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Dewhirst T. Lucky Strike advertising: the use of 'anaphora' as a rhetorical device to highlight 'smooth' as a cigarette product descriptor. Tob Control 2024; 33:275-277. [PMID: 35953285 DOI: 10.1136/tc-2022-057517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Timothy Dewhirst
- Department of Marketing and Consumer Studies, Gordon S Lang School of Business and Economics, University of Guelph, Guelph, Ontario, Canada
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2
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Pearson J, Gratale SK, Ganz O, Erinoso OA, Ohman-Strickland P, Wackowski OA. Longitudinal relationship between relative harm perceptions, beliefs about organic and additive-free tobacco, and cigarette brand switching among Natural American Spirit, Camel and Marlboro cigarette smokers. Tob Control 2023:tc-2023-057933. [PMID: 37562949 PMCID: PMC10858295 DOI: 10.1136/tc-2023-057933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 07/20/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION While previous research has examined misperceptions related to Natural American Spirit (NAS), a premium cigarette brand using 'natural'-themed marketing, the longitudinal relationship between NAS-related harm beliefs and switching to NAS has not been established. METHODS Using data from the PATH study, we modelled the longitudinal relationship between (1) brand switching and subsequent belief that one's own brand might be less harmful than other brands (Waves 1-5); (2) belief that organic and/or additive-free tobacco products are less harmful and subsequent brand switching (Waves 3-5); and (3) belief that some types of cigarettes are less harmful and subsequent brand switching (Waves 3-5) for NAS and two leading comparator brands (Camel and Marlboro). RESULTS Among people who did not think their prior brand might be less harmful, switching to NAS or maintaining NAS preference increased the odds of believing one's own brand might be less harmful (aOR 19.4; 95% CI: 15.19, 24.8; aOR 6.1; 95% CI: 4.23, 8.67, respectively). Prior belief that organic and additive-free tobacco products were less harmful increased the odds of switching to (aOR 2.5; 95% CI: 1.68, 3.74) and decreased the odds of switching away (0.57; 955 CI: 0.36, 0.92) from NAS in the subsequent wave. Parallel analyses for Marlboro/Camel were largely null or in the opposite direction. CONCLUSIONS NAS use may maintain or shape new beliefs that the brand may be less harmful than other brands; holding pre-existing beliefs about the relative harm of some tobacco products may increase risk for NAS use.
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Affiliation(s)
- Jennifer Pearson
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada Reno, Reno, Nevada, USA
- Department of Health, Behavior, and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Stefanie Kristen Gratale
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Ollie Ganz
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
- Department of Health Behavior, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Olufemi A Erinoso
- Department of Health Behavior, Policy, and Administration Sciences, School of Public Health, University of Nevada Reno, Reno, Nevada, USA
- Lagos State University Teaching Hospital, Lagos, Nigeria
| | - Pamela Ohman-Strickland
- Department of Epidemiology and Statistics, Rutgers School of Public Health, Piscataway, New Jersey, USA
| | - Olivia A Wackowski
- Rutgers Center for Tobacco Studies, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
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Changing Behaviour: Blindness to Risk and a Critique of Tobacco Control Policy in China—A Qualitative Study. CHILDREN 2022; 9:children9091412. [PMID: 36138721 PMCID: PMC9497915 DOI: 10.3390/children9091412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/10/2022] [Accepted: 09/15/2022] [Indexed: 11/30/2022]
Abstract
(1) Background: It is well recognised that a focus on changing behaviour remains a dominant and often appealing approach to develop health policies. This study provides a sociological insight into young adults’ knowledge of the health effects of smoking cigarettes. We also examine the challenges in tobacco control and criticize the implementation policies in Chinese context. (2) Methods: The study applies both a micro-sociological and a macro-sociological approach using semi-structured interviews and documents as the primary research methodology. Fieldwork was conducted from July to September 2016 and December 2016 to March 2017. The qualitative study involved 45 semi-structured interviews with young adults aged 16–24 years (15 females and 30 males) in Tianjin, China. A grounded theory approach was used for a thematic analysis. (3) Results: The participants knew cigarettes are harmful, although they lacked a comprehensive understanding of the health risks of smoking. Because the health consequences usually emerge after a long period of smoking, young smokers decide to take the health risk. All participants have a general understanding of China’s tobacco control policies and think that the implementation is ineffective. (4) Conclusions: Changing in smoking is a process embedded in complex social environments and cultures. Smoking behaviour is not only a personal choice, but also related to personal connections with peers and identity in Chinese society. The Chinese government has made significant achievements in tobacco control since joining the WHO framework convention on tobacco control in 2005. However, implementation needs to be stricter in order to achieve international levels of control, especially in taxes on tobacco product and the price of cigarettes. There is an urgent need for the regulation of e-cigarettes in China.
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Czaplicki L, Patel M, Rahman B, Yoon S, Schillo B, Rose SW. Oral nicotine marketing claims in direct-mail advertising. Tob Control 2022; 31:663-666. [PMID: 33958422 PMCID: PMC9411885 DOI: 10.1136/tobaccocontrol-2020-056446] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/10/2021] [Accepted: 03/17/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND Little is known regarding how oral nicotine products (eg, nicotine pouches, lozenges) are marketed to consumers, including whether potential implicit reduced harm claims are used. In the current study, we explored the marketing claims present in a sample of direct-mail oral nicotine advertisements sent to US consumers (March 2018-August 2020). METHODS Direct-mail ads (n=50) were acquired from Mintel and dual-coded for the following claims: alternative to other tobacco products, ability to use anywhere, spit-free, smoke-free and product does not contain tobacco leaf. We merged the coded data with Mintel's volume estimate (number of mail pieces sent to consumers) and calculated the proportion of oral nicotine advertisements containing claims by category. RESULTS Of the 38 million pieces of oral nicotine direct-mail sent to US consumers, most featured claims that the product could be used anywhere (84%, 31.8 million pieces); was an alternative to other tobacco products (69%, 26.1 million pieces); and did not contain tobacco leaf (eg, 'tobacco leaf-free', 'simple' approach of extracting nicotine from tobacco; 55%, 20.7 million pieces). A slightly smaller proportion contained claims that oral nicotine was 'spit-free' (52%, 19.8 million pieces) or 'smoke-free' (31%, 11.7 million pieces). CONCLUSION Our results provide an early indication of marketing claims used to promote oral nicotine. The strategies documented, particularly the use of language to highlight oral nicotine is tobacco-free, may covey these products as lower-risk to consumers despite the lack of evidence or proper federal authorisation that oral nicotine products are a modified-risk tobacco product. Future research is needed to examine consumer perceptions of such claims.
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Affiliation(s)
- Lauren Czaplicki
- Health, Behavior & Society, Johns Hopkins University, Baltimore, MD, USA
| | - Minal Patel
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Basmah Rahman
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | - Stephanie Yoon
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | - Shyanika W Rose
- Behavioral Sciences, University of Kentucky College of Medicine, Lexington, KY, USA
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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: 0] [Impact Index Per Article: 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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Wang J, Wong S, Zhuang YL, Jiang Y, Zhu SH. Slim cigarette smoking in Urban China: Who are the early adopters and why? PLoS One 2021; 16:e0254682. [PMID: 34255811 PMCID: PMC8277019 DOI: 10.1371/journal.pone.0254682] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 06/30/2021] [Indexed: 11/18/2022] Open
Abstract
Sales data in China indicate that slim cigarette consumption has increased dramatically over the last few years. This study examined who smoked slim cigarettes and the reasons for adopting these new products. A survey of an online panel from 19 Chinese cities was conducted from October 2018 to April 2019 with 20,055 members aged 16 and older. Among the 31.7% [95% confidence interval (CI) = 30.1-33.4] of panel members who reported currently smoking, 37.7% (95% CI = 34.8-40.5) smoked slim cigarettes. Among smokers, women were significantly more likely to smoke slim cigarettes than men [56.5% (95% CI = 50.8-62.2) vs. 35.5% (95% CI = 32.8-38.1)]. Smokers with a bachelor's degree were more likely to smoke slim cigarettes than those without [41.3% (95% CI = 38.1-44.4) vs. 33.1% (95% CI = 30.0-36.1)]. Most slim cigarette smokers were dual smokers [77.7% (95% CI = 75.3-80.1)], smoking both regular and slim cigarettes. Among dual smokers, 97.5% (95% CI = 96.7-98.3) started smoking regular cigarettes before slim cigarettes. Of the many reasons given for smoking slim cigarettes, 37.0% (95% CI = 34.3-39.7) directly related to harm reduction with another 10.1% (95% CI = 8.4-11.7) reporting their reason as wanting "to reduce consumption of regular cigarettes," a plausible indication of harm reduction. These findings suggest strong interest in harm reduction among the current Chinese smoking population and that the popularity of slim cigarettes is likely to increase, with the more educated as the early adopters. Given the absence of any evidence that these products actually reduce harm, it is urgent that the public health community be on high alert in order to avoid repeating the sad history of low-tar cigarettes, when a supposed harm-reduction product misled the field of tobacco control.
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Affiliation(s)
- Jijiang Wang
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
| | - Shiushing Wong
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
| | - Yue-Lin Zhuang
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
| | - Yuan Jiang
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shu-Hong Zhu
- Moores Cancer Center, University of California, San Diego, La Jolla, California, United States of America
- * E-mail:
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van der Eijk Y, Ng XY, Lee JK. Cross-sectional survey of flavored cigarette use among adult smokers in Singapore. Tob Induc Dis 2021; 19:42. [PMID: 34131420 PMCID: PMC8173988 DOI: 10.18332/tid/135321] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/24/2021] [Accepted: 03/31/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Singapore, a city-state with a multi-ethnic Asian population, has one of the world's largest market shares for cigarettes with added flavors, such as menthol and fruit, which increase the appeal of smoking. Little is known on the sociodemographic or smoking-related traits associated with flavored cigarette use in the Asian context. METHODS A cross-sectional survey was conducted in January-March 2020 of 1123 Singaporean adult (aged 21-69 years) current smokers using a self-completed online or postal questionnaire. We used descriptive statistics and bivariate analyses to compare the answers of flavored and non-flavored cigarette users and fitted a multivariate logistic regression model to identify correlates of flavored cigarette use. RESULTS Of the respondents, 85.2% reported ever use and 52.7% of respondents with a regular brand reported current use of flavored cigarettes. Older age 40-49 years (AOR= 0.63) age ≥50 years (AOR=0.60), Indian ethnicity (AOR=0.39), and a moderate (AOR=0.57) or high (AOR=0.34) dependence level were correlated with non-flavored cigarette use, while female gender (AOR=2.53) and a later initiation age (16-20 years: AOR=1.72; age ≥21 years: AOR=2.19) were correlated with flavored cigarette use. CONCLUSIONS Consistent with findings from other countries, flavored cigarette use in Singapore is associated with being younger in age, female, of a certain ethnicity (Malay or Chinese), and having a lower nicotine dependence level.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Xian Yi Ng
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jeong Kyu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Felicione NJ, Norton KJ, Bansal-Travers M, Rees VW, Cummings KM, O'Connor RJ. Smokers' perceptions of different classes of cigarette brand descriptors. Tob Prev Cessat 2021; 7:9. [PMID: 33575516 PMCID: PMC7869751 DOI: 10.18332/tpc/131243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 11/24/2020] [Accepted: 12/07/2020] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Cigarette brand descriptors such as 'light' are banned in several countries and often replaced by alternative descriptors that continue to mislead smokers about the relative risk from those brands. The objective of this study was to evaluate perceptions from current brand descriptors when presented independently of cigarette packaging. METHODS Eighty-eight daily cigarette smokers attended semi-structured interviews at three US research laboratories in 2018-2019 to assess smokers' perceptions of cigarette brand descriptors in four classes of brand features: prestige, connotation, taste, and color. Participants ranked descriptors within each brand feature on perceived harm, attractiveness, and appeal (willingness to try). Ranked perceptions were described using median rankings and percentages. Chi-squared was used to assess demographic effects on perceptions. Spearman's correlation was used to assess the association between harm, attractiveness, and appeal rankings. RESULTS Brand descriptors influenced perceptions of harm, attractiveness, and appeal within each brand feature. Smooth was perceived as the most attractive (42.5%) and appealing (33.0%) taste descriptor. Red was perceived as the most harmful (45.4%) and least appealing (22.7%) color descriptor. Perceptions of certain descriptors differed by demographic characteristics such as sex and age. Rankings of attractiveness and appeal were more strongly correlated (r=0.63) than rankings of harm and appeal (r=0.20, p<0.01). CONCLUSIONS Cigarette manufacturers replaced banned descriptors with alternative descriptors that continue to influence perceptions of cigarettes. Regulatory agencies should closely evaluate all brand descriptors and consider implications for alternative products with fewer regulations.
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Affiliation(s)
- Nicholas J Felicione
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Kaila J Norton
- The Ohio State University Comprehensive Cancer Center, Columbus, United States
| | - Maansi Bansal-Travers
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
| | - Vaughan W Rees
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, United States
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, United States
| | - Richard J O'Connor
- Department of Health Behavior, Roswell Park Comprehensive Cancer Center, Buffalo, United States
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Paek HJ, Dewhirst T, Hove T. Can Removing Tar Information From Cigarette Packages Reduce Smokers' Misconceptions About Low-Tar Cigarettes? An Experiment From One of the World's Lowest Tar Yield Markets, South Korea. Nicotine Tob Res 2020; 22:990-996. [PMID: 30726984 DOI: 10.1093/ntr/ntz016] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 01/31/2019] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Despite regulations that forbid cigarette packages from displaying messages such as "mild," "low-tar," and "light," many smokers still have misperceptions about "light" or "low-tar" cigarettes. One reason may be that tar amount displays continue to be permitted. This study examines whether removing tar delivery information from packaging reduces consumer misperceptions about "low-tar" cigarettes. METHODS An online experiment was conducted in South Korea among 531 smokers who were randomly assigned to one of two conditions: with and without tar information on cigarette packages. Participants evaluated which type of cigarette was mildest, least harmful, easiest for nonsmokers to start smoking, and easiest for smokers to quit. RESULTS Ten out of 12 chi-square tests showed that people judged the lowest reported tar delivery cigarette to be the mildest (p < .01), least harmful (p < .05), easiest to start (p < .05), and easiest to quit (p < .05)-less so in the "no-tar" condition than the "tar" condition. A higher level of misbeliefs about supposed low-tar cigarettes were found in the "tar" condition compared to the "no-tar" condition for all three brands (t = 5.85, 4.07, 3.82, respectively, p < .001). Regression analyses showed that the "no-tar" condition negatively predicted the level of misbeliefs after controlling for demographic and smoking-related variables (B [SE] = -.72 (.12), -.50 (.12), -.48 (.13), respectively, p < .001). CONCLUSIONS Banning reported tar deliveries from cigarette packages is likely to reduce smokers' misconceptions about "low-tar" cigarettes. When reported tar deliveries are absent, smokers have inconsistent judgments about differently packaged cigarettes. IMPLICATIONS When cigarette packages depict lower reported tar number deliveries, participants erroneously perceive them to be less harmful than packages displaying higher tar numbers. These misperceptions of harm may prompt smokers who might otherwise attempt to quit smoking to instead consume cigarettes with lower tar deliveries due to the mistaken belief that they will reduce their risk.
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Affiliation(s)
- Hye-Jin Paek
- Department of Advertising and Public Relations, Hanyang University, Ansan, South Korea
| | - Timothy Dewhirst
- Department of Marketing and Consumer Studies, University of Guelph, Guelph, Ontario, Canada
| | - Thomas Hove
- Department of Advertising and Public Relations, Hanyang University, Ansan, South Korea
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van der Eijk Y, Tan GPP. Tobacco industry targeting of health-conscious youth with 'lighter' cigarettes: the case of Singapore. Tob Control 2020; 30:e20-e26. [PMID: 33067408 DOI: 10.1136/tobaccocontrol-2020-055923] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 08/27/2020] [Accepted: 08/29/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Despite Singapore's strict tobacco control policies, smoking rates have not decreased since 2004. We examined the primary targets, motivations and strategies behind targeted marketing activities in Singapore from the tobacco industry's perspective to understand how tobacco companies continue to target people in their marketing. METHODS Snowball search in the Truth Tobacco Industry Documents Library for documents covering the industry's targeted marketing activities in Singapore. Information from the documents was subsequently triangulated with market data obtained from the Euromonitor Passport database, analysed for trends by tar segment and data from cigarette packs purchased from Singapore retailers, analysed in terms of product positioning. RESULTS In the 1970s and 1980s, as young people in Singapore became more health-conscious, tobacco companies positioned 'light' cigarettes for growth in the 1990s. Many of these 'lights' contained similar tar and nicotine levels as regular brands; they were only light in their branding. In the 1990's, 'lights' became more popular in Singapore and this demand was largely youth driven. Into the 2010s, while the low tar (<6 mg) segment comprised only a small portion of Singapore's cigarette market, most cigarette variants were marketed as 'lighter' or as having harm reductive benefits to appeal to more health-conscious people. CONCLUSIONS The differentiation of 'lighter' cigarettes remains an important marketing tool for tobacco companies amidst Singapore's strict regulations. Legislation to remove all remaining avenues for tobacco companies to make harm reduction claims on their products, explicit or implicit, coupled with improving health literacy and exposing industry deception, could help to further bring down smoking prevalence in Singapore.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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11
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Xu S, Gravely S, Meng G, Elton-Marshall T, O’Connor RJ, Quah AC, Feng G, Jiang Y, Hu GJ, Fong GT. Impact of China National Tobacco Company's 'Premiumization' Strategy: longitudinal findings from the ITC China Surveys (2006-2015). Tob Control 2019; 28:s68-s76. [PMID: 30158207 PMCID: PMC6445774 DOI: 10.1136/tobaccocontrol-2017-054193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND In 2009, the China National Tobacco Company (CNTC) began their Premiumization Strategy, designed to encourage smokers to trade up to more expensive brands, mainly by promoting the concept that higher class cigarettes are better quality and less harmful. This study is the first evaluation of the strategy's impact on: (1) prevalence of premium brand cigarettes (PBC), mid-priced brand cigarettes (MBC) and discount brand cigarettes (DBC) over 9 years, from 3 years pre-strategy (2006) to 6 years post-strategy (2015); and (2) changes in reasons for choosing PBCs, MBCs and DBCs. METHODS A representative cohort of adult Chinese smokers (n=9047) in seven cities who participated in five waves of the International Tobacco Control (ITC) China Survey: pre-implementation (Wave 1 (2006; n=3452), Wave 2 (2007-2008; n=3586)); mid-implementation (Wave 3 (2009; n=4172)); and post-implementation (Wave 4 (2011-2012; n=4070), Wave 5 (2013-2015; n=2775)). Generalised estimating equations were conducted to examine changes in prevalence of PBCs, MBCs and DBCs, and reasons for brand choice from pre-implementation to post-implementation. RESULTS From pre-implementation to post-implementation, there was an increase in prevalence of PBCs (5.4% to 23.2%, p<0.001) and MBCs (40.0% to 50.4%, p<0.001), and a decrease in DBCs (54.6% to 26.5%, p<0.001). There was an increase in smokers who chose their current brand because they believed it to be less harmful, both for MBC smokers (+13.0%, p=0.001) and PBC smokers (+9.0%, p=0.06). There was an increase for smokers in all brand classes for choosing their current brand because they were 'higher in quality' and because of affordable price, but the greatest increase was among PBC smokers (+18.6%, p<0.001 and +34.9%, p<0.001, respectively). CONCLUSIONS Our findings demonstrate that the rising trend in Chinese smokers' choice of 'less harmful', 'higher quality' and 'affordable' cigarettes, particularly PBCs, is likely due to CNTC's aggressive marketing strategies. Strong tobacco control policies that prohibit CNTC's marketing activities are critical in order to dispel erroneous beliefs that sustain continued smoking in China, where the global tobacco epidemic is exerting its greatest toll.
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Affiliation(s)
- Steve Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
| | | | - Anne C.K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Guoze Feng
- Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yuan Jiang
- Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Grace J. Hu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - 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
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12
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U.S. adult perceptions of the harmfulness of tobacco products: descriptive findings from the 2013-14 baseline wave 1 of the path study. Addict Behav 2019; 91:180-187. [PMID: 30502927 DOI: 10.1016/j.addbeh.2018.11.023] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 02/01/2023]
Abstract
INTRODUCTION This study is the first nationally representative survey of U.S. adults (18+) to examine perceptions of the relative harms of eight non-cigarette tobacco products. METHODS Data are from Wave 1 of the Population Assessment of Tobacco and Health (PATH) Study Adult Questionnaire, a nationally representative study of 32,320 adults in the United States conducted from September 2013 to December 2014. RESULTS 40.7% of adults believed that electronic cigarettes were less harmful than cigarettes, and 17.8% of adults believed that hookah was less harmful than cigarettes. Those less knowledgeable about the health risks of smoking were more likely to believe that the non-cigarette products were less harmful than cigarettes. Current non-cigarette tobacco product users were more likely to perceive that product to be less harmful than cigarettes (except filtered cigars). There was a significant positive correlation between beliefs that cigarettes were harmful and the likelihood of using hookah; perceptions of the harmfulness of cigarettes was not associated with the likelihood of using any other product. CONCLUSIONS Perceptions of harmfulness varied widely across non-cigarette tobacco products. E-cigarettes and hookah in particular are seen as less harmful compared to cigarettes.
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Sutfin EL, Soule EK, McKelvey K, Jenson D. Implications and challenges for implementation of the FDA's final deeming rule for waterpipe tobacco. Tob Control 2018; 27:347-351. [PMID: 28667092 PMCID: PMC5748017 DOI: 10.1136/tobaccocontrol-2017-053634] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 04/28/2017] [Accepted: 05/09/2017] [Indexed: 11/04/2022]
Abstract
For the first time, the Food and Drug Administration's (FDAs) Center for Tobacco Products now has regulatory authority over all tobacco products, including waterpipe tobacco. In the rule expanding its authority to cover all tobacco products, the FDA uses largely a one-size-fits-all approach. However, several aspects of waterpipe tobacco smoking make it unique from other tobacco products, which may require more specific, tailored rules. This paper describes the distinct features of waterpipe tobacco products and accessories, and identifies unique challenges to the current regulation posed by this form of tobacco use. Additionally, we highlight the need for further research-generated evidence to support additional rulemaking.
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Affiliation(s)
- Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Eric K Soule
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
| | - Karma McKelvey
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Desmond Jenson
- Tobacco Control Legal Consortium, a program of the Public Health Law Center, Mitchell Hamline School of Law, St Paul, MN, USA
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14
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Philpott SE, Gehlert S, Waters EA. Smokers' unprompted comments on cigarette additives during conversations about the genetic basis for nicotine addiction: a focus group study. BMC Public Health 2018; 18:495. [PMID: 29653524 PMCID: PMC5899393 DOI: 10.1186/s12889-018-5395-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 04/03/2018] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Research designed to elicit smokers' cognitive and affective reactions to information about chemicals that tobacco companies add to cigarettes ("additives") found that knowledge is limited. However, little is known about smokers' unprompted thoughts and feelings about additives. Such information could be used to shape future communication efforts. We explored the content and possible functions of spontaneous statements about cigarette additives made by smokers during a study examining reactions to learning about the genetic link to nicotine addiction. METHODS Adult smokers (N = 84) were recruited from a medium-sized Midwestern city. Focus groups (N = 13) were conducted between April-September 2012. Data were analyzed by 2 coders using thematic analysis. RESULTS Comments about cigarette additives arose without prompting by the focus group moderator. Three main themes were identified: (1) discussing additives helped participants navigate the conceptual link between smoking and genetics, (2) additives were discussed as an alternative mechanism for addiction to cigarettes, and (3) additives provided an alternative mechanism by which cigarette smoking exacerbates physical harm. Notably, discussion of additives contained a pervasive tone of mistrust illustrated by words like "they" and "them," by statements of uncertainty such as "you don't know what they're putting into cigarettes," and by negative affective verbalizations such as "nasty" and "disgusting". CONCLUSIONS Participants had distinct beliefs about cigarette additives, each of which seemed to serve a purpose. Although mistrust may complicate communication about the health risks of tobacco use, health communication experts could use smokers' existing beliefs and feelings to better design more effective anti-smoking messages.
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Affiliation(s)
- Sydney E. Philpott
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri USA
| | - Sarah Gehlert
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri USA
| | - Erika A. Waters
- Division of Public Health Sciences, Washington University in St. Louis School of Medicine, St. Louis, Missouri USA
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15
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Abstract
Objectives This paper describes the effects of non-tobacco, physical cigarette design features on smoke emissions, product appeal, and smoking behaviors - 3 factors that determine smoker's exposure and related health risks. Methods We reviewed available evidence for the impact of filter ventilation, new filter types, and cigarettes dimensions on toxic emissions, smoker's perceptions, and behavior. For evidence sources we used scientific literature and websites providing product characteristics and marketing information. Results Whereas filter ventilation results in lower machine-generated emissions, it also leads to perceptions of lighter taste and relative safety in smokers who can unwittingly employ more intense smoking behavior to obtain the desired amount of nicotine and sensory appeal. Filter additives that modify smoke emissions can also modify sensory cues, resulting in changes in smoking behavior. Flavor capsules increase the cigarette's appeal and novelty, and lead to misperceptions of reduced harm. Slim cigarettes have lower yields of some smoke emissions, but smoking behavior can be more intense than with standard cigarettes. Conclusions Physical design features significantly impact machine-measured emission yields in cigarette smoke, product appeal, smoking behaviors, and exposures in smokers. The influence of current and emerging design features is important in understanding the effectiveness of regulatory actions to reduce smoking-related harm.
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Huang X, Fu W, Zhang H, Li H, Li X, Yang Y, Wang F, Gao J, Zheng P, Fu H, Ding D, Chapman S. Development and validation of a smoking rationalization scale for male smokers in China. J Health Psychol 2017; 25:472-489. [PMID: 28810494 DOI: 10.1177/1359105317720276] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The purpose of this study is to develop a smoking rationalization scale for Chinese male smokers. A total of 35 focus groups and 19 one-on-one interviews were conducted to collect items of the scale. Exploratory factor analyses and confirmatory factor analyses were conducted to identify the underlying structure of the scale. Results found a 26-item scale within six dimensions (smoking functional beliefs, risk generalization beliefs, social acceptability beliefs, safe smoking beliefs, self-exempting beliefs, and quitting is harmful beliefs). The scale showed acceptable validity and reliability. Results highlight that smoking rationalization is common among Chinese male smokers, and some beliefs of smoking rationalization seem to be peculiar to China.
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Affiliation(s)
- Xinyuan Huang
- Fudan University, China.,Shanghai Pudong New Area Center for Disease Control and Prevention, China
| | - Wenjie Fu
- Fudan University, China.,Shanghai Pudong New Area Center for Disease Control and Prevention, China
| | | | - Hong Li
- Guangxi Medical University, China
| | | | - Yong Yang
- Mudanjiang Medical University, China
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Carroll AJ, Labarthe DR, Huffman MD, Hitsman B. Global tobacco prevention and control in relation to a cardiovascular health promotion and disease prevention framework: A narrative review. Prev Med 2016; 93:189-197. [PMID: 27717667 PMCID: PMC5125629 DOI: 10.1016/j.ypmed.2016.10.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 08/18/2016] [Accepted: 10/03/2016] [Indexed: 11/21/2022]
Abstract
The purpose of this review is to emphasize the role of tobacco prevention and control in cardiovascular health (CVH) promotion and cardiovascular disease (CVD) prevention, including the importance of these endpoints for measuring the full impact of tobacco-related policies, programs, and practices. In this review, we describe an overview of tobacco control interventions that have led to substantial declines in tobacco use and the relationship between these declines with CVH and CVD. We review interventions that have had success in high-income countries (HICs) as well as those that are gaining traction in low- and middle-income countries (LMICs). We emphasize the challenges to comprehensive tobacco prevention and control strategies faced by LMICs, and highlight the special role of cardiovascular health professionals in achieving CVH promotion and CVD prevention endpoints through tobacco control. Tobacco prevention and control strategies have a strong scientific basis, yet a distinct gap remains between this evidence and implementation of tobacco control policies, particularly in LMICs. Health professionals can contribute to tobacco control efforts, especially through patient-level clinical interventions, when supported by a health care system and government that recognize and support tobacco control as a critical strategy for CVH promotion and CVD prevention. Understanding, supporting, and applying current and evolving policies, programs, and practices in tobacco prevention and control is the province of all health professionals, especially those concerned with CVH promotion and CVD prevention. A new tobacco control roadmap from the World Heart Federation provides a strong impetus to the needed interdisciplinary collaboration.
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Affiliation(s)
- Allison J Carroll
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Darwin R Labarthe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Mark D Huffman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States
| | - Brian Hitsman
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, United States.
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18
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Yang T, Peng S, Jiang S, Oliffe JL, Yu L. Who switches from regular to light cigarettes? A study of six provincial capital cities in China. Public Health 2016; 140:272-275. [PMID: 27424463 DOI: 10.1016/j.puhe.2016.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Revised: 04/07/2016] [Accepted: 06/15/2016] [Indexed: 11/26/2022]
Affiliation(s)
- T Yang
- Centre for Tobacco Control Research/Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, China.
| | - S Peng
- Centre for Tobacco Control Research/Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - S Jiang
- Centre for Tobacco Control Research/Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, China
| | - J L Oliffe
- School of Nursing, University of British Columbia, Vancouver, Canada
| | - L Yu
- Centre for Tobacco Control Research/Department of Social Medicine, Zhejiang University School of Medicine, Hangzhou, China
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19
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Green AC, Fong GT, Borland R, Quah ACK, Seo HG, Kim Y, Elton-Marshall T. The importance of the belief that "light" cigarettes are smoother in misperceptions of the harmfulness of "light" cigarettes in the Republic of Korea: a nationally representative cohort study. BMC Public Health 2015; 15:1108. [PMID: 26547549 PMCID: PMC4637138 DOI: 10.1186/s12889-015-2472-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 11/03/2015] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A number of countries have banned misleading cigarette descriptors such as "light" and "low-tar" as called for by the WHO Framework Convention on Tobacco Control. These laws, however, do not address the underlying cigarette design elements that contribute to misperceptions about harm. This is the first study to examine beliefs about "light" cigarettes among Korean smokers, and the first to identify factors related to cigarette design that are associated with the belief that "light" cigarettes are less harmful. METHODS We analysed data from Wave 3 of the ITC Korea Survey, a telephone survey of a nationally representative sample of 1,753 adult smokers, conducted October - December 2010. A multinomial logistic regression was used to examine which factors were associated with the belief that "light" cigarettes are less harmful than regular cigarettes. RESULTS One quarter (25.0 %) of smokers believed that "light" cigarettes are less harmful than regular cigarettes, 25.8 % believed that smokers of "light" brands take in less tar, and 15.5 % held both of these beliefs. By far the strongest predictor of the erroneous belief that "light" cigarettes are less harmful was the belief that "light" cigarettes are smoother on the throat and chest (p < 0.001, OR = 44.8, 95 % CI 23.6-84.9). CONCLUSIONS The strong association between the belief that "light" cigarettes are smoother on the throat and chest and the belief that "light" cigarettes are less harmful, which is consistent with previous research, provides further evidence of the need to not only ban "light" descriptors, but also prohibit cigarette design and packaging features that contribute to the perception of smoothness.
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Affiliation(s)
- Annika C Green
- Department of Psychology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada.
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada.
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada.
| | - Ron Borland
- The Cancer Council, Melbourne, Victoria, Australia.
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, 200 University Ave West, Waterloo, Ontario, N2L 3G1, Canada.
| | - Hong Gwan Seo
- Center for Cancer Prevention and Detection, National Cancer Center, Goyang, Republic of Korea.
| | - Yeol Kim
- Division of Cancer Management and Policy, National Cancer Control Institute, National Cancer Center, Goyang, Republic of Korea.
| | - Tara Elton-Marshall
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada.
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
- School of Health Studies, Western University, London, Canada.
- Department of Epidemiology and Biostatistics, Western University, London, Canada.
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20
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Schneller LM, Zwierzchowski BA, Caruso RV, Li Q, Yuan J, Fong GT, O'Connor RJ. Changes in tar yields and cigarette design in samples of Chinese cigarettes, 2009 and 2012. Tob Control 2015; 24 Suppl 4:iv60-3. [PMID: 25352560 PMCID: PMC4693290 DOI: 10.1136/tobaccocontrol-2014-051803] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 09/10/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND China is home to the greatest number of smokers as well as the greatest number of smoking-related deaths. An active and growing market of cigarettes marketed as 'light' or 'low tar' may keep health-concerned smokers from quitting, wrongly believing that such brands are less harmful. OBJECTIVE This study sought to observe changes in cigarette design characteristics and reported tar, nicotine and carbon monoxide (TNCO) levels in a sample of cigarette brands obtained in seven Chinese cities from 2009 to 2012. METHODS Cigarettes were purchased and shipped to Roswell Park Cancer Institute, where 91 pairs of packs were selected for physical cigarette design characteristic testing and recording of TNCO values. Data analysis was conducted using SPSS, and was initially characterised using descriptive statistics, correlations and generalised estimating equations to observe changes in brand varieties over time. FINDINGS Reported TNCO values on packs saw mean tar, nicotine and CO levels decrease from 2009 to 2012 by 7.9%, 4.5% and 6.0%, respectively. Ventilation was the only cigarette design feature that significantly changed over time (p<0.001), with an increase of 31.7%. Significant predictors of tar and CO yield overall were ventilation and per-cigarette tobacco weight, while for nicotine tobacco moisture was also an independent predictor of yield. CONCLUSIONS The use of ventilation to decrease TNCO emissions is misleading smokers to believe that they are smoking a 'light/low' tar cigarette that is healthier, and is potentially forestalling the quitting behaviours that would begin to reduce the health burden of tobacco in China, and so should be prohibited.
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Affiliation(s)
- Liane M. Schneller
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Rosalie V. Caruso
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Qiang Li
- Department of Psychology, University of Waterloo, Ontario, Canada
- Chinese Centers for Disease Control and Prevention, Beijing, PRC
| | - Jiang Yuan
- Chinese Centers for Disease Control and Prevention, Beijing, PRC
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Richard J. O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY, USA
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21
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Yang T, Jiang S, Oliffe JL, Feng X, Zheng J. Environmental Smoking Restrictions and Light Cigarette Adoption Among Chinese Urban Smokers. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2015; 16:801-10. [PMID: 25522885 DOI: 10.1007/s11121-014-0541-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Light cigarette adoption involves complex psychological and behavioral processes with many underlying factors. While numerous studies have shown that environmental restrictions on smoking are associated with higher probability of smoking cessation, it is also possible that some smokers may switch from regular to light cigarettes due to environmental pressures. The current study evaluates whether smoking restrictions in households, workplaces, and public places were respectively associated with light cigarette adoption. A cross-sectional multistage sampling process was used to recruit participants and collect data about demographics and smoking characteristics and environmental restriction variables. Multiple logistic models were employed to examine the association between environmental smoking restrictions and light cigarette adoption. Of 4735 respondents, 1592 (30.3 %) were current smokers, and 69.7 % (N = 1141) of the smokers were identified as light cigarette adopters. In a multivariate model, smoking restrictions in households, workplaces, and public places were significantly associated with higher light cigarette adoption. Under environmental smoking restrictions, which pose unique challenges to tobacco control efforts, light cigarette adoption may increase. The study findings are essential for health policy makers in designing and implementing targeted smoking cessation interventions and health education programs.
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Affiliation(s)
- Tingzhong Yang
- Center for Tobacco Control Research, Zhejiang University, School of Medicine, Hangzhou, 310058, China,
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22
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Elton-Marshall T, Fong GT, Yong HH, Borland R, Xu SS, Quah ACK, Feng G, Jiang Y. Smokers' sensory beliefs mediate the relation between smoking a light/low tar cigarette and perceptions of harm. Tob Control 2014; 24 Suppl 4:iv21-7. [PMID: 25370698 DOI: 10.1136/tobaccocontrol-2014-051977] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Accepted: 10/15/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND The sensory belief that 'light/low tar' cigarettes are smoother can also influence the belief that 'light/low tar' cigarettes are less harmful. However, the 'light' concept is one of several factors influencing beliefs. No studies have examined the impact of the sensory belief about one's own brand of cigarettes on perceptions of harm. OBJECTIVE The current study examines whether a smoker's sensory belief that their brand is smoother is associated with the belief that their brand is less harmful and whether sensory beliefs mediate the relation between smoking a 'light/low tar' cigarette and relative perceptions of harm among smokers in China. METHODS Data are from 5209 smokers who were recruited using a stratified multistage sampling design and participated in Wave 3 of the International Tobacco Control (ITC) China Survey, a face-to-face survey of adult smokers and non-smokers in seven cities. RESULTS Smokers who agreed that their brand of cigarettes was smoother were significantly more likely to say that their brand of cigarettes was less harmful (p<0.001, OR=6.86, 95% CI 5.64 to 8.33). Mediational analyses using the bootstrapping procedure indicated that both the direct effect of 'light/low tar' cigarette smokers on the belief that their cigarettes are less harmful (b=0.24, bootstrapped bias corrected 95% CI 0.13 to 0.34, p<0.001) and the indirect effect via their belief that their cigarettes are smoother were significant (b=0.32, bootstrapped bias-corrected 95% CI 0.28 to 0.37, p<0.001), suggesting that the mediation was partial. CONCLUSIONS These results demonstrate the importance of implementing tobacco control policies that address the impact that cigarette design and marketing can have in capitalising on the smoker's natural associations between smoother sensations and lowered perceptions of harm.
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Affiliation(s)
- Tara Elton-Marshall
- Social and Epidemiological Research Department, Centre for Addiction and Mental Health, London, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Canada School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Hua-Hie Yong
- The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Ron Borland
- The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Steve Shaowei Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Guoze Feng
- Office of Tobacco Control, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Yuan Jiang
- Office of Tobacco Control, Chinese Center for Disease Control and Prevention, Beijing, China
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Hu TW, Lee AH, Mao Z. WHO Framework Convention on Tobacco Control in China: barriers, challenges and recommendations. Glob Health Promot 2013; 20:13-22. [PMID: 24297769 PMCID: PMC4041682 DOI: 10.1177/1757975913501910] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to analyze the barriers in the implementation of the Framework Convention on Tobacco Control (FCTC) in China and present recommendations on ways to address these challenges in tobacco control in China. METHODS We review the available literature on progress and explore the barriers and challenges that impede a speedier pace in the adoption of the effective tobacco control measures, and present recommendations based on in-depth knowledge of decision-making process on the implementation of FCTC in China. RESULTS The pace of progress in China is too slow. China faces intractable political, structural, economic and social barriers in tobacco control, which make the whole-hearted implementation of FCTC measures a painstaking process. DISCUSSION The authors recommend a comprehensive approach to speed up the implementation of tobacco control measures. This includes strong political leadership from the top, structural changes to the tobacco industry and government oversight of the tobacco industry, as well as advocacy and support for tobacco control from civil society at the grassroots level.
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Affiliation(s)
- Teh-Wei Hu
- 1.Center for International Tobacco Control, Public Health Institute, Oakland, CA, USA
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24
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O'Connor RJ, Caruso RV, Borland R, Cummings KM, Bansal-Travers M, Fix BV, King B, Hammond D, Fong GT. Relationship of cigarette-related perceptions to cigarette design features: findings from the 2009 ITC U.S. Survey. Nicotine Tob Res 2013; 15:1943-7. [PMID: 23943847 DOI: 10.1093/ntr/ntt075] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Many governments around the world have banned the use of misleading cigarette descriptors such as "light" and "mild" because the cigarettes so labeled were found not to reduce smokers' health risks. However, underlying cigarette design features, which are retained in many brands, likely contribute to ongoing belief that these cigarettes are less harmful by producing perceptions of lightness/smoothness through lighter taste and reduced harshness and irritation. METHODS Participants (N = 320) were recruited from the International Tobacco Control U.S. Survey conducted in 2009 and 2010, when they answered questions about smoking behavior, attitudes and beliefs about tobacco products, and key mediators and moderators of tobacco use behaviors. Participants also submitted an unopened pack of their usual brand of cigarettes for analysis using established methods. RESULTS Own-brand filter ventilation level (M 29%, range 0%-71%) was consistently associated with perceived lightness (p < .001) and smoothness (p = .005) of own brand. Those whose brand bore a light/mild label (55% of participants) were more likely to report their cigarettes were lighter [71.9% vs. 41.9%; χ(2)(2) = 38.1, p < .001] and smoother than other brands [75.5% vs. 68.7%; χ(2)(2) = 7.8, p = .020]. CONCLUSION Product design features, particularly filter ventilation, influence smokers' beliefs about product attributes such as lightness and smoothness, independent of package labels. Regulation of cigarette design features such as filter ventilation should be considered as a complement to removal of misleading terms in order to reduce smokers' misperceptions regarding product risks.
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Affiliation(s)
- Richard J O'Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, NY
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25
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Kilic D, Ozturk S. Gender differences in cigarette consumption in Turkey: evidence from the Global Adult Tobacco Survey. Health Policy 2013; 114:207-14. [PMID: 23810173 DOI: 10.1016/j.healthpol.2013.05.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 05/01/2013] [Accepted: 05/28/2013] [Indexed: 11/16/2022]
Abstract
OBJECTIVE The aim of this study is to examine the potential factors associated with both smoking participation and the level of cigarette consumption in Turkey from a gender perspective, the understanding of which are crucial to the formulation and implementation of anti-smoking policies. METHODS The Global Adult Tobacco Survey for 2008 is used in the analysis. Since the dependent variable, the number of cigarettes smoked per day, consists of nonnegative integer values, Negative Binomial and Zero-inflated Negative Binomial models are used as an estimation methodology. The zero-inflated model allows the interpretation of smoking propensity and smoking intensity behaviours separately. RESULTS The main findings of this study are twofold. First, the factors affecting the smoking behaviour of males and females are different. Second, there are also differences between the factors affecting the decisions of whether to smoke and how much to smoke for both genders. Cigarette prices, for example, affect the level of cigarette consumption of females but not of males whereas pro-cigarette marketing affects the decision of how much to smoke for males with no effect on female smoking. CONCLUSIONS The findings highlight the importance of gender differences in cigarette consumption. Overall, education programs, cigarette taxation and tobacco advertising bans have different effects on each gender whereas social interaction is important for cigarette smoking behaviour of both genders. The anti-smoking policies can be more effective if policy makers take into account gender differences in both smoking propensity and intensity.
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Affiliation(s)
- Dilek Kilic
- Hacettepe University, Department of Economics, Beytepe Campus, 06800 Ankara, Turkey.
| | - Selcen Ozturk
- Hacettepe University, Department of Economics, Beytepe Campus, 06800 Ankara, Turkey.
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26
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Smoking and vascular risk: are all forms of smoking harmful to all types of vascular disease? Public Health 2013; 127:435-41. [DOI: 10.1016/j.puhe.2012.12.021] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2011] [Revised: 04/02/2012] [Accepted: 12/21/2012] [Indexed: 11/21/2022]
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Brown A, McNeill A, Mons U, Guignard R. Do smokers in Europe think all cigarettes are equally harmful? Eur J Public Health 2012; 22 Suppl 1:35-40. [PMID: 22294783 PMCID: PMC3269294 DOI: 10.1093/eurpub/ckr198] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Despite the ban on misleading descriptors such as light or mild cigarettes in Europe, there are still widespread misperceptions of the relative harmfulness of different brands of cigarettes among smokers. This study examined the extent to which smokers in three European countries believed that some cigarette brands are less harmful and why, using data from the International Tobacco Control (ITC) Europe surveys. METHODS Cross-sectional analyses were completed among nationally representative samples of 4,956 current smokers (aged ≥ 18) from Germany (n = 1,515), France (n = 1,735) and the United Kingdom (n = 1,706) conducted between September 2006 and November 2007. Logistic regression models examined whether outcomes, including beliefs that some cigarettes could be less harmful than others, varied by socio-demographic and country of residence. FINDINGS Around a quarter of smokers in the UK and France, and a third in Germany believed some cigarettes are less harmful than others. Overall, of smokers who falsely believed that some cigarettes are less harmful, 86.3% thought that tar/nicotine yields, 48.7% taste, and 40.4% terms on packs such as 'smooth' or 'ultra' indicated less harmful brands. About a fifth of smokers across all countries chose their brand based on health reasons, and a similar proportion gave tar yields as a reason for choosing brands. CONCLUSIONS Our research suggests that the current European Tobacco Products Directive is inadequate in eliminating misperceptions about the relative risk of brand descriptors on cigarettes. There is therefore an urgent need to protect smokers in Europe from these misperceptions via stronger measures such as plain packaging regulations.
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Affiliation(s)
- Abraham Brown
- Centre for Tobacco Control Research, Institute for Social Marketing, University of Stirling, UK.
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28
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Zhang J, Ou JX, Bai CX. Tobacco smoking in China: prevalence, disease burden, challenges and future strategies. Respirology 2012; 16:1165-72. [PMID: 21910781 DOI: 10.1111/j.1440-1843.2011.02062.x] [Citation(s) in RCA: 132] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
About one-third of the world's tobacco is produced and consumed in China. Despite existing tobacco control policies and activities, the prevalence of smoking in China remains high with 350 million smokers and 740 million passive smokers. Furthermore, smoking rates in the young population and in females are increasing. The number of deaths attributed to tobacco use has reached 1.2 million per year, whereas the death toll is expected to rise to 2 million annually by 2025. Sociocultural factors favouring smoking initiation, lack of awareness among the public about the hazards of smoking, weak support from the government and strong resistance from the tobacco industry are major reasons for the lack of effectiveness of current tobacco control measures. Effective intervention efforts are urgently required. Commitments from the government are crucial in tobacco control. Firm action should be taken on tobacco control issues at multiple levels including a reduction in tobacco supply, increased tobacco taxation, increased education, tobacco advertising limitations, decreased second-hand smoke exposure and smoking cessation support. The health-care community should also play a leading role in anti-tobacco campaigns and take a more active role in smoking cessation programmes.
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Affiliation(s)
- Jing Zhang
- Department of Pulmonary Medicine, Zhongshan Hospital, Shanghai Medical College, Fudan University, Shanghai, China
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Socioeconomic differences in the effectiveness of the removal of the "light" descriptor on cigarette packs: findings from the International Tobacco Control (ITC) Thailand Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2170-80. [PMID: 21776224 PMCID: PMC3138019 DOI: 10.3390/ijerph8062170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/08/2011] [Indexed: 11/30/2022]
Abstract
Many smokers incorrectly believe that “light” cigarettes are less harmful than regular cigarettes. To address this problem, many countries have banned “light” or “mild” brand descriptors on cigarette packs. Our objective was to assess whether beliefs about “light” cigarettes changed following the 2007 removal of these brand descriptors in Thailand and, if a change occurred, the extent to which it differed by socioeconomic status. Data were from waves 2 (2006), 3 (2008), and 4 (2009) of the International Tobacco Control (ITC) Thailand Survey of adult smokers in Thailand. The results showed that, following the introduction of the ban, there was an overall decline in the two beliefs that “light” cigarettes are less harmful and smoother than regular cigarettes. The decline in the “less harmful” belief was considerably steeper in lower income and education groups. However, there was no evidence that the rate of decline in the “smoother” belief varied by income or education. Removing the “light” brand descriptor from cigarette packs should thus be viewed not only as a means to address the problem of smokers’ incorrect beliefs about “light” cigarettes, but also as a factor that can potentially reduce socioeconomic disparities in smoking-related misconceptions.
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Mutti S, Hammond D, Borland R, Cummings MK, O'Connor RJ, Fong GT. Beyond light and mild: cigarette brand descriptors and perceptions of risk in the International Tobacco Control (ITC) Four Country Survey. Addiction 2011; 106:1166-75. [PMID: 21481054 PMCID: PMC4419584 DOI: 10.1111/j.1360-0443.2011.03402.x] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To examine perceptions of risk related to type of cigarette brand. DESIGN AND SETTING Cross-sectional findings from wave 5 of the ITC Four Country Survey, conducted with nationally representative samples of smokers in 2006. PARTICIPANTS A total of 8243 current and former adult (≥18 years) smokers from Canada (n=2022), the United States (n=2034), the United Kingdom (n=2019) and Australia (n=2168). MEASUREMENTS Outcomes included beliefs about the relative risks of cigarettes, including perceptions of 'own' brand. Correlates included socio-demographic, smoking-related covariates and brand characteristics. FINDINGS One-fifth of smokers believed incorrectly that 'some cigarette brands could be less harmful' than others. False beliefs were higher in both the United States and United Kingdom compared to Canada and Australia. Smokers of 'light/mild', 'slim' and 100 mm/120 mm cigarettes were more likely to believe that some cigarettes could be less harmful [odds ratio (OR)=1.29, 95% confidence interval (CI)=1.12-1.48 and that their own brand might be a little less harmful (OR=2.61, 95% CI=2.01-3.41). Smokers of 'gold', 'silver', 'blue' or 'purple' brands were more likely to believe that their 'own brand might be a little less harmful' compared to smokers of 'red' or 'black' brands (OR=12.48, 95% CI=1.45-107.31). CONCLUSIONS Despite current prohibitions on the words 'light' and 'mild', smokers in western countries continue to falsely believe that some cigarette brands may be less harmful than others. These beliefs are associated with descriptive words and elements of package design that have yet to be prohibited, including the names of colours and long, slim cigarettes.
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Affiliation(s)
- Seema Mutti
- Department of Health Studies and Gerontology, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada
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Jiang Y, Elton-Marshall T, Fong GT, Li Q. Quitting smoking in China: findings from the ITC China Survey. Tob Control 2011; 19 Suppl 2:i12-7. [PMID: 20935194 PMCID: PMC2975995 DOI: 10.1136/tc.2009.031179] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background Few studies have examined interest in quitting smoking and factors associated with quitting in mainland China. Objective To characterise interest in quitting, quitting behaviour, the use of cessation methods and reasons for thinking about quitting among adult urban smokers in six cities in China. Methods Data is from Wave 1 of the ITC China Survey, a face-to-face household survey of 4732 adult smokers randomly selected from six cities in China in 2006. Households were sampled using a stratified multistage design. Findings The majority of smokers had no plan to quit smoking (75.6%). Over half (52.7%) of respondents had ever tried to quit smoking. Few respondents thought that they could successfully quit smoking (26.5%). Smokers were aware of stop-smoking medications (73.5%) but few had used these medications (5.6%). Only 48.2% had received advice from a physician to quit smoking. The number one reason for thinking about quitting smoking in the last 6 months was concern for personal health (55.0%). Most smokers also believed that the government should do more to control smoking (75.2%). Conclusion These findings demonstrate the need to: (1) increase awareness of the dangers of smoking; (2) provide cessation support for smokers; (3) have physicians encourage smokers to quit; (4) denormalise tobacco use so that smokers feel pressured to quit; (5) implement smoke-free laws to encourage quitting; (6) develop stronger warning labels about the specific dangers of smoking and provide resources for obtaining further cessation assistance; and (7) increase taxes and raise the price of cigarettes.
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Affiliation(s)
- Yuan Jiang
- Department of Psychology, PAS Building, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada
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O'Connor RJ, Wilkins KJ, Caruso RV, Cummings KM, Kozlowski LT. Cigarette characteristic and emission variations across high-, middle- and low-income countries. Public Health 2010; 124:667-74. [PMID: 21030055 DOI: 10.1016/j.puhe.2010.08.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2009] [Revised: 06/22/2010] [Accepted: 08/27/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. STUDY DESIGN Multicountry observational study. METHODS Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank's per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. RESULTS Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ(2)(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. CONCLUSIONS This study showed that as a country's income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries.
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Affiliation(s)
- R J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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O'Connor RJ, Wilkins KJ, Caruso RV, Cummings KM, Kozlowski LT. Cigarette characteristic and emission variations across high-, middle- and low-income countries. Public Health 2010. [PMID: 21030055 DOI: 10.1016/j.puhe.2010.08.018s0033-3506(10)00290-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVES The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. STUDY DESIGN Multicountry observational study. METHODS Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank's per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. RESULTS Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ(2)(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. CONCLUSIONS This study showed that as a country's income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries.
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Affiliation(s)
- R J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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O'Connor RJ, Li Q, Stephens WE, Hammond D, Elton-Marshall T, Cummings KM, Giovino GA, Fong GT. Cigarettes sold in China: design, emissions and metals. Tob Control 2010; 19 Suppl 2:i47-53. [PMID: 20935196 PMCID: PMC2976001 DOI: 10.1136/tc.2009.030163] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2009] [Revised: 06/26/2009] [Accepted: 07/01/2009] [Indexed: 11/30/2022]
Abstract
BACKGROUND China is the home to the world's largest cigarette maker, China National Tobacco Company (CNTC), yet little is known publicly about the design and emissions of Chinese cigarettes. CNTC is currently in the process of consolidating its brands and has ambitions to export its cigarettes. Machine-measured tar yields of many of its cigarette brands have also been reduced, similar to what occurred in Western countries from the 1970s through the 1990s with so-called 'low-tar' cigarettes introduced to address consumer concerns about health risks from smoking. METHOD The current study examines the design and physical characteristics, labelled smoke emissions and tobacco metals content of leading brands of Chinese cigarettes from seven cities purchased in 2005-6 and in 2007. RESULTS Findings suggest that similar to most countries, tar levels of Chinese cigarettes are predicted primarily by tobacco weight and filter ventilation. Ventilation explained approximately 50% of variation observed in tar and 60% variation in carbon monoxide yields. We found little significant change in key design features of cigarettes purchased in both rounds. We observed significant levels of various metals, averaging 0.82 μg/g arsenic (range 0.3-3.3), 3.21 μg/g cadmium (range 2.0-5.4) and 2.65 μg/g lead (range 1.2-6.5) in a subsample of 13 brands in 2005-6, substantially higher than contemporary Canadian products. CONCLUSION Results suggest that cigarettes in China increasingly resemble those sold in Western countries, but with tobacco containing higher levels of heavy metals. As CNTC looks to export its product around the world, independent surveillance of tobacco product characteristics, including tobacco blend characteristics, will become increasingly important.
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Affiliation(s)
- Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Sciences, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA.
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