working on recommended interventions and subsequently analysed changes in effort over time. RESULTS The proportion of state tobacco control partners working to promote clean indoor air legislation remained at more than 70% in all three years. The proportion working to increase taxes on tobacco rose significantly between 1999 and 2002 (from 54% to 70%), and those working to reduce patient costs for tobacco cessation treatments never exceeded 31% in any year. Use of mass media targeting youths decreased significantly in all years (from 40% to 32% to 26%), and the proportion of state tobacco control partners participating in a quitline has increased steadily and significantly in all years (from 24% to 36% to 41%). The level of effort in each area varied widely between states and over time. CONCLUSIONS State tobacco control partners are implementing evidence based interventions, but more focus is needed on the tobacco cessation and mass media campaign components of comprehensive tobacco control programmes.
Collapse
|
34
|
Apollonio DE, Bero LA. The creation of industry front groups: the tobacco industry and "get government off our back". Am J Public Health 2007; 97:419-27. [PMID: 17267719 PMCID: PMC1805008 DOI: 10.2105/ajph.2005.081117] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We investigated how industries use front groups to combat public health measures by analyzing tobacco industry documents, contemporaneous media reports, journal articles, and press releases regarding "Get Government Off Our Back," a coalition created by the tobacco industry. RJ Reynolds created Get Government Off Our Back in 1994 to fight federal regulation of tobacco. By keeping its involvement secret, RJ Reynolds was able to draw public and legislative support and to avoid the tobacco industry reputation for misrepresenting evidence. The tobacco industry is not unique in its creation of such groups. Research on organizational background and funding could identify other industry front groups. Those who seek to establish measures to protect public health should be prepared to counter the argument that government should not regulate private behavior.
Collapse
Affiliation(s)
- Dorie E Apollonio
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, CA 94143, USA
| | | |
Collapse
|
35
|
Andersen PA, Buller DB, Voeks JH, Borland R, Helme D, Bettinghaus EP, Young WF. Predictors of support for environmental tobacco smoke bans in state government. Am J Prev Med 2006; 30:292-9. [PMID: 16530615 DOI: 10.1016/j.amepre.2005.12.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2005] [Revised: 12/19/2005] [Accepted: 12/19/2005] [Indexed: 11/17/2022]
Abstract
BACKGROUND Environmental tobacco smoke (ETS) is a major threat to public health, associated with a number of serious diseases, and a leading cause of death. Previous research demonstrates that enactment of government policies mandating clean indoor air is effective in creating more smoke-free public places and decreasing the incidence of smoking. Both researchers and community activists have an interest in understanding the factors that predict support for the regulation of ETS. METHODS This study examined predictors of support for regulating ETS by surveying 684 city and county public officials in Colorado who were interviewed by phone and mail (response rate 61%). RESULTS Thirty-five percent of public officials reported that it is a "serious" or "very serious" problem that nonsmokers breathe in other people's cigarette smoke, 21% were "neutral," and 42% said that it was "not serious" or "not serious at all." Results indicated that support for policies to control ETS and promote clean indoor air is significantly more prevalent among public officials who: (1) believe that tobacco use is a serious problem in their community, (2) believe that breathing environmental tobacco smoke is a serious problem for nonsmokers, (3) believe that city and county government should get involved with people's decisions about smoking, (4) support smoking-cessation programs for public employees, and (5) have smoked less than 100 cigarettes during their lifetime. CONCLUSIONS Both the harms of ETS and legislation to create smoke-free environments remain controversial among local officials. Smoke-free advocates should support officials who believe that ETS is a problem and persuade officials on the harms of ETS and the need for government intervention.
Collapse
Affiliation(s)
- Peter A Andersen
- School of Communication, San Diego State University, San Diego, California 92182-4561, USA.
| | | | | | | | | | | | | |
Collapse
|
36
|
Katz JE. Individual rights advocacy in tobacco control policies: an assessment and recommendation. Tob Control 2005; 14 Suppl 2:ii31-7. [PMID: 16046700 PMCID: PMC1766189 DOI: 10.1136/tc.2004.008060] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Efforts to control environmental tobacco smoke (ETS) could be assisted if the tobacco control movement gave greater emphasis to the issue of individual rights. Benefits that may accrue from the promotion of a clear individual rights perspective in tobacco control include adding coherence to the tobacco control advocacy agenda and winning support from those who may have been concerned about loss of personal freedom, excessive governmental power, use of social coercion, or the rights of smokers. Risks also attend to such a policy. It might inadvertently assist the tobacco industry, stir resistance to ETS limitation efforts, or confuse tobacco control supporters. On balance, though, liabilities are outweighed by the ethical and operational merits in tobacco control of a heightened pro-individual rights stance.
Collapse
Affiliation(s)
- J E Katz
- Rutgers University, 4 Huntington Street, New Brunswick, NJ 08901, USA.
| |
Collapse
|
37
|
Callard C, Thompson D, Collishaw N. Transforming the tobacco market: why the supply of cigarettes should be transferred from for-profit corporations to non-profit enterprises with a public health mandate. Tob Control 2005; 14:278-83. [PMID: 16046692 PMCID: PMC1748051 DOI: 10.1136/tc.2005.011353] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Current tobacco control strategies seek primarily to decrease the demand for cigarettes through measures that encourage individuals to adopt healthier behaviours. These measures are impeded and undermined by tobacco corporations, whose profit drive compels them to seek to maintain and expand cigarette sales. Tobacco corporations seek to expand cigarette sales because they are for-profit business corporations and are obliged under law to maximise profits, even when this results in harm to others. It is not legally possible for a for-profit corporation to relinquish its responsibility to make profits or for it to temper this obligation with responsibilities to support health. Tobacco could be supplied through other non-profit enterprises. The elimination of profit driven behaviour from the supply of tobacco would enhance the ability of public health authorities to reduce tobacco use. Future tobacco control strategies can seek to transform the tobacco market from one occupied by for-profit corporations to one where tobacco is supplied by institutions that share a health mandate and will help to reduce smoking and smoking related disease and death.
Collapse
Affiliation(s)
- C Callard
- Physicians for a Smoke-Free Canada, 1226A Wellington Street, Ottawa, Ontario K1Y 3A1, Canada.
| | | | | |
Collapse
|
38
|
de Guia NA, Cohen JE, Ashley MJ, Pederson L, Ferrence R, Bull S, Northrup D, Poland B. Support for tobacco control policies: how congruent are the attitudes of legislators and the public? Canadian Journal of Public Health 2003. [PMID: 12583669 DOI: 10.1007/bf03405050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To examine the congruence in perceptions and attitudes of legislators and the public regarding tobacco and tobacco control policies. METHODS Two cross-sectional surveys were used, one of elected federal and provincial legislators and one of adult residents in Ontario, Canada. Perceptions and attitudes were analyzed as dependent variables using multiple logistic regression, and adjusted for age, sex, educational attainment, and smoking status. FINDINGS Congruence was found in most instances, however, some differences were found. Legislators were more likely than the public to agree that most smokers are addicted and were more supportive of a smoking ban in workplaces, but these differences disappeared after controlling for socio-demographic characteristics. Legislators were also more aware than the public of the magnitude of deaths due to tobacco compared to alcohol, whereas the public was more supportive of strong penalties against stores that sell cigarettes to minors. CONCLUSIONS Our findings provide considerable evidence for congruence in the "real-world" (unadjusted) perceptions and attitudes of Ontario legislators and the Ontario public toward tobacco control policies. Such findings are positive for tobacco control advocates and should be leveraged to bring forward strong tobacco policies in the political arena.
Collapse
Affiliation(s)
- Nicole A de Guia
- Ontario Tobacco Research Unit, Centre for Health Promotion, University of Toronto, Toronto, ON
| | | | | | | | | | | | | | | |
Collapse
|
39
|
de Guia NA, Cohen JE, Ashley MJ, Pederson L, Ferrence R, Bull S, Northrup D, Poland B. Support for tobacco control policies: how congruent are the attitudes of legislators and the public? CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2003; 94:36-40. [PMID: 12583669 PMCID: PMC6980002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVES To examine the congruence in perceptions and attitudes of legislators and the public regarding tobacco and tobacco control policies. METHODS Two cross-sectional surveys were used, one of elected federal and provincial legislators and one of adult residents in Ontario, Canada. Perceptions and attitudes were analyzed as dependent variables using multiple logistic regression, and adjusted for age, sex, educational attainment, and smoking status. FINDINGS Congruence was found in most instances, however, some differences were found. Legislators were more likely than the public to agree that most smokers are addicted and were more supportive of a smoking ban in workplaces, but these differences disappeared after controlling for socio-demographic characteristics. Legislators were also more aware than the public of the magnitude of deaths due to tobacco compared to alcohol, whereas the public was more supportive of strong penalties against stores that sell cigarettes to minors. CONCLUSIONS Our findings provide considerable evidence for congruence in the "real-world" (unadjusted) perceptions and attitudes of Ontario legislators and the Ontario public toward tobacco control policies. Such findings are positive for tobacco control advocates and should be leveraged to bring forward strong tobacco policies in the political arena.
Collapse
Affiliation(s)
- Nicole A. de Guia
- Ontario Tobacco Research Unit, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1 Canada
| | - Joanna E. Cohen
- Ontario Tobacco Research Unit, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Department of Public Health Sciences, University of Toronto, Canada
| | - Mary Jane Ashley
- Ontario Tobacco Research Unit, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Department of Public Health Sciences, University of Toronto, Canada
| | - Linda Pederson
- Office on Smoking and Health, Epidemiology Branch, Centers for Disease Control and Prevention, Atlanta, GA Canada
| | - Roberta Ferrence
- Ontario Tobacco Research Unit, University of Toronto, 33 Russell Street, Toronto, ON M5S 2S1 Canada
- Department of Public Health Sciences, University of Toronto, Canada
- Centre for Addiction and Mental Health, Toronto, Canada
| | - Shelley Bull
- Department of Public Health Sciences, University of Toronto, Canada
- Samuel Lunenfeld Research Institute, Toronto, Canada
| | - David Northrup
- Institute for Social Research, York University, Toronto, Canada
| | - Blake Poland
- Department of Public Health Sciences, University of Toronto, Canada
| |
Collapse
|
40
|
Cohen JE, de Guia NA, Ashley MJ, Ferrence R, Northrup DA, Studlar DT. Predictors of Canadian legislators' support for tobacco control policies. Soc Sci Med 2002; 55:1069-76. [PMID: 12220090 DOI: 10.1016/s0277-9536(01)00244-1] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
It is clear that regulatory strategies can be effective in reducing tobacco use. Because legislators ultimately determine whether many of these policies are enacted, they are a key focus for tobacco policy research. This study identifies political and personal predictors of Canadian legislators' support for tobacco control policies. Data are from a 1996-97 survey of federal, provincial and territorial legislators. Multivariate regression analysis was used to assess relationships between five groups of variables (political factors including political ideology, personal characteristics, tobacco experiences, tobacco knowledge, interest group saliency) and support for tobacco control based on an 11-item scale. Support for tobacco control varied by political party. Support was higher among legislators who thought government had a duty to promote healthy lifestyles, knew second-hand smoke could cause lung cancer, knew tobacco caused more deaths than alcohol, and said they wanted more contact with medical associations about tobacco issues. Support was lower among current smokers and those with tobacco industry jobs in their ridings. The findings indicate that political party membership cannot be ignored in enlisting legislator support for tobacco control. It also appears that legislators who oppose tobacco control measures may not be opposed to tobacco control per se, but are more generally opposed to a government role in health promotion. Thus, public health professionals and tobacco control advocates need to be more attentive to the way tobacco control issues are framed for particular legislators. Further, meetings with health groups about tobacco issues would be welcomed by many legislators; non-governmental organizations and other health advocates could work to increase tobacco knowledge among legislators.
Collapse
Affiliation(s)
- Joanna E Cohen
- Ontario Tobacco Research Unit, Centre for Health Promotion, University of Toronto, Canada.
| | | | | | | | | | | |
Collapse
|
41
|
Cohen JE, de Guia NA, Ashley MJ, Ferrence R, Studlar DT, Northrup DA. Predictors of Canadian legislators' support for public health policy interventions. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2001; 92:188-9. [PMID: 11496627 PMCID: PMC6979899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/24/2000] [Accepted: 02/21/2001] [Indexed: 02/21/2023]
Affiliation(s)
- J E Cohen
- Ontario Tobacco Research Unit, Centre for Health Promotion, University of Toronto.
| | | | | | | | | | | |
Collapse
|
42
|
Abstract
The causes of many health problems such as smoking are beyond individual action. To change them requires the development of interventions dealing with the social factors that cause them, interventions of a political nature. In this paper we review for Spain public policies influencing smoking, with an emphasis on those with greater potential impact (fiscal policies to increase price, and those controlling the promotion and publicity of tobacco products), as well as the role of different government levels in regulation (local, regional central and European). The role of the Central government and of the European Union are crucial today in Spain. Some aspects influencing the adoption of smoking prevention policies (problem definition, private interests, and ideology) are also analyzed, as well as the need for a strategic coalition to promote them.
Collapse
Affiliation(s)
- J Villalbí
- Comité Nacional de Prevención del Tabaquismo. Madrid
| | | |
Collapse
|
43
|
Cohen J, de Guia NA, Ashley MJ, Ferrence R, Studlar DT, Northrup DA. Predictors of Canadian Legislators’ Support for Public Health Policy Interventions. Canadian Journal of Public Health 2001. [DOI: 10.1007/bf03404302] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|