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Jin T, Seo J, Ye S, Lee S, Park EY, Oh JK, Han C, Kim B. Suicide mortality following the implementation of tobacco packaging and pricing policies in Korea: an interrupted time-series analysis. BMC Med 2024; 22:180. [PMID: 38679738 PMCID: PMC11057188 DOI: 10.1186/s12916-024-03372-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 03/26/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND To prevent tobacco use in Korea, the national quitline number was added to tobacco packages in December 2012, tobacco prices were raised by 80% in January 2015, and graphic health warning labels were placed on tobacco packages in December 2016. This study evaluated the association of these tobacco packaging and pricing policies with suicide mortality in Korea. METHODS Monthly mortality from suicide was obtained from Cause-of-Death Statistics in Korea from December 2007 to December 2019. Interrupted time-series analysis was performed using segmented Poisson regression models. Relative risks (RRs) and 95% confidence intervals (CIs) were calculated adjusted for suicide prevention strategies. RESULTS Suicide mortality was 20 per 1,000,000 in December 2007 and showed a downward trend over the study period. After the implementation of tobacco packaging and pricing policies, suicide mortality immediately declined by - 0.09 percent points (95% CI = - 0.19 to 0.01; P > 0.05) for the national quitline number, - 0.22 percent points (95% CI = - 0.35 to - 0.09; P < 0.01) for tobacco prices, and - 0.30 percent points (95% CI = - 0.49 to - 0.11; P < 0.01) for graphic health warning labels. The corresponding RRs for these post-implementation changes compared with the pre-implementation level were 0.91 (95% CI = 0.83 to 1.00), 0.80 (95% CI = 0.70 to 0.91), and 0.74 (95% CI = 0.61 to 0.90), respectively. Significant associations between tobacco control policies and suicide mortality were observed even when stratified by sex and region. CONCLUSIONS The findings of this study provide new evidence for an association between tobacco control policies and deaths by suicide. An array of effective tobacco control policies should be considered for prevention programs targeting suicide.
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Affiliation(s)
- Taiyue Jin
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
| | - Juhee Seo
- Vital Statistics Division, Statistics Korea, Daejeon, South Korea
| | - Shinhee Ye
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Incheon, South Korea
| | - Seulbi Lee
- Department of Big Data Strategy, National Health Insurance Service, Wonju, South Korea
| | - Eun Young Park
- Department of Preventive Medicine, Korea University College of Medicine, Seoul, South Korea
| | - Jin-Kyoung Oh
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea
| | - Changwoo Han
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon, South Korea
| | - Byungmi Kim
- Division of Cancer Prevention, National Cancer Control Institute, National Cancer Center, 323 Ilsan-Ro, Ilsandong-Gu, Goyang, Gyeonggi, 10408, South Korea.
- Department of Cancer Control and Population Health, Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, South Korea.
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Havale NG, Naik PM, Kalappa H, Undi M, Naik M, Shreedhar S. Awareness about pictorial warnings on tobacco products and its impact on tobacco consumers in coastal Karnataka. INDIAN JOURNAL OF COMMUNITY HEALTH 2022. [DOI: 10.47203/ijch.2022.v34i03.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background: Tobacco use is a major risk factor for many chronic diseases, including cancer. India revised the pictorial warnings on all tobacco products in 2018, but its impact on tobacco consumers after the revision is less studied. Aim and Objective: To assess the awareness of the revised pictorial warnings on tobacco products and the impact of it on tobacco consumers in a coastal town. Methods: This cross-sectional study was conducted from 1st to 31st March 2021 among 185 adult tobacco consumers in a coastal town in Karnataka after obtaining ethical clearance and informed consent. The data was analysed using SPSS version 16.0 by descriptive statistics, Chi-square, Fisher’s exact test and binary logistic regression analysis. Results: Majority (95.7%) were males and 96.2% had seen the pictorial warning on the tobacco products. The commonly consumed tobacco products were panmasala (44.9%), gutka (38.9%), cigarette (31.4%) and bidi (15.1%). The mean age of initiation of consuming tobacco products was 24.8 years and mean duration of the habit was 17 years. Conclusions: A majority (96.2%) have seen the pictorial warnings on the tobacco products and significant predictors for reducing tobacco consumption were those who inferred the pictorial warnings as tobacco is injurious to health and cancerous.
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Yau MTK, Yau KW, Hussaini T, Yoshida EM. A Narrative Review of the Efficacy and Design of Safety Labels on Tobacco Products to Promote the Use of Safety Labels on Alcohol Products in Canada. Cureus 2022; 14:e25306. [PMID: 35755528 PMCID: PMC9226242 DOI: 10.7759/cureus.25306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/23/2022] [Indexed: 11/07/2022] Open
Abstract
Alcohol is consumed by approximately three-quarters of Canadians. Alcohol causes acquired liver disease, increases the risk of cancer, has detrimental effects on mental health, and leads to adverse pregnancy outcomes. Alcohol-related morbidity and mortality are high, and urgent public health measures are warranted to prevent and control these. Tobacco safety labels have been shown in numerous studies to reduce tobacco consumption. Much can be learned from the design of tobacco safety labels in creating promising alcohol safety labels that can possibly help reduce alcohol consumption. The aim of this paper is to review the efficacy of tobacco safety labels in reducing tobacco consumption and the design of tobacco safety labels and to propose a promising design for alcohol safety labels based on our findings. English peer-reviewed papers published in western countries since 2000 were searched on PubMed and Google Scholar. Keywords and synonyms were used to search pertinent papers, which were subsequently screened by title and abstract and fully reviewed if relevant. Findings from studies comparing designs of safety labels on alcohol and tobacco products are similar. Graphics, higher emotion content, and greater size are associated with greater attention, awareness, negative emotions, intention to quit, and reduction in consumption. Mixed results are found for testimonials containing safety labels on tobacco products. It is unclear whether testimonials on alcohol safety labels reduce alcohol consumption or not. Safety labels with specific information, such as tobacco-related costs and alcohol-related cancer risks, are more effective in reducing tobacco consumption. In conclusion, preliminary alcohol safety labels show promise. Large safety labels with graphics and high emotional content appear to be most effective and may reduce alcohol consumption.
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Affiliation(s)
| | - Kiana W Yau
- Faculty of Medicine, McGill University, Montreal, CAN
| | - Trana Hussaini
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, CAN
| | - Eric M Yoshida
- Division of Gastroenterology, Faculty of Medicine, University of British Columbia, Vancouver, CAN
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Howse E, Cullerton K, Grunseit A, Bohn-Goldbaum E, Bauman A, Freeman B. Measuring public opinion and acceptability of prevention policies: an integrative review and narrative synthesis of methods. Health Res Policy Syst 2022; 20:26. [PMID: 35246170 PMCID: PMC8895540 DOI: 10.1186/s12961-022-00829-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 02/15/2022] [Indexed: 11/21/2022] Open
Abstract
Acceptability of and public support for prevention are an important part of facilitating policy implementation. This review aims to identify, summarize and synthesize the methods and study designs used to measure and understand public opinion, community attitudes and acceptability of strategies to prevent chronic noncommunicable disease (NCDs) in order to allow for examination of imbalances in methodological approaches and gaps in content areas. We searched four scientific databases (CINAHL, Embase, Ovid/MEDLINE and Scopus) for peer-reviewed, English-language studies published between January 2011 and March 2020 in high-income, democratic countries across North America, Europe and the Asia–Pacific region. Studies were included if they focused on opinions, attitudes and acceptability of primary prevention strategies and interventions addressing the key NCD risk factors of alcohol use, unhealthy diet, overweight/obesity, tobacco use and smoking, and physical inactivity. A total of 293 studies were included. Two thirds of studies (n = 194, 66%) used quantitative methods such as cross-sectional studies involving surveys of representative (n = 129, 44%) or convenience (n = 42, 14%) samples. A smaller number of studies used qualitative methods (n = 60, 20%) such as focus groups (n = 21, 7%) and interviews (n = 21, 7%). Thirty-nine studies (13%) used mixed methods such as content analysis of news media (n = 17, 6%). Tobacco control remains the dominant topic of public opinion literature about prevention (n = 124, 42%). Few studies looked solely at physical inactivity (n = 17, 6%). The results of this review suggest that public opinion and acceptability of prevention in the peer-reviewed literature is investigated primarily through cross-sectional surveys. Qualitative and mixed methods may provide more nuanced insights which can be used to facilitate policy implementation of more upstream strategies and policies to prevent NCDs.
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Affiliation(s)
- Eloise Howse
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia. .,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Katherine Cullerton
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,School of Public Health, Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Anne Grunseit
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Erika Bohn-Goldbaum
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Adrian Bauman
- The Australian Prevention Partnership Centre, Sax Institute, Sydney, Australia.,Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Becky Freeman
- Prevention Research Collaboration, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Kyriakos CN, Driezen P, Girvalaki C, Hitchman SC, Filippidis FT, Gravely S, Balmford J, Nikitara K, Mons U, Fernández E, Przewoźniak K, Trofor AC, Demjén T, Zatoński W, Tountas Y, Fong GT, Vardavas CI. Awareness and correlates of noticing changes to cigarette packaging design after implementation of the European Tobacco Products Directive: findings from the EUREST-PLUS ITC Europe Surveys. Eur J Public Health 2020; 30:iii98-iii107. [PMID: 32918819 PMCID: PMC7526785 DOI: 10.1093/eurpub/ckaa057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The European Tobacco Products Directive (TPD), which went into effect in May 2016, regulates packaging design and labelling of cigarettes and roll-your-own (RYO) tobacco. The aim of the current study was to examine whether smokers and recent quitters in six European Union (EU) countries (Germany, Greece, Hungary, Poland, Romania and Spain) reported noticing TPD-related changes to packaging, and correlates of noticing these changes. METHODS Cross-sectional data from the Wave 2 of the ITC 6 European Country Survey in 2018 after implementation of the TPD. Bivariate analyses included adult smokers (n = 5597) and recent quitters (n = 412). Adjusted logistic regression analyses were restricted to the subset of current smokers (n = 5597) and conducted using SAS-callable SUDAAN. RESULTS Over half of smokers (58.2%) and 30% of quitters noticed at least one of five types of TPD-related pack changes. Over one-quarter of all respondents noticed changes to health warnings (30.0%), standardized openings (27.7%), minimum pack unit size (27.9%), and the removal of tar, nicotine and carbon monoxide information (26.7%) on packaging. Cross-country differences were observed across all measures, with noticing all pack changes markedly lower in Spain than the other countries. Correlates of noticing specific pack changes included sociodemographic characteristics, smoking behaviours and related to packaging. CONCLUSIONS This is one of the first cross-country studies to examine the extent to which TPD changes to cigarette and RYO tobacco packaging are being noticed by smokers and recent quitters. Findings indicate that the majority of smokers noticed at least one type of pack change, but this varied across countries and sub-populations.
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Affiliation(s)
- Christina N Kyriakos
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Canada
| | - Charis Girvalaki
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | | | - Filippos T Filippidis
- Department of Primary Care and Public Health, Imperial College London, London, UK
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - James Balmford
- Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center, University of Freiburg, Freiburg im Breisgau, Germany
| | - Katerina Nikitara
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
| | - Ute Mons
- Cancer Prevention Unit and WHO Collaborating Centre for Tobacco Control, German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Esteve Fernández
- Tobacco Control Unit, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat (Barcelona), Catalonia, Spain
- Tobacco Control Research Group, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Catalonia, Spain
- School of Medicine and Health Sciences, Bellvitge Campus, Universitat de Barcelona, L'Hospitalet de Llobregat, Catalonia, Spain
- Consortium for Biomedical Research in Respiratory Diseases (CIBER of Respiratory Diseases, CIBERES), Madrid, Spain
| | - Krzysztof Przewoźniak
- Health Promotion Foundation, Warsaw, Poland
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
- Collegium Civitas, Warsaw, Poland
| | - Antigona C Trofor
- University of Medicine and Pharmacy 'Grigore T. Popa' Iasi, Iasi, Romania
- Aer Pur Romania, Bucharest, Romania
| | - Tibor Demjén
- Smoking or Health Hungarian Foundation, Budapest, Hungary
| | - Witold Zatoński
- Health Promotion Foundation, Warsaw, Poland
- European Observatory of Health Inequalities, President Stanislaw, Wojciechowski State University of Applied Sciences, Kalisz, Poland
| | - Yannis Tountas
- Center for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Geoffrey T Fong
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- Department of Psychology, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Constantine I Vardavas
- Laboratory of Toxicology, School of Medicine, University of Crete, Heraklion, Greece
- European Network for Smoking and Tobacco Prevention, Brussels, Belgium
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6
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Filippidis FT, Mechili EA, Girvalaki C, Vardavas C. Cost, prevalence and correlates of cigarillo use in 28 European countries in 2017. Cent Eur J Public Health 2019; 27:182-187. [PMID: 31580551 DOI: 10.21101/cejph.a5583] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 07/27/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Although manufactured cigarettes remain the most popular tobacco product worldwide, the use of other products, including little cigar and cigarillo, has been rising in recent years; however, there is a paucity of data on the correlates of current and ever use of cigarillos in Europe. The aim of this study was to explore the extent and determinants of cigarillo use, as well as to describe the cost and affordability of cigarillos across the EU, in light of the current regulatory framework at a European level. METHODS We performed a secondary analysis of data collected across 28 European Union (EU) Member States through wave 87.1 of the Eurobarometer survey, conducted in March 2017 (N = 27,901). A multilevel logistic regression model was fitted to assess the association of current and ever cigarillo use with the above socio-demographic factors. We also analysed Euromonitor International data on cigarillo prices in 2017 from 24 EU Member States. RESULTS Across the EU, 0.46% (95% CI: 0.33-0.63) of those aged ≥ 15 years reported at least weekly current use of cigarillos in 2017, which corresponds to 1,966,516 (95% CI: 1,426,554-2,709,563) people. Finland recorded the highest prevalence (20.51%) of ever cigarillo use in Europe while Ireland had the lowest (1.15%). Male sex, living in urban area and being over 55 years old compared to 15-24 year olds were associated with greater odds of ever cigarillo use. Median cigarillo prices varied widely, ranging from 3.60 Euros in Portugal to 20.40 Euros in Bulgaria per 20 sticks. CONCLUSIONS The use of cigarillos in Europe is associated with several socio-demographic factors such as gender, age and living area. Policy makers of EU countries, especially now under the regulatory framework of the EU Tobacco Products Directive, should work together to enforce more restrictive rules for cigarillos.
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Affiliation(s)
- Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College, London, United Kingdom.,Centre for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Enkeleint A Mechili
- Department of Health Care, Faculty of Public Health, University of Vlora, Vlora, Albania
| | - Charis Girvalaki
- Laboratory of Toxicology, Medical School, University of Crete, Rethymnon, Greece
| | - Constantine Vardavas
- Centre for Health Services Research, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece.,Laboratory of Toxicology, Medical School, University of Crete, Rethymnon, Greece.,European Network for Smoking and Tobacco Prevention, Brussels, Belgium
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Kunst AE, van Splunter C, Troelstra SA, Bosdriesz JR. Did the introduction of pictorial health warnings increase information seeking for smoking cessation?: Time-series analysis of Google Trends data in six countries. Tob Prev Cessat 2019; 5:27. [PMID: 32411890 PMCID: PMC7205058 DOI: 10.18332/tpc/111130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2019] [Revised: 06/20/2019] [Accepted: 07/23/2019] [Indexed: 01/09/2023]
Abstract
INTRODUCTION Pictorial health warnings (PHW) can influence smoking cessation rates and precursors thereof. However, both the magnitude and duration of their impact, in national populations, remain uncertain because of limitations of the available data. In this study we used Google Trends data from six European countries to evaluate whether the implementation of PHW was followed by a short-term increase in online searches on smoking cessation. METHODS We applied an interrupted time-series design using ARIMA models. We used weekly or monthly data on the relative search volume (RSV) for search terms about smoking cessation. First, RSV trends were seasonally adjusted and adjusted for autocorrelation. Next, regression models were fitted that included terms for the potential effect of PHW in month 1, months 2–3, and months 4–6 after implementation. RESULTS Our findings for France and the United Kingdom were partly in line with our initial expectations. In France, a 4% increase (95% CI: -2% – 11%) occurred in the first month after implementation, but not later. In the UK, a 3% increase (95% CI: 1% – 6%) in ‘quit smoking’ searches occurred in months 2–3. No increases were observed for any other periods for France, the UK, Ireland, Norway, Denmark or Switzerland. CONCLUSIONS We found no consistent support that the implementation of PHW was associated with increased internet searches for smoking cessation. Further studies are needed to assess and understand the magnitude and duration of population-wide impacts of PHW.
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Affiliation(s)
- Anton E Kunst
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Casper van Splunter
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sigrid A Troelstra
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jizzo R Bosdriesz
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Bafunno D, Catino A, Lamorgese V, Pizzutilo P, Di Lauro A, Petrillo P, Lapadula V, Mastrandrea A, Ricci D, Galetta D. Tobacco control in Europe: A review of campaign strategies for teenagers and adults. Crit Rev Oncol Hematol 2019; 138:139-147. [PMID: 31092369 DOI: 10.1016/j.critrevonc.2019.01.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 01/27/2019] [Accepted: 01/27/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND In Europe the prevalence of tobacco use in adults and adolescents is among the highest within the WHO regions. Many resources have been allocated toward the prevention and support for smoking cessation. However, the implemented strategies in Europe have not been systematically evaluated. METHODS A systematic literature review was carried out to identify studies that analyzed the efficacy of the main smoking-prevention campaigns conducted in Europe. PRISMA guidelines were used to systematically review and extract data. RESULTS A total of 24 studies meeting inclusion criteria were identified. Each article was thoroughly reviewed and evaluated for quality, design, and methodology, with reference to the main areas of intervention: school (8); mass media (4) and technological tools (4); smoke-free environments (3); packaging (2) and taxes (3). The school programmes focusing on building skills to recognize and resist negative influences, the intensive use of media and technological equipments, health warnings and excise taxes have showed to be effective tools in reducing the tobacco use. CONCLUSIONS Intervention programmes to implement tobacco control policies and smoking cessation are active in many European countries. However, these programmes need to be constantly sustained to achieve a long term efficacy.
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Affiliation(s)
- Daniela Bafunno
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Annamaria Catino
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vito Lamorgese
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Pamela Pizzutilo
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Alessandra Di Lauro
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Patrizia Petrillo
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Vittoria Lapadula
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Angelica Mastrandrea
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Donata Ricci
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy
| | - Domenico Galetta
- Clinical Cancer Centre "Giovanni Paolo II", 65, Viale Orazio Flacco, 70124, Bari, Italy.
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Bhatnagar A, Whitsel LP, Blaha MJ, Huffman MD, Krishan-Sarin S, Maa J, Rigotti N, Robertson RM, Warner JJ. New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention: A Presidential Advisory From the American Heart Association. Circulation 2019; 139:e937-e958. [DOI: 10.1161/cir.0000000000000669] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The advent of new tobacco products such as electronic cigarettes and the dramatic rise in their use, especially by adolescents and young adults, are significant public health concerns. Electronic cigarettes have become the most popular tobacco products for youth and adolescents in the United States and are attracting youth to new avenues for nicotine addiction. Although these products may have benefit by helping some smokers quit or to move to a less harmful product, the long-term health effects of these products and the net public health effect associated with their use remain unclear and widely debated. There is increasing concern that the use of newer tobacco products may catalyze transition to the use of other tobacco products or recreational drugs, particularly in young adults. Therefore, there is urgent need for robust US Food and Drug Administration regulation of all tobacco products to avoid the significant economic and population health consequences of continued tobacco use. Although the American Heart Association acknowledges that the ultimate endgame would be an end to all tobacco and nicotine addiction in the United States, it supports first minimizing the use of all combustible tobacco products while ensuring that other products do not addict the next generation of youth and adolescents. The endgame strategy needs to be coordinated with the long-standing, evidence-based tobacco control strategies that have significantly reduced tobacco use and initiation in the United States.
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10
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Wintemberg J, Yu M, Caman OK. Health Warnings, Smoking Rules, and Smoking Status: A Cross-National Comparison of Turkey and the United States. Subst Use Misuse 2018; 53:963-971. [PMID: 29172930 DOI: 10.1080/10826084.2017.1387566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES This study aimed to compare the prevalence of smoking status (i.e., current, former and never) between the United States and Turkey in terms of age and gender, and examine how smoking rules and health warnings are associated with smoking status within and between the two countries. METHODS The study used data from the 2012-2013 National Adult Tobacco Survey (U.S. sample, N = 60,196) and the 2012 Global Adult Tobacco Survey (Turkey sample, N = 9,581). SAS PROC SURVEYLOGISTIC with a weighted variable was used to examine the associations between demographics (age, gender and education), smoking rules, health warnings, and smoking status within and between the two countries. RESULTS There was an 18% current smoking prevalence among U.S. sample, compared to 27% of the Turkey sample. The U.S. sample had a higher rate of former smoking compared to the Turkey sample (25% vs. 22%). In both countries, being older and male gender predicted former smoking while being younger and female gender predicted never smoking. Having seen a health warning, and not allowing smoking in the vehicle and home positively predicted former and never smoking status. Higher education predicted both smoking statuses in the U.S. only. CONCLUSIONS It is important to work with partners particularly in low- and middle-income countries (e.g., Turkey) to combat the global tobacco epidemic. In both counties, cessation endeavors should emphasize a comprehensive understanding of smoking status in terms of smoking rules in personal spaces and health warnings.
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Affiliation(s)
- Jenna Wintemberg
- a Department of Health Sciences , University of Missouri-Columbia , Columbia , Missouri , USA
| | - Mansoo Yu
- b School of Social Work, Public Health Program , University of Missouri-Columbia , Columbia , Missouri , USA
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11
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Mayerl H, Stolz E, Freidl W. Responses to textual and pictorial cigarette pack health warnings: findings from an exploratory cross-sectional survey study in Austria. BMC Public Health 2018; 18:442. [PMID: 29615008 PMCID: PMC5883578 DOI: 10.1186/s12889-018-5342-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Accepted: 03/20/2018] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Packaging and labelling tobacco products has emerged as an effective policy to reduce the global health burden of tobacco use. The main purpose of this study was to explore Austrian smokers' and ex-smokers' responses to both the textual and pictorial cigarette pack health warnings (CPHWs) recently implemented. METHODS We analysed self-reported data (N=500) from an Austrian cross-sectional survey that was conducted after the implementation of the new pictorial CPHWs in 2016. RESULTS The results showed only weak effects of the CPHWs on the decision to quit or reduce smoking, and the level of impact of the CPHWs remained limited particularly because of smokers denying the ill-effects of tobacco use. CONCLUSIONS Although the CPHWs seem to have the potential to promote a change in smoking behaviour, the warnings reached only a rather small group of smokers, while the majority of smokers appeared to remain unaffected by this intervention. Public health policies are challenged to increase the salience of CPHWs and to overcome smokers' denial of detrimental health effects.
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Affiliation(s)
- Hannes Mayerl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitaetsstrasse 6/I, Graz, 8010 Austria
| | - Erwin Stolz
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitaetsstrasse 6/I, Graz, 8010 Austria
| | - Wolfgang Freidl
- Institute of Social Medicine and Epidemiology, Medical University of Graz, Universitaetsstrasse 6/I, Graz, 8010 Austria
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12
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Abstract
Objectives Our aim was to identify message characteristics for cigarette pack inserts that aim to help smokers quit. Methods US adult smokers from an online consumer panel (N = 665) participated in a discrete choice experiment with a 2x2x2x2x4 within-subjects balanced incomplete block design, manipulating: image (vs no image), text type (testimonial vs informational), cessation resource information (vs none), call to action (vs none), and message topic (well-being, financial benefit, cravings, social support). Participants evaluated 9 choice sets, each with 4 inserts, selecting: (1) the most and least helpful for quitting; and (2) the most and least motivating to quit. Linear models regressed choices on insert characteristics, controlling for sociodemographics and smoking-related variables. We assessed interactions between insert characteristics and smoker attributes (ie, education, quit intention, self-efficacy). Results Inserts were most helpful and motivating when they included an image, provided cessation resource information, or referenced well-being and financial benefits. Significant interactions indicated that inserts with cessation resource information were relatively more helpful and motivating among smokers with low self-efficacy, an intention to quit, or lower education. Conclusion Cigarette pack inserts with imagery and cessation resource information may be particularly effective in promoting smoking cessation.
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Klein EG, Quisenberry AJ, Shoben AB, Cooper S, Ferketich AK, Berman M, Peters E, Wewers ME. Health Warning Labels for Smokeless Tobacco: The Impact of Graphic Images on Attention, Recall, and Craving. Nicotine Tob Res 2018; 19:1172-1177. [PMID: 28339596 DOI: 10.1093/ntr/ntx021] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 01/17/2017] [Indexed: 11/13/2022]
Abstract
Introduction Little research has examined the impacts of graphic health warnings on the users of smokeless tobacco products. Methods A convenience sample of past-month, male smokeless tobacco users (n = 142; 100% male) was randomly assigned to view a smokeless tobacco advertisement with a graphic health warning (GHW) or a text-only warning. Eye-tracking equipment measured viewing time, or dwell time, in milliseconds. Following the advertisement exposure, participants self-reported smokeless tobacco craving and recalled any content in the health warning message (unaided recall). Linear and logistic regression analyses evaluated the proportion of time viewing the GHW, craving, and GHW recall. Results Participants who viewed a GHW spent a significantly greater proportion of their ad viewing time on GHWs (2.87 seconds or 30%), compared to those viewing a text-only warning (2.05 seconds or 24%). Although there were no significant differences by condition in total advertisement viewing duration, those participants viewing a GHW had increased recall of health warning messages compared to the text-only warning (76% had any warning message recall compared to 53%; p < .05). Self-reported craving after advertisement exposure was lower in the GHW compared to text-only condition, but the difference was not statistically significant (a rating of 4.4 vs. 5.3 on a 10-point scale; p = .08). Conclusions GHWs attracted greater attention and greater recall of health warning messages compared to text-only warnings among rural male smokeless tobacco users. Implications Among a sample of rural smokeless tobacco users, GHWs attracted more attention and recall of health warning messages compared to text-only warnings when viewed within smokeless tobacco advertising. These findings provide additional empirical support that GHWs are an effective tobacco control tool for all tobacco products and advertisements.
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Affiliation(s)
| | | | | | - Sarah Cooper
- College of Public Health, Ohio State University, Columbus, OH
| | - Amy K Ferketich
- College of Public Health, Ohio State University, Columbus, OH
| | - Micah Berman
- College of Public Health, Ohio State University, Columbus, OH.,College of Law, Ohio State University, Columbus, OH
| | - Ellen Peters
- College of Arts and Sciences, Ohio State University, Columbus, OH
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14
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Hendlin YH, Veffer JR, Lewis MJ, Ling PM. Beyond the brotherhood: Skoal Bandits' role in the evolution of marketing moist smokeless tobacco pouches. Tob Induc Dis 2017; 15:46. [PMID: 29270101 PMCID: PMC5735793 DOI: 10.1186/s12971-017-0150-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 12/05/2017] [Indexed: 11/10/2022] Open
Abstract
Background Since 2006, "snus" smokeless tobacco has been sold in the U.S.. However, U.S. Smokeless Tobacco (USST) and Swedish Match developed and marketed pouched moist snuff tobacco (MST) since 1973. Methods Analysis of previously secret tobacco documents, advertisements and trade press. Results USST partnered with Swedish Match, forming United Scandia International to develop pouch products as part of the "Lotus Project." Pouched MST was not commonly used, either in Sweden or the U.S. prior to the Lotus Project's innovation in 1973. The project aimed to transform smokeless tobacco from being perceived as an "unsightly habit of old men" into a relevant, socially acceptable urban activity, targeting 15-35 year-old men. While USST's initial pouched product "Good Luck," never gained mainstream traction, Skoal Bandits captured significant market share after its 1983 introduction. Internal market research found that smokers generally used Skoal Bandits in smokefree environments, yet continued to smoke cigarettes in other contexts. Over time, pouch products increasingly featured increased flavor, size, nicotine strength and user imagery variation. Conclusions Marlboro and Camel Snus advertising mirrors historical advertising for Skoal Bandits, designed to recruit new users and smokers subjected to smokefree places. Despite serious efforts, pouched MST marketing has been unable to dispel its association with traditional smokeless tobacco stereotypes as macho and rural. Public education efforts to discourage new users and dual use of MST and cigarettes should emphasize that "new" pouch products are simply repackaging "old" smokeless tobacco.
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Affiliation(s)
- Yogi H Hendlin
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, USA
| | - Jessica R Veffer
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, USA
| | - M Jane Lewis
- Rutgers School of Public Health, New Jersey, USA
| | - Pamela M Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, USA.,Department of Medicine, Division of General Internal Medicine, University of California San Francisco, Box 1390, 530 Parnassus Avenue, Suite 366, San Francisco, CA 94143-1390 USA
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15
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Laverty AA, Filippidis FT, Fernandez E, Vardavas CI. E-cigarette use and support for banning e-cigarette use in public places in the European Union. Prev Med 2017; 105:10-14. [PMID: 28823683 DOI: 10.1016/j.ypmed.2017.08.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 07/26/2017] [Accepted: 08/14/2017] [Indexed: 10/19/2022]
Abstract
We investigated the factors associated with support for banning e-cigarette use in public places in the European Union (EU) and how this varies by socio-demographic determinants, use of tobacco, ever use of e-cigarettes and their perceived harm. Data are from the representative Special Eurobarometer for Tobacco survey performed in 2014 (n=27,801) in 28 EU member states. Analyses were conducted separately by tobacco use status (never, current, and former smokers) and e-cigarette experimentation status. 70.9% of never smokers, 63.1% of former smokers and 45.7% of current smokers in the EU supported a ban on the use of e-cigarettes in public places. In all groups, support for banning e-cigarettes in public places was lower among those who had experimented with e-cigarettes (adjusted odds ratios (aOR) 0.43 vs. 0.50 vs. 0.61, among never, current and former smokers respectively) and higher among those who perceived e-cigarettes as harmful (aORs 2.49 vs 2.35 vs. 2.40, among never, current and former smokers respectively). 40.5% of those who had experimented with e-cigarettes supported a ban on use in public places, although levels of support were lower among those who started using e-cigarettes in order to circumvent existing smoking bans (aOR 0.54, 95% Confidence Interval 0.45-0.64). Bans of e-cigarette use in public places in Europe have high levels of public support even among former and current tobacco smokers, although this does vary across population groups. As legislators consider approaches to e-cigarette use, public opinion is likely to become more important to the passing and enforcement of any legislation.
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Affiliation(s)
- Anthony A Laverty
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, United Kingdom.
| | - Filippos T Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, United Kingdom
| | - Esteve Fernandez
- Tobacco Control Unit, WHO Collaborating Center for Tobacco Control, Institut Català d'Oncologia-ICO, L'Hospitalet de Llobregat, Barcelona, Catalonia, Spain; Cancer Prevention and Control Group, Institut d'Investigació Biomèdica de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Catalonia, Barcelona, Spain; Department of Clinical Sciences, School of Medicine, Campus de Bellvitge, Universitat de Barcelona, L'Hospitalet del Llobregat, Catalonia, Barcelona, Spain
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Bertollini R, Ribeiro S, Mauer-Stender K, Galea G. Tobacco control in Europe: a policy review. Eur Respir Rev 2016; 25:151-7. [PMID: 27246592 PMCID: PMC9487237 DOI: 10.1183/16000617.0021-2016] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 03/25/2016] [Indexed: 11/26/2022] Open
Abstract
Tobacco is responsible for the death of 6 million people every year globally, of whom 700 000 are in Europe. Effective policies for tobacco control exist; however, the status of their implementation varies across the World Health Organization (WHO) European Region. In order to tackle the tobacco epidemic, action has been taken though the implementation of both legally binding and non-legally binding measures. This article aims to present the achievements and challenges of tobacco control in Europe, focussing on the available legally binding instruments such as the WHO Framework Convention on Tobacco Control and the revision of the Tobacco Products Directive at the European Union level. Tobacco still faces heavy lobbying of the tobacco industry, which has systematically contrasted policies to achieve public health objectives. The legal instruments for tobacco control in Europe presented here are not always adequately enforced in all the countries and there is certainly room for improving their implementation. Finally, the need for a strong political commitment towards the end-game of the tobacco epidemic is emphasised.
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Affiliation(s)
| | | | | | - Gauden Galea
- WHO Regional Office for Europe, Copenhagen, Denmark
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17
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Exposure and response to current text-only smokeless tobacco health warnings among smokeless tobacco users aged ≥18years, United States, 2012-2013. Prev Med 2016; 87:200-206. [PMID: 26892913 DOI: 10.1016/j.ypmed.2016.02.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Revised: 02/02/2016] [Accepted: 02/04/2016] [Indexed: 11/21/2022]
Abstract
INTRODUCTION We assessed US adult smokeless tobacco (SLT) users' exposure and response to SLT health warnings, which are currently in text-only format, covering 30% of the two primary surfaces of SLT containers and 20% of advertisements. METHODS Data were from the 2012-2013 National Adult Tobacco Survey. Past 30-day exposure to SLT health warnings among past 30-day SLT users (n=1626) was a self-report of seeing warnings on SLT packages: "Very often," "Often," or "Sometimes" (versus "Rarely" or "Never"). We measured the association between SLT health warning exposure and perceptions of SLT harmfulness and addictiveness using logistic regression. RESULTS Of past 30-day SLT users, 77.5% reported exposure to SLT health warnings, with lower prevalence reported among females and users of novel SLT products (snus/dissolvable tobacco). Furthermore, exposure reduced linearly with reducing education and annual household income (p<0.01). Among exposed past 30-day SLT users, 73.9% reported thinking about the health risks of SLT, while 17.1% reported stopping SLT use on ≥1 occasion within the past 30days. Exposure to SLT warnings was associated with perceived SLT harmfulness (AOR=2.16; 95% CI=1.15-4.04), but not with perceived SLT addictiveness. CONCLUSION Socioeconomic disparities found in exposure and response to SLT health warnings can be addressed through implementation of large pictorial warnings.
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McKee M, Daube M. Europe’s governments must implement standardised tobacco packaging now. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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