Tobacco Control Environment Research Articles

Better cigarette tax policies and higher tobacco excise tax revenues

BackgroundIn November 2021, the Tobacconomics team published the second edition of the Cigarette Tax Scorecard which evaluates cigarette taxation in each country based on four components—cigarette price, affordability change, tax...

Changes of campus tobacco control environment and the impact on tobacco control behaviors among secondary school personnel in Shanghai, China.

Youth smoking is a serious public health problem. Nevertheless, a rigorous tobacco-free environment within schools, combined with exemplary tobacco control behavior among school personnel can effectively contribute to reducing adolescent smoking. This study compared the tobacco control environment in Shanghai secondary schools in 2017 and 2021, and explored how the tobacco control environment influenced the tobacco control behaviors of school personnel. Two cross-sectional studies were conducted from October to December 2017 and October to December 2021, using stratified cluster random sampling method, and 2403 and 1761 valid questionnaires were collected, respectively. The chi-squared test was used to test the differences between categorical variables. Binary logistic regression was conducted using survey data from 2021 to explore the influencing factors of staff's tobacco control behaviors. Compared with 2017, the percentages of staff members who were current smokers, had smoked on campus in the past year and were exposed to secondhand smoke (SHS) on campus in the past 7 days in 2021 decreased by 2.95%, 2.30% and 8.91%, respectively. However, the proportion of personnel who knew the school had organized tobacco control education decreased. Furthermore, school personnel who had received tobacco control education and agreed the school should strictly prohibit students from smoking (AOR=1.64; 95% CI: 1.25-2.15) were more likely to inform about the harm of tobacco to students. Those who had participated in tobacco control education activities or tobacco control trainings (AOR=1.87; 95% CI: 1.30-2.69) and believed that the school did not strictly prohibit either students (AOR=0.30; 95% CI: 0.22-0.41) or personnel (AOR=0.46; 95% CI: 0.36-0.59) from smoking were more inclined to stop students from smoking. Compared with 2017, the rates of smoking and secondhand smoke exposure among school personnel decreased in 2021, but some schools still lacked comprehensive education on tobacco control behaviors for the staff. Enhancing the health literacy and strengthening tobacco control education among staff were effective strategies to encouraging their active adoption of tobacco control behaviors.

As countries improve their cigarette tax policy, cigarette consumption declines

BackgroundThis study examines the association between the Tobacconomics cigarette tax scores and cigarette consumption in 97 countries during the period of 2014–2020.MethodsData on countries’ retail cigarette sales and overall cigarette...

Country differences in the cross-sectional associations between smoking and depressive symptoms in adolescence.

The aim of the present study was to compare the cross-sectional association between smoking and depressive symptoms among adolescents between Sweden and Italy, two countries historically characterized by different norms about tobacco use and different tobacco control efforts. A cross-sectional study including 3283 adolescents 15-16 years of age participating in the Swedish KUPOL study and 1947 same-age adolescents from the Italian BE-TEEN study. Current smoking was defined as any smoking in the past 30 days. Depressive symptoms were assessed using the Centre for Epidemiological Studies Depression Scale for Children (CES-DC) and the internalizing score of the Strengths and Difficulties Questionnaire (SDQ). Country differences were explored in stratified and interaction analyses. Current smoking was associated with a 2- to 3-fold increased odds of depressive symptoms among Swedish adolescents using both CES-DC and SDQ internalizing scale. Among Italian adolescents, slightly lower increased odds of 1.5-2.5 for depressive symptoms with smoking were found using the CES-DC but not the SDQ scale. Both multiplicative and additive interactions for country were significant. The association between smoking and depressive symptoms was weaker among Italian compared with Swedish adolescents for both scores. Countries with different tobacco norms and control show different associations between smoking and depressive symptoms in adolescence, probably due to different psychosocial profiles of smokers. These findings need to be considered when planning tobacco prevention programmes, e.g. by focusing on early detection of mental health distress among adolescents in settings with declining smoking prevalence and restrictive tobacco control environments.

The emergence of e-cigarette retail shops in a regulated tobacco control environment.

E-cigarettes are of growing concern. We aimed to determine the location and characteristics of retail shops selling e-cigarette products in Perth, Western Australia. Two phase study: (i) identifying all e-cigarette retailers in the Greater Capital City Statistical Area of Perth; (ii) audit at the point-of-sale to assess products, promotions and shop characteristics (n=41). Ninety-eight retailers selling e-cigarette products were identified: 43 tobacconists (44%), 21 vape shops (21% - up from one shop in 2017), 14 supermarkets (14%), 12 service stations (12%) and 8 smoke shops (8%). The most common e-cigarette product was non-nicotine e-liquid, available at 38 (93%) stores audited. Most stores sold parts of e-cigarette devices (n=25, 61%). Front counter displays were the most frequent form of promotion (n=40, 98%). Vape shops differed from other retailers, having bar-style layouts (n=15, 71%), lounge areas (n=7, 33%) and free e-liquid samples (n=17, 89%). The availability of e-cigarette products from retail shops and particularly vape shops is increasing. E-cigarette retailers are using traditional promotional techniques including point-of-sale displays to market their products, while vape shops are extending their appeal through bar style, lounge layouts and free trials. Understanding the e-cigarette retail store environment is essential for identifying emergent trends, potential regulations and future research. SO WHAT?: The e-cigarette retail market in the Perth is growing, shops using traditional and new promotional techniques to market e-cigarette products. Our findings identify a need for public health surveillance, regulations and legislation.

Quit intention and smoking cessation behavior of current smokers aged 15 years and above in China, 2018

Objective: To describe the current situation on quit intention and quit attempts among current smokers aged 15 years and above in China and explore the main factors affecting their smoking cessation behaviors. Methods: The subjects were people aged 15 years and above in China. A stratified multi-phased randomized cluster sampling method was used. The survey covered 200 districts/counties in 31 provinces (autonomous regions and municipalities directly under the central government), including 19 376 people under investigation. The data were weighted with SAS 9.4 for complex sampling analysis, and the frequency and weighted component ratio were used for description. The influencing factors were studied using the Rao Scott χ2 test and unconditional multivariate logistic regression. Results: Among current smokers, 6.63% reported that they planned to quit smoking in the next month, 5.44% for men and 8.49% for women. 17.96% of the current smokers made quit attempts in the past 12 months, with 17.80% men and 22.15% women. People who smoke occasionally (OR=3.42, 95%CI: 2.09-5.59) made quit attempts in the past (OR=4.91, 95%CI: 0.33-0.52) and knew that smoking would lead to three diseases (OR=2.24, 95%CI: 1.48-3.40) had higher quit intention. People who occasionally smoke (OR=1.68, 95%CI: 1.20-2.34) received smoking cessation suggestions from medical staff (OR=1.96, 95%CI: 1.62-2.37), were a ware of that smoking causes three diseases (OR=1.63, 95%CI: 1.32-2.02) and had smoking prohibition regulations in indoor areas of their homes, had a higher rate of quit attempts. Conclusion: Providing effective smoking cessation intervention services and creating a supportive tobacco control environment are significant in promoting smoking cessation behavior.

Smokers Increasingly Motivated and Able to Quit as Smoking Prevalence Falls: Umbrella and Systematic Review of Evidence Relevant to the "Hardening Hypothesis," Considering Transcendence of Manufactured Doubt.

IntroductionThe “hardening hypothesis” proposes that as the prevalence of smoking in a population declines, there will be a “hardening” of the remaining smoker population. This review examines the evidence regarding smokers’ motivation, dependence, and quitting behavior as smoking prevalence declines, to assess whether population “hardening” (decreasing propensity to quit) or “softening” (the converse) is occurring.MethodsMEDLINE, PsychINFO, Scopus, Web of Science, and Cochrane Library were searched to July 2019, using terms related to smoking and hardening, for reviews and large, population-based repeat cross-sectional studies. There were additional searches of reference lists and citations of key research articles. Two reviewers screened half the titles and abstracts each, and two reviewers screened full texts independently using tested criteria. Four reviewers independently and systematically extracted data from eligible publications, with one reviewer per study, checked by another reviewer.ResultsOf 265 titles identified, three reviews and ten repeat cross-sectional studies were included. Reviews concluded that hardening has not occurred among the general smoking population over time. Among repeated cross-sectional studies, five examined motivation, nine examined dependence, five examined hardcore smoking, and two examined quit outcomes. All but one study found a lack of hardening. Most found softening within the smoking population, consistent across hardening indicators, definitions, countries (and tobacco control environments), and time periods examined.ConclusionsTobacco control reduces smoking prevalence and fosters a smoking population more amenable to evidence-based interventions. Based on the weight of the available evidence, the “hardening hypothesis” should be rejected and the reality of softening accepted.ImplicationsThis umbrella review and systematic review provides a critical consideration of evidence from epidemiology and psychology and other fields regarding the “hardening hypothesis”—a persistent myth undermining tobacco control. It reaches the conclusion that the sum-total of the worldwide evidence indicates either “softening” of the smoking population, or a lack of hardening. Hence, tobacco control reduces smoking prevalence and fosters a smoking population more amenable to evidence-based interventions. The review indicates that the time has come to take active steps to combat the myth of hardening and to replace it with the reality of “softening.”

Construction of the Influence Mechanism of Participation Motivation on Safety Behavior of Mountain Outdoor Sportsmen under Tobacco Control Environment

Objectives: With the development of mountain sports, there are more and more participants but frequent safety accidents mainlyvictimizing participants. And even caused forest fires because participants smoked. However, as the motivation of participants is the driving force of their actions, theimpact on their safety behavior will inevitably affect the safety of participants in outdoor sports.And if Mountain outdoor Sportsmen are smokers, their safe behavior may be more difficult to control without smoking. Methods: in this study, a qualitative analysis was conducted on 33 interview materials to explore the mechanism of influence of participation motivation of mountain enthusiasts on safety behaviors, and the logical deduction and connotation explanation were carried out based on existing theories. Results: (1) Tobacco control environment does not affect participants’ participation motivation, so it does not affect participants’ safety behavior through participation motivation; (2) Mountain outdoor Sportsmen’ participation motivation has an impact on safety behavior; (3) Safety awareness is an intermediate variable of the influence of mountain outdoor Sportsmen’ participation in mountain outdoor sports on safety behavior; (4) Role clarity is the moderating variable of mountain outdoor sports participants’ influence on safety behavior. Conclusions: Smoking control environment cannot affect the safety behavior of mountain outdoor athletes through participation motivation, and there may be another mechanism, which needs to be further explored. The participation motivation of mountain outdoor sportsmen affected the safety behavior through the safety perception, but was moderated by Role clarity. And This mechanism needs further quantitative verification.

Cigarette Use Before and After the 2009 Flavored Cigarette Ban

PurposeOn September 22, 2009, the U.S. Food and Drug Administration's national ban on flavored cigarette products went into effect, barring the sale of flavored cigarettes with the exception of menthol. Flavored cigarettes largely appeal to and were disproportionately used by youth (under age 18 years). However, little research has evaluated the effects of the ban. This study examined past 30-day cigarette use among youth (12–17 years), young adults (18–25 years), adults (26–49 years), and older adults (≥50 years) before and after the implementation of this ban. MethodsAnalyses were conducted using 2002–2017 National Survey on Drug Use and Health (NSDUH) data (n = 893,226). Regression models—weighted for national representation—were used to examine past 30-day cigarette use before and after the flavored cigarette ban in different age groups, using a quasi-experimental design incorporating elements of interrupted time series and difference-in-differences design. This design was used to examine differences in pre- versus post-ban smoking within age groups and heterogeneous policy effects between age groups, to help adjust for the generally stronger tobacco control environment over time. ResultsThe flavor ban was associated with statistically significant immediate increases as well as reductions over time in youth and young adult use of any cigarettes and menthol cigarettes, compared to older adults. In 2017, the predicted probability of youth and young adult cigarette smoking were reduced by 43% and 27%, respectively, compared to the model predicted probability in absence of the ban. No such effect was observed for older adults. The predicted probability of menthol use was reduced by 60% and 55% for youth and young adults, respectively. ConclusionsFindings support the effectiveness of flavored cigarette bans at reducing cigarette use among young people and suggest a substitution effect between flavored tobacco products.

Evaluating the short-term impact of a tobacco-free policy in an inpatient addiction treatment setting

PurposeTobacco use is highly prevalent within addiction treatment settings, despite the potential benefits that cessation may provide to patients' psychosocial functioning and overall sobriety. Moreover, tobacco cessation is often insufficiently addressed in addiction treatment programs, although evidence suggests that tobacco control policies, such as access to evidence-based treatment or tobacco-free policies, may be effective. The objective of our study was to evaluate the impact of the implementation of these two tobacco control policies in an inpatient addiction treatment centre. MethodsUsing a 3-group quasi-experimental design, we examined how the implementation of the Ottawa Model for Smoking Cessation (OMSC) and a subsequent campus-wide tobacco ban influenced patients' overall smoking status, frequency, amount used per day, and quit attempts during treatment, compared to usual care. Participants (N = 397) responded to a comprehensive questionnaire upon admission and discharge from an addiction treatment program. We used generalized linear mixed modelling to measure changes over time while accounting for relevant sociodemographic covariates. ResultsPatients exposed to a more comprehensive tobacco control environment (i.e., the OMSC, plus complete tobacco ban) were over 80% less likely to report having used tobacco during treatment, compared to patients exposed to usual care (AOR = 0.17, 95% CI [0.05–0.63]). Receiving treatment in this setting also contributed to a 35% decrease in the average number of days patients used tobacco compared to usual care (AOR = 0.65, 95% CI [0.53–0.98]), and a 27% decrease in the average number of cigarettes used per day compared to usual care (AOR = 0.73, 95% CI [0.58–0.93]). ConclusionComprehensive tobacco control policy interventions within inpatient addiction treatment hospitals promote tobacco cessation. Such interventions should include a combination of evidence-based treatment for patients and environmental restrictions to discourage tobacco use. The results of our study suggest that, within inpatient addiction treatment settings, use of the OMSC in combination with a campus-wide tobacco ban may be more effective than usual care or the OMSC alone.

TXTTaofiTapaa: pilot trial of a Samoan mobile phone smoking cessation programme

# Background Smoking remains a major risk factor to good health across the Pacific region. Samoa, like other Pacific nations, has signed up to the Framework Convention on Tobacco Control (FCTC) to reduce the prevalence through actions including providing smoking cessation services. A text message cessation programme that had been proven successful in New Zealand was adapted and trialled in Samoa. The aims of this study were to trial the Samoan mCessation programme TXTTaofiTapaa to determine the feasibility, acceptability and potential to help smokers in Samoa to quit. # Methods One hundred smokers across Samoa were recruited to the trial but early technical issues meant not all received the programme immediately and therefore were not able to be followed up. # Results Of the 72 participants providing follow up data, 28 (38.9%) reported abstinence for at least seven days at 1-month follow up. In addition, 68 (94.4%) said they liked the programme, 61 (84.7%) said they thought it would be effective for Samoans, 67 (93.1%) said they would recommend the programme to others, and 37 (15.9%) said that it helped them to try to quit smoking at least once. # Conclusions Delivering a text message cessation programme (TXTTaofiTapaa) in Samoa is feasible, and smokers in Samoa appear to find it to be both acceptable and helpful. # Implications This study adds to our knowledge about the adaptation of proven effective technology based smoking cessation interventions from high income countries with multifaceted tobacco control strategies, to different contexts. In this case, dealing with differences in culture, language, and the tobacco control environment.

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.

Antismoking Social Norms Increase Cessation Behaviours Among Lower and Higher SES Smokers: An Australian Population-Based Study

Background: Disapproval of smoking from close others, observation of others' quitting activity and denormalisation of smoking in the broader community can provide an environment that helps smokers to quit. However, it remains unclear which social norms have the greatest influence, and if there is a similar impact on quitting-related cognitions and behaviors among lower and higher socioeconomic status (SES) smokers. Aim: This study sought to examine the influence on quitting-related cognitions and behaviors of a variety of social norms: subjective (perceived disapproval of smoking among close family and friends); internalized injunctive (feeling embarrassed about being a smoker); and close descriptive norms (living in a household with someone who, successfully or unsuccessfully, tried to quit in the past 12 months). Methods: A telephone survey was conducted among 1454 Australian adult smokers between 2012 and 2014 who were followed-up ∼1 week after the baseline interview. Logistic regression analyses examined prospective associations of baseline social norms with quitting-related cognitions and behaviors at follow-up. Analyses were adjusted for baseline demographic characteristics, addiction level, tobacco control policies (cost increases, plain packaging implementation and mass media campaign exposure) and quitting-related outcomes measured at baseline. Differences in associations between lower and higher SES smokers (based on educational attainment and area-based disadvantage) were examined through interaction terms and stratified analyses. Results: Sixty-three percent of participants perceived disapproval from family and friends, 30% felt embarrassed to be a smoker, and 12% lived with a recent quitter. Baseline disapproval, embarrassment and household quitting activity were each associated with having quitting as a high priority and with setting a firm date to quit in the next month. Both disapproval and embarrassment also predicted engaging in behaviors to limit smoking, and only embarrassment was associated with increased likelihood to talk about quitting with family or friends and to make a quit attempt. No associations were found between social norms and being highly confident to quit and seeking help to quit. Associations were mostly comparable for lower and higher SES smokers, with no significant negative effects of social norms on quitting thoughts and behaviors overall or among subgroups. Conclusion: Within the strong tobacco control environment in Australia, smokers from lower and higher SES groups who perceive that their family and friends disapprove of their smoking, feel embarrassed to be a smoker and/or who live in a household with a recent quitter are more likely to prioritize quitting and intend to quit soon. These findings also indicate that the internalized injunctive social norm (i.e., feeling embarrassed) was the strongest predictor of smokers' quitting related behaviors, including making a quit attempt.

Effects of the truth FinishIt brand on tobacco outcomes.

Since 2000, the truth campaign has grown as a social marketing brand. Back then, truth employed branding to compete directly with the tobacco industry. In 2014, the launch of truth FinishIt reflected changes in the brand's strategy, the tobacco control environment, and youth/young adult behavior.Building on a previous validation study, the current study examined brand equity in truth FinishIt, as measured by validated multi-dimensional scales, and tobacco related attitudes, beliefs, and behavior based on two waves of the Truth Longitudinal Cohort data from 2015 and 2016. A fixed effects logistic regression was used to estimate the change in brand equity between panel survey waves 3 and 4 on past 30-day smoking among ever and current smokers. Additional models determined the effects of brand equity predicting tobacco attitudes/use at follow up among the full sample. All analyses controlled for demographic factors.A one-point increase in the brand equity scale between the two waves was associated with a 66% greater chance of not smoking among ever smokers (OR 1.66, CI 1.11–2.48, p < 0.05) and an 80% greater chance of not smoking among current smokers (OR 1.80, CI 1.05–3.10, p < 0.05). Higher overall truth brand equity at wave 3 predicted less smoking at wave 4 and more positive anti-tobacco attitudes. Being male, younger, and non-white predicted some of the tobacco related attitudes.Future research should examine long-term effects of brand equity on tobacco use and how tobacco control can optimize the use of branding in campaigns.

Tobacco control environment: cross-sectional survey of policy implementation, social unacceptability, knowledge of tobacco health harms and relationship to quit ratio in 17 low-income, middle-income and high-income countries

ObjectivesThis study examines in a cross-sectional study ‘the tobacco control environment’ including tobacco policy implementation and its association with quit ratio.Setting545 communities from 17 high-income, upper-middle, low-middle and low-income countries...

Implementation of the Tobacco-Free Campus Policy on College Campuses: Evidence From a Survey of College Students in Beijing.

China issued a nationwide "Tobacco-Free Campus" Policy (TFCP) in January 2014, but it is unclear how well it was implemented across China's 2138 college campuses. We conducted an Internet survey of Beijing college students to evaluate the implementation of the TFCP in Beijing. An Internet survey of 711 students from 37 colleges in Beijing was conducted in May 2015. Respondents reported on secondhand smoking (SHS) exposure on campus, knowledge on and actions taken against SHS, and tobacco marketing exposure on campus. Almost 90% of respondents were exposed to SHS on campus at least once in the past month. Approximately 37% of nonsmokers and 61% of smokers reported seeing a teacher smoking, and the majority of both smokers and nonsmokers reported seeing a classmate smoking in campus buildings. The likelihood and location of SHS exposure depend on the participant's demographics and own smoking behavior. Nonsmokers were more likely to be aware of the health risk of SHS than smokers. Although most participants were aware of the harms, only 13% and 9% tried to stop their last SHS exposure indoors and outdoors, respectively. Forty-seven students from 14 colleges noticed tobacco marketing activities on campus. The TFCP on Chinese college campuses was only partially enforced, particularly with regard to SHS. On January 29, 2014, the Chinese Ministry of Education issued the TFCP. A major barrier to effective tobacco control in China is the difficulty in implementing policies issued by the central government. At this point, it is unclear whether the TFCP was successfully implemented on China's college campuses. Major tobacco use monitoring efforts do not include college students. The present research describes the current tobacco control environment on Beijing's college campuses 15 months after the TFCP took effect. To our knowledge, this is the first paper in the English literature on tobacco environment and exposure (rather than a prevalence survey) of college students in China.

State Level Point-of-Sale Policy Priority as a Result of the FSPTCA.

The Family Smoking Prevention and Tobacco Control Act (FSPTCA) give the U.S. Food and Drug Administration (FDA) unprecedented power to regulate tobacco products. One of the most significant provisions of the law allows state and local governments to adopt and enforce tobacco control legislation restricting the time, place, and manner (but not the content) of tobacco advertising. However, there is still reluctance among states and localities for mass adoption of laws due to challenges associated with legal feasibility and lack of U.S.-based evidence in effectiveness. The Center for Public Health Systems Science conducted interviews with key tobacco control contacts in 48 states at two time points (2012 and 2014) since the passage of the FSPTCA to assess the influence of the law on point-of-sale policy development in their state tobacco programs. Logistic regression results show that point-of-sale policy importance is growing post-FSPTCA, and that key influencers of this importance are states' tobacco control histories and environments, including that related to excise taxes and smoke free air policies. The adoption of smokefree and tax policies has become commonplace across the U.S., and the quality and extent of these laws and prevailing political will increasingly impact the ability of states to work in emerging tobacco control policy areas including those directed at the point of sale.

Tobacco control environment in the United States and individual consumer characteristics in relation to continued smoking: Differential responses among menthol smokers?

ObjectiveWe used a consumer panel augmented with state-specific measures of tobacco control activities to examine the main effects and interactions among consumer behaviors, particularly menthol cigarette smoking, and tobacco control environment on cessation over a six-year period. MethodsWe used the Nielson Homescan Panel, which tracks consumer purchasing behaviors, and tobacco control information matched to panelist zip code. We focused on 1582 households purchasing ≥20 packs from 2004 to 2009. Our analysis included demographics; purchasing behavior including menthol versus nonmenthol use (≥80% of cigarettes purchased being menthol), quality preferences (average price/pack), purchase recency, and nicotine intake (nicotine levels of cigarettes purchased); and tobacco control metrics (taxation, anti-tobacco advertising, smoke-free policies). ResultsMenthol smoking (Hazard Ratio [HR]=0.79, 95% Confidence Interval [CI] 0.64, 0.99), being African American (HR=0.67, CI 0.46, 0.98), being male (HR=0.46, CI 0.28, 0.74), higher quality premium preferences (HR=0.80, CI 0.77, 0.91), lower recency (HR=1.04, CI 1.02, 1.05), and higher nicotine intake rates (HR=0.99, CI 0.99, 0.99) were related to continued smoking. No significant interactions were found. ConclusionWhile there were no interactions between menthol use and effects of tobacco control activities, we did find additional support for the decreased cessation rates among menthol cigarette smokers, particularly in the African American population.

Fear appeals in advanced tobacco control environments: the impact of a National Mass Media Campaign in Norway

Norway has one of the most comprehensive infrastructures for tobacco control in the world and has launched several media campaigns recent years. Can yet another anti-smoking campaign, using fear appeal messages, have an immediate impact on smoking behavior, motivation to quit and health beliefs? A sample of smokers (N = 2543) completed a survey before and after a 7-week national media campaign. Individual exposure to campaign (unaided recall) was used as predictor of change. We observed no statistically significant effect on smoking status but tendencies were in the expected direction for daily smokers (P = 0.09). There were no effects on number of cigarettes per day, likelihood to quit or reduce smoking. Small but statistically significant effects were found on motivation to quit (P < 0.01, ηp(2) = 0.004) and perceived seriousness of health hazards (P < 0.05, ηp(2) = 0.002). In addition, there was an increase in interpersonal discussions about health and smoking for those exposed to the campaign (P < 0.01, ηp(2) = 0.008). We conclude that there are very small effects of a relatively short and intense mass media campaign on a population of smokers already exposed to one of the most comprehensive tobacco control programs in the world.

Tobacco Control Lessons from the Higgs Boson: Observing a Hidden Field behind Changing Tobacco Control Norms in Japan

Despite the overall theme of this Issue being the future of global tobacco control, this Article is about Japan, with the conscious intention of presenting Japan as a demonstration of a different type of tobacco control environment. To be clear, I am not trying to suggest Japan is an unambiguously positive exemplar for other nations. Rather, it is with the idea that Japan's circumstances might be showing us that things are not always as bad as they might first appear. To quote Mick Jagger and Keith Richards, great philosophers of the twentieth century, “You can't always get what you want, but if you try sometimes, you just might find, you get what you need.”