Compliance with tobacco control policies in India: an examination of facilitators and barriers

SETTING

India's Cigarettes and Other Tobacco Products Act (COTPA) prohibits smoking in public places, limits advertising at points of sale, and bans sales in close proximity to educational institutions.

OBJECTIVE

To examine key stakeholders' (i.e., tobacco retailers, hotel and restaurant owners/managers, law enforcement officials, school principals/administrators) perceptions of facilitators and barriers to compliance with COTPA.

DESIGN

Using semi-structured in-depth interviews (n = 60), we identified a range of facilitators and barriers that varied across the venues.

RESULTS

A number of simple measures to increase compliance were identified: provide signs to retailers, provide aesthetically pleasing signs more fitting for the atmosphere of the hotel/restaurant, etc., and empower law enforcement to implement the law.

CONCLUSIONS

Priority should be placed on public awareness, as it can facilitate compliance in numerous venues. Communication efforts could be undertaken to change the public's residual negative attitudes toward the policy.

The perceived influence of cigarette advertisements and smoking susceptibility among seventh graders

A perceptual bias, the third person effect, has been observed where individuals believe themselves to differ from others regarding the perceived influence of media messages. Given the frequency with which youth encounter prosmoking messages and the reported negative effects of these messages, it is of value to study whether youth perceive cigarette advertisements to influence themselves and their friends and peers. This study examined the associations between exposure to social and information prosmoking environments, the perceived influence of cigarette advertisements on self, best friends, and other youth, and smoking susceptibility. A sample of 571 seventh graders completed surveys on tobacco advertisements and promotions. Using Student's-t, chi-square, ANOVA tests and proportional odds models, we found significant associations between perceived influence of cigarette advertisements and exposure to social and information prosmoking environments as well as smoking susceptibility. These data suggest that youth be taught that everyone is vulnerable to the tobacco industry's strategies and be given skills to resist prosmoking advertising.

Psychosocial factors associated with youth involvement in community activities promoting heart health

This study examined factors that influence youth participation in heart disease prevention activities among 2,609 ninth graders in six inner-city public high schools. Constructs derived from social cognitive, empowerment, and community development theories informed the conceptual framework employed. Study participants were diverse with respect to gender, ethnicity, parent education, acculturation, and academic achievement. Perceived incentive value, self-efficacy, outcome expectancies, sense of community, and perceived policy control were all significantly associated with participation in community activities promoting heart health. In multivariate analyses, perceived incentive value, defined as the extent to which participants valued a heart-healthy environment, was most strongly associated with community participation, accounting for 11.9% of the total variance. These findings have implications for designing school curricula and after-school and community programs targeting adolescents' involvement in health advocacy activities.

Seeing, wanting, owning: the relationship between receptivity to tobacco marketing and smoking susceptibility in young people

OBJECTIVE

To assess the effect of the tobacco industry's marketing practices on adolescents by examining the relationship between their receptivity to these practices and their susceptibility to start smoking.

DESIGN

Paper-and-pencil surveys measuring association with other smokers, exposure to tobacco industry marketing strategies, experience with smoking, and resolve not to smoke in the future.

SETTING

25 randomly selected classrooms in five middle schools in San Jose, California.

SUBJECTS

571 seventh graders with an average age of 13 years and 8 months; 57% were female. Forty-five per cent of the students were Asian, 38% were Hispanic, 12% were white, and 5% were black.

MAIN OUTCOME MEASURES

Exposure to social influences, receptivity to marketing strategies, susceptibility to start smoking.

RESULTS

About 70% of the participants indicated at least moderate receptivity to tobacco marketing materials. Children who are more receptive are also more susceptible to start smoking. In addition to demographics and social influences, receptivity to tobacco marketing materials was found to be strongly associated with susceptibility.

CONCLUSIONS

Tobacco companies conduct marketing campaigns that effectively capture teenage attention and stimulate desire for their promotional items. These marketing strategies may function to move young teenagers from non-smoking status toward regular use of tobacco. Our results demonstrate that there is a clear association between tobacco marketing practices and youngsters' susceptibility to smoke. The findings, along with other research, provide compelling support for regulating the manner in which tobacco products are marketed, to protect young people from the tobacco industry's strategies to reach them.

Seventh graders' self-reported exposure to cigarette marketing and its relationship to their smoking behavior

OBJECTIVES

This study examined among youth the extent of their perceived exposure to cigarette marketing and the relationship of their perceptions to their smoking behavior.

METHODS

Surveys measuring exposure to cigarette advertisements and promotions were completed by 571 seventh graders in San Jose, Calif.

RESULTS

Eighty-eight percent of these 13-year-olds reported exposure to cigarette marketing: the majority often saw ads in magazines, on billboards, and at stores and events, and one quarter owned cigarette promotional items. After social influences to smoke were controlled for, exposure to cigarette marketing was related to self-reported smoking behavior. Likelihood of experimenting with smoking was 2.2 times greater among those who owned promotional items and 2.8 times greater among those who had received mail from a tobacco company. Seeing cigarette advertisements in magazines increased this likelihood by 21%, and seeing tobacco marketing in stores increased it by 38%.

CONCLUSIONS

Youth are daily and widely exposed to tobacco industry marketing efforts; this exposure is related to smoking behavior. More effective regulation is needed.

Policy alternatives for reducing tobacco sales to minors: results from a national survey of retail chain and franchise stores

Minors' access to tobacco has become an important public health issue. Little is known, however, about the knowledge, attitudes, beliefs, and behavior toward access among executives from businesses that sell tobacco. This study examined access from the perspective of corporate and regional headquarters of retail chains and franchises that sell tobacco. A total of 148 U.S. companies with the largest overall retail sales volume that sold tobacco were asked to participate; 91 agreed. The sample included grocery stores, convenience stores, gas station mini-marts, liquor stores, and drug stores. Data revealed at least moderate support for policies limiting youth tobacco access. Although most companies reported having in place policies to prevent minors from purchasing tobacco, these policies did not seem intensive. In addition, executives underestimated the extent of youth access. We conclude that the time is right for passage of bold policies to protect young people from tobacco.

The effects of combining education and enforcement to reduce tobacco sales to minors. A study of four northern California communities

OBJECTIVE

To examine the effects of a community education and law enforcement intervention on illegal tobacco sales to minors.

DESIGN

A 2-year, before and after trial with retail stores as the unit of analysis.

SETTING

Implementation occurred in four suburban California communities with populations of 25,000 to 100,000.

PARTICIPANTS

All the retail stores in one intervention community and half the retail stores, randomly selected, in the other three intervention communities (n = 169) were visited by minors aged 14 to 16 years with the intent to purchase tobacco.

INTERVENTION

Ongoing community and merchant education and four law enforcement operations were conducted.

MAIN OUTCOME MEASURES

Over-the-counter and vending machine sales of tobacco to minors were the primary outcomes.

RESULTS

Among a cohort of stores visited by minors at the pretest (n = 104) in June 1988, 71% sold tobacco over the counter and 92% sold tobacco through vending machines. At posttest 2 in May 1990, 24% sold tobacco over the counter and 93% sold tobacco through vending machines. Of the 31 stores issued citations, 16 were followed into the courts where the fines were dismissed or reduced.

CONCLUSIONS

Education alone had a limited effect on reducing illegal tobacco sales to minors. It did promote community support for more aggressive enforcement strategies. Education plus enforcement decreased significantly over-the-counter sales; vending machine sales were unaffected by these interventions. The lack of support at the judicial level may temper the effectiveness of enforcement. Legislative remedies addressing judicial obstacles and vending machine sales are needed.