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Coreas SI, Rodriquez EJ, Rahman SG, El-Toukhy S, Compton WM, Blanco C, Kimmel HL, Pérez-Stable EJ. Smoking Susceptibility and Tobacco Media Engagement Among Youth Never Smokers. Pediatrics 2021; 147:peds.2020-017921. [PMID: 33941582 PMCID: PMC8331193 DOI: 10.1542/peds.2020-017921] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Susceptibility to future smoking among youth never smokers has not changed in the past 20 years, although experimental cigarette smoking has decreased. We assessed how smoking susceptibility and tobacco industry-related marketing influenced smoking initiation. METHODS Four waves (2013-2018) of the Population Assessment of Tobacco and Health Study data were analyzed among youth aged 12 to 17 years at wave 1 who completed wave 4. Susceptibility was assessed by 4 items (openness to curiosity, try soon, try in the next year, and if your best friend offered) and categorized into 4 levels (0 = definitely no to all; 1 = yes to 1; 2 = yes to 2; and 3 + 4 = yes to 3 or 4 susceptibility items). Multivariable logistic regression evaluated how susceptibility levels, electronic cigarette use, and tobacco-related media activity predicted future experimental (≥1 puff), current (past 30 days), or established (≥100 cigarettes) smoking. RESULTS Among 8899 never smokers at wave 1, 16.4% became experimental smokers, 7.6% current smokers, and 1.8% established smokers at wave 4. Black and Latino/a youth were less likely to experiment. Youth who endorsed 3 or 4 susceptibility items at wave 1 were more likely to be experimental (adjusted odds ratio [aOR] = 6.0; confidence interval [CI] = 4.8-7.4), current (aOR = 4.2; CI = 3.2-5.4), or established (aOR = 4.4; CI = 2.4-7.9) smokers at wave 4. Exposure to tobacco marketing, using tobacco-related apps, seeing social media content posted about tobacco, and ever use of electronic cigarettes also predicted experimental smoking. CONCLUSIONS Smoking susceptibility and exposure to tobacco industry-related marketing were predictive of cigarette smoking. Clinicians should consider screening adolescents for smoking susceptibility and tobacco-related media exposure.
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Affiliation(s)
- Saida I. Coreas
- Division of Intramural Research, National Heart,
Lung, and Blood Institute
| | - Erik J. Rodriquez
- Division of Intramural Research, National Heart,
Lung, and Blood Institute
| | - Sana G. Rahman
- Division of Intramural Research, National Institute
on Minority Health and Health Disparities, and
| | - Sherine El-Toukhy
- Division of Intramural Research, National Institute
on Minority Health and Health Disparities, and
| | - Wilson M. Compton
- National Institute on Drug Abuse, National Institutes
of Health, Bethesda, Maryland
| | - Carlos Blanco
- National Institute on Drug Abuse, National Institutes
of Health, Bethesda, Maryland
| | - Heather L Kimmel
- National Institute on Drug Abuse, National Institutes
of Health, Bethesda, Maryland
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Houghton D, Houghton F. An examination of portrayals of smoking in graphic novels/comic books: A picture is worth a thousand words. Tob Prev Cessat 2020; 6:41. [PMID: 33083674 PMCID: PMC7549509 DOI: 10.18332/tpc/122867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Smoking continues to extract an unacceptably high toll in Ireland in terms of both mortality and morbidity. Therefore, attention needs to focus on examining pro-smoking influences on teenagers and young adults, as most smokers start smoking before the age of 21 years. Given that this critical period is one of identity formation and assertion of adulthood, it is useful to look at media representation of smoking. One form of increasingly pervasive media that may require further examination is that of the portrayal of smoking in graphic novels. The broad appeal of graphic novels has been well noted, particularly to those aged under 35 years. METHODS This research examined a random selection of ten graphic novels chosen from the main library in a provincial Irish City. The novels were examined on a panel-by-panel basis for images of smokers. Smokers were coded by gender. RESULTS Analysis identified a total of 526 panels depicting smoking. Substantial variation was noted in the number of smoking images between novels, varying from 0 to 267. A dramatic difference in the number of male to female smokers was observed, the ratio being approximately 17:1. CONCLUSIONS Graphic novels must be considered as a potentially significant source of portrayals of smoking to adolescent and young adult readers of this form of literature.
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Jones WJ, Silvestri GA. The Master Settlement Agreement and its impact on tobacco use 10 years later: lessons for physicians about health policy making. Chest 2010; 137:692-700. [PMID: 20202950 DOI: 10.1378/chest.09-0982] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The issue of tobacco industry responsibility for population health problems and compensation for their treatment has been growing since the 1960s. In 1999, the state attorneys general collectively launched the largest class action lawsuit in US history and sued the tobacco industry to recover the costs of caring for smokers. In what became known as the Master Settlement Agreement (MSA), states were rewarded billions of dollars and won concessions regarding how cigarettes could be advertised and targeted to minors. Ten years after this settlement, much is known about how MSA monies were distributed and how states have used the money. There is some understanding about how much of the money went toward offsetting the health-care costs attributable to smoking and whether resources were allocated to efforts to reduce smoking in a particular state. However, there are few data on what effect, if any, the MSA had on tobacco control locally and nationally. This commentary explores these issues, as well as how the tobacco industry has evolved to offset the losses incurred by the settlement. Finally, an analysis of the complexities of current tobacco policy making is provided so that physicians and other health-care advocacy groups can more completely understand the present-day political dynamics and be more effective in shaping tobacco control policy in the future.
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Affiliation(s)
- Walter J Jones
- Division of Health Administration and Policy, Medical University of South Carolina, Charleston, SC 29425-6300, USA
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Vardavas C. Key points in preventing tobacco use among adolescents. Tob Induc Dis 2010; 8:1. [PMID: 20148103 PMCID: PMC2819233 DOI: 10.1186/1617-9625-8-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Accepted: 01/05/2010] [Indexed: 11/10/2022] Open
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Owusu-Dabo E, Lewis S, McNeill A, Anderson S, Gilmore A, Britton J. Smoking in Ghana: a review of tobacco industry activity. Tob Control 2009; 18:206-11. [PMID: 19359263 PMCID: PMC2679188 DOI: 10.1136/tc.2009.030601] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: African countries are a major potential market for the tobacco industry, and the smoking epidemic is at various stages of evolution across the continent. Ghana is an African country with a low prevalence of smoking despite an active tobacco industry presence for over 50 years. This study explores potential reasons for this apparent lack of industry success. Objective: To explore the history of tobacco industry activity in Ghana and to identify potential reasons for the current low prevalence of smoking. Methods: A search was made of tobacco industry archives and other local sources to obtain data relevant to marketing and consumption of tobacco in Ghana. Findings: British American Tobacco, and latterly the International Tobacco Company and its successor the Meridian Tobacco Company, have been manufacturing cigarettes in Ghana since 1954. After an initial sales boom in the two decades after independence in 1957, the sustained further increases in consumption typical of the tobacco epidemic in most countries did not occur. Possible key reasons include the taking of tobacco companies into state ownership and a lack of foreign exchange to fund tobacco leaf importation in the 1970s, both of which may have inhibited growth at a key stage of development, and the introduction of an advertising ban in 1982. BAT ceased manufacturing cigarettes in Ghana in 2006. Conclusion: The tobacco industry has been active in Ghana for over 50 years but with variable success. The combination of an early advertising ban and periods of unfavourable economic conditions, which may have restricted industry growth, are likely to have contributed to the sustained low levels of tobacco consumption in Ghana to date.
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Affiliation(s)
- E Owusu-Dabo
- UK Centre for Tobacco Control Studies, Division of Epidemiology and Public Health, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, UK.
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Goldberg ME, Davis RM, O'Keefe AM. The role of tobacco advertising and promotion: themes employed in litigation by tobacco industry witnesses. Tob Control 2006; 15 Suppl 4:iv54-67. [PMID: 17130625 PMCID: PMC2563582 DOI: 10.1136/tc.2006.017947] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2006] [Accepted: 10/04/2006] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To identify key themes related to tobacco advertising and promotion in testimony provided by tobacco industry-affiliated witnesses in tobacco litigation, and to present countervailing evidence and arguments. METHODS Themes in industry testimony were identified by review of transcripts of testimony in the Tobacco Deposition and Trial Testimony Archive (http://tobaccodocuments.org/datta) from a sample of defence witnesses, including three academic expert witnesses, six senior executives of tobacco companies, and one industry advertising consultant. Counterarguments to the themes embodied in defence testimony were based on information from peer-reviewed literature, advertising trade publications, government reports, tobacco industry documents, and testimony provided by expert witnesses testifying for plaintiffs. RESULTS Five major themes employed by defence witnesses were identified: (1) tobacco advertising has a relatively weak "share of voice" in the marketing environment and is a weak force in affecting smoking behaviour; (2) tobacco advertising and promotion do not create new smokers, expand markets, or increase total tobacco consumption; (3) the tobacco industry does not target, study, or track youth smoking; (4) tobacco advertising and promotion do not cause smoking initiation by youth; and (5) tobacco companies and the industry adhere closely to relevant laws, regulations, and industry voluntary codes. Substantial evidence exists in rebuttal to these arguments. CONCLUSIONS Tobacco industry-affiliated witnesses have marshalled many arguments to deny the adverse effects of tobacco marketing activities and to portray tobacco companies as responsible corporate citizens. Effective rebuttals to these arguments exist, and plaintiffs' attorneys have, with varying degrees of success, presented them to judges and juries.
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Affiliation(s)
- Marvin E Goldberg
- Smeal College of Business, Penn State University, University Park, Pennsylvania 16802, USA.
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Rovniak LS, Johnson-Kozlow MF, Hovell MF. Reducing the gap between the economic costs of tobacco and funds for tobacco training in schools of public health. Public Health Rep 2006; 121:538-46. [PMID: 16972507 PMCID: PMC1564463 DOI: 10.1177/003335490612100509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tobacco use costs approximately dollar 167 billion annually in the U.S., but few tobacco education opportunities are available in schools of public health. Reasons for the discrepancy between the costs of tobacco use and the creation of tobacco training opportunities have not been well explored. Based on the Behavioral Ecological Model, we present 10 recommendations for increasing tobacco training in schools of public health. Six recommendations focus on policy changes within the educational, legislative, and health care systems that influence funds for tobacco training, and four recommendations focus on strategies to mobilize key social groups that can advocate for change in tobacco control education and related policies. In addition, we present a model tobacco control curriculum to equip public health students with the skills needed to advocate for these recommended policy changes. Through concurrent changes in the ecological systems affecting tobacco control training, and through the collaborative action of legislators, the public, the media, and health professionals, tobacco control training can be moved to a higher priority in educational settings.
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Affiliation(s)
- Liza S Rovniak
- Center for Behavioral Epidemiology and Community Health, Graduate School of Public Health, San Diego State University, San Diego, CA 92123, USA.
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Koh HK, Judge CM, Robbins H, Celebucki CC, Walker DK, Connolly GN. The first decade of the Massachusetts Tobacco Control Program. Public Health Rep 2005; 120:482-95. [PMID: 16224981 PMCID: PMC1497757 DOI: 10.1177/003335490512000503] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article provides a comprehensive overview of the first decade of the Massachusetts Tobacco Control Program (MTCP). Born after Massachusetts passed a 1992 ballot initiative raising cigarette excise taxes to fund the program, MTCP greatly reduced statewide cigarette consumption before being reduced to a skeletal state by funding cuts. The article describes the program's components and goals, details outcomes, presents a summary of policy accomplishments, and reviews the present status of MTCP in the current climate of national and state fiscal crises. The first decade of the MTCP offers many lessons learned for the future of tobacco control.
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Affiliation(s)
- Howard K Koh
- Division of Public Health Practice, Harvard School of Public Health, Boston, MA 02115, USA.
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Henriksen L, Feighery EC, Schleicher NC, Haladjian HH, Fortmann SP. Reaching youth at the point of sale: cigarette marketing is more prevalent in stores where adolescents shop frequently. Tob Control 2005; 13:315-8. [PMID: 15333890 PMCID: PMC1747887 DOI: 10.1136/tc.2003.006577] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Although numerous studies describe the quantity and nature of tobacco marketing in stores, fewer studies examine the industry's attempts to reach youth at the point of sale. This study examines whether cigarette marketing is more prevalent in stores where adolescents shop frequently. DESIGN, SETTING, AND PARTICIPANTS Trained coders counted cigarette ads, products, and other marketing materials in a census of stores that sell tobacco in Tracy, California (n = 50). A combination of data from focus groups and in-class surveys of middle school students (n = 2125) determined which of the stores adolescents visited most frequently. MAIN OUTCOME MEASURES Amount of marketing materials and shelf space measured separately for the three cigarette brands most popular with adolescent smokers and for other brands combined. RESULTS Compared to other stores in the same community, stores where adolescents shopped frequently contained almost three times more marketing materials for Marlboro, Camel, and Newport, and significantly more shelf space devoted to these brands. CONCLUSIONS Regardless of whether tobacco companies intentionally target youth at the point of sale, these findings underscore the importance of strategies to reduce the quantity and impact of cigarette marketing materials in this venue.
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Affiliation(s)
- L Henriksen
- Stanford University School of Medicine, Stanford Prevention Research Center, 211 Quarry Road, N145, Stanford, CA 94305-5705, USA.
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Braverman MT, Aarø LE. Adolescent smoking and exposure to tobacco marketing under a tobacco advertising ban: findings from 2 Norwegian national samples. Am J Public Health 2004; 94:1230-8. [PMID: 15226148 PMCID: PMC1448426 DOI: 10.2105/ajph.94.7.1230] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the extent to which adolescents in Norway have been exposed to tobacco marketing despite an existing ban, and whether exposure is related to their current smoking or expectations they will smoke in the future. METHODS Questionnaires were administered to nationally representative systematic samples of Norwegian youths aged 13 to 15 years in 1990 (n = 4282) and 1995 (n = 4065). RESULTS About half in each cohort reported exposure to marketing. Youths reporting exposure were significantly more likely to be current smokers and to expect to be smokers at 20 years of age, after control for important social influence predictors. CONCLUSIONS Adolescents' current smoking and future smoking expectations are linked to marketing exposure even in limited settings, suggesting the need for comprehensive controls to eliminate the function of marketing in promoting adolescent smoking.
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Affiliation(s)
- Marc T Braverman
- Department of Human and Community Development, University of California, Davis 95616, USA.
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Celebucki CC, Diskin K. A longitudinal study of externally visible cigarette advertising on retail storefronts in Massachusetts before and after the Master Settlement Agreement. Tob Control 2002; 11 Suppl 2:ii47-53. [PMID: 12034982 PMCID: PMC1766083 DOI: 10.1136/tc.11.suppl_2.ii47] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the effect of the Master Settlement Agreement (MSA) on the amount of cigarette advertisements visible from outside of over-the-counter tobacco retailers, for five specific premium brands and an "all other" category, for five types of establishments, and in three areas (windows/doors, building/other detached areas, and sidewalks); to assess the relation of total exterior retail cigarette advertising to illegal sales to youth. METHODS Observations were conducted on the number of cigarette advertisements visible from outside tobacco retail establishments in a paired convenience sample (n = 556) in Massachusetts before and after the MSA. Archival databases containing information on merchant compliance with age related sales laws during the time period were used to assess the relation of total cigarette advertising with sales to underage youth. Paired sample t tests assessed planned comparisons pre- to post-MSA; Spearman's rho tested associations for dichotomous variables. RESULTS Significant post-ban increases were observed in the prevalence of exterior cigarette advertising on gas (petrol) stations and gas mini/marts (gasoline retailers) buildings, windows, and doors. Significant declines were observed on windows of liquor stores. Winston advertising declined overall, while advertisements of the "all other" brand category increased. Correlations between advertising and illegal sales, while modest, were significant. CONCLUSIONS These pre- to post-MSA increases suggest the tobacco industry may be shifting expenditures selectively from billboard advertising to retailer exteriors more favoured by youth. Greater amount of cigarette advertising visible from outside over-the-counter tobacco retailers is associated with greater cigarette sales to minors.
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Affiliation(s)
- Carolyn C Celebucki
- Massachusetts Tobacco Control Program, Massachusetts Department of Public Health, 250 Washington Street, 4th Floor, Boston, MA 02108, USA.
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