Tobacco Endgame Research Articles

Ready for a goodbye to tobacco? — Assessment of support for endgame strategies on smoking among adults in a Danish regional health survey

ObjectivesTo assess support for a future ban on smoking and for increasing tobacco taxes in Denmark, and to explore if support differed across sex, age, educational attainment, smoking status and intention to quit. MethodsData from a 2013 health survey representative of the population aged ≥16years in the Capital Region of Denmark (N=41,356, response rate=43.5) was linked with data on sex, age and education from central registers. Participants were asked if they supported: 1) a future ban on smoking in Denmark, and 2) increased taxes on tobacco products. Subgroup differences were explored using logistic regression. Results30.6% supported a future ban on smoking, while 59.0% supported increased taxes. Women were less supportive of a future ban (OR=0.83 (0.78–0.88)) and more supportive of increasing taxes (OR=1.11 (1.06–1.18)) than men. Support for both measures was higher among the youngest. Only small differences were found in ban support across educational attainment, while support for taxes increased with increasing education. Support for both measures were greatest among never smokers (OR=2.66 (2.40–2.93) and OR=9.69 (8.83–10.63)) compared to daily smokers. Smokers intending to quit were two to three times as likely to support a future ban or increased taxes compared to smokers with no quit intensions. ConclusionOne third supported a future ban on smoking, while six out of ten supported increasing taxes. This first Danish study of support for more radical tobacco control adds to the growing literature on tobacco endgame and sets a baseline for future assessments of public support.

The tobacco endgame: a qualitative review and synthesis

The tobacco endgame concept reorients discussion away from the persistent control of tobacco toward plans for ending the tobacco epidemic, and envisions a tobacco-free future. A variety of policy approaches...

"What Is Our Story?" Philip Morris's Changing Corporate Narrative.

We sought to learn how employees reacted to changes in the corporate narrative of Philip Morris Companies (PMC) in the late 1990s and early 2000s. We analyzed archival internal tobacco industry documents about PMC's creation of a new corporate story. In response to litigation and public opprobrium, PMC replaced its market success-oriented corporate narrative with a new one centered on responsibility. Although management sought to downplay inconsistencies between the old and new narratives, some employees reportedly had difficulty reconciling them, concerned that the responsibility focus might affect company profitability. However, others embraced the new narrative, suggesting radical ideas to prevent youth smoking. These ideas were not adopted. PMC's new narrative was unconvincing to many of its employees, who perceived it either as a threat to the company's continued profits or as incongruous with what they had previously been told. As it had done with the public, PMC misled its employees in explaining a narrative repositioning that would help the company continue business as usual. Moving toward a tobacco endgame will require ongoing discursive and symbolic efforts to disrupt this narrative.

Curbing the tobacco epidemic: Employing behavioral strategies or rearranging the deckchairs on the Titanic?

Henningfield brilliantly dissected the deadly comprehensive tactics of the tobacco industry but Food and Drug Administration and WHO strategies against the tobacco epidemic must be questioned. The Food and Drug Administration has the authority to regulate tobacco production (2009 Tobacco Control Act) but fails to ban menthol and reduce cigarettes nicotine content. As little has changed, the Healthy People 2010 objective of reducing the prevalence of cigarette smoking among adults to 12% by 2010 in the US will be attained by 2030. The monitoring of the WHO Framework Convention on Tobacco Control (WHO FCTC) is passive, even when governments repeatedly violate the Article 5.3 of the Convention, which specifically requires protecting public policy from tobacco industry interference. Since 2004, the year after the adoption of the Convention, the prevalence of daily smoking has leveled off and the 2012 annualized rate of change in prevalence of daily smoking was almost null. This contrasts with a 2% annual decrease in the prevalence of daily smoking from 1980 to 2004. The tobacco endgame needs acts, not bureaucracies. Two counties have been moving forward, Brazil has banned menthol and Australia has implemented plain packaging.

Public support for a tobacco endgame among adults living in the Capital Region of Denmark

Public support for a tobacco endgame among adults living in the Capital Region of Denmark

Second-hand Smoking and CV Risk.

Issues related to passive smoking have recently been addressed in the specialty literature, and they are particularly relevant from two perspectives: the effects on health and implications in the initiation of smoking among youth. The mechanisms by which tobacco smoke is involved in the pathology of heart disease are numerous, and are based not on a single action, but involve multiple factors. The effects of "second-hand" smoking on the cardiovascular system are evident in cardiovascular disease biomarkers seen in nonsmokers and the increased risk of mortality. In 2003, the World Health Assembly adopted the Framework Convention on Tobacco Control (FCTC), which was negotiated under the auspices of the World Health Organization (WHO) and is an evidence-based treaty promulgated with the intent of implementing effective policies for tobacco control. The effects of such policies have been documented in numerous studies. For example, the number of ER patients presenting with acute coronary events (myocardial infarction) has decreased 27-40 % in the U.S., 13 % in Italy, and 17 % in Scotland. The harmful consequences of passive smoking in cardiovascular and other organ systems must be confronted across the medical community. Cardiologists should unite with other specialists to encourage concerted legal action, economic measures, and public education as we work toward the tobacco endgame.

The tobacco endgame: It's all about behavior

One of the ten great public health achievements in the 20th century was turning the tide on one of the greatest public health disasters of that century: the tobacco use and related disease epidemic. The premature death and disease caused by tobacco can be considered largely as a side-effect of tobacco use behavior and the disease of addiction. The spread of that disease was fostered by an industry that researched the behavioral and biological basis of tobacco use and addiction and applied its findings and knowledge to develop products and marketing approaches to increase the likelihood that people, especially young people, would try tobacco products and develop persistent use and addiction. Researchers outside of the tobacco industry also investigated the behavioral biology of tobacco use and their research has been critical in turning the tide of the tobacco and disease epidemic. The behavioral factors are considered vital to understand and address by United States Food and Drug Administration and Surgeon General, as well as the World Health Organization in their tobacco control efforts. This commentary discusses key behavioral factors in the rise and fall of the epidemic, as well as some of those increasingly discussed as potential contributors to the endgame.

Modelling the implications of regular increases in tobacco taxation in the tobacco endgame

ObjectiveWe examine the potential role for taxation in the tobacco endgame in New Zealand, where the goal is to become ‘smokefree’ (less than 5% smoking prevalence) by 2025.DesignModelling study using...

Support for a tobacco endgame strategy in 18 European countries

ObjectiveThe feasibility of a tobacco endgame strategy, aiming to bring smoking prevalence to near-zero levels, is currently under debate. We provide information on public support for such a strategy in Europe. MethodsIn 2010 we conducted a face-to-face representative survey in 18 European countries (Albania, Austria, Bulgaria, the Czech Republic, Croatia, England, Finland, France, Greece, Hungary, Ireland, Italy, Latvia, Poland, Portugal, Romania, Spain and Sweden). The present analysis is based on 16,947 individuals aged ≥15years providing information on their attitudes towards a complete ban on the use or sale of tobacco. ResultsOverall, 34.9% of adults (32.8% in men and 37.0% in women; p<0.001) supported a complete ban strategy on use or sale of tobacco, 41.2% of never, 29.4% of ex- and 25.6% of current smokers. The highest support was observed in southern Europe (42.5%), followed by eastern (39.1%), northern (27.5%) and western Europe (23.0%; p<0.001). A significant inverse trend was observed with both age and education. ConclusionApproximately one in three adults (and one in four smokers) supports a comprehensive tobacco endgame intervention. This first study in Europe provides a baseline for evaluating future trends in public support for extreme propositions to end or drastically cut smoking.

How adolescents view the tobacco endgame and tobacco control measures: trends and associations in support among 14–15 year olds

Background and aimsAdolescents represent the next generation and have the greatest amount to gain from the tobacco endgame. They will provide the future momentum to achieve the tobacco endgame, thus...

Tobacco endgame: the poverty conundrum.

AbstractThere is no more striking public health triumph than the demise of the “brown plague.” The cigarette was once the accoutrement of a good life, but smoking is now a tragic habit of the poor. By the mid‐1960s, half of all men and a third of women in the United States smoked. Today the national prevalence is 18 percent, with rates in major cities below 15 percent. A suite of policies drove down smoking rates—antismoking campaigns, taxation, clean air laws, package labeling, and marketing curbs. These policies, and the resultant behavior changes, however, have diminishing returns. Is it possible that tobacco rates will remain relatively stagnant? If so, what “endgame” strategies might drive rates to negligible levels, say, lower than 5 percent? And if society does achieve such an audacious goal, how attentive should it be to the problems of social justice?

Development of an integrated tobacco endgame strategy

In recent years, various tobacco ‘endgame’ strategies have been suggested as a means to phase out tobacco consumption. Using country examples, this paper discusses three potential strategies: replacing cigarettes with...

The tobacco endgame in Hong Kong: public support for a total ban on tobacco sales

BackgroundTobacco endgame policies are increasingly advocated to end tobacco use. This study investigated public support for a total ban on tobacco sales, use and possession in Hong Kong.MethodsA telephone survey...

Tobacco: Prohibition, Coffee Shops, or Discouragement?

The aim of this commentary is to discuss Dubljevic's points (2013) in the context of future tobacco control policy. The idea of a tobacco endgame—the complete phasing out of tobacco consumption—has...

Potential advantages and disadvantages of an endgame strategy: a ‘sinking lid’ on tobacco supply

BackgroundOne possible supply-side strategy for the tobacco endgame is a government-mandated ‘sinking lid’ on tobacco supply (tradeable but decreasing quotas on sales or imports).MethodsWe considered literature on quota systems and...

Cultivating the next generation of tobacco endgame advocates

Long-term success for any tobacco endgame is contingent not only on acquiring political will, but also on sustaining it over a long period of time, perhaps even for decades. Future...

In and across bureaucracy: structural and administrative issues for the tobacco endgame

This article assesses the structural choices for the proposed tobacco endgame strategies. I focus on the issues associated with particular structural choices for the location of the implementation. Specifically, I...

Political impediments to a tobacco endgame

Any serious consideration of exploring a tobacco endgame in the USA must build upon the enviable track record of reducing tobacco use through a mixture of federal and state policies....

Tobacco endgame strategies: challenges in ethics and law

There are complex legal and ethical tradeoffs involved in using intensified regulation to bring smoking prevalence to near-zero levels. The authors explore these tradeoffs through a lens of health justice,...

Large-scale unassisted smoking cessation over 50 years: lessons from history for endgame planning in tobacco control

In the 50 years since the twentieth century's smoking epidemic began to decline from the beginning of the 1960s, hundreds of millions of smokers around the world have stopped smoking...