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Guindon GE, Mentzakis E, Buckley NJ. Cigarette packaging, warnings, prices, and contraband: A discrete choice experiment among smokers in Ontario, Canada. ECONOMICS AND HUMAN BIOLOGY 2024; 52:101340. [PMID: 38134576 DOI: 10.1016/j.ehb.2023.101340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 11/22/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023]
Abstract
In Canada, despite substantial decline, tobacco use remains the leading risk factor responsible for mortality and morbidity. There is overwhelming evidence that higher tobacco taxes reduce tobacco use, even if high taxes create an incentive to avoid or evade tobacco taxes. Recently, in addition to taxes, plain and standardized packaging and printing a warning on each cigarette have been lauded to reduce tobacco use. In November 2019, Canada became the country with the most comprehensive cigarette packaging regulations; and in June 2022, Canada proposed to print health warnings on individual cigarettes, the first jurisdiction to ever do so. The regulations came into force on August 1, 2023, and are being implemented through a stepwise approach. Our objective was to examine the effects of plain and standardized packaging, warning on cigarettes, price, and the availability of illicit cigarettes on intention to purchase and risk perceptions. We conducted a discrete choice experiment, and examined heterogeneity in preferences using latent class models among smokers in Ontario, Canada. We found that using latent class analyses was essential in quantifying preferences for attributes of cigarettes and cigarette packs. First, nearly half of smokers stated a preference for cheaper illicit cigarettes in a branded pack without any health warnings, regardless of the licit cigarette alternatives. For about 20% of respondents, plain packaging and especially warning on cigarette sticks decreased the probability of stating a purchasing preference for these alternatives. Third, about a third of respondents chose competing alternatives with mostly one attribute in mind, price. Lastly, none of the products and attributes seem to have significantly influenced risk perception. Our findings attest to the importance of prices and taxes, to the potential of warnings on cigarette sticks to control tobacco use, and indicate that efforts to restrict the availability of illicit cigarettes may yield substantial benefits.
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Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada; Department of Economics, McMaster University, Hamilton, ON, Canada.
| | | | - Neil J Buckley
- Department of Economics, York University, Toronto, ON, Canada
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Maiyo AK, Kibet JK, Kengara FO. A review of the characteristic properties of selected tobacco chemicals and their associated etiological risks. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:479-491. [PMID: 35538694 DOI: 10.1515/reveh-2022-0013] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 04/21/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Despite the quantum of research findings on tobacco epidemic, a review on the formation characteristics of nicotine, aldehydes and phenols, and their associated etiological risks is still limited in literature. Accordingly, knowledge on the chemical properties and free radical formation during tobacco burning is an important subject towards unravelling the relationship between smoking behaviour and disease. This review investigates how scientific efforts have been advanced towards understanding the release of molecular products from the thermal degradation of tobacco, and harm reduction strategies among cigarette smokers in general. The mechanistic characteristics of nicotine and selected aldehydes are critically examined in this review. For the purpose of this work, articles published during the period 2004-2021 and archived in PubMed, Google Scholar, Medley, Cochrane, and Web of Science were used. The articles were selected based on the health impacts of cigarette smoking, tobacco burning kinetics, tobacco cessation and tobacco as a precursor for emerging diseases such as Covid-19. CONTENT The toxicity of cigarette smoke is directly correlated with its chemical composition derived from the pyrolysis of tobacco stem and leaves. Most of the harmful toxic substances are generated by pyrolysis during smoking and depends on pyrolysis conditions. Detailed studies have been conducted on the kinetics of nicotine by use of robust theoretical models in order to determine the rate constants of reactions in nicotine and those of nicotine dissociation via C-C and C-N scission, yielding pyridinyl and methyl radicals, respectively. Research has suggested that acetaldehyde enhances the effect of nicotine, which in turn reinforces addiction characteristics whereas acrolein and crotonaldehyde are ciliatoxic, and can inhibit lung clearance. On the other hand, phenol affects liver enzymes, lungs, kidneys, and the cardiovascular system while m-cresol attacks the nervous system. SUMMARY AND OUTLOOK The characteristics of chemical release during tobacco burning are very important in the tobacco industry and the cigarette smoking community. Understanding individual chemical formation from cigarette smoking will provide the necessary information needed to formulate sound tobacco reform policies from a chemical standpoint. Nonetheless, intense research is needed in this field in order to prescribe possible measures to deter cigarette smoking addiction and ameliorate the grave miseries bedevilling the tobacco smoking community.
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Affiliation(s)
- Alfayo K Maiyo
- Department of Chemistry and Biochemistry, Moi University, Eldoret, Kenya
- African Centre of Excellence in Phytochemicals, Textiles and Renewable Energy (ACE II-PTRE), Eldoret, Kenya
| | - Joshua K Kibet
- Department of Chemistry, Egerton University, Njoro, Kenya
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Al-Zalabani AH, Monshi SS, Al-Ahmadi AF, Ali AKA, Mirdad GA, Alanazi MM, Alsaedi MQ, Alanazi AM. Dissuasive cigarettes as a tobacco control measure: a scoping review. Tob Control 2023:tc-2023-057974. [PMID: 37414527 DOI: 10.1136/tc-2023-057974] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/28/2023] [Indexed: 07/08/2023]
Abstract
OBJECTIVE The aim was to identify and review the research literature on dissuasive cigarettes, including key concepts, types, sources of evidence and research gaps. DATA SOURCES PubMed, Scopus and Web of Science databases were searched up to January 2023 with no language or date restrictions. All study designs were included. Reference lists of the identified studies were manually searched. Studies on tobacco products other than cigarettes or on external cigarette packaging alone were excluded. STUDY SELECTION Two reviewers screened titles and abstracts independently using eligibility criteria. The full text of the selected articles was subsequently screened independently by two reviewers to confirm eligibility. DATA EXTRACTION Two reviewers independently extracted data from all studies using data abstraction forms. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS We identified 24 original studies, 3 review articles and 4 commentary articles. Research on dissuasive cigarettes was reported from Australia, New Zealand, Europe and North America. We presented results in four themes: the concept of dissuasive cigarettes; approaches and types; potential benefits, barriers and concerns; and current research gaps. CONCLUSIONS Dissuasive cigarettes represent a promising strategy that could be used in tobacco control. Parallel implementation with plain packaging would be feasible and synergistic.
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Affiliation(s)
| | - Sarah S Monshi
- Department of Health Services Management, College of Public Health and Health Informatics, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Ahmed Khalid A Ali
- Model of Care, Al-Madinah Health Cluster, Al-Madinah Al-Munawarah, Saudi Arabia
| | | | - Manal Muteb Alanazi
- Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Mawada Qabl Alsaedi
- Saudi Board Preventive Medicine Program, Al-Madinah Al-Munawarah, Saudi Arabia
| | - Abdullah M Alanazi
- Respiratory Therapy, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
- King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
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van der Eijk Y. Standardised cigarettes: the next step for tobacco policy? Tob Control 2022:tobaccocontrol-2022-057417. [PMID: 35768214 DOI: 10.1136/tc-2022-057417] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/20/2022] [Indexed: 11/03/2022]
Abstract
As tobacco marketing restrictions intensify, tobacco companies increasingly turn to the cigarette product itself as a marketing medium with new flavours, capsules, novelty filter features and attractive cigarette stick designs. This paper considers a 'standardised cigarettes' policy as a potential next step in restricting tobacco marketing. This policy would remove from cigarette products all the elements that increase their appeal and addictiveness: added flavours, nicotine, and visual designs and branding. The result would be a cigarette that is flavourless, not especially addicting, and visually off-putting. This paper discusses what a standardised cigarettes policy might look like from a regulatory standpoint, and how it fits into current policy obligations under the WHO Framework Convention on Tobacco Control.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Jankowski M, Ostrowska A, Sierpiński R, Skowron A, Sytnik-Czetwertyński J, Giermaziak W, Gujski M, Wierzba W, Pinkas J. The Prevalence of Tobacco, Heated Tobacco, and E-Cigarette Use in Poland: A 2022 Web-Based Cross-Sectional Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4904. [PMID: 35457771 PMCID: PMC9031359 DOI: 10.3390/ijerph19084904] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 04/13/2022] [Accepted: 04/16/2022] [Indexed: 02/06/2023]
Abstract
Monitoring tobacco use on a regular schedule is a basic tool of tobacco control policy. This study aimed (1) to assess the current prevalence and patterns of tobacco and e-cigarette use, as well as (2) to identify socioeconomic factors associated with smoking behavior among adults in Poland. This cross-sectional study was carried out in March 2022 on a nationwide, representative sample of 1090 adults in Poland. The computer-assisted web interview (CAWI) technique was used. Daily tobacco smoking was declared by 28.8% of respondents (27.1% of females and 30.8% of males; p = 0.2) and 4.2% were occasional smokers (4.2% of females and 4.3% of males; p = 0.8). Most of the current smokers (62.1%) smoked regular cigarettes and 25.2% smoked hand-rolled cigarettes. The prevalence of daily e-cigarette use was 4.8% (4.0% among females and 5.6% among males; p = 0.2). Daily heated tobacco use was declared by 4.0% of respondents (5.1% of females and 2.9% of males; p = 0.07). Age, having children, and educational level were significantly associated with current daily tobacco smoking. This study revealed a high prevalence of tobacco and e-cigarette use among adults in Poland. The presented data underscore the importance of further improvements in adopting a comprehensive tobacco control strategy in Poland.
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Affiliation(s)
- Mateusz Jankowski
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland; (A.O.); (A.S.); (J.S.-C.); (J.P.)
| | - Aurelia Ostrowska
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland; (A.O.); (A.S.); (J.S.-C.); (J.P.)
| | - Radosław Sierpiński
- Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszyński University, 01-815 Warsaw, Poland;
| | - Adam Skowron
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland; (A.O.); (A.S.); (J.S.-C.); (J.P.)
| | - Janusz Sytnik-Czetwertyński
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland; (A.O.); (A.S.); (J.S.-C.); (J.P.)
| | | | - Mariusz Gujski
- Department of Public Health, Medical University of Warsaw, 02-097 Warsaw, Poland;
| | - Waldemar Wierzba
- UHE Satellite Campus in Warsaw, University of Humanities and Economics in Łódź, 01-513 Warsaw, Poland;
- Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, 02-507 Warsaw, Poland
| | - Jarosław Pinkas
- School of Public Health, Centre of Postgraduate Medical Education, 01-826 Warsaw, Poland; (A.O.); (A.S.); (J.S.-C.); (J.P.)
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Al-Natour A, Gillespie GL, Alzoubi F. "We cannot stop smoking": Female university students' experiences and perceptions. Appl Nurs Res 2021; 61:151477. [PMID: 34544576 DOI: 10.1016/j.apnr.2021.151477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 07/08/2021] [Accepted: 07/17/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND While findings are available about smoking in young females, there is a dearth of research reporting this problem among Jordanian females, particularly university students. Also, there is lack of studies that describe the daily experience and the causative factors for smoking among female university students. PURPOSE The purpose of this study is to describe the experience of smoking as perceived by female Jordanian university students. In addition, this study aimed to describe the predisposing factors for initiating smoking and feelings toward that experience. METHOD A descriptive qualitative study was employed. A purposive sample of 12 female Jordanian university students who smoke cigarettes were asked to participate in this study. A semi-structured, face-to-face interviews were conducted. RESULTS Five themes of the study included: (1) living and enjoying smoking with other females, (2) hazardous effect of smoking, (3) our culture stigmatizing female smoking, (4) why we don't stop smoking, and (5) strategies to combat smoking among females. CONCLUSION Female university students disclosed peer pressure and stress as intensifying factors for smoking. Also they were unable to quit smoking because they were attached and addicted to smoking cigarettes. STUDY IMPLICATIONS The findings of our study have several implications for nursing education, policymaking, and practice. An important target would be to motivate university students who are smokers to attempt smoking cessation leveraging cultural leaders as role models. Policy makers also should revise policies related to importing and taxation of cigarettes is essential. In addition, policy makers should enforce legislation for smoking fee areas and prevention of smoking in closed areas.
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Affiliation(s)
- Ahlam Al-Natour
- Community and Mental Health Nursing, College of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
| | - Gordon Lee Gillespie
- University of Cincinnati College of Nursing, P.O. Box 210038, Cincinnati, OH 45221-0038, United States of America.
| | - Fatmeh Alzoubi
- Community and Mental Health Nursing Department, College of Nursing, Jordan University of Science and Technology, P.O. Box 3030, Irbid 22110, Jordan.
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A review of tobacco abuse and its epidemiological consequences. JOURNAL OF PUBLIC HEALTH-HEIDELBERG 2021; 30:1485-1500. [PMID: 33425659 PMCID: PMC7786188 DOI: 10.1007/s10389-020-01443-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 11/20/2020] [Indexed: 12/12/2022]
Abstract
Aim The economic burden caused by death and disease in the world is credited mainly to tobacco use—currently linked to approximately 8,000,000 deaths per year with approximately 80% of these faralities reported in low and middle income economies. The World Health Organization (WHO) estimates that nearly 7,000,000 deaths are attributed to direct tobacco use, while approximately 1,200,000 non-smokers exposed to second hand cigarette smoke die every year. Accordingly, tobacco use is a major threat to the public health infrastructure; therefore, proper cessation interventions must be put in place to curb tobacco abuse and ease economic and social burdens caused by the tobacco epidemic. Methods A systematic review was conducted to investigate how scientific efforts have been advanced towards harm reduction among smokers and non-smokers. Relevant articles published during the period 2010–2020 in PubMed, Crossref, Google scholar, and Web of Science were used in this study. The articles were selected based on health impacts of cigarette smoking, tobacco cessation and emerging diseases, including Covid−19. Various cessation strategies have been identified although their efficiency is yet to match the desired results. Results A series of carcinogenic chemicals are generated during cigarette smoking resulting in serious health complications such as cancer and mutagenesis. The precursors for tobacco induced diseases are toxic and carcinogenic chemicals of the nitrosamine type, aldehydes, polonium-210 and benzo[a]pyrene, which bio-accumulate in the body system during cigarette smoking to cause disease. Rehabilitation facilities, use of drugs to diminish the desire to smoke, heavy taxation of tobacco products and warning labels on cigarettes are some of the cessation strategies employed towards curbing tobacco abuse. Conclusion The need for further research to develop better methods and research based policies for safe cigarette smoking and workable cessation strategies must be a priority in order to deal with the tobacco epidemic. Campaigns to promote tobacco cessation and abstinence are recommended in this review as a sure measure to mitigate against the deleterious impacts caused by cigarette smoking and tobacco abuse.
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian University Student Perceptions of Health Messages on Cigarette Sticks. HEALTH COMMUNICATION 2020; 35:456-464. [PMID: 30676104 DOI: 10.1080/10410236.2019.1567442] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
University students are exposed to casual smoking, increasing their risk of developing nicotine addiction, which can extend into adulthood. A novel anti-tobacco intervention being investigated is the use of health warnings on individual cigarette sticks. We explored the perceptions of university students on the effectiveness of health warnings on cigarette packaging and individual cigarette sticks. An online survey was distributed to first-year university students enrolled at a regional university in North-Eastern Australia. Participants rated on 5-point Likert scales and commented using open-text comment boxes, the effectiveness of current cigarette packaging warnings, and 12 text warnings (divided into four themes; immediate and short-term consequences [ISC], long-term and mortality consequences [LMC], social and financial consequences [SFC], and supportive messages to quit [SMQ]) on individual cigarette sticks, in preventing non-smokers from smoking, and in encouraging current smokers to quit. Participants (n = 479; Mean age = 22 years) rated three themes (ISC, LMC, and SFC) as being overall more effective (all p < .001) than current packaging warnings (Odds Ratios = 5.93 [4.51-7.80], 3.60 [2.79-4.64], and 2.86 [2.21-3.69] respectively). Participants described a desensitisation to current packaging warnings, and the novel warnings displayed potentially overcoming this issue, with over 85% agreeing that individual cigarette sticks should include health warnings. Health warnings on cigarette sticks may serve as an effective means in reducing tobacco use, with the provision of this additional intervention for communicating the health and other negative consequences of smoking likely reinforcing the effects of current packaging warnings.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University
| | | | - Beverley Glass
- College of Medicine and Dentistry, James Cook University
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Romijnders KAGJ, Pennings JLA, van Osch L, de Vries H, Talhout R. A Combination of Factors Related to Smoking Behavior, Attractive Product Characteristics, and Socio-Cognitive Factors are Important to Distinguish a Dual User from an Exclusive E-Cigarette User. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4191. [PMID: 31671505 PMCID: PMC6862614 DOI: 10.3390/ijerph16214191] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 10/18/2019] [Accepted: 10/24/2019] [Indexed: 01/18/2023]
Abstract
Although total cessation of nicotine and tobacco products would be most beneficial to improve public health, exclusive e-cigarette use has potential health benefits for smokers compared to cigarette smoking. This study investigated differences between dual users and exclusive e-cigarette users provide information to optimize health communication about smoking and vaping. A cross-sectional survey (n = 116) among 80 current, adult dual users and 36 current, adult-exclusive e-cigarette users was conducted in the Netherlands. The questionnaire assessed four clusters of factors: (1) Past and current smoking and vaping behavior, (2) product characteristics used, (3) attractiveness and reasons related to cigarettes and e-cigarettes, and (4) socio-cognitive factors regarding smoking, vaping, and not smoking or vaping. We used random forest-a machine learning algorithm-to identify distinguishing features between dual users and e-cigarette users. We are able to discern a dual user from an exclusive e-cigarette user with 86.2% accuracy based on seven factors: Social ties with other smokers, quantity of tobacco cigarettes smoked in the past (e-cigarette users) or currently (dual users), self-efficacy to not vape and smoke, unattractiveness of cigarettes, attitude towards e-cigarettes, barriers: accessibility of e-cigarettes, and intention to quit vaping (A). This combination of features provides information on how to improve health communication about smoking and vaping.
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Affiliation(s)
- Kim A G J Romijnders
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, 9, 3721 MA Bilthoven, The Netherlands.
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, POB 616 6200 MD Maastricht, The Netherlands.
| | - Jeroen L A Pennings
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, 9, 3721 MA Bilthoven, The Netherlands.
| | - Liesbeth van Osch
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, POB 616 6200 MD Maastricht, The Netherlands.
| | - Hein de Vries
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, POB 616 6200 MD Maastricht, The Netherlands.
| | - Reinskje Talhout
- Centre for Health Protection, National Institute for Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan, 9, 3721 MA Bilthoven, The Netherlands.
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Dissuasive cigarettes: which cues are the most effective at deterring young people from smoking? Public Health 2019; 174:22-30. [DOI: 10.1016/j.puhe.2019.05.034] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 04/29/2019] [Accepted: 05/30/2019] [Indexed: 11/21/2022]
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: A four-country study. Tob Induc Dis 2019; 17:23. [PMID: 31582934 PMCID: PMC6751965 DOI: 10.18332/tid/104753] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Innovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarette-stick warnings across four countries. METHODS An online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis. RESULTS Participants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75–4.25, p<0.001 and OR=2.85, 95% CI: 2.29–3.55, p<0.001, respectively) and cited as strong messages to reduce smoking. Half of the participants either ‘agreed’ or ‘strongly agreed’ to the use of cigarette-stick warnings. CONCLUSIONS The findings of this study suggest that cigarette packaging warnings may experience a loss of effectiveness over time, eventually resulting in minimal impact on smoker behaviour. Health and non-health focused warnings and messages on individual cigarette sticks represent a novel and potentially effective method for reducing tobacco use. This would complement tobacco control interventions currently employed, resulting in public health benefits.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian School Student Perceptions of Effective Anti-tobacco Health Warnings. Front Public Health 2018; 6:297. [PMID: 30386764 PMCID: PMC6199459 DOI: 10.3389/fpubh.2018.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/28/2018] [Indexed: 11/26/2022] Open
Abstract
Background: Recent research posits that anti-tobacco health warnings on cigarette packaging may gradually lose their effectiveness in dissuading adolescents from tobacco products several years after implementation. Health warnings on individual cigarette sticks represent a novel warning medium, and may further educate adolescents on the dangers associated with smoking, and reduce tobacco experimentation amongst this vulnerable population. Methods: In an online survey of school students in Queensland, Australia, participants were requested to rate (on five-point Likert scales) and comment on the perceived effectiveness of current cigarette packaging warnings, and 12 text warnings on cigarette sticks, in preventing non-smokers from smoking, and encouraging current smokers to quit. The warnings were divided into four themes to establish the most effective types of anti-tobacco messages: mortality statistics, health condition consequences, social and financial consequences, and supportive messages. These themes were based on current anti-tobacco interventions within Australia, and the rising cost of tobacco products, and designed to align with the Health Belief Model. Results: Participants (N = 150; Age = 15-18) from five schools completed the survey, and generally viewed current packaging warnings as gross and disgusting, and rating them as somewhat effective in preventing non-smokers from smoking. Current warnings were however considered less effective in prompting current smokers to quit with participants describing them as being un-relatable to teenagers, and smokers as having become desensitized to the warnings used. One theme of cigarette-stick warning (mortality statistics) was rated as significantly more effective (p < 0.001) than current cigarette packaging, with an odds ratio (OR) of 2.77 (95% confidence interval [CI]: 1.67-4.62). Overall, warnings were considered to be 4.71 times (95%CI: 2.72-6.43, p < 0.001) more effective on non-smokers than on smokers. Over three-quarters of participants supported using health warnings on individual cigarette sticks. Conclusions: Current cigarette packaging warnings have retained some effectiveness in dissuading adolescents from smoking, though novel and thought-provoking text-only warnings on cigarette sticks may serve as an additional intervention in reducing tobacco use. Further research requires identification of the most effective warnings, and the perceptions of a more diverse participant base.
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