Promote Tobacco Use Research Articles

The vector of the tobacco epidemic: tobacco industry practices in low and middle-income countries

To understand transnational tobacco companies' (TTCs) practices in low and middle-income countries which serve to block tobacco-control policies and promote tobacco use. Systematic review of published research on tobacco industry activities to promote tobacco use and oppose tobacco-control policies in low and middle-income countries. TTCs' strategies used in low and middle-income countries followed four main themes-economic activity; marketing/promotion; political activity; and deceptive/manipulative activity. Economic activity, including foreign investment and smuggling, was used to enter new markets. Political activities included lobbying, offering voluntary self-regulatory codes, and mounting corporate social responsibility campaigns. Deceptive activities included manipulation of science and use of third-party allies to oppose smoke-free policies, delay other tobacco-control policies, and maintain support of policymakers and the public for a pro-tobacco industry policy environment. TTCs used tactics for marketing, advertising, and promoting their brands that were tailored to specific market environments. These activities included direct and indirect tactis, targeting particular populations, and introducing new tobacco products designed to limit marketing restrictions and taxes, maintain the social acceptability of tobacco use, and counter tobacco-control efforts. TTCs have used similar strategies in high-income countries as these being described in low and middle-income countries. As required by FCTC Article 5.3, to counter tobacco industry pressures and to implement effective tobacco-control policies, governments and health professionals in low and middle-income countries should fully understand TTCs practices and counter them.

Pinocchio shows how to end the tobacco epidemic

When Tobacco Control published its first issue in 1992, the idea of ending the tobacco epidemic was not even on the horizon. Indeed, the goal was merely to get control...

Estrategias de las tabaqueras para captar fumadores jóvenes en España: una revisión de los documentos internos

Tobacco companies' strategies to promote tobacco use and undermine tobacco control policy are key in tobacco use among young people. The analysis of tobacco companies' internal documents can be instrumental in identifying those strategies, improving social support for tobacco control policy, and planning public health interventions. The goal of this study was to identify and analyze internal documents related to the activities of tobacco companies during the 1980s and 90s aimed at promoting smoking in young Spaniards. Electronic search by key word of tobacco industry documents held at the Legacy Tobacco Documents Library. More than 1,000 documents were identified and reviewed, including letters, messages, memos, and other documents. Seventeen documents related to the objective of the study are analyzed and discussed. Tobacco companies funded and conducted activities aimed at maintaining high smoking incidence and prevalence in Spain. These activities, which included research, cigarette and packaging design, promotion, and social and political manipulation, may have had an impact on current levels of tobacco use in Spain.

China's tobacco industry's communication practices: Paradoxes and proposals for public policymaking

The People's Republic of China's expanding tobacco-control efforts call for additional, urgent government action on two major fronts: (a) conducting comprehensive health-communication campaigns on the clinical and economic effects of tobacco use; and (b) requiring major policy changes in the (structural and administrative) relationships between the State Tobacco Monopoly Administration (STMA) and the industry at large, that is, primarily, the China National Tobacco Company (CNTC). China's signing (in 2003) and ratifying (in 2005) the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) place it in a position to adopt some of the anti-smoking measures common in some developed nations. Even though the country's tobacco industry acknowledges publicly health concerns over its products, it engages in communication practices that are paradoxical, in that they circumvent public-health initiatives and the expanding regulatory regimes of product-risk reduction even as the government promotes tobacco use. That paradox calls for three public-policymaking proposals: to conduct more comprehensive, nationwide health-communication campaigns; to use legislation to reduce tobacco use; and to restructure the tobacco industry.

Improving the Delivery of Global Tobacco Control

Tobacco control must remain a critical global health priority given the growing burden of tobacco-induced disease in the developing world. Insights from the emerging field of global health delivery suggest that tobacco control could be improved through a systematic, granular analysis of the processes through which it is promoted, implemented, and combated. Using this framework, a critical bottleneck to the delivery of proven health promotion emerges in the role that the tobacco industry plays in promoting tobacco use and blocking effective tobacco-control policies. This "corporate bottleneck" can also be understood as a root cause of massive disease and suffering upon vulnerable populations worldwide, for the goal of maximizing corporate profit. Naming, understanding, and responding to this corporate bottleneck is crucial to the success of tobacco-control policies. Three case studies of tobacco-control policy--South Africa, the Framework Convention on Tobacco Control, and Uruguay--are presented to explore and understand the implications of this analysis.

Talking to Iraq and Afghanistan War Veterans About Tobacco Use

Our goal in this study was to examine beliefs and attitudes about tobacco use in the newest generation of combat veterans, those who served in Afghanistan (Operation Enduring Freedom [OEF]) and Iraq (Operation Iraqi Freedom [OIF]). We held 5 focus groups (n = 17) with Minnesota Army National Guard soldiers who had recently returned from combat deployment in support of OEF/OIF. Sessions were audiorecorded, transcribed, coded, and analyzed using a grounded theory approach. We found that it is common to use tobacco in the combat zone for stress and anger management and boredom relief. Tobacco was also a tool for staying alert, a way to socialize, and provided a chance to take breaks. Participants recognized the culture of tobacco use in the military. Stress, nicotine dependence, the tobacco environment at drill activities, and perceived inaccessibility of cessation tools perpetuated use at home and served as a barrier to cessation. Repeatedly, participants cited tobacco policies (such as increased taxes and smoke-free workspaces) as motivators for quitting. There are specific circumstances common to combat zones that promote tobacco use. Results suggest that environmental changes that address the prominence of tobacco in military culture, the acceptance of nonsmoking breaks, and cessation programs that address stress issues and make cessation aids available may be effective in reducing tobacco use.

Dental Students’ Attitudes and Behavior Toward Smoking Cessation as Part of Their Professional Education

Background: Dental professionals have a major role in promoting tobacco use cessation (TUC). Purpose: The objective is to assess dental students’ knowledge, attitudes, behavior, and perception regarding their potential expected role. Methods: Self-administered anonymous questionnaires were used for all students of the Jerusalem Dental Medicine School. Results: Among 275 responding students, 17% reported smoking. Most students reported asking patients about smoking, counseling against smoking, and advising to quit. Only a minority reported providing antismoking educational material, suggesting nicotine replacements, and arranging follow-ups. Most students did not consider a list of suggested potential obstacles (lack of resources, not their role, etc.) as true barriers. Analysis by stage of studies revealed significant differences in reported TUC strategies and positive attitudes and decreases in perceived potential obstacles. Conclusions: These results indicate specific and practical areas for promoting antismoking intervention. Dental schools need to emphasize their role in preparing the next generation with a clear dedication toward TUC.

Prevalence and correlates of tobacco use among middle and high school students in western Alaska

Objectives. Tobacco use is the leading cause of preventable death in the United States and contributes to increased incidence, morbidity and mortality from cancer, heart disease, stroke, complications of pregnancy and respiratory illness. Tobacco use rates are highest among American Indians and Alaska Natives. This study examined the prevalence and correlates of tobacco use among youth residing in rural western Alaska.Study design. Data were analysed from the 2003 Youth Risk Behavior Survey (YRBS) administered to a regional sample of adolescents attending school in western Alaska.Methods. Data were analysed from 260 middle school (52% female, 87% Alaska Native) and 258 high school (48% female, 93% Alaska Native) students.Results. Among middle school students, 39% reported current use of ST, 24% reported cigarette smoking and 50% reported current use of any tobacco product. On multivariate analysis, independent correlates of current use of any tobacco were Alaska Native ethnicity (p=0.002) and ever use of marijuana (p&0.001). Among high school students, 38% reported current ST use, 43% reported cigarette smoking and 60% reported current use of any tobacco product. Independent correlates of current use of any tobacco were increasing age (p=0.007), ever use of marijuana (p&0.001), current use of marijuana (p=0.005) and reporting a suicide attempt within the past 12 months (p=0.003). No significant gender differences on tobacco use emerged for middle or high school students.Conclusions. This study documents the high tobacco use rates among youth residing in western Alaska, with over half of the adolescents reporting tobacco use. Developing interventions to promote tobacco use prevention and cessation is an essential step towards reducing tobacco-related health disparities in this rural population. Expanded efforts are needed to address tobacco use among youth residing in this region of Alaska.

Gruesome photos on cigarette packages reduce tobacco use

Gruesome photos on cigarette packages reduce tobacco use

Tobacco Industry Lifestyle Magazines Targeted to Young Adults

Purpose This is the first study describing the tobacco industry's objectives developing and publishing lifestyle magazines, linking them to tobacco marketing strategies, and how these magazines may encourage smoking. Methods Analysis of previously secret tobacco industry documents and content analysis of 31 lifestyle magazines to understand the motives behind producing these magazines and the role they played in tobacco marketing strategies. Results Philip Morris (PM) debuted Unlimited in 1996 to nearly 2 million readers and RJ Reynolds (RJR) debuted CML in 1999, targeting young adults with their interests. Both magazines were developed as the tobacco companies faced increased advertising restrictions. Unlimited contained few images of smoking, but frequently featured elements of the Marlboro brand identity in both advertising and article content. CML featured more smoking imagery and fewer Camel brand identity elements. Conclusions Lifestyle promotions that lack images of smoking may still promote tobacco use through brand imagery. The tobacco industry still uses the “under-the-radar” strategies used in development of lifestyle magazines in branded Websites. Prohibiting lifestyle advertising including print and electronic media that associate tobacco with recreation, action, pleasures, and risky behaviors or that reinforces tobacco brand identity may be an effective strategy to curb young adult smoking.

Tobacco Intervention Attitudes and Practices Among Certified Registered Nurse Anesthetists

The period before surgery represents an opportunity for perioperative nurses, including certified registered nurse anesthetists (CRNAs), to address the tobacco use of their patients. To assess the current practices and attitudes of CRNAs toward tobacco interventions. A survey assessing current attitudes, practices and beliefs, and respondent demographics was mailed to 1,000 practicing CRNAs randomly selected from the membership of the American Association of Nurse Anesthetists, with one follow-up reminder. Summary statistics of survey responses were prepared. The response rate was 44% (N = 439). Almost all respondents (92%) reported routinely asking their patients if they smoke cigarettes, and the majority felt that it was their responsibility to advise their patients to quit smoking. However, most do not routinely do so. Identified barriers to intervention included a lack of time to intervene and a lack of training. Interest in learning more about tobacco interventions was high, with strong majorities willing to take an extra 5 minutes preoperatively to intervene and to refer patients to other intervention services. These results can inform efforts to promote tobacco use interventions in surgical patients by CRNAs. Increasing the frequency and effectiveness of tobacco use interventions provided by CRNAs would benefit not only immediate perioperative outcomes, but also the long-term health of surgical patients who take advantage of the surgical episode to initiate long-term tobacco abstinence.

Tools for health: the efficacy of a tailored intervention targeted for construction laborers

Novel approaches to worksite health promotion are needed for high-risk workers who change job sites frequently, and thus may have limited access to worksite health promotion efforts. The objective of this study was to test a behavioral intervention among construction laborers. Using a randomized-controlled design, we tested the efficacy of a tailored telephone-delivered and mailed intervention to promote smoking cessation and increased fruit and vegetable consumption (n = 582). At baseline, 40% of control group participants and 45% of intervention group participants reported using any tobacco in the last seven days. At final, 8% of baseline cigarette smokers in the control group had quit, compared to 19% in the intervention group (p = 0.03). In both groups, the mean consumption of fruits and vegetables at baseline was over five servings per day. At final, the intervention group had increased consumption by approximately one and one-half servings, compared to a slight decrease in consumption in the control group (p < 0.001). A tailored intervention can be efficacious in promoting tobacco use cessation and increased fruit and vegetable consumption among construction laborers, a high-risk, mobile workforce.

Tobacco advertisements and promotion industry on smoking in Tanzania: a review of negative public health implications for current and future generations.

SummarySmoking places a burden on the health care system in developed countries but even more so in the already compromised health services in developing countries. The promotion of tobacco is a root cause of continued consumption even after highlighting the effects. The main aim of this news analysis is to discuss various strategies used by the tobacco industry in promoting tobacco use in Tanzania.

Problématique du tabac en Afrique francophone et perspectives régionales de l'OTAF

The tobacco problem is one which is both global and political. The epidemic and the growing smoking crisis in Africa is a menace to the health of our continent, with significant socio-economic repercussions to follow in the coming years. Approximately 1.1 billion people around the world smoke, and between now and the year 2025, this number will most likely increase to 1.6 billion. By 2030, 10 million tobacco-related deaths will have occurred, and for the most part those deaths will be concentrated in developing countries. The tobacco industry clearly lies at the heart of the development of the tobacco pandemic in the 20th century. Specifically, cigarettes have made tobacco a massively consumed product, constantly expanding and opening up new markets; the day before yesterday it was men, yesterday it was women and youth, and today it is the developing world. The strategy is identical: increase sales, and do goat a price which puts a heavy burden on the population's health. The industries turn themselves towards developing countries, and namely Africa, in order to compensate for their losses in the markets of the Northern Hemisphere at a time when the demand in these countries is decreasing. The industry's cynical strategy targets Africa as its strongest potential market for development, counting on an estimated increase in consumption of 16% over the next decade, according to WHO's recent World Tobacco Atlas. The illegal importation of cigarettes is a practice which is growing more and more within African countries, with a well-structured African network for smuggling. Smuggled cigarettes are even more toxic with very elevated levels of nicotine and tar. Sponsorship as well as direct and indirect advertising are rapidly developing in all kinds of formats, with a proliferation of aggressive advertising messages targeting African populations with cynicism, manipulation, the complicity of smuggling in broad daylight, and disrespect for the law, while exploiting all of the themes which promote tobacco use to the target audiences (youth, women, the poorest groups). Everyday the tobacco industry recruits new African smokers to replace those who die. The future of the industry is represented by about 8 out of 10 people who began smoking before the age of 18 years old. It was imperative to establish a Tobacco Observatory in Francophone Africa (OTAF) in order to resituate the African tobacco situation, contribute to the development of the French-speaking nations in Africa, and to make known and increase awareness of its needs, its initiatives, and its actions across the world, and finally to effectively fight against tobacco and the industry's practices. One year after OTAF was established in Bamako thanks to the consolidated efforts of all its members and support of the French League against Cancer and the International Union against Cancer, OTAF OTAF is an independent entity whose mission is to gather, analyse and disseminate information on all aspects of tobacco with the objective of soliciting and supporting public health activities and interventions. It is a reference centre for Francophone Africa and a technical advisory group for the public authorities on tobacco issues. OTAF's work is counted upon to inform the public authorities on the most effective measures to use in the fight against tobacco. OTAF's duty is to promote activities which protect the health of young people and non-smokers, and communicate on the harmful effects of tobacco and the tobacco industry's practices. The goal is to organise a fight against tobacco based on solid, scientific data of the highest level of quality. OTAF is the only Francophone African surveillance organisation for monitoring the tobacco epidemic, and the practices, schemes and methods of the tobacco industry which are known to be dishonest Today, OTAF is a unique reference centre as far as the fight against tobacco is concerned in Francophone Africa. It is a partner in a number of projects with the French League against Cancer, the International Union against Cancer, and the International Union for Health Promotion and Education, among others. The success of OTAF has been crowned by a trophee having been awarded by WHO and an honorary degree signed by WHO's Director General.

Depressive symptoms and smoking among Hong Kong Chinese adolescents

To examine associations among depressive symptoms, smoking, smoking trajectories and quitting smoking in Hong Kong. Prospective longitudinal design, with wave 1 at baseline (T1) and wave 2 (T2) 12 months later. Form 1 (equivalent to 7th grade in the United States) students, mean age = 12.7 years, n = 1894. Self-reported smoking status, attempts to quit and depressive symptoms. At both waves, current as well as ex-smokers had higher depressive symptoms than never smokers. T1 smoking predicted T2 depressive symptoms among those with low baseline depressive symptoms. Depressive symptoms at T1 predicted smoking at T2 among non-smokers at T1. Trajectories were defined by separating participants who were never smokers at both waves ('non-smokers'), those who smoked at both waves ('persistent smokers'), those who smoked at one time but were not smoking at either wave ('past smokers), and those who had never smoked at T1 but reported smoking a year later ('new smokers'). Persistent, past and new smokers had higher depressive symptoms at both waves than non-smokers. Smokers who reported not wanting or trying to quit and those who had been unsuccessful at quitting had higher depressive symptoms at T2 than those who successfully quit. Our results suggest that depressive symptoms promote tobacco use in Asian adolescents by making it more likely that an adolescent will begin smoking and less likely that she or he will quit. These findings elucidate risk factors in Hong Kong for two important public health concerns for adolescents: smoking and depression.

Teacher tobacco use and tobacco use prevention in two regions in India: qualitative research findings

Background This paper uses qualitative data to explore differences in tobacco use patterns and tobacco use prevention efforts among teachers in two Indian states with high versus low prevalence of tobacco use. Methods We conducted a series of 12 focus groups with teachers in 12 schools in Maharashtra and Bihar following a standardized script, and analyzed data using standard qualitative methods. Results Teachers in Bihar reported higher levels of tobacco use and stronger social norms promoting tobacco use compared to those in Maharashtra; nonetheless, teachers in both states reported strong social prescriptions about teachers' not using tobacco. Few supports were available for cessation. Although focus group participants were generally aware that tobacco use has deleterious health effects, not all were knowledgeable of specific health consequences, in particular resulting from the use of smokeless tobacco. Key barriers to teaching about tobacco use prevention were reported, including the lack of its inclusion in standard curricula and large class sizes; these results also underscore the importance of support for tobacco control policies. Conclusions These findings point to the need for a multi-pronged approach to tobacco use prevention that involves the government, school administration, as well as teachers, parents, and the broader community, and including support to tobacco use cessation.

In conversation: high school students talk to students about tobacco use and prevention strategies.

The purpose of this multi-site qualitative study is to explore how adolescents talk about tobacco use. Sixty-six students in four high schools became co-researchers and led focus group interviews with 205 fellow students. From the interviews, the authors develop a story line that reports how adolescents begin smoking, how smoking becomes a pervasive influence, how attitudes form about smoking, what it means to be a smoker, and, ultimately, student suggestions for tobacco use prevention. Embedded within this story line are complex questions and contradictions. We explore whether peers really are influential, if the media is important, whether smoking is a matter of personal choice, if schools actually promote tobacco use, and whether adolescents can quit smoking.

Targeting of Asian Americans and Pacific Islanders by the tobacco industry: results from the Minnesota Tobacco Document Depository

Objective: The study objective was to review internal tobacco industry documents written between 1985 and 1995 regarding the Asian American and Pacific Islander (AAPI) population in the USA. These documents...

Smoking and Its Relationship to Depression and Anxiety Among Saudi University Students

Cigarette smoking is a major, worldwide health hazard [1]. Ninety percent of teenagers who smoke 3-4 cigarettes a day become regular smokers for 35-40 years [2]. Disorders resulting from tobacco use were included for the first time by the American Psychiatric Association in its third edition of the Diagnostic and statistical manual of mental disorders (DSM-III) [3]. It is now considered the number-one cause of death among the DSM-III disorders [4]. Dependence on nicotine, the addictive substance in cigarettes, has been found to be associated with high rates of depression and anxiety [5] and to increase the lifetime risk for these disorders [6]. With declining sales elsewhere, the tobacco industry is increasingly promoting tobacco use in the developing countries, which consume almost 52% of tobacco products [7]. Imports of tobacco into Saudi Arabia have increased about ninefold in less than ten years [8], which would seem to indicate an increase in smoking. Previous studies have shown that smoking is prevalent among Saudi physicians and school and university students [9-1 5]. These studies have explored the knowledge, attitudes, and beliefs of smokers and nonsmokers, but none have thus far assessed the relation-

The tobacco industry's code of advertising in the United States: myth and reality.

The major American tobacco companies developed and agreed to abide by the Cigarette Advertising Code in 1964. The stated aims of the code were to prohibit advertising directed at young people, to prohibit advertising that used fraudulent health claims, and to assure compliance with the code's provisions through the establishment of an administrative arm and enforcement mechanism to prescreen and monitor all cigarette advertising. In the 32 years since the Cigarette Advertising Code's adoption, the tobacco industry has used the existence of this code and its revisions and promises of self-regulation in accordance with this code as evidence that it promotes tobacco use only in a responsible manner. The code has served as the basis of the industry's efforts to avoid further local, state, and federal regulatory oversight of its marketing activities. A historical review of cigarette advertising since 1964 indicates that the voluntary code's major provisions have been regularly violated in the spirit and the letter. The administrative and enforcement provisions of the original Cigarette Advertising Code were quietly dismantled soon after the voluntary code's adoption and were completely omitted from the revised code in 1990. The historical evidence indicates that self-regulation of cigarette advertising and promotion by the tobacco industry has been repeatedly given trials and has not worked.