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Khayat A, Levine H, Berg CJ, Shauly-Aharonov M, Manor O, Abroms L, Romm KF, Wysota CN, Bar-Zeev Y. IQOS and cigarette advertising across regulatory periods and population groups in Israel: a longitudinal analysis. Tob Control 2024; 33:e3-e10. [PMID: 36368887 PMCID: PMC10172385 DOI: 10.1136/tc-2022-057585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 10/12/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Tobacco regulation recently changed in Israel, including a partial advertisement ban. We assessed the impact of regulatory changes on Philip Morris International's (PMI) IQOS and cigarette advertisements. METHODS Weekly number of ads and weekly adspend of PMI's IQOS and cigarettes were analysed descriptively and using Quasi-Poisson regressions over time, across regulatory periods and in relation to subpopulations (general public, Arab, Russian and Ultra-Orthodox), from 25 December 2016 to 4 August 2020. Exponentiated coefficients (a value >1 indicates an increase) and 95% CIs are reported. RESULTS The average weekly number of ads and the average weekly adspend of IQOS were higher than cigarettes (42.22 vs 26.76 ads/week and 59 409 vs 45 613 new Israeli shekels/week; p<0.001 for both) during the study period, with exclusive IQOS advertisements during market penetration (December 2016 to May 2017). Variation in both outcomes was observed with regard to regulatory decisions. After the advertisement ban, there was a significant decrease in the weekly number of ads (IQOS: ß=0.04, 95% CI 0.002 to 0.20; cigarettes: ß=0.05, 95% CI 0.01 to 0.15) and weekly adspend (IQOS: ß=0.15, 95% CI 0.07 to 0.29; cigarettes: ß=0.31, 95% CI 0.17 to 0.53) for both products. The Ultra-Orthodox had significantly higher average weekly ads compared with the Arab population (IQOS: 0.67 vs 0.07; cigarettes: 2.74 vs 0.13; p=0.02 for both) but lower adspend. CONCLUSIONS IQOS and cigarette advertisements varied over time and appeared to have been impacted by regulatory changes. PMI invested more in IQOS advertisements than in cigarettes, with a partial advertisement ban decreasing both products' advertisements. PMI might be targeting the Ultra-Orthodox Jewish population which has a low smoking rate. Further research and surveillance are needed to better understand targeting strategies in order to inform tobacco control policy.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Michal Shauly-Aharonov
- Department of Industrial Engineering, Jerusalem College of Technology, Jerusalem, Israel
| | - Orly Manor
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Christina N Wysota
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Khayat A, Berg CJ, Levine H, Rodnay M, Abroms L, Romm KF, Duan Z, Bar-Zeev Y. PMI's IQOS and cigarette ads in Israeli media: a content analysis across regulatory periods and target population subgroups. Tob Control 2024; 33:e54-e61. [PMID: 36418166 PMCID: PMC10203057 DOI: 10.1136/tc-2022-057671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Accepted: 11/11/2022] [Indexed: 11/24/2022]
Abstract
BACKGROUND IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We examined how PMI's advertising messages changed during these regulatory periods for both IQOS and cigarettes. METHODS Content analysis of PMI's IQOS and cigarette ads was performed using a predefined framework. Ad characteristics included regulatory period, target population, setting, product presentation, age and use restrictions, retail accessibility, additional detail cues (eg, QR code) and promotions. Ad themes included product features, legislation-related elements, social norms and comparative claims. Comparisons between IQOS and cigarette ads, and across regulatory periods, were examined using χ2 test or Fisher's exact test. RESULTS The dataset included 125 IQOS ads and 71 cigarette ads. IQOS ads featured more age restrictions, retail accessibility and additional detail cues, compared with cigarette ads (93.6% vs 16.9%; 56.0% vs 0.0%; and 95.2% vs 33.8%, p<0.001 for all). Cigarette ads featured mostly price promotions (52.1% vs 10.1% of IQOS ads, p<0.001). The main ad themes were technology for IQOS (85.6%) and quality for cigarettes (50.7%). In later (vs earlier) restrictive regulatory periods, IQOS ads featured more direct comparisons to cigarettes, QR codes and indoor settings, and did not feature product packaging. CONCLUSIONS IQOS advertisement content shifted as more restrictions went into effect, with several elements used to circumvent legislation. Findings from this study point to the necessity of a complete advertisement ban and ongoing marketing surveillance.
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Affiliation(s)
- Amal Khayat
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Carla J Berg
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Lorien Abroms
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Katelyn F Romm
- Department of Pediatrics, College of Medicine, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma, Oklahoma, USA
| | - Zongshuan Duan
- Department of Prevention and Community Health, George Washington University Milken Institute School of Public Health, Washington, DC, Washington, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hadassah Medical Organization, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Khayat A, Levine H, Berg CJ, Abroms LC, Duan Z, Wang Y, LoParco CR, Elbaz D, Cui Y, Bar-Zeev Y. IQOS point-of-sale marketing: a comparison between Arab and Jewish neighborhoods in Israel. RESEARCH SQUARE 2024:rs.3.rs-3953025. [PMID: 38464035 PMCID: PMC10925470 DOI: 10.21203/rs.3.rs-3953025/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/12/2024]
Abstract
Background Philip Morris International's (PMI) IQOS, with its heatsticks (HEETS), is the heated tobacco product with the largest global market share. IQOS and/or electronic cigarettes use rate is higher among Arabs vs. Jews in Israel. This paper aims to compare IQOS point-of-sale (POS) marketing strategies, and regulatory compliance in Arab vs. Jewish neighborhoods in Israel. Methods We integrated data from two separate studies including a cross-sectional survey with IQOS retailers (December 2020-April 2021) and audits of POS that sold IQOS/HEETS (April 2021-July 2021) in 5 large cities in Israel, after marketing restrictions including a POS display ban and plain packaging became effective in Israel (January 2020). The survey included 69 POS (21 Arab, 48 Jewish neighborhoods) and the audits included 129 POS (48 Arab, 81 Jewish neighborhoods). Comparisons of IQOS marketing strategies between POS in Arab and Jewish neighborhoods were conducted using Chi-Square test, Fisher's exact test or Mann-Whitney test, as appropriate. Thematic analysis was used to analyze open-ended questions. Results Most marketing strategies, such as promotions to customers, were uniform across POS in Arab and Jewish neighborhoods. The most noteworthy differences were that a higher proportion of retailers from Arab neighborhoods were invited to IQOS parties (47.6% vs. 21.7%, p<0.05) and reported personal communication with a PMI representative (80.0% vs. 51.2%, p<0.05). Additionally, PMI representatives assisted POS in both Arab and Jewish neighborhoods in implementing the display ban by providing free compliant cabinets and product placement instructions, and directly interacted with customers. POS in Arab neighborhoods were more compliant with the display ban (25.5% vs. 8.8%, p<0.05), but less compliant with plain packaging (62.5% vs. 79.3%, p<0.05). Conclusions There were not many notable differences in IQOS marketing across POS in Arab vs. Jewish neighborhoods, but PMI utilized marketing elements of cultural significance, especially for POS in Arab neighborhoods, such as more personal communication and invitation to social events. Continuous surveillance of tobacco POS marketing and legislation compliance is needed, with a special focus on demographic/location-based differences.
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Affiliation(s)
- Amal Khayat
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Hagai Levine
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
| | - Carla J Berg
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Lorien C Abroms
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | | | - Yan Wang
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Cassidy R LoParco
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Daniel Elbaz
- Hebrew University of Jerusalem Faculty of Medicine
| | - Yuxian Cui
- George Washington University School of Public Health and Health Services: The George Washington University Milken Institute of Public Health
| | - Yael Bar-Zeev
- Hebrew University of Jerusalem Braun School of Public Health and Community Medicine
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Guri-Scherman ALY, Neumark Y, Rodnay M, Bar-Zeev Y. Barriers and Enablers to Implementing a Smoke-free Home and Car During Pregnancy: A Qualitative Study Among Expectant Israeli Fathers. Nicotine Tob Res 2024; 26:94-101. [PMID: 37565607 DOI: 10.1093/ntr/ntad149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 08/01/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
INTRODUCTION Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. This study aims to identify barriers and facilitators for implementing a smoke-free home and car among expectant Israeli fathers. AIMS AND METHODS Twenty-four qualitative semistructured telephone interviews were audio-recorded, transcribed, and analyzed according to a reflexive and collaborative thematic approach. Inclusion criteria were being male, Hebrew speaker, age ≥18 years, smoking at least one cigarette a day, and living with their nonsmoking pregnant spouse. The Capability, Opportunity and Motivation for Behavior (COM-B) model was used as a theoretical model for analysis. RESULTS Participants reported feeling a strong responsibility for their pregnant spouse's comfort and health, stating that they are doing the best they can to reduce their spouse's secondhand smoke exposure (Motivation). Participants had a low level of knowledge about specific secondhand smoke health consequences, effective strategies to reduce secondhand smoke exposure, with incorrect perceptions about what constitutes exposure (Capability). Couple relationships were not affected by the husband's smoking habits, and participants expressed mutual consideration and understanding (Opportunity). Participants also expressed positive attitudes regarding smoke-free home and car implementation but emphasized that any changes have to be their own decision (Motivation). CONCLUSIONS The present study identified principal Capability, Opportunity and Motivation barriers and facilitators that influence Israeli expectant fathers' decision to implement a smoke-free home and car. Those findings will inform the development of a digital behavioral intervention targeting expectant fathers to reduce prenatal secondhand smoke exposure. IMPLICATIONS Secondhand smoke exposure during pregnancy is a significant cause of negative health effects. Interventions among expectant fathers that focus on creating a smoke-free home and car may be effective because pregnancy has been identified as a "window of opportunity" that generates a strong motivation and creates a sense of urgency to change smoking behavior, while being considered more achievable than smoking cessation. Interventions might be effective if they focus on strengthening the parental responsibility among expectant fathers and emphasize the benefits of a smoke-free home and car, while maintaining male autonomy and increasing skills to effectively implement a smoke-free home and car.
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Affiliation(s)
| | - Yehuda Neumark
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Rubinson NG, Fong GT, Gravely S, Quah ACK, Bitan M, Lev Ari S, Rosen LJ. The association between risk perceptions, anxiety, and self-reported changes in tobacco and nicotine product use due to COVID-19 in May-June 2020 in Israel. BMC Public Health 2023; 23:759. [PMID: 37098558 PMCID: PMC10126559 DOI: 10.1186/s12889-023-15351-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 03/01/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Early in the COVID-19 pandemic, reports about a possible protective effect of nicotine on COVID-19 conflicted with messaging by public health organizations about increased risks of COVID-19 due to smoking. The ambiguous information the public received, combined with COVID-19-induced anxiety, may have led to changes in tobacco or other nicotine product use. This study examined changes in use of combustible cigarettes (CCs), nargila (hookah/waterpipe), e-cigarettes, and IQOS and home-smoking behaviors. We also assessed COVID-19 related anxiety and perceptions regarding changes in risk of COVID-19 severity due to smoking. METHODS We used cross-sectional data from a population telephone survey that was conducted in Israel in the early phase of the COVID-19 pandemic (May-June 2020) and included 420 adult (age 18+) individuals who reported having ever used CCs (n = 391), nargila (n = 193), and/or electronic cigarettes (e-cigarettes)/heated tobacco products (e.g., IQOS) (n = 52). Respondents were asked about the effect that COVID-19 had on their nicotine product use (quit/reduced use, no change, increased use). We assessed changes in product use, risk perceptions, and anxiety using adjusted multinomial logistic regression analyses. RESULTS Most respondents did not change their frequency of product use (CCs: 81.0%, nargila: 88.2%, e-cigarettes/IQOS: 96.8%). A small percentage either decreased use (CCs: 7.2%, nargila: 3.2%, e-cigarettes/IQOS:2.4%) or increased use (CCs:11.8%, nargila:8.6%, e-cigarettes/IQOS:+ 0.9%). 55.6% of respondents used a product in the home prior to COVID-19; but during the first lockdown COVID-19 period, a greater percentage increased (12.6%) than decreased (4.0%) their home use. Higher levels of anxiety due to COVID-19 were associated with increased home smoking (aOR = 1.59, 95% CI:1.04-2.42, p = 0.02). Many respondents believed that increased severity of COVID-19 illness was associated with CCs (62.0%) and e-cigarettes/vaping (45.3%), with uncertainty about the association being lower for CCs (20.5%) than for vaping (41.3%). CONCLUSIONS While many respondents believed that nicotine product use (particularly CCs and e-cigarettes) was associated with increased risk of COVID-19 disease severity, the majority of users did not change their tobacco/nicotine use. The confusion about the relationship between tobacco use and COVID-19 calls for clear evidence-based messaging from governments. The association between home smoking and increased COVID-19-related stress suggests the need for campaigns and resources to prevent smoking in the home, particularly during times of stress.
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Affiliation(s)
- Noah G Rubinson
- School of Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Canada
- School of Public Health Sciences, University of Waterloo, Waterloo, Canada
- Ontario Institute for Cancer Research, Toronto, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Anne C K Quah
- Department of Psychology, University of Waterloo, Waterloo, Canada
| | - Michal Bitan
- Department of Computer Science, College of Management Academic Studies, Rishon LeZion, Israel
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Shahar Lev Ari
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel
| | - Laura J Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel.
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Rosen LJ, Zucker DM, Gravely S, Bitan M, Rule AM, Myers V. Tobacco Smoke Exposure According to Location of Home Smoking in Israel: Findings from the Project Zero Exposure Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3523. [PMID: 36834219 PMCID: PMC9965201 DOI: 10.3390/ijerph20043523] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 02/10/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Young children are particularly vulnerable to harms from tobacco smoke exposure (TSE). This study aimed to compare TSE: (1) between children who live in smoking families and those who do not; and (2) among children who live in smoking households with varying smoking locations. The data came from two studies that were conducted concurrently in Israel (2016-2018). Study 1: a randomized controlled trial of smoking families (n = 159); Study 2: a cohort study of TSE among children in non-smoking families (n = 20). Hair samples were collected from one child in each household. Baseline hair nicotine data were analyzed for 141 children in Study 1 and 17 children in Study 2. Using a logistic regression analysis (exposed vs. not exposed as per laboratory determination) and a linear regression (log hair nicotine), we compared TSE between: (1) children in Study 1 vs. Study 2; (2) children in families with different smoking locations in Study 1: balcony; garden, yard, or other place outside of the home; or inside the home (designated smoking areas within the home (DSAs) or anywhere). A higher proportion of children living in smoking households were measurably exposed to tobacco smoke (68.8%) compared to children living in non-smoking households (35.3%, p = 0.006). Among children from smoking families, 75.0% of those whose parents smoked in the house were exposed, while 61.8% of children whose parents restricted smoking to the porch (n = 55) were exposed, and 71.4% of those whose parents smoked outside the home (including gardens and yards) (n = 42) were exposed. In univariable and multivariable models, smoking location was not significantly associated with exposure. The majority of children in smoking families were measurably exposed to TSE, even if smoking was restricted to designated areas in the home, balconies, orgarden/yard/other outdoor areas. Reducing population smoking rates, particularly among parents, restricting smoking to at least 10 meters from homes and children, and denormalizing smoking around others are recommended to reduce population-level child TSE and tobacco-attributable disease and death.
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Affiliation(s)
- Laura J. Rosen
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - David M. Zucker
- Department of Statistics and Data Science, Hebrew University, Jerusalem 9190501, Israel
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Michal Bitan
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Department of Computer Science, College of Management Academic Studies, Rishon LeTsiyon 7579806, Israel
| | - Ana M. Rule
- Department of Environmental Health and Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Vicki Myers
- Department of Health Promotion, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
- Gertner Institute of Epidemiology and Health Policy Research, Sheba Medical Center, Ramat Gan 5262100, Israel
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Levine H, Duan Z, Bar-Zeev Y, Abroms LC, Khayat A, Tosakoon S, Romm KF, Wang Y, Berg CJ. IQOS Use and Interest by Sociodemographic and Tobacco Behavior Characteristics among Adults in the US and Israel. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3141. [PMID: 36833831 PMCID: PMC9961058 DOI: 10.3390/ijerph20043141] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 02/04/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
Heated tobacco products (HTPs) have expanded globally. IQOS, a global HTP leader, was launched in Israel in 2016 and the US in 2019. To inform tobacco control efforts, it is critical to understand who is likely to use HTPs in different countries with distinct regulatory and marketing contexts. Thus, we conducted a cross-sectional survey among adult (ages 18-45) online panelists in the US (n = 1128) and Israel (n = 1094), oversampling tobacco users, in the fall of 2021, and used multivariable regression to identify correlates of (1) ever using IQOS; (2) past-month vs. former among ever users; and (3) interest in trying IQOS among never users. Among US adults, correlates of ever use included being Asian (aOR = 3.30) or Hispanic (aOR = 2.83) vs. White, and past-month use of cigarettes (aOR = 3.32), e-cigarettes (aOR = 2.67), and other tobacco (aOR = 3.34); in Israel, correlates included being younger (aOR = 0.97), male (aOR = 1.64), and cigarette (aOR = 4.01), e-cigarette (aOR = 1.92) and other tobacco use (aOR = 1.63). Among never users, correlates of greater interest included cigarette and e-cigarette use in the US (β = 0.57, β = 0.90) and Israel (β = 0.88, β = 0.92). IQOS use prevalence was low (US: 3.0%; Israel: 16.2%) but represented in vulnerable subpopulations (younger adults, racial/ethnic minorities).
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Affiliation(s)
- Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem 9112002, Israel
| | - Zongshuan Duan
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem 9112002, Israel
| | - Lorien C. Abroms
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Medicine, The Hebrew University of Jerusalem and Hadassah, Jerusalem 9112002, Israel
| | - Sararat Tosakoon
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Katelyn F. Romm
- TSET Health Promotion Research Center, Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA
| | - Yan Wang
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
| | - Carla J. Berg
- Milken Institute School of Public Health, George Washington University, Washington, DC 20052, USA
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Moodie C, O’Donnell R. Reasons for Using Roll-Your-Own Tobacco and Perceptions of Health-Promoting Pack Inserts: A Focus Group Study with Roll-Your-Own Tobacco Smokers in Scotland. Nicotine Tob Res 2022; 24:1937-1944. [PMID: 35907266 PMCID: PMC9653084 DOI: 10.1093/ntr/ntac184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 05/13/2022] [Accepted: 07/21/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Use of roll-your-own (RYO) tobacco is increasing in most regions, but few qualitative studies have explored why RYO smokers use this product, and no study has considered their views of health-promoting pack inserts. METHODS Eight focus groups were conducted with 18-35-year-old RYO smokers (n = 50) in Greater Glasgow (Scotland) in February-March 2020 to explore reasons for using RYO and perceptions of health-promoting inserts. Participants were shown four inserts adapted from those required in cigarette packs in Canada, with all encouraging quitting, and two RYO-specific inserts explaining that RYO is not less harmful than cigarettes. RESULTS Lower price, better taste, the pleasure of rolling and ability to customize roll-ups, and the belief that RYO was less harmful than cigarettes were drivers for use. There were mixed perceptions of the extent to which inserts would capture attention if included in RYO packs. The positive messaging used on the Canadian inserts was considered motivational and inspirational, and contrasted with the on-pack warnings. The messaging on the RYO inserts, in comparison, was viewed unfavorably and generally dismissed. Participants, most of whom were not interested in quitting, did not feel that inserts would lead them to change their smoking behavior. However, some felt that the Canadian inserts could be helpful for those thinking about quitting and young people contemplating smoking. CONCLUSIONS Inserts with positive messaging about quitting, rather than messaging explicating the harms of RYO, were preferred by RYO smokers. What, if any, RYO-specific messaging resonates with RYO smokers merits further attention. IMPLICATIONS Aside from price, taste, and the pleasure associated with rolling and ability to individualize roll-ups, the erroneous belief that RYO is less harmful than cigarettes was a key reason for use. While inserts with positive messaging about quitting, as used on the Canadian inserts, were viewed as potentially helpful, inserts that challenged the idea that RYO was not less harmful than cigarettes were generally dismissed. Research is needed to understand what types of RYO-specific messaging could most effectively be used on inserts, or indeed in other media, to challenge the misperceptions that many RYO smokers hold.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
| | - Rachel O’Donnell
- Institute for Social Marketing and Health, Faculty of Health Sciences and Sport, University of Stirling, Stirlingshire, UK
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Moodie C, O'Donnell R. 'I'm killing myself, but I'm saving the planet': rolling tobacco smokers' perceptions of rolling papers. Tob Control 2022; 31:479-482. [PMID: 33229464 DOI: 10.1136/tobaccocontrol-2020-056103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Revised: 09/28/2020] [Accepted: 10/12/2020] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite the global growth of rolling tobacco, we are unaware of any research that has explored smokers' perceptions of the types of rolling papers available, or plain rolling papers, which are now required in Canada and Israel. METHODS Eight focus groups were conducted with rolling tobacco smokers (n=50) in Greater Glasgow (Scotland) between February and March 2020. Participants were shown a number of packs of promotional rolling papers (natural, transparent, prerolled cones, flavoured) and plain rolling papers. RESULTS Rolling papers were often viewed as functional, a necessity for making roll-ups. The appeal of papers was based on the packaging, with a booklet-style pack of natural papers viewed very positively, as well as novelty, usability and taste/smell. Participants often associated papers with particular users, with prerolled cones and some flavoured papers thought to be used by cannabis smokers or younger people and those just starting to smoke. In terms of harm perceptions, natural papers were viewed as a healthier choice than standard papers and more environmentally friendly, whereas transparent papers raised concerns about safety to both the user and the environment. Participants were generally ambivalent towards plain papers, which they did not feel would alter their purchasing or smoking behaviour, although some felt they may be less appealing to youth as the branding would be diminished. CONCLUSIONS The panoply of rolling papers available offers consumers considerable choice. As some promotional papers can increase appeal or create misperceptions of harm then standardising papers would help to counter this.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Rachel O'Donnell
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Moodie C, Hoek J, Hammond D, Gallopel-Morvan K, Sendoya D, Rosen L, Mucan Özcan B, van der Eijk Y. Plain tobacco packaging: progress, challenges, learning and opportunities. Tob Control 2022; 31:263-271. [PMID: 35241599 DOI: 10.1136/tobaccocontrol-2021-056559] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 10/12/2021] [Indexed: 11/03/2022]
Abstract
The aim of this paper is to overview progress made with respect to the adoption of plain (or standardised) packaging, key challenges faced, evaluative evidence and opportunities for extending this policy. It has been a decade since Australia became the first country to require tobacco products to be sold in plain packaging; after slow initial uptake, 16 countries have now fully implemented this policy. Since 2020, plain packaging laws have become more comprehensive in some countries, expanding coverage beyond traditional tobacco products to include heated tobacco, tobacco accessories (rolling papers) and other nicotine-containing products (e-cigarettes). Laws have also become more innovative: some now ban non-biodegradable filters, include provision for a periodic change of the pack colour or require both plain packaging and health-promoting pack inserts. The tobacco industry has and will continue to use multi-jurisdictional strategies to oppose this policy. Evaluations suggest that plain packaging has improved health outcomes and has not burdened retailers, although research is limited to early policy adopters and important gaps in the literature remain. While the power of packaging as a sales tool has diminished in markets with plain packaging, tobacco companies have exploited loopholes to continue to promote their products and have increasingly focused on filter innovations. Opportunities exist for governments to strengthen plain packaging laws.
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Affiliation(s)
- Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Janet Hoek
- Departments of Public Health and Marketing, University of Otago, Dunedin, New Zealand
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | | | - Diego Sendoya
- Facultad de Derecho, Universidad de la Republica Uruguay, Montevideo, Uruguay
| | - Laura Rosen
- Department of Health Promotion, School of Public Health, Tel Aviv University Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Burcu Mucan Özcan
- Department of Business Administration, Celal Bayar University, Manisa, Turkey
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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Bar-Zeev Y, Berg CJ, Khayat A, Romm KF, Wysota CN, Abroms LC, Elbaz D, Levine H. IQOS marketing strategies at point-of-sales: a cross-sectional survey with retailers. Tob Control 2022:tobaccocontrol-2021-057083. [PMID: 35140170 DOI: 10.1136/tobaccocontrol-2021-057083] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 01/25/2022] [Indexed: 12/11/2022]
Abstract
BACKGROUND The point-of-sale (POS) is adapting to marketing restrictions, societal changes and the inclusion of new products, such as heated tobacco products (eg, Philip Morris International's (PMI) IQOS device and HEETS sticks). We aimed to assess (1) PMI's influences on IQOS/HEETS POS marketing and (2) the implications of the new legislation (POS display ban and plain packaging) for retailers. METHODS A cross-sectional survey of 43 IQOS/HEETS POS owners/managers in five Israeli cities assessed POS and participant characteristics, marketing strategies, attitudes towards IQOS, and POS implications of the legislation and COVID-19, including industry reactions. Bivariate analysis explored differences between POS selling of the IQOS device versus POS selling of HEETS only. RESULTS A higher proportion of those carrying IQOS (n=15) (vs HEETS only) had special displays (100% vs 17.9%, p<0.001) and interacted with specific IQOS salespersons (73.3% vs 28.6%, p=0.013). Common promotions were financial incentives based on HEETS sales for retailers (37.5%) and price discounts on HEETS for customers (48.7%). Most indicated positive attitudes towards IQOS (72.1%; eg, 'less harmful'), opposition to the legislation (62.7%), limited government assistance to implement the legislation (62.8%), and industry provision of display cases and/or signage to comply with the legislation (67.4%). CONCLUSION PMI uses similar tactics to promote IQOS at POS as they previously used for combustible products, including direct promotional activities with retailers, and circumvented legislation by using special displays and signage. Governments need to ban these measures and support retailers with clear practical guidance regarding the implementation of marketing restrictions at POS.
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Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Katelyn F Romm
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Chritina N Wysota
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Lorien C Abroms
- Milken Institute School of Public, George Washington University, Washington, DC, USA
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University and Hadassah Medical Centre, Jerusalem, Israel
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12
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Bar-Zeev Y, Berg CJ, Kislev S, Geva HH, Godinger E, Abroms L, Levine H. Tobacco legislation reform and industry response in Israel. Tob Control 2021; 30:e62-e64. [PMID: 32887740 PMCID: PMC8191540 DOI: 10.1136/tobaccocontrol-2020-056041] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 07/27/2020] [Accepted: 08/04/2020] [Indexed: 11/04/2022]
Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem - Hadassah Medical Centre, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | | | - Haim Haspil Geva
- Tobacco Control Unit, Public Health Services, Israel Ministry of Health, Jerusalem, Israel
| | - Elad Godinger
- Public Policy Unit, Israeli Medical Association, Ramat Gan, Israel
| | - Lorien Abroms
- Milken Institute School of Public Health, George Washington University, Washington, District of Columbia, USA
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Hebrew University of Jerusalem - Hadassah Medical Centre, Jerusalem, Israel
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13
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Shuval K, Stoklosa M, Nargis N, Drope J, Tzafrir S, Keinan-Boker L, DeFina LF, Qadan M. Cigarette Prices and Smoking Behavior in Israel: Findings from a National Study of Adults (2002-2017). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168367. [PMID: 34444117 PMCID: PMC8394522 DOI: 10.3390/ijerph18168367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 07/31/2021] [Accepted: 08/03/2021] [Indexed: 11/16/2022]
Abstract
Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous countries, scant evidence exists on this topic for Israel. Accordingly, we assessed the association between cigarette prices and smoking prevalence and intensity from a national sample of adults in Israel (2002-2017). Data on smoking behavior were derived from the Israeli Knowledge Attitudes and Practices (KAP) survey, a repeated cross-sectional survey. Price information is from the Economist Intelligence Unit (EIU) since it was not collected in the KAP survey. We used the price of a pack of 20 cigarettes for Marlboro and the local brand. These two price variables were the primary independent variables, and we adjusted for inflation. The dependent variables were current smoking (yes/no) and smoking intensity, defined as the number of cigarettes smoked per week. Multivariable analysis was employed using a two-part model while adjusting for covariates. The first step of the model utilized logistic regression with current smoking as the dependent variable. The second step examining smoking intensity as the dependent variable, used OLS regression. Price elasticity was estimated as well. Analysis revealed that a one-unit increase (Israeli currency) in the price of local brand of cigarettes was related to 2.0% (OR = 0.98; 95%CI 0.98, 0.99) lower odds of being a current smoker, adjusting for covariates including household income. Moreover, a one unit increase in the price of the local brand of cigarettes was related to consuming 1.49 (95% CI -1.97, -1.00) fewer weekly cigarettes, controlling for household income and covariates. Similar results were found with the Marlboro cigarette prices. The total price elasticity of cigarette demand, given by the sum of price elasticities of smoking prevalence and intensity, showed that a 10.0% increase in the price is associated with a 4.6-9.2% lower cigarette consumption among Israeli adults. Thus, increasing cigarette prices will likely lead to a reduction in cigarette smoking thereby improving public health in Israel.
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Affiliation(s)
- Kerem Shuval
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel;
- The Cooper Institute, Dallas, TX 75230, USA;
- Correspondence:
| | - Michal Stoklosa
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Nigar Nargis
- Economic and Health Policy Research, American Cancer Society, Atlanta, GA 30303, USA;
| | - Jeffrey Drope
- Health Policy & Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL 60608, USA;
| | - Shay Tzafrir
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
| | - Lital Keinan-Boker
- School of Public Health, Faculty of Social Welfare & Health Sciences, University of Haifa, Haifa 3498838, Israel;
- Israel Center for Disease Control, Ministry of Health, Sheba Medical Center, Ramat Gan 5262160, Israel
| | | | - Mahmoud Qadan
- School of Business Administration, Faculty of Social Sciences, University of Haifa, Haifa 3498838, Israel; (S.T.); (M.Q.)
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Bar-Zeev Y, Berg CJ, Abroms LC, Rodnay M, Elbaz D, Khayat A, Levine H. Assessment of IQOS Marketing Strategies at Points-of-Sale in Israel at a Time of Regulatory Transition. Nicotine Tob Res 2021; 24:100-108. [PMID: 34216461 DOI: 10.1093/ntr/ntab142] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 07/01/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION IQOS, a tobacco heating system, and accompanying tobacco sticks (HEETS) entered the Israeli market in 2016, prior to rapid regulatory change. This study assessed IQOS marketing strategies and regulatory compliance at IQOS/HEETS point-of-sale (POS) in Israel in December 17, 2019-January 7, 2020, after the ban on advertisement went into effect in March 8, 2019. METHODS Research staff audited 80 randomly-selected IQOS/HEETS POS in 4 cities using a structured form to assess store types, product placement, price, promotional strategies, and regulatory compliance. POS data was linked to neighbourhood characteristics, including socioeconomic status (SES), ethnicity, and proximity (under 300 meters) to schools. RESULTS Almost half of the stores (48.7%) were convenience stores. HEETS were visible to the customers in 46.1% of POS, 35% carried at least four HEETS colours, 20.0% had IQOS/HEETS special displays, and 13.8% displayed HEETS near youth-oriented merchandise. Mean HEETS pack price was 8.7 USD (range: 7.5-11.3 USD), 27% more than the least expensive cigarette pack, and 39% less than the most expensive cigarette. HEETS promotions were uncommon. Compliance with the newly-introduced advertisement ban was fairly high for HEETS (94.8%). Only one POS was located in a low-SES area; 68.7% were in close proximity to a school. CONCLUSION The relatively limited IQOS/HEETS marketing at POS suggests that, with regulatory changes, online or other forms of marketing might be prioritized. IQOS may be promoted to higher SES populations, as indicated by pricing and POS neighbourhood characteristics. Access near schools and placement near youth-oriented merchandise are potential concerns necessitating further research. IMPLICATIONS Globally, the point-of-sale is considered the least regulated channel for advertising and marketing of tobacco products. Assessing IQOS marketing strategies at the point-of-sale provides valuable findings that can inform regulatory efforts in Israel and other countries as well. Limited IQOS/HEETS marketing at point-of-sale suggests that primary marketing strategies may shift to online or other forms/channels as regulatory contexts become more progressive/restrictive. Ongoing surveillance of IQOS via online marketing and point-of-sales, specifically with regard to product placement and proximity to schools, is needed.
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Affiliation(s)
- Yael Bar-Zeev
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Carla J Berg
- Milken Institute School of Public Health, George Washington University, NW, Washington, USA
| | - Lorien C Abroms
- Milken Institute School of Public Health, George Washington University, NW, Washington, USA
| | - Maya Rodnay
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Daniel Elbaz
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Amal Khayat
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
| | - Hagai Levine
- Braun School of Public Health and Community Medicine, Faculty of Health, The Hebrew University of Jerusalem and Hadassah, Jerusalem, Israel
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Myers V, Lev E, Guttman N, Tillinger E, Rosen L. "I can't stand it…but I do it sometimes" parental smoking around children: practices, beliefs, and conflicts - a qualitative study. BMC Public Health 2020; 20:693. [PMID: 32408872 PMCID: PMC7226982 DOI: 10.1186/s12889-020-08863-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
Background Many parents continue to smoke around their children despite the widely known risks of children’s exposure to tobacco smoke. We sought to learn about parental smoking behavior around children from parents’ perspective. Methods Semi-structured interviews were conducted with 65 smoking parents or partners of smoking parents of children up to age 7, to learn about home smoking rules, behaviours performed to try to protect children, and smoking-related conflicts, from parents’ perspective. Interviews were recorded and transcribed and thematic analysis performed. Recruitment was challenging due to the sensitive nature of the topic. Results Many parents described smoking around their children in certain areas of the home, outdoors, and in what they consider to be open or ventilated areas. Participants emphasized efforts to protect their children and described various mitigating practices but held mixed views as to their effectiveness. Parents had different conceptions of which areas or distances were considered ‘safe’. Many smoking parents described conflicts both internal and with other family members regarding the protection of children. Some parents who continue to smoke around their children despite understanding the health risks felt powerless to effect change, as well as being uncertain as to the effectiveness of their protective strategies; others were aware but reluctant to change. Conclusion Findings shed light on some of the difficulties faced by smoking parents and obstacles to maintaining a smoke-free environment for their children, providing insight for the type of information and support required to help parents better protect their children from exposure to tobacco smoke. Awareness of health risks associated with secondhand smoke was demonstrated, yet parents in smoking families were confused regarding which rules and behaviours best protect children from exposure to tobacco smoke. Parents were sometimes aware that their smoking ‘rules’ and mitigating practices were limited in their effectiveness. Guidelines should be provided explaining how and when exposure occurs and how to keep children safe.
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Affiliation(s)
- Vicki Myers
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel.
| | - Eimi Lev
- Department of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel.,Department of Communications, Gordon College of Education, Haifa, Israel
| | - Nurit Guttman
- Department of Communications, Faculty of Social Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Efrat Tillinger
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
| | - Laura Rosen
- Department of Health Promotion, School of Public Health, Faculty of Medicine, Tel Aviv University, Ramat Aviv, Tel Aviv, Israel
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