Anti-tobacco Mass Media Campaigns Research Articles

Televised Anti-Tobacco Media and Smoking Outcomes Among Heterosexual and Sexual Minority Adults in the United States.

The prevalence of smoking is higher among sexual minority (SM) individuals compared with heterosexuals. The impact of televised anti-tobacco mass media campaigns on smoking outcomes among SMs is not known. We examined whether televised anti-tobacco advertising was differentially associated with current smoking and smoking intensity for SM and heterosexual adults. We combined county-level anti-tobacco advertising data (gross rating points) with restricted, geocoded individual-level National Health Interview Survey data on smoking (2013-2015). We estimated associations between advertising and smoking outcomes, including potential effect modification by SM status. Greater anti-tobacco advertising exposure was associated with lower smoking prevalence (prevalence ratio [PR] = 0.97; 95% confidence interval [CI] = [0.94, 1.00]). Although the direction of the association differed for heterosexual and SM adults, differences were not statistically significant. No significant associations were observed with regard to smoking intensity. Associations between anti-tobacco advertising and smoking were not significantly different for heterosexual and SM adults.

Smoking initiation in Italian regions, 2014, and Regional Prevention Plans

to evaluate smoking prevalence in adolescents by Italian region from the Health Behaviour Study in School-aged Children (HBSC) of 2014 and to correlate it with the presence, in the 2014-2018 Regional Prevention Plans (PRPs), of school-based smoking prevention interventions. the 2014 HBSC surveillance system provided data on 48,000 adolescents aged 11, 13, and 15 years; Ministry of Health provided data for each PRP on interventions with a tobacco control component and, among them, school-based smoking prevention interventions. weekly smoking prevalence; proportion of school-based smoking prevention interventions out of prevention interventions with tobacco control measures. regions with the highest weekly smoking prevalence were Sardinia and Apulia for all age groups, Abruzzo for 11- and 15-year-old children, Basilicata for 15-year-old children, Bolzano for girls aged 13 years old; Liguria for females, Molise, Calabria, and Veneto for males. In the regions with the highest prevalence of smoking in 2014, in girls aged 11 and 13 years (Sardinia, Apulia, Basilicata, Liguria, Bolzano), a greater proportion of school-based smoking prevention interventions to be developed in the period 2014-2018 have been recorded. smoking prevalence in Italian adolescents is high, especially in 15-year-old children. Implementing policies recommended by the World Health Organization - Framework Convention on Tobacco Control (higher tobacco taxes, anti-tobacco mass media campaigns, plain tobacco package) could work synergistically with school-based interventions in order to decrease tobacco initiation among adolescents in Italy.

Which are the communication styles of anti-tobacco spots that most impress adolescents?

Abstract Objectives To evaluate emotions and opinions of Italian adolescents aged 13-18 years old about different anti-tobacco spots delivered by the mass media campaigns over the world. Methods A multicenter cross-sectional study was conducted. Italian students from different regions were enrolled. A video that collected 7 anti-tobacco spots from all over the world. The spots describe the tobacco dependence, the health damages and the tobacco components using different communication styles (funny, scientific, dramatic, comedians, shocking, and sad). Information on age, gender, smoking status of family and peers were gathered. Descriptive and univariate analysis of emotional and cognitive reactions to spots were performed with respect to gender, smoking status of adolescents, their peers and parents. Results 495 students were enrolled. 14% of them were current smokers. Two spots resulted to have most impressed the students: Sponge (29%) and Icons (18%). In the first spot the sponges represent human lungs, a pair of hands squeeze the tar from the sponge, revealing the cancer-producing tar that goes into the lungs of a pack-a-day smoker every year. The second one contrasts tobacco industry images such as a cowboy, a hip-hop DJ with a more accurate depiction of the repercussions of smoking: a dying man in a wheelchair who warns, ‘The reality is you can end up looking like this’. The reactions on these videos are disgust, reflection and sadness, respectively: Sponge 79%, 44% and 15%; Icons 60%, 3% and 20%. Univariate analysis showed differences by smoking status about video considered most impressive (p = 0.02) and by gender about the choice of spot in the role of the Minister of Health (p < 0.001). Conclusions The spot media campaigns that gave a clear and scientific message or that changed the “icon” of the smoker were preferred by adolescents. Further research is needed to study adolescents’ responses and smoking outcomes obtained by different anti-tobacco mass media campaigns. Key messages The study demonstrates the preference of adolescents for spot giving clear scientific messages or using strategies that fight manipulation of the tobacco industry and aimed at changing smoker’s icon. The present study underlines that it is necessary to monitor the effect of a multimedia campaign and to examine its longitudinal impact, especially its impact on smoking behavior.

A long way to go: 20-year trends from multiple surveillance systems show a still huge use of tobacco in minors in Italy.

Main aim was to describe youth smoking prevalence in Italy over the last two decades, and to provide recent trends in knowledge, attitudes towards smoking, awareness of anti-tobacco mass media campaigns, second-hand smoke (SHS) exposure and access to cigarettes. Figures from three surveillance systems, with 12 representative cross-sectional surveys (about 43 000 participants): European School Survey Project on Alcohol and Other Drugs, 15-16-year-old students, 1995-2015; Health Behaviour in School-aged Children, 11-, 13-, 15-year-old students, 2002-14 and Global Youth Tobacco Survey, 13-15-year-old students, 2010, 2014. Among 11- and 13-year-old students, daily and non-daily smokers decreased by 30-50% from 2002 to 2014. Among 15-16-year-old adolescents, ever smokers significantly decreased by 10% in the period 1995-2015, whereas current and daily smokers have been stalling or even increased. Appeal of smoking increased in 2014 compared to 2010, perception of SHS as harmful, and awareness of recent anti-tobacco mass media campaigns decreased. Moreover, a significant 30% reduction in reporting retailers did not refuse to sell cigarettes to adolescents and a decrease in reporting to buy cigarettes were reported. Policies enforced in Italy over the last 20 years slightly reduced ever smokers, but did not decrease current and daily smokers in 15-16-year-old adolescents, and determined an impact among younger adolescents. Stricter rules on youth tobacco access reduced ease of access to cigarettes, but did not affect adolescents' tobacco use. Stronger tobacco control measures are urgently needed in order to determine a steeper decline in smoking prevalence in adolescents.

State-Specific Prevalence of Tobacco Product Use Among Adults - United States, 2014-2015.

Despite recent declines in cigarette smoking prevalence, the tobacco product landscape has shifted to include emerging tobacco products* (1,2). Previous research has documented adult use of smokeless tobacco and cigarettes by state (3); however, state-specific data on other tobacco products are limited. To assess tobacco product use in the 50 U.S. states and the District of Columbia (DC), CDC and the National Cancer Institute analyzed self-reported use of six tobacco product types: cigarettes, cigars, regular pipes, water pipes, electronic cigarettes (e-cigarettes), and smokeless tobacco products among adults aged ≥18 years using data from the 2014-2015 Tobacco Use Supplement to the Current Population Survey (TUS-CPS). Prevalence of ever-use of any tobacco product ranged from 27.0% (Utah) to 55.4% (Wyoming). Current (every day or some days) use of any tobacco product ranged from 10.2% (California) to 27.7% (Wyoming). Cigarettes were the most common currently used tobacco product in all states and DC. Among current cigarette smokers, the proportion who currently used one or more other tobacco products ranged from 11.5% (Delaware) to 32.3% (Oregon). Differences in tobacco product use across states underscore the importance of implementing proven population-level strategies to reduce tobacco use and expanding these strategies to cover all forms of tobacco marketed in the United States. Such strategies could include comprehensive smoke-free policies, tobacco product price increases, anti-tobacco mass media campaigns, and barrier-free access to clinical smoking cessation resources (1,4).

Inferring Social Influence of Anti-Tobacco Mass Media Campaign.

Anti-tobacco mass media campaigns are designed to influence tobacco users. It has been proved that campaigns will produce users' changes in awareness, knowledge, and attitudes, and also produce meaningful behavior change of audience. Anti-smoking television advertising is the most important part in the campaign. Meanwhile, nowadays, successful online social networks are creating new media environment, however, little is known about the relation between social conversations and anti-tobacco campaigns. This paper aims to infer social influence of these campaigns, and the problem is formally referred to as the Social Influence inference of anti-Tobacco mass mEdia campaigns (Site) problem. To address the Site problem, a novel influence inference framework, TV advertising social influence estimation (Asie), is proposed based on our analysis of two real anti-tobacco campaigns. Asie divides audience attitudes toward TV ads into three distinct stages: 1) cognitive; 2) affective; and 3) conative. Audience online reactions at each of these three stages are depicted by Asie with specific probabilistic models based on the synergistic influences from both online social friends and offline TV ads. Extensive experiments demonstrate the effectiveness of Asie.

Current Cigarette Smoking Among Adults - United States, 2005-2015.

Tobacco use is the leading cause of preventable disease and death in the United States, and cigarettes are the most commonly used tobacco product among U.S. adults (1,2). To assess progress toward achieving the Healthy People 2020 target of reducing the proportion of U.S. adults who smoke cigarettes to ≤12.0% (objective TU1.1),* CDC assessed the most recent national estimates of cigarette smoking prevalence among adults aged ≥18 years using data from the 2015 National Health Interview Survey (NHIS). The proportion of U.S. adults who smoke cigarettes declined from 20.9% in 2005 to 15.1% in 2015, and the proportion of daily smokers declined from 16.9% to 11.4%. However, disparities in cigarette smoking persist. In 2015, prevalence of cigarette smoking was higher among adults who were male; were aged 25-44 years; were American Indian/Alaska Native; had a General Education Development certificate (GED); lived below the federal poverty level; lived in the Midwest; were insured through Medicaid or were uninsured; had a disability/limitation; were lesbian, gay, or bisexual; or who had serious psychological distress. Proven population-based interventions, including tobacco price increases, comprehensive smoke-free laws, anti-tobacco mass media campaigns, and barrier-free access to tobacco cessation counseling and medications, are critical to reducing cigarette smoking and smoking-related disease and death among U.S. adults, particularly among subpopulations with the highest smoking prevalences (3).

Tobacco Advertising and Promotional Expenditures in Sports and Sporting Events - United States, 1992-2013.

Smokeless tobacco has been actively promoted by tobacco companies using endorsements by major sport figures, and research indicates that tobacco advertising can lead to youth initiation of tobacco use (1,2). Television and radio advertisements for cigarettes and smokeless tobacco have been prohibited since 1969,* and the 1998 Master Settlement Agreement(†) further prohibited tobacco companies from targeting youths with tobacco product advertisements in specified areas. In 2010, the Food and Drug Administration (FDA), under authority of the 2009 Family Smoking Prevention and Tobacco Control Act (FSPTCA), prohibited tobacco-brand sponsorship (i.e., sponsorship of sports and entertainment events or other social or cultural events using the tobacco brand name or anything identifiable with any brand of cigarettes or smokeless tobacco).(§) However, corporate-name tobacco sponsorship (i.e., sponsorship using the name of the corporation that manufactures regulated tobacco products) is still permitted under certain conditions.(¶) To monitor tobacco advertising and promotional activities in sports in the United States, CDC analyzed trends in sports-related marketing expenditures for cigarettes and smokeless tobacco during 1992-2013 using data from the Federal Trade Commission (FTC). During 1992-2013, sports-related marketing expenditures, adjusted by the consumer price index to constant 2013 dollars, decreased significantly for both cigarettes (from $136 million in 1992 to $0 in 2013) and smokeless tobacco (from $34.8 million in 1992 to $2.1 million in 2013). During 2010-2013, after the prohibition of tobacco-brand sponsorship in sports under the FSPTCA, cigarette manufacturers reported no spending (i.e., $0) on sports-related advertising and promotional activities; in contrast, smokeless tobacco manufacturers reported expenditures of $16.3 million on advertising and promoting smokeless tobacco in sports during 2010-2013. These findings indicate that despite prohibitions on brand sponsorship, smokeless tobacco products continue to be marketed in sports in the United States, potentially through other indirect channels such as corporate-name sponsorship. Enhanced measures are warranted to restrict youth-oriented tobacco marketing and promotional activities that could lead to tobacco initiation and use among children and adolescents (2). Reducing tobacco industry promotion through sponsorship of public and private events is an evidence-based strategy for preventing youth initiation of tobacco use (3). In addition, other proven interventions (e.g., tobacco price increases, anti-tobacco mass media campaigns, tobacco-free policies inclusive of smokeless tobacco, and barrier-free access to cessation services), could help reduce smokeless tobacco use in the United States (1).

Tobacco Product Use Among Adults - United States, 2013-2014.

While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products* has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic whites, non-Hispanic blacks, and non-Hispanics of other races(†); persons aged <45 years; persons living in the Midwest or South; persons with a General Educational Development (GED) certificate; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons with annual household income <$20,000; and persons who were lesbian, gay, or bisexual (LGB). Population-level interventions that focus on all forms of tobacco product use, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting tobacco use, in conjunction with FDA regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.(§).

OC08_04 Impact of New Graphic Health Warnings and Their Increased Size on Conventional and Plain Tobacco Packs: Perceptions of Asian Indians

Introduction: Evidence from high-income countries has shown tobacco control mass media campaigns to be cost-effective in reducing tobacco consumption, but similar evidence from low-income countries is rarely reported. An evaluation of the Government of India’s 2009 smokeless tobacco campaign, titled Surgeon, which ran nationally on television and radio for 5 weeks, provided an opportunity to test its cost-effectiveness. Objectives: To determine the cost-effectiveness of mass media campaigns in low and middle-income countries, using a national anti-smokeless tobacco mass media campaign from India as an example. The cost-benefit of the Indian campaign and the health savings accrued from the campaign were calculated. Methods: Standard methods of cost-benefit analysis using a societal perspective were employed. Primary data for the analysis was obtained from a nationally representative household survey of 2,898 smokeless tobacco users that was designed to test the Surgeon campaign’s impact. Campaign costs were estimated to be US$ 1,005,000. Based on the estimated additional quit attempt among smokeless users due to the national campaign compared to status quo, the burdens of smokeless population such as health expenditure, disabled adjusted life-years (DALYs). Results: The Surgeon campaign was found to be highly cost-effective: It resulted in an estimated additional 869,436 successful smokeless quitters after 1 year with a cost per net quit at US$1.16. It was further estimated that the campaign resulted in 20,106 Disability Adjusted Life Years gained and savings from direct medical costs worth US$ 4.9 million. The savings from the total medical costs (considering caregiver cost and labor loss) was worth US$ 21.9 million. The Incremental Cost-Effectiveness Ratio (ICER) of the campaign was US$ 50 per disabled-adjusted life year, which is significantly lower than India’s 2010 GDP/Capita of US$ 1400, the World Health Report recommended benchmark for identifying cost-effective interventions. Conclusion: These findings replicate evidence from high-income countries and suggest that anti-tobacco mass media campaigns can be highly cost-effective, with significant returns on investment, in low-income countries. They are recommended even in resourcelimited settings to combat tobacco related morbidity and mortality. Disclosure of Interest: None Declared

Overview of systematic reviews on the health-related effects of government tobacco control policies.

BackgroundGovernment interventions are critical to addressing the global tobacco epidemic, a major public health problem that continues to deepen. We systematically synthesize research evidence on the effectiveness of government tobacco control policies promoted by the Framework Convention on Tobacco Control (FCTC), supporting the implementation of this international treaty on the tenth anniversary of it entering into force.MethodsAn overview of systematic reviews was prepared through systematic searches of five electronic databases, published up to March 2014. Additional reviews were retrieved from monthly updates until August 2014, consultations with tobacco control experts and a targeted search for reviews on mass media interventions. Reviews were assessed according to predefined inclusion criteria, and ratings of methodological quality were either extracted from source databases or independently scored.ResultsOf 612 reviews retrieved, 45 reviews met the inclusion criteria and 14 more were identified from monthly updates, expert consultations and a targeted search, resulting in 59 included reviews summarizing over 1150 primary studies. The 38 strong and moderate quality reviews published since 2000 were prioritized in the qualitative synthesis. Protecting people from tobacco smoke was the most strongly supported government intervention, with smoke-free policies associated with decreased smoking behaviour, secondhand smoke exposure and adverse health outcomes. Raising taxes on tobacco products also consistently demonstrated reductions in smoking behaviour. Tobacco product packaging interventions and anti-tobacco mass media campaigns may decrease smoking behaviour, with the latter likely an important part of larger multicomponent programs. Financial interventions for smoking cessation are most effective when targeted at smokers to reduce the cost of cessation products, but incentivizing quitting may be effective as well. Although the findings for bans on tobacco advertising were inconclusive, other evidence suggests they remain an important intervention.ConclusionWhen designing and implementing tobacco control programs, governments should prioritize smoking bans and price increases of tobacco products followed by other interventions. Additional studies are needed on the various factors that can influence a policy’s effectiveness and feasibility such as cost, local context, political barriers and implementation strategies.Electronic supplementary materialThe online version of this article (doi:10.1186/s12889-015-2041-6) contains supplementary material, which is available to authorized users.

The effect of exposure to media campaign messages on adult cessation

IntroductionNumerous studies have examined the relationship between antitobacco mass-media campaigns and quit attempts. However, less is known about the effect of these campaigns on relapse. This paper evaluates the effect of media exposure on smokers' quit attempts and relapse. MethodsWe used data from the Florida Adult Cohort Survey, a telephone follow-up survey of adult smokers and recent quitters, who completed the Florida Adult Tobacco Survey. For this study, 1823 unique smokers and recent quitters from baseline first observed between July 2008 and October 2012 were surveyed through up to seven follow-up interviews between October 2009 and October 2013. Media exposure during this period primarily represents exposure to Florida's Tobacco Free Florida (TFF) campaign, although it also includes exposure to the Centers for Disease Control and Prevention's Tips From Former Smokers media campaign in 2012–2013. A multiple-spell discrete-time survival model was estimated using logistic regression. Each spell represents a quit attempt or relapse event. ResultsThe odds of the first observed quit attempt are higher at higher levels of target rating points (TRPs) (aOR=1.02, p=0.023). The odds ratio for relapse and second quit and second relapse was not statistically significant. ConclusionsThe results suggest that exposure to media campaign messages in Florida has led to increases in quit attempts. Although the estimates were not statistically significant for relapse or the second spell of quit attempts or relapse, the results suggest that media messages might also influence subsequent quit attempts or relapses after an initial quit attempt.

Cancer-Related News from the CDC

Cancer-Related News from the CDC

Effect of hypnotherapy on smoking cessation among secondary school students

Background: Hypnotherapy is widely promoted as a method for aiding smoking cessation. It is proposed to act on underlying impulses to weaken the desire to smoke or strengthen the will to stop. The aim of this study was to examine the effect of hypnotherapy on smoking cessation among secondary school students. Method: A random sample of 59 male smokers was selected from two governmental secondary schools. Design: A quasi- experimental design was used. Tools: Data were collected using; A- an Interview Questionnaire included; I- smoking assessment tool to determine the smoking rate among males students. II-Characteristics of studied students regarding smoking pattern. III- Smoking Cessation Questionnaire. B- Wisconsin smoking withdrawal scale. The hypnotherapy was implemented after assessing the rate of male smokers, the researchers trained the students in practicing self hypnosis, and asked them to practice it at home and to document the frequency of daily smoked packs for nine weeks. Results: The present study findings indicated that the rate of male smokers among secondary school students in Beni-Suef city was 52.4%, about two third of studied students (65.4%) stopped smoking after nine weeks of practicing hypnosis and the percentage of smoked packs of cigarettes/ day decreased after implementing the program. Conclusion: The present study findings showed that hypnotherapy has a therapeutic effectiveness in achieving a high rate of smoking cessation among secondary school students. There was a highly significant difference in total score of smoking withdrawal index before and after intervention. Recommendation: Community and school education programs should include sessions on quitting smoking, implementing school-based interventions in combination with antitobacco mass media campaigns.

Potential effectiveness of anti-smoking advertisement types in ten low and middle income countries: Do demographics, smoking characteristics and cultural differences matter?

Unlike high income countries, there is limited research to guide selection of anti-tobacco mass media campaigns in low and middle income countries, although some work suggests that messages emphasizing serious health harms perform better than other message types. This study aimed to determine whether certain types of anti-smoking advertisements are more likely to be accepted and perceived as effective across smokers in 10 low to middle income countries. 2399 18–34 year old smokers were recruited in Bangladesh, China, Egypt, India, Indonesia, Mexico, Philippines, Russia, Turkey and Vietnam to view and rate 10 anti-tobacco ads. Five ads were shown in all countries and five ads were chosen by country representatives, providing a total of 37 anti-smoking ads across all countries (10 graphic health effects ads, 6 simulated health effects, 8 emotional stories of health effects, 7 other health effects and 6 non-health effects). Smokers rated ads on a series of 5-point scales containing aggregated measures of Message Acceptance and Perceived Effectiveness. All ads and materials were translated into the local language of the testing regions. In multivariate analysis, graphic health effects ads were most likely to be accepted and perceived as effective, followed by simulated health effects ads, health effects stories, other health effects ads, and then non-health effects ads. Interaction analyses indicated that graphic health effects ads were less likely to differ in acceptance or perceived effectiveness across countries, gender, age, education, parental status and amount smoked, and were less likely to be affected by cultural differences between characters and contexts in ads and those within each country. Ads that did not emphasize the health effects of smoking were most prone to inconsistent impact across countries and population subgroups. Graphic ads about the negative health effects of smoking may be most suitable for wide population broadcast in low and middle income countries.

Current Cigarette Smoking Among Adults—United States, 2011

Despite significant declines during the past 30 years, cigarette smoking among adults in the United States remains widespread, and year-to-year decreases in prevalence have been observed only intermittently in recent years. To assess progress made toward the Healthy People 2020 objective of reducing the proportion of U.S. adults who smoke cigarettes to ≤12% (objective TU-1.1),* this report provides the most recent national estimates of smoking prevalence among adults aged ≥18 years, based on data from the 2012 National Health Interview Survey (NHIS). The findings indicate that the proportion of U.S. adults who smoke cigarettes fell to 18.1% in 2012. Moreover, during 2005-2012, the percentage of ever smokers who quit increased significantly, from 50.7% to 55.0%, and the proportion of daily smokers who smoked ≥30 cigarettes per day (CPD) declined significantly, from 12.6% to 7.0%. Proven population-level interventions, including tobacco price increases, high-impact antitobacco mass media campaigns, comprehensive smoke-free laws, and barrier-free access to help quitting, are critical to decreasing cigarette smoking and reducing the health and economic burden of tobacco-related diseases in the United States.

Anti‐tobacco mass media and socially disadvantaged groups: A systematic and methodological review

Only a limited amount of research has been conducted to explore whether there are socioeconomic status differences in responses to mass media. However, the methodological quality of this evidence has not been assessed, limiting confidence in conclusions that can be drawn regarding study outcomes. A systematic review of the effectiveness of anti-tobacco mass media campaigns with socially disadvantaged groups was conducted, and the methodological quality of included studies was assessed. Medline, The Cochrane Library, PsycInfo, Embase and Web of Science were searched using MeSH and keywords for quantitative studies conducted in Western countries prior to March 2012. A methodological quality assessment and narrative analysis of included studies was undertaken. Seventeen relevant studies (reported in 18 papers) were identified; however, weak study designs and selection bias were common characteristics, limiting strong conclusions about effectiveness. Using predominantly non-cessation related outcome measures reviewed papers indicated mixed results for mass media tobacco control campaign effectiveness among various social groups. Most studies assessed mass media impact on low socioeconomic status groups rather than highly socially disadvantaged groups. Methodological rigour of evaluations in this field must be improved to aid understanding regarding the effectiveness of mass media campaigns in driving cessation among disadvantaged groups. The results of this review indicate a gap in methodologically rigorous research into the effectiveness of mass media campaigns among socially disadvantaged groups, particularly the highly disadvantaged.

The balancing act: Experts' opinions about the relative resourcing of tobacco control efforts for the general population versus disadvantaged populations

Despite the persistent socioeconomic gradient associated with smoking, little is known about how to 'close the gap'. There is a debate regarding the implications of directing resources away from general population efforts towards disadvantaged groups. The study explored views of those with expertise in tobacco control about the appropriate balance of tobacco control resourcing between the general population and disadvantaged groups. A Web-based survey of 192 respondents (response rate 65%) working in tobacco control in Australia and New Zealand was completed. Respondents were sampled from the Australian and New Zealand Tobacco Control Contact List and a literature search. Respondents were asked to allocate a hypothetical budget for: (a) anti-tobacco mass media campaigns; and (b) tobacco control research. The vast majority (93%) of respondents believed that some tobacco control resources should be specifically directed towards disadvantaged groups. Respondents believed up to half of mass media resources should be directed towards disadvantaged groups. In the case of tobacco control research, the median allocation to the general population was approximately one-third of a hypothetical research budget. It appears there is a desire among the Australian and New Zealand tobacco control community for substantial effort to be directed towards disadvantaged groups. It is important to develop an evidence base to ensure an efficient and equitable approach to balancing the potentially competing demands of general population versus disadvantaged group activities in relation to tobacco control.

Impact of Tobacco Control Interventions on Smoking Initiation, Cessation, and Prevalence: A Systematic Review

Background. Policymakers need estimates of the impact of tobacco control (TC) policies to set priorities and targets for reducing tobacco use. We systematically reviewed the independent effects of TC policies on smoking behavior. Methods. We searched MEDLINE (through January 2012) and EMBASE and other databases through February 2009, looking for studies published after 1989 in any language that assessed the effects of each TC intervention on smoking prevalence, initiation, cessation, or price participation elasticity. Paired reviewers extracted data from studies that isolated the impact of a single TC intervention. Findings. We included 84 studies. The strength of evidence quantifying the independent effect on smoking prevalence was high for increasing tobacco prices and moderate for smoking bans in public places and antitobacco mass media campaigns. Limited direct evidence was available to quantify the effects of health warning labels and bans on advertising and sponsorship. Studies were too heterogeneous to pool effect estimates. Interpretations. We found evidence of an independent effect for several TC policies on smoking prevalence. However, we could not derive precise estimates of the effects across different settings because of variability in the characteristics of the intervention, level of policy enforcement, and underlying tobacco control environment.

Increasing Evidence for the Efficacy of Tobacco Control Mass Media Communication Programming in Low- and Middle-Income Countries

Antitobacco mass media campaigns have had good success at changing knowledge, attitudes, and behaviors with respect to smoking in high-income countries provided they are sustained. Mass media campaigns should be a critical component of tobacco control programs in low- and lower-middle-income countries. Mounting evidence shows that graphic campaigns and those that evoke negative emotions run over long periods of time have achieved the most influence. These types of campaigns are now being implemented in low- and middle-income countries. The authors provide 3 case studies of first-ever graphic warning mass media campaigns in China, India, and Russia, 3 priority high-burden countries in the global Bloomberg Initiative to Reduce Tobacco Use. In each of these countries, message testing of core messages provided confidence in messages, and evaluations demonstrated message uptake. The authors argue that given the initial success of these campaigns, governments in low- and middle-income countries should consider resourcing and sustaining these interventions as key components of their tobacco control strategies and programs.