1
|
Bhatia M, Sharma N, Saifi S, Parashar S, Nisha N, Srivastava R, Jain M. Evolution of tobacco control in India: a narrative review of the legislative and regulatory approach. REVIEWS ON ENVIRONMENTAL HEALTH 2024; 39:1-12. [PMID: 36103211 DOI: 10.1515/reveh-2022-0160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 08/28/2022] [Indexed: 06/15/2023]
Abstract
Tobacco is the only consumer product that kills half its users yearly. The challenges posed by tobacco control are limitless especially in a country like India where in addition to smoked forms, other smokeless forms of tobacco are also highly prevalent. Apart from being a health hazard tobacco is also a great environmental hazard. Policies for controlling tobacco use also include policy to prevent people from second hand smoke, which is aimed at improvement of air quality. According to the National Non-Communicable Disease Monitoring Survey, 2017-18, daily tobacco use was 32.8% in adults (18-69 years) and 3.1% in adolescents (15-17 years). Overall reduction in tobacco users by 8.1 Million was seen from GATS-1 to GATS-2, and prevalence amongst youth decreased from 18.4 to 12.4%. GYTS-4 (2019) revealed that 8.5% of students, 9.6% of boys and 7.4% of girls-currently used any tobacco products. This makes tobacco control a priority in India. Tobacco control consists of different approaches such as educational, healthcare, legislative, regulatory and fiscal. In the present article we traverse nearly five decades and decode the evolution of legislative, regulatory and fiscal approaches to Tobacco Control in India. A critical evaluation of all these approaches is described in the format of the MPOWER strategy for Tobacco Control which stands for Monitoring Tobacco use, Preventing people from Second Hand Smoke, Offering help to quit, Waring regarding ill effects of tobacco, Enforcing bans and Raising taxes on tobacco products.
Collapse
Affiliation(s)
- Muskan Bhatia
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Nikita Sharma
- Manav Rachna Dental College and Hospital, Faridabad, India
| | | | - Swati Parashar
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Nisha Nisha
- Manav Rachna Dental College and Hospital, Faridabad, India
| | - Roomani Srivastava
- Faculty of Dental Sciences, Manav Rachna Dental College and Hospital, MRIIRS, Faridabad, India
| | - Meena Jain
- Department of Public Health Dentistry, Faculty of Dental Sciences, Manav Rachna Dental College, MRIIRS, Faridabad, India
| |
Collapse
|
2
|
Barker HE, Czaplicki L, Cui Y, Shen R, Nian Q, Xie M, Cohen JE. Exposure to and Appeal of Tobacco Ads and Displays in China: A Qualitative Exploration of Chinese Youth Perceptions. Nicotine Tob Res 2024; 26:427-434. [PMID: 37788378 PMCID: PMC10959156 DOI: 10.1093/ntr/ntad192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Adolescents are uniquely vulnerable to nicotine addiction, and smoking is common among male adolescents in China. Although China implemented a ban on cigarette and e-cigarette advertising in public places, Chinese youth remain exposed to this marketing, which may contribute to future use. AIMS AND METHODS From December 2021 to January 2022, we conducted 20 online focus group discussions with 119 adolescents in 10 Chinese cities to explore sources of tobacco marketing exposure, defined as exposure to cigarette and e-cigarette ads and product displays, and what features made marketing attractive. RESULTS All groups discussed exposure to tobacco ads/displays in public places, including locations near their home or school. Nearly all groups discussed that exposure to online tobacco ads was common, particularly exposure to e-cigarette commercial ads and posts made by classmates or friends selling e-cigarettes. Most groups identified how eye-catching colors, imagery, product packaging, and price promotions featured in e-cigarette ads/displays attracted their attention. CONCLUSIONS Results suggest Chinese adolescents are exposed to cigarette and e-cigarette ads and displays, many of which are placed in youth-friendly locations and contain youth-appealing features. IMPLICATIONS Only a handful of studies have examined the influence of cigarette and e-cigarette advertising on youth in the context of China. Prior research has established the relationship between youth exposure to tobacco marketing and increased susceptibility to future use. Our findings emphasize the importance of effectively enforcing and expanding restrictions on cigarette and e-cigarette marketing in order to protect youth from exposure and future smoking/vaping initiation.
Collapse
Affiliation(s)
- Hannah E Barker
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Yuxian Cui
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Rachel Shen
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Marn Xie
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| |
Collapse
|
3
|
Ay P, Yasin Y, Elbek O, Guner M, Gezer T, Pece Sonmez U, Ceyhan M, Yildiz F, Dagli E. Will plain packaging of cigarettes achieve the expected?
Perceptions among medical students. Tob Induc Dis 2022; 20:92. [DOI: 10.18332/tid/154056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Revised: 11/20/2021] [Accepted: 09/14/2022] [Indexed: 11/06/2022] Open
|
4
|
Grilo G, Lagasse LP, Cohen JE, Moran MB, Reynales-Shigematsu LM, Smith KC. "It's all About the Colors:" How do Mexico City Youth Perceive Cigarette Pack Design. Int J Public Health 2021; 66:585434. [PMID: 34744557 PMCID: PMC8565279 DOI: 10.3389/ijph.2021.585434] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 01/12/2021] [Indexed: 11/21/2022] Open
Abstract
Objectives: Cigarette packs are relevant to branding strategies, designed to appeal to specific groups. There is little research on how pack features increase product appeal among key constituents such as youth in low- and middle-income countries. Methods: We conducted 10 focus group discussions (FGDs) with adolescents and 5 FGDs with young adult smokers in Mexico City, separated by age, gender, smoking, and socioeconomic status. Participants separated 23 cigarette packs into “appealing” and “unappealing” groups, and were asked to explain their decisions, describing the features that supported their views. FGDs were video-recorded, transcribed in Spanish, translated into English, and subjected to thematic analysis. Results: Pack groupings did not differ greatly across FGDs; bold, contrasting colors and elements communicating flavor and promotion increased cigarette pack appeal and desire to try. Participants perceived packs with these features to be used by and designed for youth, like themselves. Conclusion: Our findings reinforce the importance of packaging design in attracting new consumers and maintaining current ones. Mexico should consider stronger tobacco advertising policies that include packaging color and depiction of flavor to reduce product appeal.
Collapse
Affiliation(s)
- Graziele Grilo
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Lisa P Lagasse
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Meghan B Moran
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Prevención y Control de Tabaquismo, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Katherine C Smith
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| |
Collapse
|
5
|
Nazar GP, Arora M, Gupta VK, Rawal T, Yadav A, Kannuri NK, Shrivastava S, Grills N, Webster P. Adolescent and adult perceptions of the effects of larger size graphic health warnings on conventional and plain tobacco packs in India: A community-based cross-sectional study. Tob Induc Dis 2019; 17:70. [PMID: 31636525 PMCID: PMC6786002 DOI: 10.18332/tid/110677] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/07/2019] [Accepted: 07/12/2019] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION We studied adolescent and adult perceptions of the effects of larger size, 85% versus 40%, Graphic Health Warnings (GHWs) on conventional and plain tobacco packs, in India. METHODS A cross-sectional survey was conducted with 2121 participants (aged ≥13 years), during the period 2015–16, in Delhi and Telangana, India. Four categories of GHWs on tobacco packs were shown: A – 40% existing (April 2013–April 2016), B – 40% new (April 2016–present), C – 85% new, and D – plain packs (85% new). Regression models tested percentage differences in choice of categories for eight outcomes, adjusted for gender, area of residence, socioeconomic status, age, and tobacco use. RESULTS Of the total 2121 participants, 1120 were from Delhi, 1001 from Telangana, 50% were males, 62% were urban residents, 12% were adolescents, and 72% had never used tobacco. Among packs shown, the majority of participants perceived the 85% size GHWs more effective than the 40% size GHWs across all outcomes. The perceived increase in noticeability of GHWs was 45% for category C (p<0.05) and 43.5% for category D (p<0.05) versus category B. In Delhi, participants perceived plain packs to be most effective in motivating quitting, preventing initiation and conveying the health message. In Telangana, adolescents believed GHWs on plain packs were most noticeable, most effective for quitting and preventing initiation. CONCLUSIONS The larger size 85% GHWs were perceived to be more effective in increasing noticeability of warnings, motivating cessation, preventing initiation, and conveying the intended health message. Support for plain packaging was higher in Delhi and among adolescents in Telangana.
Collapse
Affiliation(s)
- Gaurang P Nazar
- Health Promotion Division, Public Health Foundation of India, Gurugram, India.,HRIDAY, New Delhi, India
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, Gurugram, India.,HRIDAY, New Delhi, India
| | - Vinay K Gupta
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | - Tina Rawal
- Health Promotion Division, Public Health Foundation of India, Gurugram, India.,HRIDAY, New Delhi, India
| | - Amit Yadav
- Center for Tobacco Control Research and Education, University of California, San Francisco, United States
| | | | | | - Nathan Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Australia
| | - Premila Webster
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
6
|
Bhat A, Shilpashree KB, Krishnamurthy A, Manjunath C, Shwetha R, Madhusudhan S. Adolescent's Perception about the Introduction of New Cigarette Packaging and Plain Packaging of Cigarette Packs: A Qualitative Study. Indian J Community Med 2019; 43:S47-S51. [PMID: 30686875 PMCID: PMC6324033 DOI: 10.4103/ijcm.ijcm_97_18] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Introduction: Larger health warning labels on cigarette packages were introduced in India in 2016 to more clearly inform consumers about the health risks associated with tobacco use. The aim of this study was to know the adolescent's perception on the introduction of new cigarette packaging and plain packaging of cigarette packs. Methodology: A qualitative study was carried out among adolescents aged 16–19 years. Eighteen participants were selected using purposive sampling technique. Three focus group discussions with thefirst group consisting of 6 smokers and the second and third groups consisted of 6 quit smokers and 6 nonsmokers were conducted. The data were later transcribed and analyzed using grounded theory approach. Results: Nearly all participants were aware of tobacco products, brand names, colors, and pictorial warnings on tobacco products. While the nonsmokers perceived fear was greater regarding warning and the pictorial messages, the current smoker's perceptions were unaffected by fear appeals. Almost all participants reported that new cigarette warning labels were more visible, informative, and scarier than the older ones. Conclusion: Positive impact of warning labels was seen among nonsmokers and few quit smokers whereas the current smoker's perceptions were unaffected.
Collapse
Affiliation(s)
- Archana Bhat
- Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India
| | - K B Shilpashree
- Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India
| | - Archana Krishnamurthy
- Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India
| | - C Manjunath
- Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India
| | - R Shwetha
- Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India
| | - S Madhusudhan
- Department of Public Health Dentistry, The Oxford Dental College, Bengaluru, Karnataka, India
| |
Collapse
|
7
|
Yadav A, Nazar GP, Rawal T, Arora M, Webster P, Grills N. Plain packaging of tobacco products: the logical next step for tobacco control policy in India. BMJ Glob Health 2018; 3:e000873. [PMID: 30294458 PMCID: PMC6169668 DOI: 10.1136/bmjgh-2018-000873] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/24/2018] [Accepted: 07/27/2018] [Indexed: 11/16/2022] Open
Abstract
India implemented larger 85% pictorial health warnings on all tobacco products from 1 April 2016. However, to remove the last bit of glamour and attraction from the tobacco packs, it must now embrace plain packaging. Plain packaging prevents tobacco packs from carrying the tobacco industry brand imagery as mobile billboards. Postimplementation of larger 85% pictorial health warnings on all tobacco products, this analysis was undertaken to assess the feasibility of plain packaging as the next logical tobacco control policy measure in India. As part of this analysis, the research team reviewed the available literature on legal and policy challenges to plain packaging as a tobacco control policy initiative for India. Literature from 2010 to 2016 in English language was reviewed, which reveals that, India has taken several preparatory steps implemented by other countries like Australia and the UK that have introduced plain packaging, for example, stronger smoke-free laws, ban on tobacco advertising, promotion and sponsorship, increase in taxes and a report from civil society task force on plain packaging. The trade and investment agreements signed by India are also within the international trade norms relating to public health. A Private Member's Bill on plain packaging is also pending in the Parliament of India. Other potential challenges against such policy decision, for example, freedom of trade, right to property, violation of competition law and other laws including consumer protection laws, were found unsubstantiated by the research team. Plain packaging is the next logical step for tobacco control policy in India.
Collapse
Affiliation(s)
| | | | | | - Monika Arora
- HRIDAY, New Delhi, Delhi, India
- Health Promotion Division, Public Health Foundation of India, Gurugram, India
| | - Premila Webster
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nathan Grills
- Nossal Institute for Global Health, University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
8
|
Jradi H, Saddik B. Graphic warnings and text warning labels on cigarette packages in Riyadh Kingdom of Saudi Arabia: Awareness and perceptions. Ann Thorac Med 2018; 13:22-29. [PMID: 29387252 PMCID: PMC5772104 DOI: 10.4103/atm.atm_45_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Graphic warning labels have been shown to be effective in smoking initiation and cessation and were implemented in Saudi Arabia in 2012. To date, no study has assessed the effectiveness of these labels and the Saudi population's perceptions on the effectiveness of cigarette health warning labels. METHODS We used a cross-sectional qualitative study comprising of nine focus groups among 3 different community group members including health-care workers, adult women and adult men. We conducted in-depth interviews among community leaders. Both focus groups and interviews assessed awareness levels and elicited perceptions about health warning labels on cigarette boxes currently used in the Kingdom of Saudi Arabia. RESULTS While most participants in the study were aware and supported the use of graphic warning labels on cigarette packages, the awareness of the specific details on the labels was low. Participants perceived the effectiveness of current labels somewhat vague in smoking cessation and advocated for stronger and more aggressive graphics. Community leaders, however, preferred text-only labels and did not support aggressive labels which were deemed culturally and religiously inappropriate. CONCLUSIONS The study suggests that while graphic warning labels are perceived as necessary on cigarette packages the currently used messages are not clear and therefore do not serve their intended purposes. Measures should be undertaken to ensure that pictorial cigarette labels used in Saudi Arabia are culturally and ethnically appropriate and are rotated on a regular basis to ensure salience among smokers and nonsmokers alike.
Collapse
Affiliation(s)
- Hoda Jradi
- Department of Community and Environmental Health, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Basema Saddik
- Department of Community and Environmental Health, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.,Department of Family and Community Medicine and Behavioral Sciences, College of Medicine, University of Sharjah, Sharjah, UAE
| |
Collapse
|
9
|
Parashar M, Sharma N, Agarwalla R, Dwivedi S, Pathak R. Prevalence and correlates of tobacco chewing among construction site workers: A cross-sectional study in Delhi. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2017. [DOI: 10.1016/j.injms.2017.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
10
|
Hughes N, Arora M, Grills N. Perceptions and impact of plain packaging of tobacco products in low and middle income countries, middle to upper income countries and low-income settings in high-income countries: a systematic review of the literature. BMJ Open 2016; 6:e010391. [PMID: 27000787 PMCID: PMC4809104 DOI: 10.1136/bmjopen-2015-010391] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE To review the current literature around the potential impact, effectiveness and perceptions of plain packaging in low income settings. METHOD A systematic review of the literature. DATA SOURCES 9 databases (PubMed, Global Health, Social Policy and Practice, Applied Social Sciences Index and Abstracts (ASSIA), CINAHL, PsycINFO, British Library for Development Studies (BLDS), Global Health Library and Scopus) were searched. The terms used for searching combined terms for smoking and tobacco use with terms for plain packaging. STUDY SELECTION Studies investigating the impact of plain packaging on the determinants of tobacco use, such as smoking behaviour, appeal, prominence, effectiveness of health warnings, response to plain packs, attitudes towards quitting or likelihood of smoking in low-income settings, were identified. Studies must have been published in English and be original research of any level of rigour. DATA EXTRACTION Two independent reviewers assessed studies for inclusion and extracted data. DATA SYNTHESIS The results were synthesised qualitatively, with themes grouped under four key headings: appeal and attractiveness; salience of health warnings and perceptions of harm; enjoyment and perceived taste ratings; and perceptions of the impact on tobacco usage behaviour. RESULTS This review has identified four articles that met the inclusion criteria. Studies identified that tobacco products in plain packaging had less appeal than in branded packaging in low-income settings. CONCLUSIONS This review indicates that plain packaging appears to be successful in reducing appeal of smoking and packets, and supports the call for plain packaging to be widely implemented in conjunction with other tobacco control policies. However, there are considerable gaps in the amount of research conducted outside high-income countries.
Collapse
Affiliation(s)
- Nicole Hughes
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Monika Arora
- Health Promotion Division, Public Health Foundation of India, New Delhi, India
| | - Nathan Grills
- Nossal Institute for Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
11
|
Tobacco Usage in Uttarakhand: A Dangerous Combination of High Prevalence, Widespread Ignorance, and Resistance to Quitting. BIOMED RESEARCH INTERNATIONAL 2015; 2015:132120. [PMID: 26273585 PMCID: PMC4530211 DOI: 10.1155/2015/132120] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Revised: 01/06/2015] [Accepted: 01/21/2015] [Indexed: 11/24/2022]
Abstract
Background. Nearly one-third of adults in India use tobacco, resulting in 1.2 million deaths. However, little is known about knowledge, attitudes, and practices (KAP) related to smoking in the impoverished state of Uttarakhand. Methods. A cross-sectional epidemiological prevalence survey was undertaken. Multistage cluster sampling selected 20 villages and 50 households to survey from which 1853 people were interviewed. Tobacco prevalence and KAP were analyzed by income level, occupation, age, and sex. 95% confidence intervals were calculated using standard formulas and incorporating assumptions in relation to the clustering effect. Results. The overall prevalence of tobacco usage, defined using WHO criteria, was 38.9%. 93% of smokers and 86% of tobacco chewers were male. Prevalence of tobacco use, controlling for other factors, was associated with lower education, older age, and male sex. 97.6% of users and 98.1% of nonusers wanted less tobacco. Except for lung cancer (89% awareness), awareness of diseases caused by tobacco usage was low (cardiac: 67%; infertility: 32.5%; stroke: 40.5%). Conclusion. A dangerous combination of high tobacco usage prevalence, ignorance about its dangers, and few quit attempts being made suggests the need to develop effective and evidence based interventions to prevent a health and development disaster in Uttarakhand.
Collapse
|
12
|
Smith CN, Kraemer JD, Johnson AC, Mays D. Plain packaging of cigarettes: do we have sufficient evidence? Risk Manag Healthc Policy 2015; 8:21-30. [PMID: 25897269 PMCID: PMC4396458 DOI: 10.2147/rmhp.s63042] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Tobacco industry marketing is a primary factor influencing cigarette smoking behavior and the cigarette pack has become an important marketing vehicle for tobacco companies. Standardized "plain" cigarette packaging is advocated as a public health policy to prevent and reduce morbidity and mortality caused by smoking by reducing youth smoking initiation and promoting cessation among smokers. Plain packaging was implemented in Australia in December 2012, and several other countries are considering doing so, but each faces foreseeable legal resistance from opponents to such measures. Tobacco companies have challenged these public health policies, citing international trade agreements and intellectual property laws. Decision-making in these court cases will hinge in part on whether the evidence indicates the public health benefits of plain packaging outweigh any potential harm to tobacco manufacturers' interests. We reviewed the available evidence in support of plain packaging, finding evidence from observational, experimental, and population-based studies. Results indicate that plain packaging can reduce positive perceptions of smoking and dissuade tobacco use. Governments deciding to implement plain cigarette packaging measures can rely on this evidence to help make a strong case that plain packaging plays an important role in the context of comprehensive smoking prevention efforts.
Collapse
Affiliation(s)
- Collin N Smith
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - John D Kraemer
- Department of Health Systems Administration, School of Nursing and Health Studies, Georgetown University, Washington, DC, USA
| | - Andrea C Johnson
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| | - Darren Mays
- Department of Oncology, Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC, USA
| |
Collapse
|
13
|
Sethi A, Prakash A. Tobacco – Whose friend and who is friend with it? INDIAN JOURNAL OF MEDICAL SPECIALITIES 2015. [DOI: 10.1016/j.injms.2015.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
14
|
Swift E, Borland R, Cummings KM, Fong GT, McNeill A, Hammond D, Thrasher JF, Partos TR, Yong HH. Australian smokers' support for plain or standardised packs before and after implementation: findings from the ITC Four Country Survey. Tob Control 2014; 24:616-21. [PMID: 25385449 DOI: 10.1136/tobaccocontrol-2014-051880] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2014] [Accepted: 10/07/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Plain packaging (PP) for tobacco products was fully implemented in Australia on 1 December 2012 along with larger graphic health warnings. Using longitudinal data from the Australian arm of the ITC Four Country Survey, we examined attitudes to the new packs before and after implementation, predictors of attitudinal change, and the relationship between support and quitting activity. METHODS A population-based cohort study design, with some cross-sectional analyses. Surveys of Australian smokers assessed attitudes to PP at four time points prior to implementation (from 2007 to 2012) and one post-implementation wave collected (early/mid-2013). RESULTS Trend analysis showed a slight rise in opposition to PP among smokers in the waves leading up to their implementation, but no change in support. Support for PP increased significantly after implementation (28.2% pre vs 49% post), such that post-PP more smokers were supportive than opposed (49% vs 34.7%). Multivariate analysis showed support either before or after implementation was predicted by belief in greater adverse health impacts of smoking, desire to quit and lower addiction. Among those not supportive before implementation, having no clear opinion about PP (versus being opposed) prior to the changes also predicted support post-implementation. Support for PP was prospectively associated with higher levels of quitting activity. CONCLUSIONS Since implementation of PP along with larger warnings, support among Australian smokers has increased. Support is related to lower addiction, stronger beliefs in the negative health impacts of smoking, and higher levels of quitting activity.
Collapse
Affiliation(s)
- Elena Swift
- The Cancer Council, Victoria, Melbourne, Victoria, Australia
| | - Ron Borland
- The Cancer Council, Victoria, Melbourne, Victoria, Australia
| | - K Michael Cummings
- Department of Psychiatry & Behavioral Sciences, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ann McNeill
- Addictions Department, Kings College London, UK Centre for Tobacco & Alcohol Studies: United Kingdom, London, UK
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - James F Thrasher
- Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA
| | - Timea R Partos
- The Cancer Council, Victoria, Melbourne, Victoria, Australia
| | - Hua-Hie Yong
- The Cancer Council, Victoria, Melbourne, Victoria, Australia
| |
Collapse
|
15
|
Moodie C, Bauld L, Ford A, Mackintosh AM. Young women smokers' response to using plain cigarette packaging: qualitative findings from a naturalistic study. BMC Public Health 2014; 14:812. [PMID: 25100245 PMCID: PMC4131050 DOI: 10.1186/1471-2458-14-812] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/29/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of this study was to explore in-depth the response of young women smokers (18-35 years) to using dark brown 'plain' cigarette packs in naturalistic settings. METHODS Participants were recruited in six towns and cities in Scotland to take part in a naturalistic study, where they used plain cigarette packs for a week. Participants completed a number of questionnaires during the study period (reported elsewhere), and a sub-sample participated in post-study telephone interviews to explore their experiences of using the plain packs. Of the 187 participants who completed the study, 23 were randomly selected to participate in the post-study interviews. Within the interviews a semi-structured topic guide was used to assess perceptions of the plain pack, feelings created by the pack, feelings about smoking, and avoidant and smoking behaviour. RESULTS The brown (plain) packs were perceived negatively due to the colour, the undesirable image the pack conveyed, and the reaction from others. The plain packs were also associated with negative feelings, such as embarrassment, discomfort and guilt. Some participants also commented that they felt differently about the product, considered to be less enjoyable or more harmful, when using the plain packs, and were less interested in, or felt more negatively about, smoking. A number of participants said that they had engaged in avoidant behavior with the plain packs, such as hiding it, due to their negative thoughts about the packs and the reaction of others. Some participants also mentioned cessation-related behaviours when using the plain packs, such as forgoing cigarettes, stubbing cigarettes out early and thinking about quitting, largely due to the decreased enjoyment of smoking. CONCLUSIONS The experience of using cigarettes in plain packs prompted a range of negative responses from young women smokers, who are a crucial target group for tobacco control interventions.
Collapse
Affiliation(s)
- Crawford Moodie
- />Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA Scotland, UK
- />UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - Linda Bauld
- />Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA Scotland, UK
- />UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - Allison Ford
- />Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA Scotland, UK
- />UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| | - Anne Marie Mackintosh
- />Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, Stirling, FK9 4LA Scotland, UK
- />UK Centre for Tobacco and Alcohol Studies, Stirling, UK
| |
Collapse
|