Implications For Tobacco Control Research Articles

E-cigarette flavours and vaping as a social practice: implications for tobacco control

ABSTRACT E-liquid flavours are perhaps the most materially disruptive aspect of vaping compared with smoking, especially for people who smoke tobacco and who wish to quit. A better understanding of whether and how e-liquid flavours create personal and social value for people who smoke may offer insights into how vaping has become a social practice among this group. These insights may be useful for countries such as New Zealand, where health authorities have endorsed e-cigarettes to help achieve the Government’s Smokefree 2025 goal. We drew on longitudinal in-depth interviews with 11 New Zealand young adults (19–29 years old) who smoked tobacco and who were willing to try an e-cigarette to stop smoking. Each participant was interviewed five times over 18–24 weeks during 2018–2019 and at every interview asked about their e-liquid flavour use and perceptions and experiences of these flavours compared to smoking. We thematically analysed the transcripts with an emphasis on exploring tensions between old and new skills, meanings, and emotions associated with smoking, vaping, and e-liquid flavours. We found that flavours could disrupt tobacco’s value proposition by provoking emotional responses that had a crucial impact on participants’ feelings of emotional security when vaping. Competence to deal with initially unsettling feelings when vaping was key to helping participants reorient meanings and emotions and embed vaping in their lives. As e-liquids are purchased regularly, and flavours ideally sampled in-person, countries could optimise vaping regulations by limiting online sales and mandating cessation advice and support at all point-of-sale interactions.

A longitudinal study of transitions between smoking and smokeless tobacco use from the ITC Bangladesh Surveys: implications for tobacco control in the Southeast Asia region.

In Southeast Asia, tobacco use is a major public health threat. Tobacco users in this region may switch between or concurrently use smoked tobacco and smokeless tobacco (SLT), which makes effective tobacco control challenging. This study tracks transitions of use among different product users (cigarettes, bidis, and SLT) in Bangladesh, one of the largest consumers of tobacco in the region, and examines factors related to transitions and cessation. Four waves (2009-2015) of the International Tobacco Control (ITC) Bangladesh Survey with a cohort sample of 3245 tobacco users were analysed. Generalized Estimating Equations (GEE) models were used to explore the socioeconomic correlates of transitions from the exclusive use of cigarettes, bidis, or SLT to the use of other tobacco products or quitting over time. Among exclusive cigarette users, most remained as exclusive cigarette users (68.1%). However, rural smokers were more likely than urban smokers to transition to bidi use (odds ratio [OR]=3.02, 95% confidence interval [CI]=1.45-6.29); to SLT use (OR=2.68, 95% CI=1.79-4.02) and to quit tobacco (OR=1.57, 95% CI=1.06-2.33). Among exclusive bidi users, transitional patterns were more volatile. Fewer than half (43.3%) of the exclusive bidi users maintained their status throughout the waves. Those with higher socio-economic status (SES) were more likely to quit (OR=4.16, 95% CI=1.08-13.12) compared to low SES smokers. Exclusive SLT users either continued using SLT or quit with minimal transitions to other products (≤2%). Nevertheless, males were more likely to switch to other tobacco products; younger (OR=2.94, 95% CI=1.23-6.90 vs. older), more educated (OR=1.55, 95% CI=1.77-3.12 vs. less educated), and urban SLT users (OR=0.52, 95% CI=0.30-0.86 for rural vs. urban users) were more likely to quit. Complex transitional patterns were found among different types of tobacco product users over time in Bangladesh. These findings can inform more comprehensive and multi-faceted approaches to tackle diversified tobacco use in Bangladesh and neighbouring countries in the Southeast Asia region with similar tobacco user profiles of smoked tobacco and SLT products. This is an unfunded observational study with the use the ITC Bangladesh datasets. The ITC Bangladesh Surveys were supported by grants from the US National Cancer Institute (P01 CA138389), the International Development Research Centre (IDRC Grant 104831-003), and Canadian Institutes of Health Research (MOP-79551, MOP-115016).

Trends in Smoking Prevalence and Intensity between 2010 and 2018: Implications for Tobacco Control in China.

Background: China is the world’s largest producer and consumer of cigarettes. Since 2010, the Chinese government has implemented many policies to combat the tobacco epidemic, yet little is known about their overall impacts. This study aims to investigate the trends in smoking prevalence and intensity between 2010 and 2018. Methods: We use five waves of data from China Family Panel Studies (CFPS), a nationally representative survey, to examine the trends in smoking prevalence and intensity. We use the chi-square test and t-test to examine differences across waves. Binary logistic regressions and linear regressions are applied to examine the association between smoking behaviors and risk factors. Results: The current smoking prevalence dropped from 30.30% in 2010 (90% CI 29.47–31.31) to 28.69% (90% CI 27.69–29.69) in 2018. As for smoking intensity, the average daily cigarettes consumption decreased steadily from 16.96 cigarettes (90% CI 16.55–17.36) in 2010 to 15.12 cigarettes (90% CI 15.07–15.94) in 2018. Smoking risk factors for men included marriage status, education level, employment status, alcohol consumption, and physical activities. The smoking risk was higher for women with a lower education level, lower household income, unemployment status, and alcohol consumption behavior. Conclusions: Our study shows declined trends in both smoking prevalence and intensity between 2010 and 2018, suggesting some positive progress in tobacco control in China. Nonetheless, to achieve the goal of reducing smoking prevalence among people aged 15 and above to less than 20% by 2030, the Chinese government needs to take stronger anti-tobacco measures.

Health Effects of Tobacco at the Global, Regional, and National Levels: Results From the 2019 Global Burden of Disease Study.

The purpose was to quantify the health effects of tobacco using data from the 2019 Global Burden of Disease study. We collected detailed information on tobacco consumption overall as well as its individual aspects (smoking, secondhand smoke, and chewing tobacco) for the deaths and disability-adjusted life years (DALYs) for all-cause disease, cardiovascular disease, neoplasms, and chronic respiratory diseases, and their age-standardized rates (ASRs). Tobacco was responsible for 8.71 million deaths and 229.77 million DALYs globally in 2019. The ASRs of all tobacco-related deaths and DALYs declined from 1990 to 2019, to 108.55 deaths per 100 000 population and 2791.04 DALYs per 100 000 population in 2019. During any year the ASRs of all tobacco-related deaths and DALYs were higher in males than in females. The ASRs of all tobacco-related deaths and DALYs were highest in countries with a low-middle sociodemographic index (SDI) and lowest in high-SDI countries in 2019. Cardiovascular disease, neoplasms, and chronic respiratory diseases were the three leading causes of tobacco-related mortality. Although the ASRs of deaths and DALYs related to tobacco have declined, the absolute number remain high. Tobacco control policies need to be strengthened further in order to reduce the heavy health burden of tobacco. This study provides a detailed description on the health effects of tobacco, including maps of the current global burden of tobacco-related disease. Although the ASRs of tobacco-related deaths and DALYs have declined, the absolute numbers remain high-tobacco was responsible for 8.71 million deaths and 229.77 million DALYs globally in 2019. The findings may have implications for tobacco control. Countries where progress has been slower in reducing tobacco-related disease burden should study and consider implementing policies and strategies that have been applied in countries like Singapore which show the greatest declines for recent decades.

A comprehensive economic assessment of the health effects of tobacco use and implications for tobacco control in Bangladesh

BackgroundDespite modest progress in reducing tobacco use, tobacco remains one of the major risk factors for non-communicable diseases in Bangladesh.MethodsUsing disease-specific, prevalence-based, cost-of-illness approach, this research estimated the economic costs...

Prevalence and determinants of dual and poly-tobacco use among males in 19 low-and middle-income countries: Implications for a comprehensive tobacco control regulation

Despite their implications for tobacco control, data on concurrent dual (using two tobacco products) and poly-tobacco use (using more than two products) are relatively scarce globally. This study aimed to estimate the prevalence of dual and poly-tobacco use among men in 19 low-and middle-income countries (LMICs) and assess potential associations with individual and country level factors. Data from 19 LMICs were obtained from the most recent wave of the Demographic and Health Survey (DHS), collected between 2015 and 2016 comprising 235,975 men aged 15–49 years. The prevalence of current single, dual and poly-tobacco use were estimated using available sample weights. Mixed-effect multilevel models were used to estimate associations of individual and country level factors with tobacco use. Results showed that the prevalence of dual or poly-tobacco use among men was highest in Timor Leste (27.1%), Nepal (18.3%), Lesotho (13.2%) and India (9.3%). Factors associated with dual and poly-tobacco use were older age, low academic achievement, low income status, being divorced, living in urban areas and high frequency of media use. Among country-level characteristics, national wealth was not associated with dual and poly-tobacco use. Implementation of MPOWER measures was inversely associated with single tobacco use; this was not the case for dual and poly-tobacco use. Findings suggest that dual and poly-tobacco use are common among men especially in South-East Asian countries. This study highlights the need for MPOWER measures to be expanded and strengthened to address all tobacco products and explicitly consider dual and poly use.

The effect of cigarette smoking on subjective well-being in South Africa and its implications for tobacco control

Orientation: The effect of cigarette smoking on health and economic well-being has been widely studied. Its effect on subjective well-being measures, such as life satisfaction, has received less scholarly attention.Research purpose: This study tested the effect of cigarette smoking on life satisfaction amongst smokers in South Africa as a precursor to assessing the effectiveness of traditional tobacco control methods.Motivation for the study: Taxation has long been the primary tool for tobacco control in South Africa; however, the psychological effects of cigarette smoking are not considered when selecting tobacco control tools.Research approach/design and method: The study applied an ordered probit regression to a panel of five waves of the National Income Dynamics Study (NIDS) data to test the relationship between cigarette smoking and life satisfaction in South Africa.Main findings: Smoking was found to negatively affect an individual’s likelihood of reporting higher satisfaction with life relative to non-smokers, a finding that is in line with the limited literature on the subject and with the findings of similar studies that used objective measures of well-being. Furthermore, the current tobacco control framework is not as effective as expected as smoking prevalence is fairly constant, notably amongst the poor, despite large increases in excise duties on cigarettes over time.Practical/managerial implications: The study’s main finding promotes the case for reassessing the approach taken to formulating tobacco control policies and for implementing alternative tobacco control policies that consider the psychological effects of cigarette smoking. As smoking cessation is shown to increase the likelihood of reporting higher life satisfaction, measures aimed at cessation (such as broad-scale smoking bans) could prove more successful than taxation.Contribution/value-add: This study contributes to the limited literature regarding the relationship between subjective well-being and cigarette smoking in the developing world. The study provides insight to whether standard tobacco control policies should be applied generically without accounting for the relationship between cigarette smoking and subjective well-being.

Association Between Serum Cotinine Level and Serological Markers of Epstein-Barr Virus in Healthy Subjects in South China Where Nasopharyngeal Carcinoma Is Endemic.

Introduction: Self-reported smoking has been associated with higher seropositivity for the IgA response to Epstein–Barr virus (EBV) viral capsid antigen (VCA-IgA) and transcription activator protein (Zta) in healthy men in southern China where nasopharyngeal carcinoma (NPC) is endemic. Results on the association of biochemically verified smoking status with EBV reactivation are scarce. We aimed to investigate the relations of serum cotinine level with serological markers of EBV in healthy women, in addition to men.Methods: We collected information on demographic, lifestyle, environmental factors, and EBV serological markers in a cross-sectional study on 2,275 healthy subjects who were recruited from physical examination centers in Guangdong Province, China. In the present analysis, 901 subjects' serum cotinine levels have been measured by enzyme-linked immunosorbent assay (ELISA). Odds ratios (seropositivity of four EBV serological markers vs. seronegativity) for categorical serum cotinine levels were calculated by unconditional logistic regression with a group-specific confidence interval (CI).Results: In women, compared with lower serum cotinine level (0–0.71 ng/ml), higher cotinine level (>0.71–1.20 ng/ml; >1.20–228.40 ng/ml) was associated but non-significantly with higher seropositivity for EBV VCA-IgA (age- and education-adjusted OR = 1.18, 95% CIs = 0.84–1.64, 1.06, 0.75–1.50). These associations remained but still non-significant after adjusting for 5-year age group, education, family history of cancer, consumption of tea, Chinese herbal tea, salted fish at childhood, and exposure to occupational dust, chemical, fume, and radiation (multivariable adjusted OR = 1.21, 95% CIs = 0.85–1.71, 1.09, 0.76–1.55). In men, compared with lower serum cotinine level (0–2.15 ng/ml), higher cotinine level (>2.15–103.6 ng/ml; >103.6–419.4 ng/ml) was significantly associated with higher seropositivity for EBV VCA-IgA and Zta-IgA (age- and education-adjusted OR = 2.16, 95% CIs = 1.37–3.41, 1.79, 1.11–2.90; 1.98, 1.17–3.34, 1.95, 1.14–3.34). The association remained significant after adjusting for potential confounders for Zta-IgA (OR = 2.32, 95% CI = 1.37–3.93 for >2.15–103.6, and 2.50, 1.43–4.38 for >103.6–419.4 ng/ml), but not for VCA-IgA (2.06, 1.29–3.27, and 1.61, 0.96–2.71).Conclusions: Higher serum cotinine level is associated with higher seropositivity for EBV serological markers in healthy men in southern China. Such positive association was also observed in women but became non-significant. If confirmed to be causal, this finding has important implications for tobacco control and prevention of EBV-related disease, particularly for NPC.

A Duty to Consult Foreign Investors When Changing the Regulatory Framework? Implications for Tobacco Control and Beyond

Several decisions of international investment tribunals can be read as suggesting that fair and equitable treatment may oblige governments to consult foreign investors in the course of developing new laws and policies. This position would significantly expand the concept of fair and equitable treatment, and goes far beyond what most domestic legal systems require of governments. Generally speaking, there may be sound instrumental and normative reasons for engaging in consultation with affected stakeholders in the course of legislative and policy development. However, with the exception of treaty provisions that otherwise so provide, no duty of consultation in the lawmaking process arises from fair and equitable treatment clauses, customary international law or general principles of law. Therefore, industries such as the tobacco industry are unlikely to succeed in a claim of failure to properly engage in consultation in the process of lawmaking.

Youth perspectives on concurrent smoking and vaping: Implications for tobacco control

Most people who smoke cigarettes begin young. Consequently, public health efforts directed at youth are a priority. The increasing popularity of electronic nicotine delivery systems (ENDS) among youth in the United States has raised concerns in the public health community about the potential of ENDS to renormalize cigarette smoking and perpetuate nicotine addiction, creating dual users who both vape and smoke. Despite limited and inconclusive evidence about dual use for young people, restrictive approaches towards ENDS have shaped tobacco control agendas in the United States. Based on analysis of 26 interviews with young dual users in California, we explored the meanings young people ascribe to their dual using practices and how those meanings relate to the broader tobacco control environment which structures their lives. Results suggest that dual users of ENDS and cigarettes overwhelmingly perceive a utilitarian meaning of dual use and view vaping as a tool for reducing smoking-related harm in the near term and facilitating quitting smoking in the long term. Also, participants’ narratives related to Tobacco 21 laws, which prohibit sales of both ENDS and cigarettes to individuals under 21 years of age, revealed concerns about restrictive policies that limit access to less harmful tobacco products. Results of this study raise important questions about whether we are working towards further reductions in the prevalence of smoking and tobacco-related diseases.

One unhealthy commodities industry? Understanding links across tobacco, alcohol and ultra-processed food manufacturers and their implications for tobacco control and the SDGS

One unhealthy commodities industry? Understanding links across tobacco, alcohol and ultra-processed food manufacturers and their implications for tobacco control and the SDGS

Framing Tobacco Dependence as a “Brain Disease”: Implications for Policy and Practice

Like other forms of drug dependence, tobacco dependence is increasingly being described as a "chronic brain disease." The potential consequences of this medical labelling have been examined in relation to other addictions, but the implications for tobacco control have been neglected. Some have posited that biomedical conceptions of addiction will reduce stigma and increase uptake of efficacious treatments. Others have countered that it could increase stigma, reduce treatment seeking, and deter unassisted quitting. We explored how smokers respond to the labelling of smoking as a brain disease. Semi-structured interviews with 29 Australian smokers recruited using purposive sampling. Thematic analysis was used to analyze the results. Most participants questioned the accuracy of the brain disease label as applied to smoking. They believed that smoking was not a chronic disease because they perceived smoking to be an individual's choice. In addition, many believed that this label would increase the stigma that they already felt and, did not want to adopt a "sick role" in relation to their smoking. Describing smoking as a brain disease is more likely to alienate smokers than to engage them in quitting. The application of overly medical labels of smoking are inconsistent with smokers own conceptualizations of their smoking, and may have unintended consequences if they are widely disseminated in healthcare settings or antismoking campaigns. The participants in this project believed that biomedical labels of smoking as a "brain disease" or a "chronic disease" were discordant their existing understandings of their smoking. Explanations of addiction that downplay or ignore the role of choice and autonomy risk being perceived as irrelevant by smokers, and could lead to suspicion of health professionals or an unwillingness to seek treatment.

Commentary on Greenland (2016): Tobacco companies' response to plain packaging in Australia and implications for tobacco control.

Commentary on Greenland (2016): Tobacco companies' response to plain packaging in Australia and implications for tobacco control.

The gendered experience of smoking stigma: implications for tobacco control

Tobacco denormalization is a widely accepted tobacco control strategy, shaping policies and programs throughout the United States as well as globally. In spite of widespread beliefs about the effectiveness of tobacco denormalization approaches, concerns about their emphasis on stigmatization have emerged. Social science research on smoking stigma raises questions about the potential iatrogenic consequences of tobacco denormalization approaches. Few studies have considered how smoking stigma may be internalized differently by different people, particularly those who experience stigmatization because of other socially ascribed makers of inequity (e.g. race, ethnicity, gender, sexuality). The intersection of multiple stigmas may work to intensify the ‘social isolation and marginalization’ that some people already experience. This paper presents results from a pattern-level analysis of focus group and interview data from a study investigating smoking-related stigma and perceptions of tobacco denormalization approaches among 15 low income Black women who smoke in the San Francisco Bay Area. Our analysis revealed a cycle where Black women’s experiences with structural oppression resulted in stress and the use of cigarettes to cope with that stress. Though the connection between smoking and stress is well documented in previous research, our analysis further revealed the additional contribution of the stigmatization of smoking and how it intensifies inequity for Black women who smoke. Implications of these findings for tobacco control and prevention are discussed.

A Qualitative Study on Chinese Canadian Male Immigrants' Perspectives on Stopping Smoking: Implications for Tobacco Control in China.

China has the largest number of smokers in the world; more than half of adult men smoke. Chinese immigrants smoke at lower rates than the mainstream population and other immigrant groups do. This qualitative study was to explore the influence of denormalization in Canada on male Chinese immigrant smoking after migration. Semistructured interviews were conducted with 22 male Chinese Canadian immigrants who were currently smoking or had quit smoking in the past 5 years. The study identified that, while becoming a prospective/father prompted the Chinese smokers to quit or reduce their smoking due to concern of the impacts of their smoking on the health of their young children, changes in smoking were also associated with the smoking environment. Four facilitators were identified which were related to the denomormalized smoking environment in Canada: (a) the stigma related to being a smoker in Canada, (b) conformity with Canadian smoking bans in public places, (c) the reduced social function of smoking in Canadian culture, and (d) the impact of graphic health messages on cigarette packs. Denormalization of tobacco in Canada in combination with collectivist values among Chinese smokers appeared to contribute to participants' reducing and quitting smoking. Although findings of the study cannot be claimed as generalizable to the wider population of Chinese Canadian immigrants due to the small number of the participants, this study provides lessons for the development of tobacco control measures in China to reverse the current prosmoking social environment.

Awareness, trial, and current use of electronic cigarettes in 10 countries: Findings from the ITC project.

Background: In recent years, electronic cigarettes (e-cigarettes) have generated considerable interest and debate on the implications for tobacco control and public health. Although the rapid growth of e-cigarettes is global, at present, little is known about awareness and use. This paper presents self-reported awareness, trial and current use of e-cigarettes in 10 countries surveyed between 2009 and 2013; for six of these countries, we present the first data on e-cigarettes from probability samples of adult smokers. Methods: A cross-sectional analysis of probability samples of adult (≥ 18 years) current and former smokers participating in the International Tobacco Control (ITC) surveys from 10 countries. Surveys were administered either via phone, face-to-face interviews, or the web. Survey questions included sociodemographic and smoking-related variables, and questions about e-cigarette awareness, trial and current use. Results: There was considerable cross-country variation by year of data collection and for awareness of e-cigarettes (Netherlands (2013: 88%), Republic of Korea (2010: 79%), United States (2010: 73%), Australia (2013: 66%), Malaysia (2011: 62%), United Kingdom (2010: 54%), Canada (2010: 40%), Brazil (2013: 35%), Mexico (2012: 34%), and China (2009: 31%)), in self-reports of ever having tried e-cigarettes (Australia, (20%), Malaysia (19%), Netherlands (18%), United States (15%), Republic of Korea (11%), United Kingdom (10%), Mexico (4%), Canada (4%), Brazil (3%), and China (2%)), and in current use (Malaysia (14%), Republic of Korea (7%), Australia (7%), United States (6%), United Kingdom (4%), Netherlands (3%), Canada (1%), and China (0.05%)). Conclusions: The cross-country variability in awareness, trial, and current use of e-cigarettes is likely due to a confluence of country-specific market factors, tobacco control policies and regulations (e.g., the legal status of e-cigarettes and nicotine), and the survey timing along the trajectory of e-cigarette awareness and trial/use in each country. These ITC results constitute an important snapshot of an early stage of what appears to be a rapid progression of global e-cigarette use.

Recent Increases in Efficiency in Cigarette Nicotine Delivery: Implications for Tobacco Control

Recent increases in nicotine yield of cigarettes sold in the United States have been attributed by tobacco manufacturers to natural variation in agricultural products. We tested this assertion using data reported by the manufacturers. Data were collected from the annual reports filed with the Massachusetts Department of Public Health by 4 major manufacturers of cigarettes from 1997 to 2012. Reportable measures included nicotine yield (mg/cig) in smoke generated by a smoking machine based on the Massachusetts smoking regimen and nicotine content in the unburned tobacco per cigarette (mg/cig). We used multilevel linear mixed-effect models to examine temporal trends in and predictors of these measures, overall and by brand style and by brand family. While nicotine content remained relatively stable in the range of 12-14 mg/cig between 1998 and 2012, average nicotine yield increased significantly (p < .01) over time and ranged from the lowest level of 1.65 mg/cigarette in 1999 to the highest level of 1.89 mg/cigarette in 2011. Nicotine yield and yield-to-content ratio varied significantly among manufacturers and brand families. When controlling for market category and all available design features, the yield-to-content ratio of all manufacturers except Lorillard increased significantly over time. The data provided by tobacco manufacturers suggest that the increasing trend in yield is not related to variations in nicotine content but to the yield-to-content ratio, which contradicts their assertions of agricultural variations. Nicotine yield and yield-to-content ratio are controllable features of cigarettes, and they should be monitored and regulated by government agencies.

Use of smokeless tobacco and cigarettes among Nigerian youths: implications for tobacco control policies in Africa

Background: Smokeless tobacco (SLT) use among youths in Africa is an emerging epidemic. This paper aimed to determine patterns of tobacco use among youths in Nigeria and the implications for tobacco control in Africa. Methods: The cross-sectional study was conducted in Benue state, Nigeria, in 2011. The study population comprised of 536 randomly selected senior high school students aged 9–19 years. Results: About 17.7% of high school youths were current SLT users, 19.4% were current smokers and an alarming 11.9% used both smokeless and cigarette tobacco. After adjustment, significant predictors of SLT use among youths included their parents’ smoking status (OR 1.70, 95% C.I.: 1.01–2.87, p = 0.046) and the perception of the lack of harm from tobacco use (OR 2.06, 95% C.I.: 1.08–3.92, p = 0.027). Current cigarette smoking was again predicted by parental and peer smoking status (OR 2.58, 95% C.I.: 1.55–4.31and OR 2.93, 95% C.I.: 1.84–4.66, respectively). Adjusted regression analysis for dual tobacco use provided similar results. Conclusion: Both SLT and cigarette use, as well as dual use remains high, particularly among rural youth. Tobacco control policies based on the Framework Convention on Tobacco Control (FCTC) that primarily focus on reducing smoking in Nigeria and other African nations where SLT is popular should be modified to address not only cigarettes but also SLT use given the high use of both products singly and concurrently.

Seasonality in Sales of Nicotine Replacement Therapies: Patterns and Implications for Tobacco Control

Over the counter, nicotine replacement therapies (NRTs) are the most widely used smoking cessation treatment. This study sheds light on the seasonality of sales of NRT. A seasonal adjustment algorithm was applied to data on the sales of NRT products for 50 metro markets in the United States to test for and characterize seasonality in NRT sales. Granger's test was applied to the data to test whether changes in NRT sales systematically predicted changes in cigarette sales 1 month later. The results show (a) that sales of NRT products are seasonal, (b) that the seasonality pattern is the opposite of the seasonality pattern for cigarette sales, (c) that seasonally higher NRT sales in a given month tend to be followed by seasonally lower cigarette sales in the following month, and (d) that seasonally high months for NRT sales (January to March) correspond to seasonally low months for cigarette sales. NRT sales show a strong seasonality pattern that is the opposite of the seasonality pattern for cigarette sales. These patterns are indicative of seasonal variations in quitting behavior.

Tobacco control and the inequitable socio-economic distribution of smoking: smokers’ discourses and implications for tobacco control

Warning: this article contains strong language. This paper focuses on the ways in which social context structures smokers’ views of, and reactions to, tobacco control. This exploratory study examined the interactions between tobacco control and smokers’ social contexts and how this may be contributing to inequalities in smoking. We found in our sample that higher socio-economic status (SES) smokers are more likely to positively respond and adapt to tobacco control messages and policies, viewing them for their future health betterment. Lower SES smokers in our study, on the other hand, are in conflict with tobacco control and feel intransigent with regard to the effects that tobacco control is having on their smoking. A better understanding of how social context structures people's perceptions of tobacco control may help us to understand why social inequalities in smoking are deepening, and potentially what can be done better in tobacco control to decrease them.