Curb Tobacco Use Research Articles

Affect, risk perception, and the use of cigarettes and e-cigarettes: a population study of U.S. adults

BackgroundTobacco companies argue that the decision to smoke is made by well-informed rational adults who have considered all the risks and benefits of smoking. Yet in promoting their products, the tobacco industry frequently relies on affect, portraying their products as part of a desirable lifestyle. Research examining the roles of affect and perceived risks in smoking has been scant and non-existent for novel tobacco products, such as electronic cigarettes (e-cigarettes).MethodsWe examined the relationship between affect, perceived risk, and current use for cigarettes and e-cigarettes in 2015 in a nationally representative sample of 5398 U.S. adults who were aware of e-cigarettes.ResultsParticipants held various affective associations with tobacco products, and affect towards cigarettes was more negative than affect towards e-cigarettes. Using structural equation modeling (SEM), affect towards cigarettes and e-cigarettes was associated with cigarette smoking and e-cigarette use respectively, and these associations were both direct and partially mediated by risk perceptions towards smoking and e-cigarette use. More positive affect towards cigarettes or e-cigarettes was associated with lower perceived risks, which in turn was associated with higher odds of being a current cigarette or e-cigarette user.ConclusionsIn developing models explaining tobacco use behavior, or in creating public communication campaigns aimed at curbing tobacco use, it is useful to focus not only on the reason based predictors, such as perceptions of risks and benefits, but also on affective predictors. Educational efforts aimed at further smoking reductions should highlight and reinforce negative images and associations with cigarettes.

Are good knowledge and positive attitudes regarding the cigarettes and other tobacco products act prevalent among rural Indian adults?

Background: Cigarettes and other tobacco products (COTPA) Act is a legislation passed to curb tobacco use in India by imposing restrictions on tobacco products. This study appraised knowledge and attitudes regarding COTPA Act among adults in a rural area and elicited socio-demographic predictors of knowledge and attitudes regarding COTPA Act among study participants.Methods: A cross-sectional study was conducted from September to December 2014 on adults (aged ≥18 years) in a rural area of Coastal Karnataka. A pre-designed, pre-tested proforma was used to collect information from study participants regarding their knowledge and attitudes about COTPA Act. Knowledge and attitude scores were computed. A score of ≥4 was good knowledge and ≥3 was regarded as positive attitudes.Results: Nearly 49.14% had good knowledge, while 51.29% displayed positive attitudes. Those belonging to upper and upper middle socio-economic class (Class I+Class II) had higher odds for good knowledge (AOR=2.09, 95% CI=0.82-5.92), when compared to their counterparts belonging to other socio-economic classes. Age ≥60 years (AOR=3.80, 95% CI= 0.30-9.98), education beyond primary school (AOR=2.88, 95% CI=1.24-6.19), upper and upper middle class socio-economic status (AOR=3.68, 95% CI=1.34-7.02) were the key predictor variables for positive attitudes.Conclusions:Nearly half the study participants had good knowledge and positive attitudes towards COTPA Act. High socio-economic status could predict good knowledge, while age ≥60 years, education beyond primary school and a high socio-economic status were the key variables predicting positive attitudes. Educational campaigns can help improve knowledge. Assessment of knowledge and attitude is imperative prior to implementation of policies to ensure effectiveness.

A Tobacco-Free Medical Campus Policy Is Associated With Decreased Secondhand Smoke Exposure and Increased Satisfaction Among Military Medical Employees: Results of a Mixed-Methods Evaluation

Tobacco control is an ongoing concern for the U.S. Army. Although tobacco use is currently prohibited within all military hospitals and clinics, known as military treatment facilities (MTFs), no such facility had implemented a tobacco-free medical campus (TFMC) policy before 2012. This evaluation examined the effects of one Army installation's TFMC policy implementation at its medical facilities. Online questionnaires were distributed to medical campus employees, including Active Duty Soldiers, civilians, and contractors, before policy implementation (N = 1,210) and 12 months following policy implementation (N = 1,147). Chi-square analyses, independent t tests, and logistic regression models were utilized to examine pretest/post-test changes in employees' secondhand smoke (SHS) exposure; tobacco use, motivation to quit, and cessation; and health outcomes. Twenty-three focus groups, interviews, and informal discussions with 65 employees and patients were conducted 13 months after initial policy implementation to capture both the intended and unintended policy effects. After controlling for demographic characteristics, the study found that employees had more than twice the odds of exposure to SHS in the workplace at baseline than at 12-month follow-up (odds ratio: 2.06, 95% confidence interval: 1.73-2.46, p < 0.001). Employees also reported a lower prevalence of diagnosis with chronic bronchitis (p < 0.05) at follow up compared to baseline. Although the mean number of sick days taken for respiratory illness decreased over time, results were not significant after controlling for demographic factors. No significant differences existed in tobacco-use prevalence or quit rates among tobacco users over time. Employees reported significantly higher levels of satisfaction with a TFMC policy than the original policy (p < 0.001) though this finding was moderated by smoker status such that smokers reported lower levels of satisfaction with the policy over time. Qualitative findings revealed that the most common policy effect was that the policy caused smokers to change the location of where they used tobacco to off campus. Findings further revealed several unintended policy effects, including safety concerns and greater visibility of smokers in front of the MTF. The first Army MTF TFMC policy was associated with reported reductions in SHS exposure and improvements in some short-term health outcomes. The policy had no observed association with tobacco-use prevalence, motivation to quit, or cessation at 12-month follow-up. Focus group participants discussed several positive and negative policy effects. These policies should be expanded and studied in more depth across military installations, and policy makers should plan mitigation strategies to reduce unintended effects. This is an important step in military tobacco control, but additional efforts will be necessary to curb tobacco use within this population.

Campaign for a revised Tobacco Products Directive in the European Union: lessons learnt

In 2009, the European Commission (EC) made the decision to revise the outdated 2001 Tobacco Products Directive (TPD). This Directive relates to the subsequently agreed WHO Framework Convention on Tobacco...

A Risk-Continuum Categorization of Product Use Among US Youth Tobacco Users.

To examine prevalence and correlates of five mutually exclusive tobacco-use patterns among US youth tobacco users. A nationally representative sample of tobacco users (N = 3202, 9-17 years) was classified into five product-use patterns. Weighted multinominal and multivariate logistic regression models were used to examine prevalence of product-use patterns by gender, race and ethnicity, and grade level; and associations between product-use patterns and perceived accessibility of tobacco products, exposure and receptivity to pro-tobacco marketing, social benefits of smoking, and tobacco-associated risks. Dual use (ie, use of two product categories) was the most prevalent pattern (30.5%), followed by non-cigarette combustible only (26.7%), polytobacco (ie, use of three product categories; 17.5%), cigarette only (14.9%), and noncombustible only (10.4%) use. Product-use patterns differed by gender, race, and ethnicity. Compared to cigarette only users, dual and polytobacco users were more likely to be exposed to and be receptive to pro-tobacco marketing, and were less likely to acknowledge tobacco-use related risks (Ps < .05). Curbing tobacco use warrants research on users of more than one tobacco-product categories according to the risk-continuum categorization. We present a risk-continuum categorization of product-use patterns among tobacco users not older than 17 years. We classify tobacco users into five mutually exclusive product-use patterns: cigarette only users, non-cigarette combustible only users, noncombustible only users, dual use, and polytobacco use. This categorization overcomes limitations in current literature on tobacco-use patterns, which include exclusion of certain products (eg, e-cigarettes) and product-use patterns (eg, exclusive users of non-cigarette products), and inconsistent classification of tobacco users. It is parsimonious yet complex enough to retain differential characteristics of sub-tobacco users based on number (single, dual, polytobacco) and categories (cigarettes, non-cigarette combustibles, noncombustibles) of tobacco products consumed.

Economic policy - Public health linkage and the importance of a regional platform: The case of tobacco control.

Southeast Asia has been the source of some recent encouraging developments on the health front, particularly in the area of tobacco control. In December 2012, the Philippines passed a landmark sin tax legislation that restructures the decade-old tax system for tobacco and alcohol products, updates the tax rates and indexes them for automatic increases, and earmarks its incremental proceeds for universal health financing. In August 2013, Malaysia proposed to exclude tobacco from the Trans-Pacific Partnership Agreement (TPPA), a bid to protect tobacco control measures from any state-to-state or investor–state challenge. Earlier in July 2012, it was reported that Health Ministers of the Association of Southeast Asian Nations (ASEAN) agreed to withdraw tobacco from the ASEAN Free Trade Agreement (AFTA). While their actual Joint Statement made no mention of trade, the language referring to tobacco control was clear (ASEAN, 2012).

Alternative Tobacco Products as a Second Front in the War on Tobacco

Alternative Tobacco Products as a Second Front in the War on Tobacco

Smoking: Disease or Therapy

During the past 20 years Canada and several other state members of the WHO have been using regular sales tax increases as part of a policy to curb tobacco use. The WHO recent report (2015) on tobacco use classifies smoking as a disease. This report shows that the effect of tax increase on tobacco use is marginal and is difficult to isolate from the effects of other tobacco use measures such as restrictions on marketing, sales to minors, and public education. It is proposed that the unreasonable increase in tobacco taxes introduces additional stress on the smokers and further compromises their health. It is further proposed that tobacco use is treated as a form of selftherapy rather than a disease.

English

Tobacco has been recognized as a universal demerit good and it is well acknowledged fact that tobacco use in any form is potentially harmful from both economic and human development considerations. Government of India has enacted various legislations to curb tobacco use in recent times. The tobacco cessation clinics were set up in diverse settings to help people stop tobacco use. The present concept of mobile tobacco cessation clinic can be looked as an innovative step forward in reaching the youth population.

USPSTF: Primary Care Clinicians Can Help Curb Tobacco Use in Youths

Based on evidence produced in the past decade, the US Preventive Services Task Force (USPSTF) is recommending for the first time that primary care clinicians provide such interventions as education or brief counseling to prevent school-aged children and adolescents from initiating tobacco use. The advice marks a shift from the USPSTF�s position in 2003, when task force members concluded that evidence at that time was insufficient to recommend for or against routine screening for tobacco use or interventions to prevent tobacco use in these young populations.

Smoking habits in Hungary: analysis based on surveys of the past decade

Passing the amendments to the anti-smoking law in Hungary indicates a firm determination of the Department of Health to curb tobacco use. Professional steps were destined to follow policies and control measures. The Methodological Support Center for Smoking Cessation began operation at the National Korányi Institute of Tuberculosis and Pulmonology, Budapest, Hungary in 2012. The objective is to provide methodological assistance for evidence based smoking cessation support. The Center aspires to unite and direct the activities aimed at tobacco control, as well as initiate the drafting of appropriate medical guidelines. The Center works to ensure that information regarding smoking and personalized cessation support reaches wide range of Hungarian smokers through individual group and telephone counseling methods. Analysis of the results of national surveys conducted during the past decade on the adult population reveals that the proportion of daily smokers in Hungary has decreased to 28-29%. The proportion of men smokers (32-34%) indicates a more significant decrease, while the proportion of women smokers (24-25%) levels. Groups that are most affected by increased risk of smoking are people with low level of education, those facing economic hardship, the age groups of 17-34 and 35-64 years and women.

Analyzing Exposure, Use, and Policies Related to Tobacco Use on Campus for the Development of Comprehensive Tobacco Policies at Canadian Post-secondary Institutions

Canadians in their early twenties represent the highest prevalence of reported tobacco use among all age groups. With the majority of Canadian young adults accessing post-secondary education, post-secondary institutions can facilitate targeting of health promotion efforts to curb tobacco use among young adults. Effective targeting requires clear comprehensive campus tobacco policies. However, the development and implementation of comprehensive campus tobacco policies has been lacking among Canadian post-secondary institutions. As the first step towards the development of a comprehensive campus tobacco policy at the University of Guelph, an on-line survey of students, faculty and staff was conducted in November 2012. The objectives of this survey were two-fold: (1) Determine the current level of exposure to second-hand smoke on campus, the type and frequency of tobacco use, opinions on seven different tobacco policy options, and the level of awareness of current tobacco policies and programs and; (2) Determine if any associations between opinions on tobacco policy options and exposure to second-hand smoke and tobacco use existed. The results of this survey demonstrate that tobacco use is associated with opinions on tobacco policy options and that the level of awareness of tobacco policies and programs is relatively low and is not associated with tobacco use. This study represents one of the first studies to examine the association between tobacco use and support of policy options and awareness of tobacco policies and programs. As other post-secondary institutions develop comprehensive tobacco policies, these findings will serve as a comparison for other similar institutions.

Tabakkonsum im gesellschaftlichen Wandel. Verbreitung des Konsums und Einstellung zu Rauchverboten, Düsseldorf 1997–2009

Since the late 1990s several measures have been introduced in Germany to curb tobacco use and to protect non-smokers. Smoking bans in public spaces, including restaurants and pubs, are part of them. It is the aim of the paper to analyse the change in smoking prevalence and attitudes towards smoking bans in the population of Düsseldorf, Germany, over time. Random samples from the population register of the city of Düsseldorf of persons with German nationality, 18 years onwards were approached. Mail surveys were sent with up to 3 reminders in the years 1997, 1998, 2004, 2007 and 2009. Response rates were between 52% and 59% (N per date of comparison ca. 700-1 200). The number of daily smokers has declined between 1997/98 and 2009 from 33% to 21%. Likewise, the number of cigarettes smoked per day has declined. The number of respondents who favour smoking bans has increased. Rather than favouring a total ban, a partial ban is often preferred (with a zone for smokers). Whether a smoking ban is favoured depends on whether the respondent is using tobacco and whether dangers are ascribed to tobacco use and tobacco smoke. Self-rated health does not exert an impact on attitudes towards smoking bans with the exception of the most recent survey, done in 2009. Here those respondents were most often in favour of bans who considered their health as being very good. Possibly this reflects a new situation where the acceptance of smoking bans has become part of a self-perceived healthy lifestyle.

Effectiveness of Individual and Group Counseling for Cessation of Tobacco Habit Amongst Industrial Workers in Pimpri, Pune - An Interventional Study

In India, tobacco consumption is responsible for one of the highest rates of oral cancer in the world, the annual oral cancer incidence is steadily increasing among young tobacco users. Studies have documented efforts taken by physicians, doctors and even dentists, in the form of individual or group counseling to curb tobacco use in smoke or smokeless form. However, which one is more effective, still remains an unanswered question. The aim of the study was to compare the effectiveness of individual and group counseling for cessation of the tobacco habit amongst industrial workers in Pune and to compare quit rates. An interventional study design was selected for 150 industrial workers which were stratified randomly into three groups (control, individual and group counseling groups) and interventions were provided to individual and group counseling groups over a period of six months, which were then compared with the control group that received brief intervention at the start of the study. There was significant difference in the quit rates of the participants in the individual counseling group (ICG) and group counseling group (GCG) when compared at 6 months with the control counseling group (CCG). In the individual counseling group was 6% while in group counseling group it was 7.5% after six months of counseling. No conclusion could be drawn whether individual or group counseling were better interms of quit rates. Individual and group counseling groups were definitely better than the control group when compared at 3 and 6 months, respectively.

The cost-effectiveness of a school-based smoking prevention program in India

Intervention programs aimed at preventing tobacco use among youth have been shown to be effective in curbing tobacco use onset and progression. However, the effects of even very successful tobacco prevention programs may not always impress policy-makers and lay audiences. Economic analysis potentially strengthens the case. In this paper, we evaluate the cost-effectiveness of a youth tobacco use prevention program which has been translated and implemented in India, a developing country. Although programs like these are inexpensive to implement in the USA, they are even less expensive in India due to low labor costs. Our results show that the costs per quality-adjusted life-year added, due to averted smoking, was $2057, even without including averted medical costs. If we ignore student time, cost-effectiveness improves by roughly 10%. To put the cost-effectiveness of this smoking prevention program into context, it is over 24 times more cost-effective than dialysis in the USA, which costs $50,000 for a life-year.

Expectations for the United Nations high-level meeting on noncommunicable diseases

The United Nations General Assembly’s decision to convene a high-level meeting on the prevention and control of noncommunicable diseases (NCDs) worldwide in September 2011 is a major, timely opportunity to elevate chronic diseases onto the global stage and to encourage action by individual governments.1 Just as the 2001 United Nations General Assembly Special Session on HIV/AIDS was a pivotal moment in the global response to AIDS, there is hope that the September session on NCDs will become an historic rallying point. How shall we judge the success of the meeting? If Member States can address the following five critical elements, then new measurable goals and means of building accountability may be within reach. First, the meeting should put a spotlight on the true scale of morbidity and mortality caused by NCDs and the economic consequences for households, health systems and national economies. It should result in an endorsement of the World Health Organization (WHO) Action plan for the global strategy for the prevention and control of noncommunicable diseases2 and a commitment to a study of their projected economic impact as well as the cost of preventive action. Second, governments should commit to developing national NCD plans by convening, for example, a multisectoral national task force or commission to elaborate country-specific strategies and targets. WHO could support countries in this process. These plans should be required by 2013, with updates on specific targets by 2015 and continuous monitoring by the United Nations. The third key element of success is financing. It is unlikely that there will be new funds pledged at the meeting. In fact, it could be detrimental to focus on raising a specific amount of funding as this might distract governments from other key tasks. Rather than establishing a new institution such as a Global Fund for NCDs or expanding the mandate of the Global Fund to Fight AIDS, Tuberculosis and Malaria, we suggest three feasible financial avenues. These are: (i) seeking joint financing mechanisms such as public–private partnerships;3 (ii) investing in health system reform to deal better with NCDs, e.g. supply of essential drugs and devices, health worker retention, provision of diabetes care through primary providers; and (iii) including NCDs as a line item in government health budgets and donor reporting systems to help monitor budgetary allocations. A fourth requirement is the commitment of governments to strengthening national regulation of NCD risk factors, including pushing for change in the food and beverage industry. This should put into force regulatory frameworks to reduce consumption of trans-fatty acids, salt, alcohol and sugar. Finally, incentives and mechanisms to encourage cross-sectoral action and coordination are central to sustained progress. Finance ministries need to budget sufficient funds; agriculture ministries to reduce subsidies for harmful crops; trade ministries to enlarge access to essential medicines; urban planning and transport ministries to create opportunities for greater physical activity; and education ministries to ensure that school environments provide healthy diets through banning the sale and distribution of harmful foods in schools and promoting health education. Tobacco control efforts could lead discussions in each of these areas given that there have been considerable policy gains. These include the WHO Framework Convention on Tobacco Control and the practical assistance provided to governments through WHO’s MPOWER resources; commitments of more than US$ 500 million from the Bloomberg Family Foundation and the Bill & Melinda Gates Foundation; and increasing attention to the role of tobacco in bilateral trade agreements, in taxation policy and in agriculture. Despite such progress, there is still much work required to curb tobacco use as it is the single most important risk factor for NCDs and kills an estimated 5 million people annually. If the United Nations Secretary-General makes a strong declaration to support the WHO Framework Convention on Tobacco Control in New York this year, this will add significant weight to previous commitments to the Convention made in Geneva. While tobacco use is declining in most wealthy countries, it is increasing in many poor countries of the world, with profound consequences for the future of public health and development. As stock prices for tobacco continue to rise – underscoring the confidence of the markets in tobacco – clear decisions must be made on overcoming barriers to implementation of the WHO Framework Convention on Tobacco Control. These include: investment treaties and associated pressures to open markets; agriculture and loss of employment, and subsidies for harmful crops; difficulties in regulating the private sector; illicit trade in cigarettes and tobacco smuggling; and constraints to implementing tobacco taxation. We hold high expectations for what can be achieved at this high-level meeting, especially if Member States are willing to develop and support a strong outcomes document with agreed set targets and reporting mechanisms to ensure accountability to commitments. This is a crucial first step in stemming the global epidemic in NCDs.

Social Will for Tobacco Control among the Hungarian Public Health Workforce

More than 1 in 5 deaths in Hungary can be attributed to tobacco smoking. The role of the public health agency in responding to and ameliorating the tobacco epidemic in Hungary has been, until now, unexplored. This paper explores the social will of the public health agency workers to adopt tobacco control measures. 269 Hungarian public health workers throughout Hungary completed an electronic survey on the types of programs offered by the public health agency, the perceived level of responsibility to reduce tobacco use, and the social will of the agencies to curb tobacco use. Multivariate analyses were performed to estimate factors which contribute to the social will to curb tobacco use. 48% of public health workers in Hungary report that it is absolutely important for local public health agencies to offer tobacco prevention and cessation programs, but only 3% indicate that they have earmarked funds to support anti-tobacco programs. Most workers favor more programs and policies to curb tobacco use in Hungary, such as taxation (67%) and banning smoking in restaurants (81%) and confined sporting events (93%). Factors positively associated with a stronger social will for tobacco control included being a former or never smoker (versus a current smoker) (p < 0.001) and being middle age (40-49, p = 0.04 and 50-59, p = 0.01) (versus being under the age of 30). Based on a SWOT (strengths, weaknesses, opportunities and threats) analyses, we argue that public health workers have the potential to play an important role in disseminating health promotion programs and advocating for broader statewide policies that could reduce tobacco use and exposure to environmental tobacco smoke. However, such an opportunity is missed with neither designated funding nor a nationally-dedicated office to tobacco control in Hungary.

Reach of mass media among tobacco users in India: A preliminary report

Tobacco use is a health hazard and its use is attributed to a lack of knowledge regarding the ill effects of tobacco. To identify the exposure of different mass media among a representative cohort population in the Indian subcontinent and compare the reach of the different mass media among tobacco users and nonusers using the "reach of HIV information" as a model. Secondary Data Analysis of Indian National Family Health Survey-3. Any tobacco use, gender, source of HIV information. Use of mass media. Of the study group, 27% of males and 54.4% of females never read newspaper or magazine; 29.3% of males and 52.6% of females never heard radio; 12.4% of males and 25% of females never see television; and 79.3% of males and 93.46% of females did not see a movie at least once a month. The most common source of information of HIV was television among males (71.8%) and females (81%), whereas the least common source was leaders among males (0.8%) and females (0.2%). Television is the single largest media used by both genders and was a major source of HIV information dissemination. A well-designed tobacco control program similar to HIV awareness program will help to curb tobacco use. The reach of different media among Indian tobacco users is presented and HIV model of information dissemination may prove to be effective in tobacco control.

Tobacco use among rural schoolchildren of 13-15 years age group: A cross-sectional study

An estimated 186 million of the world population are school children of 13-15 years. Among them, approximately 34.8 million are current tobacco users.(1) In India, the most susceptible time for tobacco use is during adolescence and early adulthood (15-24 years). In rural settings, family members and neighbours who often ask young children to get tobacco from nearby shops. Media advertisements and colorfully packaged tobacco products act as pro-tobacco influences.(2) There is an urgent need to curb tobacco use among youth. Hence, this study was conducted to estimate the prevalence of tobacco use among rural school children of 13-15 years and to find the reasons for use of tobacco products. Also, reasons for initiation, access, availability, source of funding, knowledge about the dangers of tobacco consumption, tobacco use among family and teachers, and cessation behavior were assessed.

Tobacco control legislation in India: Past and present

Beginning with the Cigarettes Act, 1975, a number of legislative strategies and programs to curb tobacco use have been implemented in India, with limited success. Currently, the Cigarettes and Other Tobacco Products Act, 2003, is designed to curb the use of tobacco in order to protect and promote public health. This review presents a critical appraisal of the current situation in its historical context.