Plain packaging of cigarettes and smoking behavior: study protocol for a randomized controlled study.

PubMed

Maynard, Olivia M; Leonards, Ute; Attwood, Angela S; Bauld, Linda; Hogarth, Lee; Munafò, Marcus R

2014-06-25

Previous research on the effects of plain packaging has largely relied on self-report measures. Here we describe the protocol of a randomized controlled trial investigating the effect of the plain packaging of cigarettes on smoking behavior in a real-world setting. In a parallel group randomization design, 128 daily cigarette smokers (50% male, 50% female) will attend an initial screening session and be assigned plain or branded packs of cigarettes to smoke for a full day. Plain packs will be those currently used in Australia where plain packaging has been introduced, while branded packs will be those currently used in the United Kingdom. Our primary study outcomes will be smoking behavior (self-reported number of cigarettes smoked and volume of smoke inhaled per cigarette as measured using a smoking topography device). Secondary outcomes measured pre- and post-intervention will be smoking urges, motivation to quit smoking, and perceived taste of the cigarettes. Secondary outcomes measured post-intervention only will be experience of smoking from the cigarette pack, overall experience of smoking, attributes of the cigarette pack, perceptions of the on-packet health warnings, behavior changes, views on plain packaging, and the rewarding value of smoking. Sex differences will be explored for all analyses. This study is novel in its approach to assessing the impact of plain packaging on actual smoking behavior. This research will help inform policymakers about the effectiveness of plain packaging as a tobacco control measure. Current Controlled Trials ISRCTN52982308 (registered 27 June 2013).

Effects of standardised cigarette packaging on craving, motivation to stop and perceptions of cigarettes and packs.

PubMed

Brose, Leonie S; Chong, Chwen B; Aspinall, Emily; Michie, Susan; McEwen, Andy

2014-01-01

To assess whether standardised packs of the form introduced in Australia are associated with a reduction in acute craving and/or an increase in motivation to stop, and to replicate previous findings on perceptions of packaging, perceptions of smokers using it and perceived effects on behaviour. Following abstinence of at least 12 h, 98 regular and occasional smokers were randomised to exposure to their own cigarette package, another branded package or a standardised package. Craving (QSU-brief), motivation to stop, both at baseline and post-exposure. Ratings of 10 attributes concerning package design, perceived smoker characteristics and effects on behaviour, post-exposure only. For craving, a mixed model ANCOVA showed a significant interaction of packaging and time of measurement (F(2,94) = 8.77, p < .001, partial η(2) = .16). There was no significant main effect or interaction for motivation to stop smoking (p = .9). The standardised pack was perceived to be significantly less appealing and less motivating to buy cigarettes, smokers using them were perceived as less popular and cigarettes from them expected to taste worse. Standardised cigarette packaging may reduce acute (hedonic) craving and is associated with more negative perceptions than branded packaging with less prominent health warnings.

What is included with your online e-cigarette order? An analysis of e-cigarette shipping, product and packaging features.

PubMed

Kong, Amanda Y; Derrick, Jason C; Abrantes, Anthony S; Williams, Rebecca S

2016-06-29

The electronic cigarette industry is growing, with youth using e-cigarettes at higher rates than they are using cigarettes, and retail and online sales projected to reach $10 billion in 2017. Minimal regulation of the production and marketing of e-cigarettes exists to date, which has allowed companies to promote unsupported claims. We assessed the shipping, product features and packaging of a wide variety of e-cigarettes purchased online by adults and youth. The most popular internet e-cigarette vendors were identified from a larger study of internet tobacco vendors. Between August 2013 and June 2014, adults made 56 purchase attempts from online vendors, and youth made 98 attempts. Packages received were assessed for exterior and internal packaging features, including product information, health warnings and additional materials. We analysed a total of 125 orders featuring 86 unique brands of e-cigarettes. The contents were rarely indicated on package exteriors. Product information came with just 60% of orders and just 38.4% included an instruction manual. Only 44.6% of products included a health warning, and some had unsupported claims, such as lack of secondhand smoke exposure. Additionally, some products were leaking e-liquid and battery fluid on arrival. A large variety of e-cigarette products are manufactured and marketed to consumers. Many products do not include instructions for use, and unsupported claims are being presented to consumers. Effective federal regulation of the manufacturing, packaging, product information and health claims surrounding e-cigarettes is necessary to ensure consumers are presented with accurate e-cigarette use information. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

What is included with your online e-cigarette order? An analysis of e-cigarette shipping, product and packaging features

PubMed Central

Kong, Amanda Y; Derrick, Jason C; Abrantes, Anthony S

2016-01-01

Background The electronic cigarette industry is growing, with youth using e-cigarettes at higher rates than they are using cigarettes, and retail and online sales projected to reach $10 billion in 2017. Minimal regulation of the production and marketing of e-cigarettes exists to date, which has allowed companies to promote unsupported claims. We assessed the shipping, product features and packaging of a wide variety of e-cigarettes purchased online by adults and youth. Methods The most popular internet e-cigarette vendors were identified from a larger study of internet tobacco vendors. Between August 2013 and June 2014, adults made 56 purchase attempts from online vendors, and youth made 98 attempts. Packages received were assessed for exterior and internal packaging features, including product information, health warnings and additional materials. Results We analysed a total of 125 orders featuring 86 unique brands of e-cigarettes. The contents were rarely indicated on package exteriors. Product information came with just 60% of orders and just 38.4% included an instruction manual. Only 44.6% of products included a health warning, and some had unsupported claims, such as lack of secondhand smoke exposure. Additionally, some products were leaking e-liquid and battery fluid on arrival. Conclusions A large variety of e-cigarette products are manufactured and marketed to consumers. Many products do not include instructions for use, and unsupported claims are being presented to consumers. Effective federal regulation of the manufacturing, packaging, product information and health claims surrounding e-cigarettes is necessary to ensure consumers are presented with accurate e-cigarette use information. PMID:27357936

Qualitative assessment of a Context of Consumption Framework to inform regulation of cigarette pack design in the U.S.

PubMed

Lee, Joseph G L; Averett, Paige E; Blanchflower, Tiffany; Gregory, Kyle R

2018-02-01

Researchers and regulators need to know how changes to cigarette packages can influence population health. We sought to advance research on the role of cigarette packaging by assessing a theory-informed framework from the fields of design and consumer research. The selected Context of Consumption Framework posits cognitive, affective, and behavioral responses to visual design. To assess the Framework's potential for guiding research on the visual design of cigarette packaging in the U.S., this study seeks to understand to what extent the Context of Consumption Framework converges with how adult smokers think and talk about cigarette pack designs. Data for this qualitative study came from six telephone-based focus groups conducted in March 2017. Two groups consisted of lesbian, gay, and bisexual participants; two groups of participants with less than four years college education; one group of LGB and straight identity; and one group the general population. All groups were selected for regional, gender, and racial/ethnic diversity. Participants (n=33) represented all nine U.S. Census divisions. We conducted a deductive qualitative analysis. Cigarette package designs captured the participants' attention, suggested the characteristics of the product, and reflected (or could be leveraged to convey) multiple dimensions of consumer identity. Particular to the affective responses to design, our participants shared that cigarette packaging conveyed how the pack could be used to particular ends, created an emotional response to the designs, complied with normative expectations of a cigarette, elicited interest when designs change, and prompted fascination when unique design characteristics are used. Use of the Context of Consumption Framework for cigarette product packaging design can inform regulatory research on tobacco product packaging. Researchers and regulators should consider multiple cognitive, affective, and behavioral responses to cigarette pack design.

Packaging colour research by tobacco companies: the pack as a product characteristic.

PubMed

Lempert, Lauren K; Glantz, Stanton

2017-05-01

Tobacco companies use colour on cigarette packaging and labelling to communicate brand imagery, diminish health concerns, and as a replacement for prohibited descriptive words ('light' and 'mild') to make misleading claims about reduced risks. We analysed previously secret tobacco industry documents to identify additional ways in which cigarette companies tested and manipulated pack colours to affect consumers' perceptions of the cigarettes' flavour and strength. Cigarette companies' approach to package design is based on 'sensation transference' in which consumers transfer sensations they derive from the packaging to the product itself. Companies manipulate consumers' perceptions of the taste and strength of cigarettes by changing the colour of the packaging. For example, even without changes to the tobacco blends, flavourings or additives, consumers perceive the taste of cigarettes in packages with red and darker colours to be fuller flavoured and stronger, and cigarettes in packs with more white and lighter colours are perceived to taste lighter and be less harmful. Companies use pack colours to manipulate consumers' perceptions of the taste, strength and health impacts of the cigarettes inside the packs, thereby altering their characteristics and effectively creating new products. In countries that do not require standardised packaging, regulators should consider colour equivalently to other changes in cigarette characteristics (eg, physical characteristics, ingredients, additives and flavourings) when making determinations about whether or not to permit new products on the market. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

21 CFR 1141.12 - Incorporation by reference of required warnings.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising Warnings § 1141.12 Incorporation by reference of required warnings. “Cigarette Required Warnings..., ATTN: Cigarette Warning File Requests, 9200 Corporate Blvd., Rockville, MD 20850, 1-877-CTP-1373, or...

Packaging colour research by tobacco companies: the pack as a product characteristic

PubMed Central

Lempert, Lauren K; Glantz, Stanton

2016-01-01

Background Tobacco companies use colour on cigarette packaging and labelling to communicate brand imagery, diminish health concerns, and as a replacement for prohibited descriptive words (‘light’ and ‘mild’) to make misleading claims about reduced risks. Methods We analysed previously secret tobacco industry documents to identify additional ways in which cigarette companies tested and manipulated pack colours to affect consumers’ perceptions of the cigarettes’ flavour and strength. Results Cigarette companies’ approach to package design is based on ‘sensation transference’ in which consumers transfer sensations they derive from the packaging to the product itself. Companies manipulate consumers’ perceptions of the taste and strength of cigarettes by changing the colour of the packaging. For example, even without changes to the tobacco blends, flavourings or additives, consumers perceive the taste of cigarettes in packages with red and darker colours to be fuller flavoured and stronger, and cigarettes in packs with more white and lighter colours are perceived to taste lighter and be less harmful. Conclusions Companies use pack colours to manipulate consumers’ perceptions of the taste, strength and health impacts of the cigarettes inside the packs, thereby altering their characteristics and effectively creating new products. In countries that do not require standardised packaging, regulators should consider colour equivalently to other changes in cigarette characteristics (eg, physical characteristics, ingredients, additives and flavourings) when making determinations about whether or not to permit new products on the market. PMID:27255118

21 CFR 1141.12 - Incorporation by reference of required warnings.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS; (Eff. 9-22-12) Cigarette Package and Advertising Warnings § 1141.12 Incorporation by reference of required warnings. “Cigarette... Communication and Education, ATTN: Cigarette Warning File Requests, 9200 Corporate Blvd., Rockville, MD 20850, 1...

Graphic warning labels on plain cigarette packs: will they make a difference to adolescents?

PubMed

McCool, Judith; Webb, Lisa; Cameron, Linda D; Hoek, Janet

2012-04-01

Graphic warning labels and plain cigarette packaging are two initiatives developed to increase quit behaviour among smokers. Although a little is known about how adolescents interpret graphic warning labels, very few studies have examined how plain cigarette packaging would affect adolescents' perceptions of cigarette smoking and smoking behaviour. We explored how teens interpret and respond to graphic warning labels and the plain packaging of cigarettes, to assess the potential these strategies may offer in deterring smoking initiation. Twelve focus group interviews with a sample of 80 14-16 year old students from a diverse range of schools in Auckland, New Zealand were undertaken between June and August 2009. Textual analysis revealed that graphic warning labels may influence adolescents by reiterating a negative image of smokers. Graphic warning on a plain cigarette pack increased the attention paid to graphic warning labels and the overall perceptions of harm caused by cigarette smoking, and reduced the social appeal of cigarette smoking. This research offers evidence on how adolescents are appraising and interpreting graphic warning labels, and explores how dominant appraisals may affect the role graphic warning labels play in preventing smoking. Not only would plain cigarette packaging enhance the salience and impact of graphic warning labels, but it would potentially bolster the overall message that cigarette smoking is harmful. In the context of a comprehensive tobacco control programme, graphic warning labels on plain cigarette packaging present an explicit message about the risks (to health and image) associated with cigarette smoking. Copyright © 2012 Elsevier Ltd. All rights reserved.

Plain packaging of cigarettes: do we have sufficient evidence?

PubMed Central

Smith, Collin N; Kraemer, John D; Johnson, Andrea C; Mays, Darren

2015-01-01

Tobacco industry marketing is a primary factor influencing cigarette smoking behavior and the cigarette pack has become an important marketing vehicle for tobacco companies. Standardized “plain” cigarette packaging is advocated as a public health policy to prevent and reduce morbidity and mortality caused by smoking by reducing youth smoking initiation and promoting cessation among smokers. Plain packaging was implemented in Australia in December 2012, and several other countries are considering doing so, but each faces foreseeable legal resistance from opponents to such measures. Tobacco companies have challenged these public health policies, citing international trade agreements and intellectual property laws. Decision-making in these court cases will hinge in part on whether the evidence indicates the public health benefits of plain packaging outweigh any potential harm to tobacco manufacturers’ interests. We reviewed the available evidence in support of plain packaging, finding evidence from observational, experimental, and population-based studies. Results indicate that plain packaging can reduce positive perceptions of smoking and dissuade tobacco use. Governments deciding to implement plain cigarette packaging measures can rely on this evidence to help make a strong case that plain packaging plays an important role in the context of comprehensive smoking prevention efforts. PMID:25897269

The cigarette pack as image: new evidence from tobacco industry documents

PubMed Central

Wakefield, M; Morley, C; Horan, J; Cummings, K

2002-01-01

Methods: A search of tobacco company document sites using a list of specified search terms was undertaken during November 2000 to July 2001. Results: Documents show that, especially in the context of tighter restrictions on conventional avenues for tobacco marketing, tobacco companies view cigarette packaging as an integral component of marketing strategy and a vehicle for (a) creating significant in-store presence at the point of purchase, and (b) communicating brand image. Market testing results indicate that such imagery is so strong as to influence smoker's taste ratings of the same cigarettes when packaged differently. Documents also reveal the careful balancing act that companies have employed in using pack design and colour to communicate the impression of lower tar or milder cigarettes, while preserving perceived taste and "satisfaction". Systematic and extensive research is carried out by tobacco companies to ensure that cigarette packaging appeals to selected target groups, including young adults and women. Conclusions: Cigarette pack design is an important communication device for cigarette brands and acts as an advertising medium. Many smokers are misled by pack design into thinking that cigarettes may be "safer". There is a need to consider regulation of cigarette packaging. PMID:11893817

Qualitative assessment of a Context of Consumption Framework to inform regulation of cigarette pack design in the U.S

PubMed Central

Lee, Joseph G. L.; Averett, Paige E.; Blanchflower, Tiffany; Gregory, Kyle R.

2018-01-01

INTRODUCTION Researchers and regulators need to know how changes to cigarette packages can influence population health. We sought to advance research on the role of cigarette packaging by assessing a theory-informed framework from the fields of design and consumer research. The selected Context of Consumption Framework posits cognitive, affective, and behavioral responses to visual design. To assess the Framework’s potential for guiding research on the visual design of cigarette packaging in the U.S., this study seeks to understand to what extent the Context of Consumption Framework converges with how adult smokers think and talk about cigarette pack designs. METHODS Data for this qualitative study came from six telephone-based focus groups conducted in March 2017. Two groups consisted of lesbian, gay, and bisexual participants; two groups of participants with less than four years college education; one group of LGB and straight identity; and one group the general population. All groups were selected for regional, gender, and racial/ethnic diversity. Participants (n=33) represented all nine U.S. Census divisions. We conducted a deductive qualitative analysis. RESULTS Cigarette package designs captured the participants’ attention, suggested the characteristics of the product, and reflected (or could be leveraged to convey) multiple dimensions of consumer identity. Particular to the affective responses to design, our participants shared that cigarette packaging conveyed how the pack could be used to particular ends, created an emotional response to the designs, complied with normative expectations of a cigarette, elicited interest when designs change, and prompted fascination when unique design characteristics are used. CONCLUSIONS Use of the Context of Consumption Framework for cigarette product packaging design can inform regulatory research on tobacco product packaging. Researchers and regulators should consider multiple cognitive, affective, and behavioral responses to cigarette pack design. PMID:29593883

Cigarette brand diversity and price changes during the implementation of plain packaging in the United Kingdom.

PubMed

Breton, Magdalena Opazo; Britton, John; Huang, Yue; Bogdanovica, Ilze

2018-05-29

Plain packaging of cigarettes appeared in the UK in July 2016 and was ubiquitous by May 2017. The change coincided with another legislative change, raising the minimum pack size from 10 to 20 cigarettes. Laws imposing plain packaging on cigarette packs remove another promotional route from tobacco companies but the effect of such laws on brand diversity, pricing, and sales volume is unknown. This study aimed to 1) describe and quantify changes in brand diversity, price segmentation and sales volumes and 2) estimate the association between the introduction of plain cigarette packaging and cigarette pricing in the UK. We used a natural experiment design to assess the impact of plain packaging legislation on brand diversity and cigarette prices. The data comprised a sample of 76% of sales of cigarettes in the UK between March 2013 and June 2017. United Kingdom MEASUREMENTS: Cigarette prices, number of brands and products, volumes of sales FINDINGS: During the period analysed, there was a slight decrease in the number of cigarette brands. There was also an initial increase observed in the number of cigarette products, mainly due to an increase in the number of products in packs of fewer than 20 cigarettes sold before July 2016, which was then followed by a rapid decrease in the number of products that coincided with the implementation of the new legislation. Cigarette sales volumes during this period did not deviate from the preceding secular trend, but prices rose substantially. Regression results showed that price per cigarette, regardless of pack size, was 5.0 (95% CI 4.8 to 5.3) pence higher in plain than in fully branded packs. For packs of 20 cigarettes, price increases were greater in the lower price quintiles, ranging from 2.6 (95% CI 2.4 to 2.7) GBP in the lowest to 0.3 (95% CI 0.3-0.4) GBP per pack in the highest quintile. The implementation of standardised packaging legislation in the UK, which included minimum pack sizes of 20, was associated with significant increases overall in the price of manufactured cigarettes but no clear deviation in the ongoing downward trend in total volume of cigarette sales. This article is protected by copyright. All rights reserved.

21 CFR 1141.10 - Required warnings.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Required warnings. 1141.10 Section 1141.10 Food... PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising Warnings § 1141.10 Required warnings. (a) Packages. (1) It shall be unlawful for any person to manufacture, package, sell...

Perceptions of branded and plain cigarette packaging among Mexican youth.

PubMed

Mutti, Seema; Hammond, David; Reid, Jessica L; White, Christine M; Thrasher, James F

2017-08-01

Plain cigarette packaging, which seeks to remove all brand imagery and standardize the shape and size of cigarette packs, represents a novel policy measure to reduce the appeal of cigarettes. Plain packaging has been studied primarily in high-income countries like Australia and the UK. It is unknown whether the effects of plain packaging may differ in low-and-middle income countries with a shorter history of tobacco regulation, such as Mexico. An experimental study was conducted in Mexico City to examine perceptions of branded and plain cigarette packaging among smoking and non-smoking Mexican adolescents (n = 359). Respondents were randomly assigned to a branded or plain pack condition and rated 12 cigarette packages for appeal, taste, harm to health and smoker-image traits. As a behavioral measure of appeal, respondents were offered (although not given) four cigarette packs (either branded or plain) and asked to select one to keep. The findings indicated that branded packs were perceived to be more appealing (β = 3.40, p < 0.001) and to contain better tasting cigarettes (β = 3.53, p < 0.001), but were not perceived as less harmful than plain packs. Participants rated people who smoke the branded packs as having relatively more positive smoker-image traits overall (β = 2.10, p < 0.001), with particularly strong differences found among non-smokers for the traits 'glamorous', 'stylish', 'popular' and 'sophisticated' (p < 0.001). No statistically significant difference was found for the proportion of youth that accepted when offered branded compared with plain packs. These results suggest that plain packaging may reduce brand appeal among Mexican youth, consistent with findings in high-income countries. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

A Watched Ocean World Never Boils: Inspecting the Geochemical Impact on Ocean Worlds from Their Thermal Evolution

NASA Astrophysics Data System (ADS)

Spiers, E. M.; Schmidt, B. E.

2018-05-01

I aim to acquire better understanding of coupled thermal evolution and geochemical fluxes of an ocean world through a box model. A box model divides the system into plainer elements with realistically-solvable, dynamic equations.

21 CFR 1141.16 - Disclosures regarding cessation.

Code of Federal Regulations, 2014 CFR

2014-04-01

...) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Additional Disclosure Requirements for Cigarette Packages and Advertising § 1141.16 Disclosures regarding cessation. (a) The required warning shall..., “Cigarette Required Warnings” (incorporated by reference at § 1141.12). (b) In meeting the smoking cessation...

21 CFR 1141.16 - Disclosures regarding cessation.

Code of Federal Regulations, 2013 CFR

2013-04-01

...) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Additional Disclosure Requirements for Cigarette Packages and Advertising § 1141.16 Disclosures regarding cessation. (a) The required warning shall..., “Cigarette Required Warnings” (incorporated by reference at § 1141.12). (b) In meeting the smoking cessation...

21 CFR 1141.16 - Disclosures regarding cessation.

Code of Federal Regulations, 2012 CFR

2012-04-01

...) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS; (Eff. 9-22-12) Additional Disclosure Requirements for Cigarette Packages and Advertising § 1141.16 Disclosures regarding cessation. (a) The required... specified in, “Cigarette Required Warnings” (incorporated by reference at § 1141.12). (b) In meeting the...

The cigarette pack as image: new evidence from tobacco industry documents.

PubMed

Wakefield, M; Morley, C; Horan, J K; Cummings, K M

2002-03-01

To gain an understanding of the role of pack design in tobacco marketing. A search of tobacco company document sites using a list of specified search terms was undertaken during November 2000 to July 2001. Documents show that, especially in the context of tighter restrictions on conventional avenues for tobacco marketing, tobacco companies view cigarette packaging as an integral component of marketing strategy and a vehicle for (a) creating significant in-store presence at the point of purchase, and (b) communicating brand image. Market testing results indicate that such imagery is so strong as to influence smoker's taste ratings of the same cigarettes when packaged differently. Documents also reveal the careful balancing act that companies have employed in using pack design and colour to communicate the impression of lower tar or milder cigarettes, while preserving perceived taste and "satisfaction". Systematic and extensive research is carried out by tobacco companies to ensure that cigarette packaging appeals to selected target groups, including young adults and women. Cigarette pack design is an important communication device for cigarette brands and acts as an advertising medium. Many smokers are misled by pack design into thinking that cigarettes may be "safer". There is a need to consider regulation of cigarette packaging.

21 CFR 1141.12 - Incorporation by reference of required warnings.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Incorporation by reference of required warnings... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising Warnings § 1141.12 Incorporation by reference of required warnings. “Cigarette Required Warnings...

Cigarette packaging and health warnings: the impact of plain packaging and message framing on young smokers

PubMed Central

Mays, Darren; Niaura, Raymond S.; Evans, W. Douglas; Hammond, David; Luta, George; Tercyak, Kenneth P.

2014-01-01

Objective This study examined the impact of pictorial cigarette warning labels, warning label message framing, and plain cigarette packaging on young adult smokers’ motivation to quit. Methods Smokers ages 18–30 (n=740) from a consumer research panel were randomized to one of four experimental conditions where they viewed online images of 4 cigarette packs with warnings about lung disease, cancer, stroke/heart disease, and death, respectively. Packs differed across conditions by warning message framing (gain versus loss) and packaging (branded versus plain). Measures captured demographics, smoking behavior, covariates, and motivation to quit in response to cigarette packs. Results Pictorial warnings about lung disease and cancer generated the strongest motivation to quit across conditions. Adjusting for pre-test motivation and covariates, a message framing by packaging interaction revealed gain-framed warnings on plain packs generated greater motivation to quit for lung disease, cancer, and mortality warnings (p < 0.05), compared with loss-framed warnings on plain packs. Conclusions Warnings combining pictorial depictions of smoking-related health risks with text-based messages about how quitting reduces risks may achieve better outcomes among young adults, especially in countries considering or implementing plain packaging regulations. PMID:24420310

Availability, Price, and Packaging of Electronic Cigarettes and E-Liquids in Guatemala City Retailers.

PubMed

Chacon, Violeta; Arriaza, Astrid; Cavazos-Rehg, Patricia; Barnoya, Joaquin

2018-01-05

Electronic cigarettes (e-cigarettes) have the potential to normalize smoking and undermine tobacco control efforts. However, if well regulated, they also have a potential as smoking cessation aids. This study sought to determine the availability and types of e-cigarettes and e-liquids in Guatemala. We also assessed packaging characteristics and price. We surveyed a convenient sample of 39 Guatemala City retailers and purchased all e-cigarettes and e-liquids available. Duplicate samples (same brand, e-liquid type, flavor, nicotine content, or packaging) were purchased when prices were different between each other. Country of manufacture, flavor, expiration date, nicotine concentration, and price were recorded. We also documented package marketing strategies and warning labels. We purchased 64 e-cigarettes (53 unique and 11 duplicates) and 57 e-liquids (52 unique and 5 duplicates), mostly found on mall retailers. Most e-cigarettes (42, 66%) were first generation, followed by second (18, 28%) and third generations (4, 6%). Price of e-cigarettes differed significantly by generation. Most e-cigarettes (31, 58%) and 24 (46%) e-liquids did not include warning labels. Nicotine content was reported in 21 (39%) e-cigarettes that included e-liquids and 41 (79%) e-liquids' packages. E-cigarettes and e-liquids are available among a variety of retailers in Guatemala City and the industry is taking advantage of the fact that they are not regulated (eg, health claims, minimum sales age, and taxation). Our findings support the need for further research on e-cigarettes and e-liquids in Guatemala. To the best of our knowledge, this is the first study describing e-cigarettes and e-liquids available in retailers in a low/middle-income country like Guatemala. E-cigarettes and e-liquids were found in a variety of types, flavors, and nicotine concentrations in Guatemalan retailers. Our findings support the need for further research on e-cigarettes and e-liquids in Guatemala. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

76 FR 36627 - Required Warnings for Cigarette Packages and Advertisements

Federal Register 2010, 2011, 2012, 2013, 2014

2011-06-22

...The Food and Drug Administration (FDA) is amending its regulations to add a new requirement for the display of health warnings on cigarette packages and in cigarette advertisements. This rule implements a provision of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) that requires FDA to issue regulations requiring color graphics, depicting the negative health consequences of smoking, to accompany the nine new textual warning statements required under the Tobacco Control Act. The Tobacco Control Act amends the Federal Cigarette Labeling and Advertising Act (FCLAA) to require each cigarette package and advertisement to bear one of nine new textual warning statements. This final rule specifies the color graphic images that must accompany each of the nine new textual warning statements.

Required warnings for cigarette packages and advertisements. Final rule.

PubMed

2011-06-22

The Food and Drug Administration (FDA) is amending its regulations to add a new requirement for the display of health warnings on cigarette packages and in cigarette advertisements. This rule implements a provision of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) that requires FDA to issue regulations requiring color graphics, depicting the negative health consequences of smoking, to accompany the nine new textual warning statements required under the Tobacco Control Act. The Tobacco Control Act amends the Federal Cigarette Labeling and Advertising Act (FCLAA) to require each cigarette package and advertisement to bear one of nine new textual warning statements. This final rule specifies the color graphic images that must accompany each of the nine new textual warning statements.

21 CFR 1141.10 - Required warnings.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Required warnings. 1141.10 Section 1141.10 Food... PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS Cigarette Package and Advertising Warnings § 1141.10 Required warnings. (a) Packages—(1) It shall be unlawful for any person to manufacture, package, sell...

Cigarette package design: opportunities for disease prevention.

PubMed

Difranza, J R; Clark, D M; Pollay, R W

2002-06-15

To learn how cigarette packages are designed and to determine to what extent cigarette packages are designed to target children. A computer search was made of all Internet websites that post tobacco industry documents using the search terms: packaging, package design, package study, box design, logo, trademark and design study. All documents were retrieved electronically and analyzed by the first author for recurrent themes. Cigarette manufacturers devote a great deal of attention and expense to package design because it is central to their efforts to create brand images. Colors, graphic elements, proportioning, texture, materials and typography are tested and used in various combinations to create the desired product and user images. Designs help to create the perceived product attributes and project a personality image of the user with the intent of fulfilling the psychological needs of the targeted type of smoker. The communication of these images and attributes is conducted through conscious and subliminal processes. Extensive testing is conducted using a variety of qualitative and quantitative research techniques. The promotion of tobacco products through appealing imagery cannot be stopped without regulating the package design. The same marketing research techniques used by the tobacco companies can be used to design generic packaging and more effective warning labels targeted at specific consumers.

Cigarette package design: opportunities for disease prevention

PubMed Central

DiFranza, JR; Clark, DM; Pollay, RW

2003-01-01

Objective To learn how cigarette packages are designed and to determine to what extent cigarette packages are designed to target children. Methods A computer search was made of all Internet websites that post tobacco industry documents using the search terms: packaging, package design, package study, box design, logo, trademark and design study. All documents were retrieved electronically and analyzed by the first author for recurrent themes. Data Synthesis Cigarette manufacturers devote a great deal of attention and expense to package design because it is central to their efforts to create brand images. Colors, graphic elements, proportioning, texture, materials and typography are tested and used in various combinations to create the desired product and user images. Designs help to create the perceived product attributes and project a personality image of the user with the intent of fulfilling the psychological needs of the targeted type of smoker. The communication of these images and attributes is conducted through conscious and subliminal processes. Extensive testing is conducted using a variety of qualitative and quantitative research techniques. Conclusion The promotion of tobacco products through appealing imagery cannot be stopped without regulating the package design. The same marketing research techniques used by the tobacco companies can be used to design generic packaging and more effective warning labels targeted at specific consumers. PMID:19570250

Cigarette package design: opportunities for disease prevention

PubMed Central

DiFranza, JR; Clark, DM; Pollay, RW

2003-01-01

Objective To learn how cigarette packages are designed and to determine to what extent cigarette packages are designed to target children. Methods A computer search was made of all Internet websites that post tobacco industry documents using the search terms: packaging, package design, package study, box design, logo, trademark and design study. All documents were retrieved electronically and analyzed by the first author for recurrent themes. Data Synthesis Cigarette manufacturers devote a great deal of attention and expense to package design because it is central to their efforts to create brand images. Colors, graphic elements, proportioning, texture, materials and typography are tested and used in various combinations to create the desired product and user images. Designs help to create the perceived product attributes and project a personality image of the user with the intent of fulfilling the psychological needs of the targeted type of smoker. The communication of these images and attributes is conducted through conscious and subliminal processes. Extensive testing is conducted using a variety of qualitative and quantitative research techniques. Conclusion The promotion of tobacco products through appealing imagery cannot be stopped without regulating the package design. The same marketing research techniques used by the tobacco companies can be used to design generic packaging and more effective warning labels targeted at specific consumers.

75 FR 69523 - Required Warnings for Cigarette Packages and Advertisements

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-12

...The Food and Drug Administration (FDA) is proposing to amend its regulations to add a new requirement for the display of health warnings on cigarette packages and in cigarette advertisements. The proposed rule would implement a provision of the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act) that requires FDA to issue regulations requiring color graphics depicting the negative health consequences of smoking to accompany the nine new textual warning statements that will be required under the Tobacco Control Act. The Tobacco Control Act amends the Federal Cigarette Labeling and Advertising Act (FCLAA) to require each cigarette package and advertisement to bear one of nine new textual warning statements. This proposed rule, once finalized, would specify the color graphics that must accompany each of the nine new textual warning statements.

Does the hand that controls the cigarette packet rule the smoker? Findings from ethnographic interviews with smokers in Canada, Australia, the United Kingdom and the USA.

PubMed

Bell, Kirsten; Dennis, Simone; Robinson, Jude; Moore, Roland

2015-10-01

Throughout the twentieth century, packaging was a carefully cultivated element of the appeal of the cigarette. However, the tobacco industry's control over cigarette packaging has been steadily eroded through legislation that aims to rebrand the packet from a desirable to a dangerous commodity-epitomized in Australia's introduction of plain packaging in 2012. Evident in both the enactment of cigarette packaging legislation and industry efforts to overturn it is the assumption that packets do things-i.e. that they have a critical role to play in either promoting or discouraging the habit. Drawing on 175 ethnographic interviews conducted with people smoking in public spaces in Vancouver, Canada; Canberra, Australia; Liverpool, England; and San Francisco, USA, we produce a 'thick description' of smokers' engagements with cigarette packets. We illustrate that despite the very different types of cigarette packaging legislation in place in the four countries, there are marked similarities in the ways smokers engage with their packets. In particular, they are not treated as a purely visual sign; instead, a primary means through which one's own cigarette packet is apprehended is by touch rather than by sight. Smokers perceive cigarette packets largely through the operations of their hands-through their 'handiness'. Thus, our study findings problematize the assumption that how smokers engage with packets when asked to do so on a purely intellectual or aesthetic level reflects how they engage with packets as they are enfolded into their everyday lives. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

Longer Term Impact of Cigarette Package Warnings in Australia Compared with the United Kingdom and Canada

ERIC Educational Resources Information Center

Li, Lin; Borland, Ron; Yong, Hua; Cummings, Kenneth M.; Thrasher, James F.; Hitchman, Sara C.; Fong, Geoffrey T.; Hammond, David; Bansal-Travers, Maansi

2015-01-01

This study examines the effects of different cigarette package warnings in Australia, Canada and the United Kingdom up to 5 years post-implementation. The data came from the International Tobacco Control Surveys. Measures included salience of warnings, cognitive responses, forgoing cigarettes and avoiding warnings. Although salience of the UK…

Young children's perceptions of health warning labels on cigarette packages: a study in six countries.

PubMed

Borzekowski, Dina L G; Cohen, Joanna E

2014-01-01

Health warning labels on cigarette packages are one way to reach youth thinking about initiating tobacco use. The purpose of this study was to examine awareness and understanding of current health warning labels among 5 and 6 year old children. Researchers conducted one-on-one interviews with urban and rural 5 and 6 year olds from Brazil, China, India, Nigeria, Pakistan, and Russia. Among the 2,423 participating children, 62 % were unaware of the health warnings currently featured on cigarette packages, with the lowest levels of awareness in India and the highest levels in Brazil. When shown the messages, the same percentage of participating children (62 %) showed no level of message understanding. While youth are receiving social and informational messages promoting tobacco use, health warning labels featured on cigarette packages are not effectively reaching young children with anti-smoking messages.

Young people's perceptions of cigarette packaging and plain packaging: an online survey.

PubMed

Moodie, Crawford; Ford, Allison; Mackintosh, Anne Marie; Hastings, Gerard

2012-01-01

In the United Kingdom, with most marketing channels prohibited, packaging is one of the few remaining ways that tobacco companies can promote their products. An online survey with young people aged 10-17 years (N = 658) was used to explore why youth choose cigarettes, perceptions of pack color, and perceptions of plain (nonbranded) cigarette packaging. Young people were also shown an image of 3 plain packs, which differed by shape and method of opening, and asked which they liked most and thought others their age would smoke. Price and what significant others smoke were key factors for choosing cigarettes, with packaging also an important influence. More than a third of the sample associated lighter pack color with weak tasting and less harmful cigarettes. Plain packs were rated negatively as were perceptions of plain pack users. One in 3 showed a preference for either a narrow "perfume type" plain pack or a plain "slide" pack that opened from the side, and 1 in 3 also thought that young people would smoke these packs. Packaging appears to both attract young people and mislead them about product strength and relative harm. Innovative pack construction (novel pack shape and method of opening) and the use of color are instrumental in these effects. The findings therefore suggest that any move to plain packaging should not only consider the benefits of removing branding (including color) but also of standardizing pack construction in terms of shape and method of opening.

How tobacco companies in the UK prepared for and responded to standardised packaging of cigarettes and rolling tobacco.

PubMed

Moodie, Crawford; Angus, Kathryn; Mitchell, Danielle; Critchlow, Nathan

2018-01-10

As a result of the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive, all packs of cigarettes (factory-made and hand-rolled) in the UK must be drab brown, display pictorial warnings on the principal display areas and contain no less than 20 cigarettes or 30 g of tobacco. The legislation was phased in between May 2016 and May 2017. Our objective was to monitor pack, brand and product changes preimplementation and postimplementation. Our surveillance of the cigarette market involved a review of the trade press, a monthly monitor of online supermarkets and regular visits to stores, from May 2015 to June 2017. Before standardised packaging there were changes to the pack graphics (eg, redesigned packs and limited editions) and pack structure (eg, resealable inner foil) and the issue of a number of reusable tins. After standardised packaging, changes included newer cigarette pack sizes for some brand variants (eg, 23 and 24 packs). Changes to the branding prestandardised packaging included brand extensions, and poststandardised packaging included brand and/or variant name change, often with the inclusion of colour descriptors and brand migrations. Product changes prestandardised packaging included the introduction of novel filters (eg, filters with two flavour-changing capsules, tube filters, firmer filters and filters with granular additives). There was non-compliance with the legislation, with slim packs, which are not permitted, on sale after standardised packaging was implemented. Our findings highlight the need to monitor developments in markets introducing standardised packaging and have policy implications for countries considering this measure. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Cigarette packaging and health warnings: the impact of plain packaging and message framing on young smokers.

PubMed

Mays, Darren; Niaura, Raymond S; Evans, W Douglas; Hammond, David; Luta, George; Tercyak, Kenneth P

2015-03-01

This study examined the impact of pictorial cigarette-warning labels, warning-label message framing and plain cigarette packaging, on young adult smokers' motivation to quit. Smokers aged 18-30 years (n=740) from a consumer research panel were randomised to one of four experimental conditions where they viewed online images of four cigarette packs with warnings about lung disease, cancer, stroke/heart disease and death, respectively. Packs differed across conditions by warning-message framing (gain vs loss) and packaging (branded vs plain). Measures captured demographics, smoking behaviour, covariates and motivation to quit in response to cigarette packs. Pictorial warnings about lung disease and cancer generated the strongest motivation to quit across conditions. Adjusting for pretest motivation and covariates, a message framing by packaging interaction revealed gain-framed warnings on plain packs generated greater motivation to quit for lung disease, cancer and mortality warnings (p<0.05), compared with loss-framed warnings on plain packs. Warnings combining pictorial depictions of smoking-related health risks with text-based messages about how quitting reduces risks, may achieve better outcomes among young adults, especially in countries considering or implementing plain packaging regulations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The impact of cigarette branding and plain packaging on perceptions of product appeal and risk among young adults in Norway: A between-subjects experimental survey.

PubMed

Scheffels, Janne; Lund, Ingeborg

2013-12-04

This study examined the perceptions of cigarette packaging and the potential impact of plain packaging regulations. The hypothesis was that the branded cigarette packages would be rated more positively than the corresponding plain packs with and without descriptors. Between-subjects experimental online survey. Male and female participants were separately randomised to one of the three experimental conditions: fully branded cigarette packs, plain packs with descriptors and plain packs without descriptors; participants were asked to evaluate 12 individual cigarette packages. The participants were also asked to compare five pairs of packs from the same brand family. Norway. 1010 youths and adults aged 15-22. Ratings of appeal, taste and harmfulness for individual packages. Ratings of taste, harm, quality, 'would rather try' and 'easier to quit' for pairs of packages. Plain with and without descriptors packs were rated less positively than the branded packs on appeal (index score 1.63/1.61 vs 2.42, p<0.001), taste (index score 1.21/1.12 vs 1.70, p<0.001) and as less harmful (index score 1.0.34/0.36 vs 0.82, p<0.001) among females. Among males, the difference between the plain with and without descriptors versus branded condition was significant for appeal (index score 2.08/1.92 vs 2.58, p<0.005) and between the plain without descriptors versus branded condition for taste (index score 1.18 vs 1.70, p<0.00). The pack comparison task showed that the packs with descriptors suggesting a lower content of harmful substances, together with lighter colours, were more positively rated in the branded compared with the plain condition on dimensions less harmful (β -0.77, 95% CI -0.97 to -0.56), would rather try (β -0.32, 95% CI -0.50 to -0.14) and easier to quit (β -0.58, 95% CI -0.76 to -0.39). The results indicate that a shift from branded to plain cigarette packaging could lead to a reduction in positive perceptions of cigarettes among young people.

Young smokers and non-smokers perceptions of typical users of plain vs. branded cigarette packs: a between-subjects experimental survey.

PubMed

Lund, Ingeborg; Scheffels, Janne

2013-10-24

In an attempt to minimize the pack design avenue of communication between tobacco producers and smokers and potential smokers, several jurisdictions, including Norway, have considered regulations on cigarette pack design. The main aim of the current study was to investigate how package design affects young people's perceptions of typical smokers of some pre-chosen cigarette brands and brand varieties. Based on data from a web survey among 1022 15-22 year-olds, possible effects of plain packaging of cigarettes on adolescents' views about typical cigarette smokers were investigated. The data collection had a between-subjects design, in which participants were allocated to one of three groups, and asked to typify the smokers of selected cigarette packs either in branded, plain or plain with descriptor versions. The sample included boys and girls, and smokers and non-smokers. The smoker characteristics included in the investigation were: gender, glamour, stylishness, popularity, coolness, sophistication and slimness. After creating sum-scores within and across packs and pack versions, analyses indicated that a shift from branded to plain cigarette packaging would result in a reduction in positive user images related to smoking among adolescents and young adults. For girls, this effect held up after controlling for confounders. To the extent that plain packaging contributes to making smoking images less positive, it can potentially be an efficient aid in reducing smoking uptake among adolescents.

Plain packaging implementation: perceptions of risk and prestige of cigarette brands among Aboriginal and Torres Strait Islander people.

PubMed

Maddox, Raglan; Durkin, Sarah; Lovett, Ray

2016-06-01

To assess the impact of plain packaging with larger graphic health warnings on perceptions of risk and prestige related to different cigarette brands among Aboriginal and Torres Strait Islander people in the Australian Capital Territory. We hypothesised that the changes would decrease perceptions that 'some cigarette brands are more harmful than others', and that 'some brands are more prestigious than others', and this would be stronger among participants aged ≤35 years, and among smokers compared with non-smokers. Participants completed the survey prior to packaging changes, and were followed up 12 months later (n=98). Repeated measures ANCOVAs assessed perception changes. Following plain packaging implementation, there was a significant reduction in perceptions that 'some cigarette brands are more harmful than others'. There was no overall change in perceptions of prestige. However, there was a significant interaction for age. Analyses indicated a reduction in perceptions that 'some cigarette brands are more prestigious than others' among younger participants (p=0.05), but no change among older participants (p>0.20). There was no interaction for smoking status for perceptions of prestige, indicating smokers' and non-smokers' perceptions did not differ on this measure. These findings provide support for the packaging changes. © 2015 Public Health Association of Australia.

Cigarette brand variant portfolio strategy and the use of colour in a darkening market.

PubMed

Greenland, Steven J

2015-03-01

To evaluate cigarette branding strategies used to segment a market with some of the toughest tobacco controls. To document brand variant and packaging portfolios and assess the role played by colour before plain packaging, as well as consider the threat that recently implemented legislation poses for tobacco manufacturers. Brand variant and packaging details were extracted from manufacturer ingredient reports, as well as a retail audit of Australian supermarkets. Details were also collected for other product categories to provide perspective on cigarette portfolios. Secondary and primary data sources were analysed to evaluate variant and packaging portfolio strategy. In Australia, 12 leading cigarette brands supported 120 brand variants. Of these 61 had names with a specific colour and a further 26 had names with colour connotation. There were 338 corresponding packaging configurations, with most variants available in the primary cigarette distribution channel in four pack size options. Tobacco companies microsegment Australian consumers with highly differentiated product offerings and a family branding strategy that helps ameliorate the effects of marketing restrictions. To date, tobacco controls have had little negative impact upon variant and packaging portfolios, which have continued to expand. Colour has become a key visual signifier differentiating one variant from the next, and colour names are used to extend brand lines. However, the role of colour, as a heuristic to simplify consumer decision-making processes, becomes largely redundant with plain packaging. Plain packaging's impact upon manufacturers' branding strategies is therefore likely to be significant. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The importance of cigarette packaging in a 'dark' market: the 'Silk Cut' experience.

PubMed

Moodie, Crawford; Angus, Kathryn; Ford, Allison

2014-05-01

In a growing number of countries tobacco companies are severely restricted in how they can legally market their products. In these 'dark' markets the role of packaging as a promotional and communications tool becomes more pronounced. How packaging is used for the most expensive cigarette brands in dark markets has received limited attention however, even though these 'premium' cigarette brands significantly impact upon the profitability of tobacco companies. We outline, using retail trade press journals, how packaging was used for premium brand 'Silk Cut' in the UK from 2004 to 2011, following a comprehensive ban on tobacco advertising, promotions and sponsorship. From 2004 to 2008 packaging was used to help launch two new variants and during this period Silk Cut market share of the premium sector grew by 1.1%. Overall share of the cigarette market for the Silk Cut house (brand family) fell however due to the continuing decline of the premium sector. From 2008 to 2011 changes to the packaging were much more frequent, including the repeated use of limited-edition designs, and modifications to pack shape, texture, style of opening, cellophane, foil and inner frame. Silk Cut's share of the premium sector grew a further 2.9% from 2008 to 2011, and overall cigarette market share increased. That a premium brand can report any level of growth within such a hostile market, where most advertising, promotion and sponsorship is banned, taxation is among the highest in the world, and in the midst of a recession, is testament to the value of packaging.

27 CFR 40.215 - Notice for cigarettes.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately imprinted...

27 CFR 40.215 - Notice for cigarettes.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately imprinted...

27 CFR 40.215 - Notice for cigarettes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately imprinted...

27 CFR 40.215 - Notice for cigarettes.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately imprinted...

27 CFR 40.215 - Notice for cigarettes.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Notice for cigarettes. 40..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES... cigarettes. Every package of cigarettes shall, before removal subject to tax, have adequately imprinted...

How tobacco companies have used package quantity for consumer targeting.

PubMed

Persoskie, Alexander; Donaldson, Elisabeth A; Ryant, Chase

2018-05-31

Package quantity refers to the number of cigarettes or amount of other tobacco product in a package. Many countries restrict minimum cigarette package quantities to avoid low-cost packs that may lower barriers to youth smoking. We reviewed Truth Tobacco Industry Documents to understand tobacco companies' rationales for introducing new package quantities, including companies' expectations and research regarding how package quantity may influence consumer behaviour. A snowball sampling method (phase 1), a static search string (phase 2) and a follow-up snowball search (phase 3) identified 216 documents, mostly from the 1980s and 1990s, concerning cigarettes (200), roll-your-own tobacco (9), smokeless tobacco (6) and 'smokeless cigarettes' (1). Companies introduced small and large packages to motivate brand-switching and continued use among current users when faced with low market share or threats such as tax-induced price increases or competitors' use of price promotions. Companies developed and evaluated package quantities for specific brands and consumer segments. Large packages offered value-for-money and matched long-term, heavy users' consumption rates. Small packages were cheaper, matched consumption rates of newer and lighter users, and increased products' novelty, ease of carrying and perceived freshness. Some users also preferred small packages as a way to try to limit consumption or quit. Industry documents speculated about many potential effects of package quantity on appeal and use, depending on brand and consumer segment. The search was non-exhaustive, and we could not assess the quality of much of the research or other information on which the documents relied. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

The effect of cigarette branding and plain packaging on female youth in the United Kingdom.

PubMed

Hammond, David; Daniel, Samantha; White, Christine M

2013-02-01

Cigarette packaging is the most prominent form of tobacco marketing remaining in countries such as the United Kingdom. The current study examined perceptions of cigarette packaging among female youth and the potential impact of "plain" cigarette packaging regulations. A national sample of 947 16- to 19-year-old female subjects in the United Kingdom completed an online survey. Participants were randomized to view 10 cigarette packs designed according to one of four experimental conditions: fully branded female packs, the same packs without descriptor words, the same packs without brand imagery or descriptors ("plain" packs), and branded non-female brands. Participants rated packs on measures of appeal and health risk, positive smoker image, and completed a behavioral pack selection task. Plain packs were rated as the least appealing and worse tasting compared with all other conditions. Plain packs were also associated with fewer false beliefs about health risks compared with branded packs. Removing brand descriptors from packs significantly reduced measures of appeal and taste, particularly for brands with flavor descriptors, such as cherry and vanilla. Plain packs were significantly less likely to be associated with positive images, such as glamour, sophistication, and slimness. Most importantly, respondents were significantly less likely to accept a pack of cigarettes when offered only plain versus branded packs (p = .026). Marketing in the form of pack branding remains a potent tool for increasing the appeal of tobacco products to young women. The findings provide empirical support for plain cigarette packaging regulations in Australia to be implemented in 2012. Copyright © 2013 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Plain packaging increases visual attention to health warnings on cigarette packs in non-smokers and weekly smokers but not daily smokers.

PubMed

Munafò, Marcus R; Roberts, Nicole; Bauld, Linda; Leonards, Ute

2011-08-01

To assess the impact of plain packaging on visual attention towards health warning information on cigarette packs. Mixed-model experimental design, comprising smoking status as a between-subjects factor, and package type (branded versus plain) as a within-subjects factor. University laboratory. Convenience sample of young adults, comprising non-smokers (n = 15), weekly smokers (n = 14) and daily smokers (n = 14). Number of saccades (eye movements) towards health warnings on cigarette packs, to directly index visual attention. Analysis of variance indicated more eye movements (i.e. greater visual attention) towards health warnings compared to brand information on plain packs versus branded packs. This effect was observed among non-smokers and weekly smokers, but not daily smokers. Among non-smokers and non-daily cigarette smokers, plain packaging appears to increase visual attention towards health warning information and away from brand information. © 2011 The Authors, Addiction © 2011 Society for the Study of Addiction.

Young smokers and non-smokers perceptions of typical users of plain vs. branded cigarette packs: a between-subjects experimental survey

PubMed Central

2013-01-01

Background In an attempt to minimize the pack design avenue of communication between tobacco producers and smokers and potential smokers, several jurisdictions, including Norway, have considered regulations on cigarette pack design. The main aim of the current study was to investigate how package design affects young people’s perceptions of typical smokers of some pre-chosen cigarette brands and brand varieties. Methods Based on data from a web survey among 1022 15–22 year-olds, possible effects of plain packaging of cigarettes on adolescents’ views about typical cigarette smokers were investigated. The data collection had a between-subjects design, in which participants were allocated to one of three groups, and asked to typify the smokers of selected cigarette packs either in branded, plain or plain with descriptor versions. The sample included boys and girls, and smokers and non-smokers. The smoker characteristics included in the investigation were: gender, glamour, stylishness, popularity, coolness, sophistication and slimness. Results After creating sum-scores within and across packs and pack versions, analyses indicated that a shift from branded to plain cigarette packaging would result in a reduction in positive user images related to smoking among adolescents and young adults. For girls, this effect held up after controlling for confounders. Conclusions To the extent that plain packaging contributes to making smoking images less positive, it can potentially be an efficient aid in reducing smoking uptake among adolescents. PMID:24156515

The cigarette box as an advertising vehicle in the United Kingdom: A case for plain packaging.

PubMed

Dewe, Michaela; Ogden, Jane; Coyle, Adrian

2015-07-01

This research aimed to study tobacco advertising between 1950-2003 and to evaluate the role of the cigarette box in advertising. Tobacco company advertisements (n = 204) were coded for content and meanings used to promote their product. There was a significant shift from cigarettes being displayed to the cigarette box only. Changes in advertising and the meanings evoked were unrelated to changes in smoking behaviour. It is argued that the cigarette box has absorbed the meanings associated with smoking and has become an effective vehicle for advertising. It is also argued that this can only be minimised with plain packaging. © The Author(s) 2013.

Text and graphic warnings on cigarette packages: findings from the international tobacco control four country study.

PubMed

Hammond, David; Fong, Geoffrey T; Borland, Ron; Cummings, K Michael; McNeill, Ann; Driezen, Pete

2007-03-01

Health warnings on cigarette packages provide smokers with universal access to information on the risks of smoking. However, warnings vary considerably among countries, ranging from graphic depictions of disease on Canadian packages to obscure text warnings in the United States. The current study examined the effectiveness of health warnings on cigarette packages in four countries. Quasi-experimental design. Telephone surveys were conducted with representative cohorts of adult smokers (n=14,975): Canada (n=3687), United States (n=4273), UK (n=3634), and Australia (n=3381). Surveys were conducted between 2002 and 2005, before and at three time points following implementation of new package warnings in the UK. At Wave 1, Canadian smokers reported the highest levels of awareness and impact for health warnings among the four countries, followed by Australian smokers. Following the implementation of new UK warnings at Wave 2, UK smokers reported greater levels of awareness and impact, although Canadian smokers continued to report higher levels of impact after adjusting for the implementation date. U.S. smokers reported the lowest levels of effectiveness for almost every measure recorded at each survey wave. Large, comprehensive warnings on cigarette packages are more likely to be noticed and rated as effective by smokers. Changes in health warnings are also associated with increased effectiveness. Health warnings on U.S. packages, which were last updated in 1984, were associated with the least effectiveness.

19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and cigarettes...

19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and cigarettes...

19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and cigarettes...

19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and cigarettes...

19 CFR 11.1 - Cigars, cigarettes, medicinal preparations, and perfumery.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Cigars, cigarettes, medicinal preparations, and..., cigarettes, medicinal preparations, and perfumery. (a) All cigars and cigarettes imported into the United... necessary for prompt determination of the estimate duty and tax on the packages of cigars and cigarettes...

Young adult smokers' perceptions of illicit tobacco and the possible impact of plain packaging on purchase behaviour.

PubMed

Moodie, Crawford; Hastings, Gerard; Joossens, Luk

2012-04-01

Plain (unbranded) packaging for cigarettes is at the top of the tobacco control agenda in both Australia and Europe. The evidence suggests that it will benefit public health by decreasing the appeal of tobacco products and increasing the power of the health warning. The tobacco industry instead argues that plain packaging would make it easier to counterfeit cigarettes, which would both confuse consumers and reduce price; thereby increasing consumption. Using focus group research we examined young adult smokers (N = 54) perceptions of, and ability to recognize, illicit tobacco and the possible impact of plain packaging on illicit tobacco purchasing behaviour. We found that the pack has no impact on the decision to buy illicit tobacco. Smokers were easily able to identify counterfeit cigarettes, not least by the pack, and buy it knowingly and in the full expectation that it will be inferior in quality. Illicit tobacco purchase, including that for counterfeit tobacco, was instead driven by availability and price. Given the extremely low manufacturing cost, per pack, of certain types of illicit cigarettes, it is difficult to envisage how plain packaging would alter the price of illicit tobacco in any meaningful way. The findings therefore suggest that a move to plain packaging would have no impact on young adult smokers' purchase behaviour.

Transnational tobacco industry promotion of the cigarette gifting custom in China.

PubMed

Chu, Alexandria; Jiang, Nan; Glantz, Stanton A

2011-07-01

To understand how British American Tobacco (BAT) and Philip Morris (PM) researched the role and popularity of cigarette gifting in forming relationships among Chinese customs and how they exploited the practice to promote their brands State Express 555 and Marlboro. Searches and analysis of industry documents from the Legacy Tobacco Documents Library complemented by searches on LexisNexis Academic news, online search engines and information from the tobacco industry trade press. From 1980-1999, BAT and PM employed Chinese market research firms to gather consumer information about perceptions of foreign cigarettes and the companies discovered that cigarettes, especially prestigious ones, were gifted and smoked purposely for building relationships and social status in China. BAT and PM promoted their brands as gifts by enhancing cigarette cartons and promoting culturally themed packages, particularly during the gifting festivals of Chinese New Year and Mid-Autumn Festival to tie their brands in to festival values such as warmth, friendship and celebration. They used similar marketing in Chinese communities outside China. BAT and PM tied their brands to Chinese cigarette gifting customs by appealing to social and cultural values of respect and personal honour. Decoupling cigarettes from their social significance in China and removing their appeal would probably reduce cigarette gifting and promote a decline in smoking. Tobacco control efforts in countermarketing, large graphic warnings and plain packaging to make cigarette packages less attractive as gifts could contribute to denormalising cigarette gifting.

Transnational tobacco industry promotion of the cigarette gifting custom in China

PubMed Central

Chu, Alexandria; Jiang, Nan; Glantz, Stanton A

2011-01-01

Objective To understand how British American Tobacco (BAT) and Philip Morris (PM) researched the role and popularity of cigarette gifting in forming relationships among Chinese customs and how they exploited the practice to promote their brands State Express 555 and Marlboro. Methods Searches and analysis of industry documents from the Legacy Tobacco Documents Library complemented by searches on LexisNexis Academic news, online search engines and information from the tobacco industry trade press. Results From 1980–1999, BAT and PM employed Chinese market research firms to gather consumer information about perceptions of foreign cigarettes and the companies discovered that cigarettes, especially prestigious ones, were gifted and smoked purposely for building relationships and social status in China. BAT and PM promoted their brands as gifts by enhancing cigarette cartons and promoting culturally themed packages, particularly during the gifting festivals of Chinese New Year and Mid-Autumn Festival to tie their brands in to festival values such as warmth, friendship and celebration. They used similar marketing in Chinese communities outside China. Conclusions BAT and PM tied their brands to Chinese cigarette gifting customs by appealing to social and cultural values of respect and personal honour. Decoupling cigarettes from their social significance in China and removing their appeal would probably reduce cigarette gifting and promote a decline in smoking. Tobacco control efforts in countermarketing, large graphic warnings and plain packaging to make cigarette packages less attractive as gifts could contribute to denormalising cigarette gifting. PMID:21282136

The impact of cigarette branding and plain packaging on perceptions of product appeal and risk among young adults in Norway: A between-subjects experimental survey

PubMed Central

Scheffels, Janne; Lund, Ingeborg

2013-01-01

Objectives This study examined the perceptions of cigarette packaging and the potential impact of plain packaging regulations. The hypothesis was that the branded cigarette packages would be rated more positively than the corresponding plain packs with and without descriptors. Design Between-subjects experimental online survey. Male and female participants were separately randomised to one of the three experimental conditions: fully branded cigarette packs, plain packs with descriptors and plain packs without descriptors; participants were asked to evaluate 12 individual cigarette packages. The participants were also asked to compare five pairs of packs from the same brand family. Setting Norway. Participants 1010 youths and adults aged 15–22. Primary outcome measures Ratings of appeal, taste and harmfulness for individual packages. Ratings of taste, harm, quality, ‘would rather try’ and ‘easier to quit’ for pairs of packages. Results Plain with and without descriptors packs were rated less positively than the branded packs on appeal (index score 1.63/1.61 vs 2.42, p<0.001), taste (index score 1.21/1.12 vs 1.70, p<0.001) and as less harmful (index score 1.0.34/0.36 vs 0.82, p<0.001) among females. Among males, the difference between the plain with and without descriptors versus branded condition was significant for appeal (index score 2.08/1.92 vs 2.58, p<0.005) and between the plain without descriptors versus branded condition for taste (index score 1.18 vs 1.70, p<0.00). The pack comparison task showed that the packs with descriptors suggesting a lower content of harmful substances, together with lighter colours, were more positively rated in the branded compared with the plain condition on dimensions less harmful (β −0.77, 95% CI −0.97 to −0.56), would rather try (β −0.32, 95% CI −0.50 to −0.14) and easier to quit (β −0.58, 95% CI −0.76 to −0.39). Conclusions The results indicate that a shift from branded to plain cigarette packaging could lead to a reduction in positive perceptions of cigarettes among young people. PMID:24309171

21 CFR 1141.10 - Required warnings.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Required warnings. 1141.10 Section 1141.10 Food... PRODUCTS CIGARETTE PACKAGE AND ADVERTISING WARNINGS; (Eff. 9-22-12) Cigarette Package and Advertising Warnings § 1141.10 Required warnings. (a) Packages—(1) It shall be unlawful for any person to manufacture...

Effects of first exposure to plain cigarette packaging on smoking behaviour and attitudes: a randomised controlled study.

PubMed

Maynard, Olivia M; Leonards, Ute; Attwood, Angela S; Bauld, Linda; Hogarth, Lee; Munafò, Marcus R

2015-03-13

Plain packaging requires tobacco products to be sold in packs with a standard shape, method of opening and colour, leaving the brand name in a standard font and location. We ran a randomised controlled trial to investigate the impact of plain packaging on smoking behaviour and attitudes. In a parallel group randomised trial design, 128 daily smokers smoked cigarettes from their usual UK brand, or a plain Australian brand that was closely matched to their usual UK brand for 24 hours. Primary outcomes were number of cigarettes smoked and volume of smoke inhaled per cigarette. Secondary outcomes were self-reported ratings of motivation to quit, cigarette taste, experience of using the pack, experience of smoking, attributes of the pack, perceptions of the health warning, changes in smoking behaviour, and views on plain packaging. There was no evidence that pack type had an effect on either of the primary measures (ps > 0.279). However, smokers using plain cigarette packs rated the experience of using the pack more negatively (-0.52, 95% CI -0.82 to -0.22, p = 0.001), rated the pack attributes more negatively (-1.59, 95% CI -1.80 to -1.39, p < 0.001), and rated the health warning as more impactful (+0.51, 95% CI 0.24 to 0.78, p < 0.001). Plain cigarette packs reduce ratings of the experience of using the cigarette pack, and ratings of the pack attributes, and increase the self-perceived impact of the health warning, but do not change smoking behaviour, at least in the short term. Current Controlled Trials ISRCTN52982308. Registered 27 June 2013.

19 CFR 10.65 - Cigars and cigarettes.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 19 Customs Duties 1 2012-04-01 2012-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be withdrawn...

19 CFR 10.65 - Cigars and cigarettes.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 19 Customs Duties 1 2011-04-01 2011-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be withdrawn...

19 CFR 10.65 - Cigars and cigarettes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 19 Customs Duties 1 2010-04-01 2010-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be withdrawn...

27 CFR 41.85 - Release from customs custody of imported tobacco articles.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., cigarette papers, and cigarettes tubes, which are not put up in packages, i.e., not placed by the... TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Tobacco Products and Cigarette Papers... Products and Cigarette Papers and Tubes Without Payment of Tax Or Certain Duty § 41.85 Release from customs...

27 CFR 41.85 - Release from customs custody of imported tobacco articles.

Code of Federal Regulations, 2012 CFR

2012-04-01

... TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Tobacco Products and Cigarette Papers... Products and Cigarette Papers and Tubes Without Payment of Tax Or Certain Duty § 41.85 Release from customs..., cigarette papers, and cigarettes tubes, which are not put up in packages, i.e., not placed by the...

19 CFR 10.65 - Cigars and cigarettes.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 19 Customs Duties 1 2013-04-01 2013-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be withdrawn...

19 CFR 10.65 - Cigars and cigarettes.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 19 Customs Duties 1 2014-04-01 2014-04-01 false Cigars and cigarettes. 10.65 Section 10.65 Customs... Equipment for Vessels § 10.65 Cigars and cigarettes. (a) Imported cigars and cigarettes in bonded warehouse... cigarettes is made up of a number of units, each in a separate package, such units may be withdrawn...

27 CFR 41.85 - Release from customs custody of imported tobacco articles.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., cigarette papers, and cigarettes tubes, which are not put up in packages, i.e., not placed by the... TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Tobacco Products and Cigarette Papers... Products and Cigarette Papers and Tubes Without Payment of Tax Or Certain Duty § 41.85 Release from customs...

27 CFR 41.85 - Release from customs custody of imported tobacco articles.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., cigarette papers, and cigarettes tubes, which are not put up in packages, i.e., not placed by the... TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Tobacco Products and Cigarette Papers... Products and Cigarette Papers and Tubes Without Payment of Tax Or Certain Duty § 41.85 Release from customs...

Adolescents' perceptions of cigarette brand image: does plain packaging make a difference?

PubMed

Germain, Daniella; Wakefield, Melanie A; Durkin, Sarah J

2010-04-01

To examine the effect of plain packaging on adolescents' perceptions of cigarette packs, attributes of smokers, and expectations of cigarette taste, and to identify the effect of increasing the size of pictorial health warnings on appraisal of plain packs. We used a 5 (degree of plain packaging and graphic health warning)x 3 (brand type) between-subjects experimental design, using a Web-based methodology to expose adolescents to one randomly selected cigarette pack, during which respondents completed ratings. When brand elements such as color, branded fonts, and imagery were progressively removed from cigarette packs, adolescents perceived packs to be less appealing, rated attributes of a typical smoker of the pack less positively, and had more negative expectations of cigarette taste. Pack appeal was reduced even further when the size of the pictorial health warning on the most plain pack was increased from 30% to 80% of the pack face, with this effect apparent among susceptible nonsmokers, experimenters, and established smokers. Removing as much brand information from cigarette packs as possible is likely to reduce positive cigarette brand image associations among adolescents. By additionally increasing the size of pictorial health warnings, positive pack perceptions of those who are at greater risk of becoming regular addicted adult smokers are most likely to be reduced. Copyright 2010 Society for Adolescent Medicine. Published by Elsevier Inc. All rights reserved.

Characteristics of illegal and legal cigarette packs sold in Guatemala.

PubMed

Arevalo, Rodrigo; Corral, Juan E; Monzon, Diego; Yoon, Mira; Barnoya, Joaquin

2016-11-25

Guatemala, as a party to the Framework Convention on Tobacco Control (FCTC), is required to regulate cigarette packaging and labeling and eliminate illicit tobacco trade. Current packaging and labeling characteristics (of legal and illegal cigarettes) and their compliance with the FCTC is unknown. We sought to analyze package and label characteristics of illegal and legal cigarettes sold in Guatemala. We visited the 22 largest traditional markets in the country to purchase illegal cigarettes. All brands registered on tobacco industry websites were purchased as legal cigarettes. Analysis compared labeling characteristics of illegal and legal packs. Most (95%) markets and street vendors sold illegal cigarettes; 104 packs were purchased (79 illegal and 25 legal). Ten percent of illegal and none of the legal packs had misleading terms. Half of the illegal packs had a warning label covering 26 to 50% of the pack surface. All legal packs had a label covering 25% of the surface. Illegal packs were more likely to have information on constituents and emissions (85% vs. 45%, p < 0.001) and were less expensive than legal ones (USD 0.70 ± 0.7 and 1.9 ± 1.8, p < 0.001). In Guatemala, neither illegal nor legal cigarette packs comply with FCTC labeling mandates. Urgent implementation and enforcement of the FCTC is necessary to halt the tobacco epidemic.

"Plain packaging" regulations for tobacco products: the impact of standardizing the color and design of cigarette packs.

PubMed

Hammond, David

2010-01-01

Tobacco packaging and labeling policies have emerged as prominent and cost-effective tobacco control measures. Although packaging policies have primarily focused on health warnings, there is growing recognition of the importance of packaging as a marketing tool for the tobacco industry. The current paper reviews evidence on the potential impact of standardizing the color and design of tobacco packages -so called "plain" packaging. The evidence indicates three primary benefits of plain packaging: increasing the effectiveness of health warnings, reducing false health beliefs about cigarettes, and reducing brand appeal especially among youth and young adults. Overall, the research to date suggests that "plain" packaging regulations would be an effective tobacco control measure, particularly in jurisdictions with comprehensive restrictions on other forms of marketing.

77 FR 37677 - Agency Forms Undergoing Paperwork Reduction Act Review

Federal Register 2010, 2011, 2012, 2013, 2014

2012-06-22

... List of Ingredients Added to Tobacco in the Manufacture of Cigarette Products--Extension--Office on... death and disability resulting from cigarette smoking and other forms of tobacco use through programs of... in cigarette products. Respondents are commercial cigarette manufacturers, packagers, or importers...

Pictorial health warning labels on cigarette packages: an investigation on opinions of male smokers.

PubMed

Shojaezadeh, Davoud; Peyman, Nooshin; Shakeri, Mohammad Taghi; Nedjat, Saharnaz; Mohaddes Hakkak, Abbas; Taghdisi, Mohammad Hossein; Mohaddes Hakkak, Hamid Reza; Shariati, Keivan; Taghipour, Ali

2014-03-01

Health warning labels on cigarette packages are among the most straightforward and important tools to communicate with smokers and various studies have illustrated their efficacy. The current study aimed to investigate the opinions of male smokers in Mashhad city about the efficacy of health warning labels printed on cigarette packages on the smoking status of smokers. This cross-sectional descriptive study was conducted in 2013 using a questionnaire. The research population included the male smokers of Mashhad. The participants were selected from the customers referring to the newsstands for cigarettes. The obtained data were analyzed employing SPSS software Version 16, and the statistical tests including Kruskal-Wallis, Spearman, and correlation coefficient of Pearson, Chi Square, Mann-Whitney, and Bonferroni correction were used in this regard. In this research, there were 500 participants with the average age of 25 years. The initiation age of smoking was eight years while the maximum age was reported as 45 years. Results of this research about the effect of these labels on decreasing cigarette consumption rate showed that almost half of the participants believed that these labels were ineffective for them (52.2%) and other smokers (53.8%).Furthermore, significant relationship was found between the age and opinion of the smokers about the influence of these labels on reducing their cigarette consumption (P < 0.001). To promote the effect of printed images on cigarette packages, it is recommended to consider the suitability of labels in the targeted culture. In addition, to be more effective consultation sites to quit smoking should be introduced under the images.

16 CFR 1632.4 - Mattress test procedure.

Code of Federal Regulations, 2012 CFR

2012-01-01

... cigarettes shall be selected for each series of tests. The cigarettes shall be removed from packaging prior... cigarettes shall be burned on the tape edge. (ii) Light and place one cigarette at a time on the mattress..., the number of cigarettes which may be lighted and placed on the mattress at one time is left to the...

Warning Statements and Safety Practices among Manufacturers and Distributors of Electronic Cigarette Liquids in the United States.

PubMed

Fagan, Pebbles; Pokhrel, Pallav; Herzog, Thaddeus A; Guy, Mignonne C; Sakuma, Kari-Lyn K; Trinidad, Dennis R; Cassel, Kevin; Jorgensen, Dorothy; Lynch, Tania; Felicitas-Perkins, Jamie Q; Palafox, Sherilyn; Hamamura, Faith; Maloney, Sarah; Degree, Kaylah; Sterling, Kymberle; Moolchan, Eric; Clanton, Mark S; Eissenberg, Thomas

2017-05-18

Prior to the Food and Drug Administration's (FDA) regulation of electronic cigarettes and warning statements related to nicotine addiction, there was no critical examination of manufacturer/distributor voluntary practices that could potentially inform FDA actions aimed to protect consumers. This study examined the content of warning statements and safety characteristics of electronic cigarette liquid bottles using a national sample. Research staff randomly selected four electronic cigarette liquid manufacturers/distributors from four U.S. geographic regions. Staff documented the characteristics of product packaging and content of warning statements on 147 electronic cigarette liquids (0-30 mg/ml of nicotine) purchased online from 16 manufacturers/distributors in April of 2016. Data showed that 97.9% of the electronic cigarette liquid bottles included a warning statement, most of which focused on nicotine exposure rather than health. Only 22.4% of bottles used a warning statement that indicated the product "contained nicotine". Of bottles that advertised a nicotine-based concentration of 12 mg/ml, 26% had a warning statements stated that the product "contains nicotine". None of the statements that indicated that the product "contained nicotine" stated that nicotine was "addictive". All bottles had a safety cap and 12% were in plastic shrink-wrap. Fifty-six percent of the websites had a minimum age requirement barrier that prevented under-aged persons from entering. Most manufacturers/distributors printed a warning statement on electronic cigarette liquid bottles, but avoided warning consumers about the presence and the addictiveness of nicotine. Studies are needed to examine manufacturer/distributor modifications to product packaging and how packaging affects consumer behaviors. These data can inform future FDA requirements related to the packaging and advertising of e-cigarette liquids; regulation related to the content of warning statements, including exposure warning statements, which are not currently mandated; and requirements on websites or language on packaging to help manufacturers adhere to the minimum age of purchase regulation. The data can also be used to help FDA develop additional guidance on the framing of statements on packaging that helps consumers make informed decisions about purchasing the product or protecting young people from use or unintentional exposure to the product. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Consumption and production waste: another externality of tobacco use.

PubMed

Novotny, T E; Zhao, F

1999-01-01

To describe the waste produced by and environmental implications of individual cigarette consumption (filter tips, packages, and cartons) and tobacco manufacturing. All available articles and reports published since 1970 related to cigarette consumption and production waste were reviewed. Global cigarette consumption data were used to estimate cigarette butt and packaging waste quantities. Data from the Center for Marine Conservation's International Coastal Cleanup Project were used to describe some environmental impacts of tobacco-related trash. Data from the United States Environmental Protection Agency's (EPA's) Toxics Release Inventory and reported global cigarette consumption totals were used to estimate waste production from cigarette manufacturing. In 1995, an estimated 5.535 trillion cigarettes (27,675 million cartons and 276,753 million packages) were sold by the tobacco industry globally. Some of the wastes from these products were properly deposited, but a large amount of tobacco consumption waste ends up in the environment. Some is recovered during environmental clean-up days. For the past eight years (1990-1997), cigarette butts have been the leading item found during the International Coastal Cleanup Project; they accounted for 19.1% of all items collected in 1997. The tobacco manufacturing process produces liquid, solid, and airborne waste. Among those wastes, some materials, including nicotine, are designated by the EPA as Toxics Release Inventory (TRI) chemicals. These are possible environmental health hazards. In 1995, the global tobacco industry produced an estimated 2262 million kilograms of manufacturing waste and 209 million kilograms of chemical waste. In addition, total nicotine waste produced in the manufacture of reduced nicotine cigarettes was estimated at 300 million kilograms. Laws against littering relative to cigarette butts could be better enforced. Additional taxes might be levied on cigarette products that would then be directed to environmental clean-up efforts. The tobacco industry should improve the biodegradability of filters, reduce packaging waste, and educate its customers. Worksites and public buildings should be encouraged or required to supply appropriate disposal mechanisms at all building entrances. Public awareness campaigns about the magnitude and prevention of cigarette consumption waste could be developed through partnerships among environmental groups, health organisations, and environmental protection agencies. Tobacco production waste should be a source of concern and regulation by governments throughout the world; it contains numerous chemicals which may be considered health hazards, not the least of which is nicotine produced in the manufacture of low-nicotine cigarettes.

Awareness of FDA-Mandated Cigarette Packaging Changes among Smokers of "Light" Cigarettes

ERIC Educational Resources Information Center

Falcone, M.; Bansal-Travers, M.; Sanborn, P. M.; Tang, K. Z.; Strasser, A. A.

2015-01-01

Previous research has clearly demonstrated that smokers associate cigarette descriptors such as "light", "ultra-light" and "low tar" with reduced health risks, despite evidence showing that cigarettes with these descriptor terms do not present lower health risk. In June 2010, regulations implemented by the US Food and…

27 CFR 45.45 - Notice for cigarettes.

Code of Federal Regulations, 2010 CFR

2010-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2010-04-01 2010-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for cigarettes...

27 CFR 45.45 - Notice for cigarettes.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2014-04-01 2014-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for cigarettes...

27 CFR 45.45 - Notice for cigarettes.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2011-04-01 2011-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for cigarettes...

27 CFR 45.45 - Notice for cigarettes.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2013-04-01 2013-04-01 false Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for cigarettes...

27 CFR 45.45 - Notice for cigarettes.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 27 Alcohol, Tobacco Products and Firearms 2 2012-04-01 2011-04-01 true Notice for cigarettes. 45..., DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES, WITHOUT PAYMENT OF TAX, FOR USE OF THE UNITED STATES Packaging Requirements § 45.45 Notice for cigarettes...

Exposure to graphic warning labels on cigarette packages: Effects on implicit and explicit attitudes towards smoking among young adults.

PubMed

Macy, Jonathan T; Chassin, Laurie; Presson, Clark C; Yeung, Ellen

2016-01-01

To test the effect of exposure to the US Food and Drug Administration's proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes towards smoking. A two-session web-based study was conducted with 2192 young adults 18-25-years-old. During session one, demographics, smoking behaviour, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current US Surgeon General's text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes. Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p = .004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current US Surgeon General's text warnings (p = .014), but there was no difference compared to those who viewed text-only warnings. Graphic health warnings on cigarette packages can influence young adult smokers' implicit attitudes towards smoking.

Tobacco branding, plain packaging, pictorial warnings, and symbolic consumption.

PubMed

Hoek, Janet; Gendall, Philip; Gifford, Heather; Pirikahu, Gill; McCool, Judith; Pene, Gina; Edwards, Richard; Thomson, George

2012-05-01

We use brand association and symbolic consumption theory to explore how plain cigarette packaging would influence the identities young adults cocreate with tobacco products. Group discussions and in-depth interviews with 86 young adult smokers and nonsmokers investigated how participants perceive tobacco branding and plain cigarette packaging with larger health warnings. We examined the transcript data using thematic analysis and explored how removing tobacco branding and replacing this with larger warnings would affect the symbolic status of tobacco brands and their social connotations. Smokers used tobacco brand imagery to define their social attributes and standing, and their connection with specific groups. Plain cigarette packaging usurped this process by undermining aspirational connotations and exposing tobacco products as toxic. Replacing tobacco branding with larger health warnings diminishes the cachet brand insignia creates, weakens the social benefits brands confer on users, and represents a potentially powerful policy measure.

Pictorial Health Warning Labels on Cigarette Packages: An Investigation on Opinions of Male Smokers

PubMed Central

Shojaezadeh, Davoud; Peyman, Nooshin; Shakeri, Mohammad Taghi; Nedjat, Saharnaz; Mohaddes Hakkak, Abbas; Taghdisi, Mohammad Hossein; Mohaddes Hakkak, Hamid Reza; Shariati, Keivan; Taghipour, Ali

2014-01-01

Background: Health warning labels on cigarette packages are among the most straightforward and important tools to communicate with smokers and various studies have illustrated their efficacy. Objectives: The current study aimed to investigate the opinions of male smokers in Mashhad city about the efficacy of health warning labels printed on cigarette packages on the smoking status of smokers. Patients and Methods: This cross-sectional descriptive study was conducted in 2013 using a questionnaire. The research population included the male smokers of Mashhad. The participants were selected from the customers referring to the newsstands for cigarettes. The obtained data were analyzed employing SPSS software Version 16, and the statistical tests including Kruskal-Wallis, Spearman, and correlation coefficient of Pearson, Chi Square, Mann-Whitney, and Bonferroni correction were used in this regard. Results: In this research, there were 500 participants with the average age of 25 years. The initiation age of smoking was eight years while the maximum age was reported as 45 years. Results of this research about the effect of these labels on decreasing cigarette consumption rate showed that almost half of the participants believed that these labels were ineffective for them (52.2%) and other smokers (53.8%).Furthermore, significant relationship was found between the age and opinion of the smokers about the influence of these labels on reducing their cigarette consumption (P < 0.001). Conclusions: To promote the effect of printed images on cigarette packages, it is recommended to consider the suitability of labels in the targeted culture. In addition, to be more effective consultation sites to quit smoking should be introduced under the images. PMID:24829777

Has the introduction of plain packaging with larger graphic health warnings changed adolescents’ perceptions of cigarette packs and brands?

PubMed Central

White, Victoria; Williams, Tahlia; Wakefield, Melanie

2015-01-01

Objective To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on adolescents’ perceptions of pack image and perceived brand differences. Methods Cross-sectional school-based surveys conducted in 2011 (prior to introduction of new cigarette packaging) and in 2013 (7–12 months afterwards). Students aged 12–17 years (2011 n=6338; 2013 n=5915) indicated whether they had seen a cigarette pack in previous 6 months. Students rated the character of four popular cigarette brands, indicated level of agreement regarding differences between brands in ease of smoking, quitting, addictiveness, harmfulness and look of pack; and indicated positive and negative perceptions of pack image. Changes in responses of students seeing cigarette packs in the previous 6 months (2011: 60%; 2013: 65%) were examined. Results Positive character ratings for each brand reduced significantly between 2011 and 2013. Changes were found for four of five statements reflecting brand differences. Significantly fewer students in 2013 than 2011 agreed that ‘some brands have better looking packs than others’ (2011: 43%; 2013: 25%, p<0.001), with larger decreases found among smokers (interaction p<0.001). Packs were rated less positively and more negatively in 2013 than in 2011 (p<0.001). The decrease in positive image ratings was greater among smokers. Conclusions The introduction of standardised packaging has reduced the appeal of cigarette packs. Further research could determine if continued exposure to standardised packs creates more uncertainty or disagreement regarding brand differences in ease of smoking and quitting, perceived addictiveness and harms. PMID:28407611

Reactions of Chinese adults to warning labels on cigarette packages: A survey in Jiangsu Province

PubMed Central

2011-01-01

Background To compare reactions to warning labels presented on cigarette packages with a specific focus on whether the new Chinese warning labels are better than the old labels and international labels. Methods Participants aged 18 and over were recruited in two cities of Jiangsu Province in 2008, and 876 face-to-face interviews were completed. Participants were shown six types of warning labels found on cigarette packages. They comprised one old Chinese label, one new label used within the Chinese market, and one Chinese overseas label and three foreign brand labels. Participants were asked about the impact of the warning labels on: their knowledge of harm from smoking, giving cigarettes as a gift, and quitting smoking. Results Compared with the old Chinese label, a higher proportion of participants said the new label provided clear information on harm caused by smoking (31.2% vs 18.3%). Participants were less likely to give cigarettes with the new label on the package compared with the old label (25.2% vs 20.8%). These proportions were higher when compared to the international labels. Overall, 26.8% of participants would quit smoking based on information from the old label and 31.5% from the new label. When comparing the Chinese overseas label and other foreign labels to the new Chinese label with regard to providing knowledge of harm warning, impact of quitting smoking and giving cigarettes as a gift, the overseas labels were more effective. Conclusion Both the old and the new Chinese warning label are not effective in this target population. PMID:21349205

Exposure to Graphic Warning Labels on Cigarette Packages: Effects on Implicit and Explicit Attitudes toward Smoking among Young Adults

PubMed Central

Macy, Jonathan T.; Chassin, Laurie; Presson, Clark C.; Yeung, Ellen

2015-01-01

Objective Test the effect of exposure to the U.S. Food and Drug Administration’s proposed graphic images with text warning statements for cigarette packages on implicit and explicit attitudes toward smoking. Design and methods A two-session web-based study was conducted with 2192 young adults 18–25 years old. During session one, demographics, smoking behavior, and baseline implicit and explicit attitudes were assessed. Session two, completed on average 18 days later, contained random assignment to viewing one of three sets of cigarette packages, graphic images with text warnings, text warnings only, or current U.S Surgeon General’s text warnings. Participants then completed post-exposure measures of implicit and explicit attitudes. ANCOVAs tested the effect of condition on the outcomes, controlling for baseline attitudes. Results Smokers who viewed packages with graphic images plus text warnings demonstrated more negative implicit attitudes compared to smokers in the other conditions (p=.004). For the entire sample, explicit attitudes were more negative for those who viewed graphic images plus text warnings compared to those who viewed current U.S. Surgeon General’s text warnings (p=.014), but there was no difference compared to those who viewed text-only warnings. Conclusion Graphic health warnings on cigarette packages can influence young adult smokers’ implicit attitudes toward smoking. PMID:26442992

Consumption and production waste: another externality of tobacco use

PubMed Central

Novotny, T.; Zhao, F.

1999-01-01

OBJECTIVE—To describe the waste produced by and environmental implications of individual cigarette consumption (filter tips, packages, and cartons) and tobacco manufacturing.
STUDY SELECTION—All available articles and reports published since 1970 related to cigarette consumption and production waste were reviewed.
DATA SOURCES—Global cigarette consumption data were used to estimate cigarette butt and packaging waste quantities. Data from the Center for Marine Conservation's International Coastal Cleanup Project were used to describe some environmental impacts of tobacco-related trash. Data from the United States Environmental Protection Agency's (EPA's) Toxics Release Inventory and reported global cigarette consumption totals were used to estimate waste production from cigarette manufacturing.
DATA EXTRACTION AND SYNTHESIS—In 1995, an estimated 5.535 trillion cigarettes (27 675 million cartons and 276 753 million packages) were sold by the tobacco industry globally. Some of the wastes from these products were properly deposited, but a large amount of tobacco consumption waste ends up in the environment. Some is recovered during environmental clean-up days. For the past eight years (1990-1997), cigarette butts have been the leading item found during the International Coastal Cleanup Project; they accounted for 19.1% of all items collected in 1997. The tobacco manufacturing process produces liquid, solid, and airborne waste. Among those wastes, some materials, including nicotine, are designated by the EPA as Toxics Release Inventory (TRI) chemicals. These are possible environmental health hazards. In 1995, the global tobacco industry produced an estimated 2262 million kilograms of manufacturing waste and 209 million kilograms of chemical waste. In addition, total nicotine waste produced in the manufacture of reduced nicotine cigarettes was estimated at 300 million kilograms.
CONCLUSIONS—Laws against littering relative to cigarette butts could be better enforced. Additional taxes might be levied on cigarette products that would then be directed to environmental clean-up efforts. The tobacco industry should improve the biodegradability of filters, reduce packaging waste, and educate its customers. Worksites and public buildings should be encouraged or required to supply appropriate disposal mechanisms at all building entrances. Public awareness campaigns about the magnitude and prevention of cigarette consumption waste could be developed through partnerships among environmental groups, health organisations, and environmental protection agencies. Tobacco production waste should be a source of concern and regulation by governments throughout the world; it contains numerous chemicals which may be considered health hazards, not the least of which is nicotine produced in the manufacture of low-nicotine cigarettes.


Keywords: tobacco waste; litter; environmental impact PMID:10465821

Impact of female-oriented cigarette packaging in the United States.

PubMed

Hammond, David; Doxey, Juliana; Daniel, Samantha; Bansal-Travers, Maansi

2011-07-01

Cigarette packaging is among the most prominent forms of tobacco marketing. This study examined the impact of cigarette pack design among young women in the United States. A national sample of 18- to 19-year-old females in the United States completed an online survey in February 2010. Participants were randomized to view eight cigarette packs designed according to one of four experimental conditions: fully branded female packs, same packs without descriptors (e.g., "slims"), same packs without brand imagery or descriptors ("plain" packs), and branded non-female brands. Participants rated packs on measures of appeal and health risk and completed a behavioral pack selection task. Fully branded female packs were rated significantly more appealing than the same packs without descriptors, "plain" packs, and non-female-branded packs. Female-branded packs were associated with a greater number of positive attributes including glamour, slimness, and attractiveness and were more likely to be perceived as less harmful. Approximately 40% of smokers and nonsmokers requested a pack at the end of the study; female-branded packs were 3 times more likely to be selected than plain packs. Plain packaging and removing descriptors such as "slims" from cigarette packs may reduce smoking susceptibility among young women.

Public attitudes toward larger cigarette pack warnings: Results from a nationally representative U.S. sample

PubMed Central

2017-01-01

A large body of evidence supports the effectiveness of larger health warnings on cigarette packages. However, there is limited research examining attitudes toward such warning labels, which has potential implications for implementation of larger warning labels. The purpose of the current study was to examine attitudes toward larger warning sizes on cigarette packages and examine variables associated with more favorable attitudes. In a nationally representative survey of U.S. adults (N = 5,014), participants were randomized to different warning size conditions, assessing attitude toward “a health warning that covered (25, 50, 75) % of a cigarette pack.” SAS logistic regression survey procedures were used to account for the complex survey design and sampling weights. Across experimental groups, nearly three-quarters (72%) of adults had attitudes supportive of larger warning labels on cigarette packs. Among the full sample and smokers only (N = 1,511), most adults had favorable attitudes toward labels that covered 25% (78.2% and 75.2%, respectively), 50% (70% and 58.4%, respectively), and 75% (67.9% and 61%, respectively) of a cigarette pack. Young adults, females, racial/ethnic minorities, and non-smokers were more likely to have favorable attitudes toward larger warning sizes. Among smokers only, females and those with higher quit intentions held more favorable attitudes toward larger warning sizes. Widespread support exists for larger warning labels on cigarette packages among U.S. adults, including among smokers. Our findings support the implementation of larger health warnings on cigarette packs in the U.S. as required by the 2009 Tobacco Control Act. PMID:28253257

21 CFR 1141.1 - Scope.

Code of Federal Regulations, 2013 CFR

2013-04-01

... requirements for the display of health warnings on cigarette packages and in advertisements for cigarettes. FDA... violation of this part as it applies to the display of health warnings in an advertisement for cigarettes if... AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) TOBACCO PRODUCTS...

21 CFR 1141.3 - Definitions.

Code of Federal Regulations, 2014 CFR

2014-04-01

... CIGARETTE PACKAGE AND ADVERTISING WARNINGS General Provisions § 1141.3 Definitions. For the purposes of this part, Cigarette means: (1) Any roll of tobacco wrapped in paper or in any substance not containing..., or purchased by, consumers as a cigarette described in paragraph (1) of this definition. Commerce...

Socioeconomically disadvantaged smokers' ratings of plain and branded cigarette packaging: an experimental study.

PubMed

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Chris; Durkin, Sarah; D'Este, Catherine

2014-02-06

This study aimed to test the potential impact of plain packaging for cigarettes on brand appeal among highly socioeconomically disadvantaged smokers using the new design for cigarettes implemented in Australia, which combines plain packaging with larger health warning labels. A 2×2 factorial design trial embedded within a cross-sectional computer touchscreen survey. Data were collected between March and December 2012. Socially disadvantaged welfare aid recipients were recruited through a large Social and Community Service Organisation in New South Wales, Australia. N=354 smokers. The majority of the sample had not completed high school (64%), earned less than $A300/week (55%) and received their income from Government payments (95%). Participants were randomised to one of the four different pack conditions determined by brand name: Winfield versus Benson & Hedges, and packaging type: branded versus plain. Participants were required to rate their assigned pack on measures of brand appeal and purchase intentions. Plain packaging was associated with significantly reduced smoker ratings of 'positive pack characteristics' (p<0.001), 'positive smoker characteristics' (p=0.003) and 'positive taste characteristics' (p=0.033) in the Winfield brand name condition only. Across the four pack conditions, no main differences were found for 'negative smoker characteristics' (p=0.427) or 'negative harm characteristics' (p=0.411). In comparison to plain packaging, the presentation of branded packaging was associated with higher odds of smokers' purchase intentions (OR=2.18, 95% CI 1.34 to 3.54; p=0.002). Plain packs stripped of branding elements, featuring larger health warning labels, were associated with reduced positive cigarette brand image and purchase intentions among highly socioeconomically disadvantaged smokers.

Socioeconomically disadvantaged smokers’ ratings of plain and branded cigarette packaging: an experimental study

PubMed Central

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Chris; Durkin, Sarah; D'Este, Catherine

2014-01-01

Objectives This study aimed to test the potential impact of plain packaging for cigarettes on brand appeal among highly socioeconomically disadvantaged smokers using the new design for cigarettes implemented in Australia, which combines plain packaging with larger health warning labels. Design A 2×2 factorial design trial embedded within a cross-sectional computer touchscreen survey. Data were collected between March and December 2012. Setting Socially disadvantaged welfare aid recipients were recruited through a large Social and Community Service Organisation in New South Wales, Australia. Participants N=354 smokers. The majority of the sample had not completed high school (64%), earned less than $A300/week (55%) and received their income from Government payments (95%). Interventions Participants were randomised to one of the four different pack conditions determined by brand name: Winfield versus Benson & Hedges, and packaging type: branded versus plain. Participants were required to rate their assigned pack on measures of brand appeal and purchase intentions. Results Plain packaging was associated with significantly reduced smoker ratings of ‘positive pack characteristics’ (p<0.001), ‘positive smoker characteristics’ (p=0.003) and ‘positive taste characteristics’ (p=0.033) in the Winfield brand name condition only. Across the four pack conditions, no main differences were found for ‘negative smoker characteristics’ (p=0.427) or ‘negative harm characteristics’ (p=0.411). In comparison to plain packaging, the presentation of branded packaging was associated with higher odds of smokers’ purchase intentions (OR=2.18, 95% CI 1.34 to 3.54; p=0.002). Conclusions Plain packs stripped of branding elements, featuring larger health warning labels, were associated with reduced positive cigarette brand image and purchase intentions among highly socioeconomically disadvantaged smokers. PMID:24503299

The effects of repeated exposure to graphic fear appeals on cigarette packages: A field experiment.

PubMed

Dijkstra, Arie; Bos, Colin

2015-03-01

Experimental studies on the effects of graphic fear appeals on cigarette packages typically expose smokers in a single session to a fear appeal, although in practice the exposure is always repeated. The present study applied an improved study design with repeated exposure to fear appeals on cigarette packages. In this field-experiment, 118 smokers were assigned to 1 of 2 conditions with either graphic fear appeals or textual warnings on their cigarette packages. During 3 weeks, fear and disgust were assessed 6 times. The intention to quit smoking after 3 weeks and quitting activity during the 3 weeks were the dependent measures. The effects of 3 pretest individual difference moderators were tested: disengagement beliefs, number of cigarettes smoked a day, and readiness to quit. Three weeks of exposure to the graphic fear appeals led to a stronger intention to quit, but only when smokers scored low on disengagement beliefs, or were heavier smokers. In addition, smokers low in disengagement more often reported to have cut down on smoking in the graphic condition. There were no indications of habituation of fear and disgust over the 3 weeks. The effects of graphic fear appeals depended on smokers' characteristics: The moderators may explain the mixed findings in the literature. The lack of habituation may be caused by the renewal of the graphics every few days. The used field-experimental design with natural repeated exposure to graphics is promising. (c) 2015 APA, all rights reserved).

Tobacco product developments in the Australian market in the 4 years following plain packaging.

PubMed

Scollo, Michelle; Bayly, Megan; White, Sarah; Lindorff, Kylie; Wakefield, Melanie

2017-10-09

This paper aimed to identify continued and emerging trends in the Australian tobacco market following plain packaging implementation, over a period of substantial increases in tobacco taxes. Since 2012, our surveillance activities (including review of trade product and price lists, ingredient reports submitted by tobacco companies to government and monitoring of the retail environment) found several trends in the factory-made cigarette market. These include the continued release of extra-long and slim cigarettes and packs with bonus cigarettes, particularly in the mainstream and premium market segments; new menthol capsule products; other novel flavourings in cigarettes; filter innovations including recessed and firm filters; continued use of evocative and descriptive product names; the proliferation of the new super-value market segment; and umbrella branding, where new products are introduced within established brand families. Several similar trends were also observed within the smoking tobacco market. While not all of these trends were new to the Australian market at the time of plain packaging implementation, their continued and increased use is notable. Plain packaging legislation could be strengthened to standardise cigarette and pack size, restrict brand and variant names, and ban features such as menthol capsules and filters innovations that provide novelty value or that may provide false reassurance to smokers. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2011 CFR

2011-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2013 CFR

2013-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2012 CFR

2012-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

21 CFR 1140.16 - Conditions of manufacture, sale, and distribution.

Code of Federal Regulations, 2014 CFR

2014-04-01

... SERVICES (CONTINUED) TOBACCO PRODUCTS CIGARETTES AND SMOKELESS TOBACCO Prohibition of Sale and Distribution... product as the trade or brand name for a cigarette or smokeless tobacco product, except for a tobacco... the United States on January 1, 1995. (b) Minimum cigarette package size. Except as otherwise provided...

Flemish adolescents’ perceptions of cigarette plain packaging: a qualitative study with focus group discussions

PubMed Central

Van Hal, Guido; Van Roosbroeck, Sofie; Vriesacker, Bart; Arts, Matheus; Hoeck, Sarah; Fraeyman, Jessica

2012-01-01

Objectives To find out whether there is a potential impact of the appearance of a plain cigarette package on the smoking perceptions and behavioural intentions of Flemish adolescents. Design We performed a cross-sectional study using the qualitative method of focus group discussions. Setting Flemish adolescents. Participants We performed eight focus group discussions, in which 55 adolescents took part, 32 female and 23 male. Inclusion criteria were: Flemish male and female 15-year-olds to 16-year-olds and 17-year-olds to 18-year-olds attending regular high-school education or vocational training who were current or had ever been smokers. Outcome measure (planned as well as measured) The opinions and perceptions of young Flemish smokers regarding the impact of cigarette packaging on their smoking behaviour. Results Plain packages are perceived as less attractive, cheap and unreliable for young people. Because of the unattractiveness of the plain packaging, the health warnings catch the eye much more strongly. Conclusions In this first scientific study in Flanders on this topic, it emerged that plain packaging could be a strong policy tool to reduce the number of adolescents starting smoking. Validation of these findings by conducting a quantitative survey in the same target group is recommended. PMID:23242481

Effectiveness of text versus pictorial health warning labels and predictors of support for plain packaging of tobacco products within the European Union.

PubMed

Agaku, Israel T; Filippidis, Filippos T; Vardavas, Constantine I

2015-01-01

Tobacco product warning labels are a key health communication medium with plain packaging noted as the next step in the evolution of tobacco packaging. We assessed the self-reported impact of text versus pictorial health warnings and the determinants of support for plain packaging of tobacco products in the European Union (EU). The Special Eurobarometer 385 survey was analyzed for 26,566 adults from 27 EU countries in 2012. The self-reported impact of warning labels (text or pictorial) and determinants of EU-wide support for plain packaging were assessed using multivariate logistic regression. Current smokers in countries where cigarette pictorial warnings were implemented had higher odds of reporting that health warning labels had any effect on their smoking behavior (making a quit attempt or reducing number of cigarettes smoked per day) compared to respondents in countries with text-only warning labels (adjusted odds ratio, aOR = 1.31; 95% confidence interval, 95% CI: 1.10-1.56). Population support for plain packaging of tobacco packs was higher in countries where cigarette pictorial warnings already existed (aOR = 1.17; 95% CI: 1.07-1.28). These findings indicate that the implementation of pictorial warnings at an EU level may have a positive behavioral impact among smokers and pave the way for population support for plain packaging in the EU.

Plain packaging policy: Preventing industry innovations.

PubMed

Al-Hamdani, Mohammed

2017-04-20

The pack is a marketing tool for the tobacco industry - its shape, colour, fonts, descriptors and logos attract and mislead smokers. Health warnings on cigarette packs serve as a knowledge reminder for smokers to quit smoking. Plain packaging eliminates brand imagery elements from cigarette packs and has many benefits, including the reduction of intention to smoke and the denormalization of smoking behaviour. The tobacco industry has devised pack and product marketing innovations that thwart the effectiveness of health warnings. Plain packaging policy needs to address these innovations by restricting their use and preventing them from undermining health warnings.

Divergence between strength indicators in packaging and cigarette engineering: a case study of Marlboro varieties in Australia and the USA.

PubMed

King, Bill; Borland, Ron; Abdul-Salaam, Shadeed; Polzin, Gregory; Ashley, David; Watson, Clifford; O'Connor, Richard J

2010-10-01

To investigate how the tobacco industry is adapting to regulatory action in accordance with provisions of the Framework Convention on Tobacco Control that targets misleading packaging and labelling. To relate the packaging and labelling of new cigarette varieties to their construction and performance. The principal design features and tar, nicotine and carbon monoxide yields of the Marlboro 'brand family' in Australia were measured and compared with those of the US equivalents. Marlboro Red and Blue/Medium, could not be differentiated in preliminary tests in Australia, but were different in the USA. However, yield testing showed Marlboro Blue/Medium did not have lower tar and nicotine yields in either country, indeed being higher in Australia. Colour can be used to market cigarettes as 'milder', independently of ISO yields and 'Light'/'Mild' descriptors. Banning of 'Light' and 'Mild' brand descriptors may be inadequate to end belief in less harmful cigarettes so long as the tobacco industry remains free to engineer 'mildness' and to use colours, other descriptors and design features to characterise varieties it wants to market as 'milder'.

Cigarette smokers' classification of tobacco products.

PubMed

Casseus, M; Garmon, J; Hrywna, M; Delnevo, C D

2016-11-01

Cigarette consumption has declined in the USA. However, cigar consumption has increased. This may be due in part to some cigarette smokers switching to filtered cigars as a less expensive substitute for cigarettes. Additionally, some cigarette smokers may perceive and consume little filtered cigars as cigarettes. The purpose of this study was to determine how cigarette smokers classify tobacco products when presented with photographs of those products. An online survey was conducted with a sample of 344 self-identified cigarette smokers. Respondents were presented with pictures of various types of tobacco products, both with and without packaging, and then asked to categorise them as either a cigarette, little cigar, cigarillo, cigar or machine-injected roll-your-own cigarette (RYO). Respondents were also asked about their tobacco use and purchasing behaviour. Overall, respondents had difficulty distinguishing between cigarettes, little cigars, cigarillos and RYO. When presented with images of the products without packaging, 93% of respondents identified RYO as a cigarette, while 42% identified a little cigar as a cigarette. Additionally, respondents stated that they would consider purchasing little cigars as substitutes for cigarettes because of the price advantage. The results of this survey suggest that when presented with photographs of tobacco products, large proportions of current smokers were unable to differentiate between cigarettes, little cigars, cigarillos, RYO and cigars. Findings have implications for existing public health efforts targeting cigarette smokers, and underscore the need to review current definitions of tobacco products and federal excise taxes on such products. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Impact of Female-Oriented Cigarette Packaging in the United States

PubMed Central

Doxey, Juliana; Daniel, Samantha; Bansal-Travers, Maansi

2011-01-01

Introduction: Cigarette packaging is among the most prominent forms of tobacco marketing. This study examined the impact of cigarette pack design among young women in the United States. Method: A national sample of 18- to 19-year-old females in the United States completed an online survey in February 2010. Participants were randomized to view eight cigarette packs designed according to one of four experimental conditions: fully branded female packs, same packs without descriptors (e.g., “slims”), same packs without brand imagery or descriptors (“plain” packs), and branded non-female brands. Participants rated packs on measures of appeal and health risk and completed a behavioral pack selection task. Results: Fully branded female packs were rated significantly more appealing than the same packs without descriptors, “plain” packs, and non–female-branded packs. Female-branded packs were associated with a greater number of positive attributes including glamour, slimness, and attractiveness and were more likely to be perceived as less harmful. Approximately 40% of smokers and nonsmokers requested a pack at the end of the study; female-branded packs were 3 times more likely to be selected than plain packs. Conclusion: Plain packaging and removing descriptors such as “slims” from cigarette packs may reduce smoking susceptibility among young women. PMID:21486994

Young Adult Smokers' Neural Response to Graphic Cigarette Warning Labels.

PubMed

Green, Adam E; Mays, Darren; Falk, Emily B; Vallone, Donna; Gallagher, Natalie; Richardson, Amanda; Tercyak, Kenneth P; Abrams, David B; Niaura, Raymond S

2016-06-01

The study examined young adult smokers' neural response to graphic warning labels (GWLs) on cigarette packs using functional magnetic resonance imaging (fMRI). Nineteen young adult smokers ( M age 22.9, 52.6% male, 68.4% non-white, M 4.3 cigarettes/day) completed pre-scan, self-report measures of demographics, cigarette smoking behavior, and nicotine dependence, and an fMRI scanning session. During the scanning session participants viewed cigarette pack images (total 64 stimuli, viewed 4 seconds each) that varied based on the warning label (graphic or visually occluded control) and pack branding (branded or plain packaging) in an event-related experimental design. Participants reported motivation to quit (MTQ) in response to each image using a push-button control. Whole-brain blood oxygenation level-dependent (BOLD) functional images were acquired during the task. GWLs produced significantly greater self-reported MTQ than control warnings ( p < .001). Imaging data indicate stronger neural activation in response to GWLs than the control warnings at a cluster-corrected threshold p <.001 in medial prefrontal cortex, amygdala, medial temporal lobe, and occipital cortex. There were no significant differences in response to warnings on branded versus plain cigarette packages. In this sample of young adult smokers, GWLs promoted neural activation in brain regions involved in cognitive and affective decision-making and memory formation and the effects of GWLs did not differ on branded or plain cigarette packaging. These findings complement other recent neuroimaging GWL studies conducted with older adult smokers and with adolescents by demonstrating similar patterns of neural activation in response to GWLs among young adult smokers.

Influence of premium versus value brand names on the smoking experience in a plain packaging environment: an experimental study

PubMed Central

Skaczkowski, Gemma; Durkin, Sarah; Kashima, Yoshihisa; Wakefield, Melanie

2017-01-01

Objective To examine the effect of branding, as indicated by brand name, on evaluation of the cigarette smoking experience. Design Between-subjects and within-subjects experimental study. Participants were randomly allocated to smoke a cigarette from a pack featuring a premium brand name and a cigarette from a pack featuring a value brand name. Within each condition, participants unknowingly smoked two identical cigarettes (either two premium or two value cigarettes). Setting Australia, October 2014, 2 years after tobacco plain packaging implementation. Participants 81 current cigarette smokers aged 19–39 years. From apparently premium and value brand-name packs, 40 smokers were allocated to smoke the same actual premium cigarettes and 41 were allocated to smoke the same actual value cigarettes. Primary outcome measures Experienced taste (flavour, satisfaction, enjoyment, quality, liking, mouthfeel and aftertaste), harshness, dryness, staleness, harm/strength measures (strength, tar, lightness, volume of smoke), draw effort and purchase intent. Results Cigarettes given a premium brand name were rated as having a better taste, were less harsh and less dry than identical cigarettes given a value brand name. This pattern was observed irrespective of whether the two packs actually contained premium or value cigarettes. These effects were specific: the brand name did not influence ratings of cigarette variant attributes (strength, tar, volume of smoke, lightness and draw effort). Conclusions Despite the belief that brand names represent genuine differences between cigarette products, the results suggest that at least some of this perceived sensory difference is attributable to brand image. PMID:28093441

75 FR 71464 - Shorewood Packaging, a Subsidiary of International Paper Company, Including On-Site Leased...

Federal Register 2010, 2011, 2012, 2013, 2014

2010-11-23

... published in the Federal Register on September 3, 2010 (75 FR 54187). The workers produce cigarette cartons... competitive with cigarette cartons; that neither the subject firm nor its major declining customers increased imports of articles like or directly competitive with cigarette cartons; that the subject workers are not...

Presence of Counterfeit Marlboro Gold Packs in Licensed Retail Stores in New York City: Evidence From Test Purchases.

PubMed

Kurti, Marin; He, Yi; Silver, Diana; Giorgio, Margaret; von Lampe, Klaus; Macinko, James; Ye, Hua; Tan, Fidelis; Mei, Victoria

2018-05-26

There are no independent studies measuring the availability of premium brand counterfeit cigarettes in New York City from licensed retailers. We forensically analyzed the cigarette packaging of Marlboro Gold (n = 1021) purchased from licensed tobacco retailers in New York City, using ultraviolet irradiation and light microscopy to determine whether they were counterfeit. We find that while only 0.5% (n = 5) of our sample exhibits at least one characteristic synonymous with counterfeit packaging, none of our packs can be conclusively classified as counterfeit. We do not find any counterfeit Marlboro Gold packs purchased at full price from licensed cigarette retailers throughout New York City. Future research using test purchases should include other venues (eg, street and online) and specifically ask for discounts to ascertain the overall presence of counterfeit cigarettes. This is the first study to independently measure the availability of counterfeit cigarette packs purchased at full price from licensed retailers in New York City. We find that none of the Marlboro Gold packs purchased from licensed cigarette retailers are counterfeit.

What Do Cigarette Pack Colors Communicate to Smokers in the U.S.?

PubMed Central

Bansal-Travers, Maansi; O’Connor, Richard; Fix, Brian V.; Cummings, K. Michael

2011-01-01

Background New legislation in the U.S. prohibits tobacco companies from labelling cigarette packs with terms such as ‘light,’ ‘mild,’ or ‘low’ after June 2010. However, experience from countries that have removed these descriptors suggests different terms, colors, or numbers communicating the same messages may replace them. Purpose The main purpose of this study was to examine how cigarette pack colors are perceived by smokers to correspond to different descriptive terms. Methods Newspaper advertisements and craigslist.org postings directed interested current smokers to a survey website. Eligible participants were shown an array of six cigarette packages (altered to remove all descriptive terms) and asked to link package images with their corresponding descriptive terms. Participants were then asked to identify which pack in the array they would choose if they were concerned with health, tar, nicotine, image, and taste. Results A total of 193 participants completed the survey from February to March 2008 (data were analyzed from May 2008 through November 2010). Participants were more accurate in matching descriptors to pack images for Marlboro brand cigarettes than for unfamiliar Peter Jackson brand (sold in Australia). Smokers overwhelmingly chose the ‘whitest’ pack if they were concerned about health, tar, and nicotine. Conclusions Smokers in the U.S. associate brand descriptors with colors. Further, white packaging appears to most influence perceptions of safety. Removal of descriptor terms but not the associated colors will be insufficient in eliminating misperceptions about the risks from smoking communicated to smokers through packaging. PMID:21565662

What do cigarette pack colors communicate to smokers in the U.S.?

PubMed

Bansal-Travers, Maansi; O'Connor, Richard; Fix, Brian V; Cummings, K Michael

2011-06-01

New legislation in the U.S. prohibits tobacco companies from labeling cigarette packs with terms such as light, mild, or low after June 2010. However, experience from countries that have removed these descriptors suggests that different terms, colors, or numbers communicating the same messages may replace them. The main purpose of this study was to examine how cigarette pack colors are perceived by smokers to correspond to different descriptive terms. Newspaper advertisements and CraigsList.org postings directed interested current smokers to a survey website. Eligible participants were shown an array of six cigarette packages (altered to remove all descriptive terms) and asked to link package images with their corresponding descriptive terms. Participants were then asked to identify which pack in the array they would choose if they were concerned with health, tar, nicotine, image, and taste. A total of 193 participants completed the survey from February to March 2008 (data were analyzed from May 2008 through November 2010). Participants were more accurate in matching descriptors to pack images for Marlboro brand cigarettes than for unfamiliar Peter Jackson brand (sold in Australia). Smokers overwhelmingly chose the "whitest" pack if they were concerned about health, tar, and nicotine. Smokers in the U.S. associate brand descriptors with colors. Further, white packaging appears to most influence perceptions of safety. Removal of descriptor terms but not the associated colors will be insufficient in eliminating misperceptions about the risks from smoking communicated to smokers through packaging. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

76 FR 66074 - Small Entity Compliance Guide: Required Warnings for Cigarette Packages and Advertisements...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-25

...The Food and Drug Administration (FDA) is announcing the availability of a guidance for industry entitled ``Required Warnings for Cigarette Packages and Advertisements--Small Entity Compliance Guide'' for a final rule published in the Federal Register on June 22, 2011. This small entity compliance guide (SECG) is intended to set forth in plain language the requirements of the regulation and to help small businesses understand and comply with the regulation.

"Their Packaging Has Always Been Like a Power": A Qualitative Study of U.S. Smokers' Perceptions of Cigarette Pack Visual Design Features to Inform Product Regulation.

PubMed

Lee, Joseph G L; Averett, Paige E; Blanchflower, Tiffany; Landi, Nunzio; Gregory, Kyle R

2017-10-17

Cigarette packaging matters to consumer behavior. However, it is less clear which changes to packaging design would be salient for adult smokers. Such information is critically important to regulators in the United States who are charged with reviewing new tobacco products for their impact on population health. In this qualitative study, U.S. adult smokers ( n = 33) participated in six telephone-based focus groups in March 2017. Separate groups were comprised of lesbian, gay, and bisexual (LGB) participants; participants with less than four years of post-secondary education; a mix of LGB and straight participants; and, the general population. All groups were purposely selected for diversity. Open thematic coding identified salient design elements used on cigarette packaging. Smokers articulated design elements' use, meaning, and links with consumer behaviors. Three themes were identified: (1) the power of color, (2) supporting color with other design elements (e.g., logos/images, typography, the pack itself), and (3) the combined product brand experience of multiple design elements. Participants linked design elements to product characteristics and to consumer behavior (e.g., purchase). As the Food and Drug Administration is charged with regulating tobacco products, these findings suggest the importance of considering the cigarette pack part of the characteristics of a product.

“Their Packaging Has Always Been Like a Power”: A Qualitative Study of U.S. Smokers’ Perceptions of Cigarette Pack Visual Design Features to Inform Product Regulation

PubMed Central

Blanchflower, Tiffany; Landi, Nunzio; Gregory, Kyle R.

2017-01-01

Cigarette packaging matters to consumer behavior. However, it is less clear which changes to packaging design would be salient for adult smokers. Such information is critically important to regulators in the United States who are charged with reviewing new tobacco products for their impact on population health. In this qualitative study, U.S. adult smokers (n = 33) participated in six telephone-based focus groups in March 2017. Separate groups were comprised of lesbian, gay, and bisexual (LGB) participants; participants with less than four years of post-secondary education; a mix of LGB and straight participants; and, the general population. All groups were purposely selected for diversity. Open thematic coding identified salient design elements used on cigarette packaging. Smokers articulated design elements’ use, meaning, and links with consumer behaviors. Three themes were identified: (1) the power of color, (2) supporting color with other design elements (e.g., logos/images, typography, the pack itself), and (3) the combined product brand experience of multiple design elements. Participants linked design elements to product characteristics and to consumer behavior (e.g., purchase). As the Food and Drug Administration is charged with regulating tobacco products, these findings suggest the importance of considering the cigarette pack part of the characteristics of a product. PMID:29039769

Open source marketing: Camel cigarette brand marketing in the "Web 2.0" world.

PubMed

Freeman, B; Chapman, S

2009-06-01

The international trend towards comprehensive bans on tobacco advertising has seen the tobacco industry become increasingly innovative in its approach to marketing. Further fuelling this innovation is the rapid evolution and accessibility of web-based technology. The internet, as a relatively unregulated marketing environment, provides many opportunities for tobacco companies to pursue their promotional ambitions. In this paper, "open source marketing" is considered as a vehicle that has been appropriated by the tobacco industry, through a case study of efforts to design the packaging for the Camel Signature Blends range of cigarettes. Four sources are used to explore this case study including a marketing literature search, a web-based content search via the Google search engine, interviews with advertising trade informants and an analysis of the Camel brand website. RJ Reynolds (RJR) has proven to be particularly innovative in designing cigarette packaging. RJR engaged with thousands of consumers through their Camel brand website to design four new cigarette flavours and packages. While the Camel Signature Blends packaging designs were subsequently modified for the retail market due to problems arising with their cartoon-like imagery, important lessons arise on how the internet blurs the line between marketing and market research. Open source marketing has the potential to exploit advertising ban loopholes and stretch legal definitions in order to generate positive word of mouth about tobacco products. There are also lessons in the open source marketing movement for more effective tobacco control measures including interactive social marketing campaigns and requiring plain packaging of tobacco products.

Influence of premium versus value brand names on the smoking experience in a plain packaging environment: an experimental study.

PubMed

Skaczkowski, Gemma; Durkin, Sarah; Kashima, Yoshihisa; Wakefield, Melanie

2017-01-16

To examine the effect of branding, as indicated by brand name, on evaluation of the cigarette smoking experience. Between-subjects and within-subjects experimental study. Participants were randomly allocated to smoke a cigarette from a pack featuring a premium brand name and a cigarette from a pack featuring a value brand name. Within each condition, participants unknowingly smoked two identical cigarettes (either two premium or two value cigarettes). Australia, October 2014, 2 years after tobacco plain packaging implementation. 81 current cigarette smokers aged 19-39 years. From apparently premium and value brand-name packs, 40 smokers were allocated to smoke the same actual premium cigarettes and 41 were allocated to smoke the same actual value cigarettes. Experienced taste (flavour, satisfaction, enjoyment, quality, liking, mouthfeel and aftertaste), harshness, dryness, staleness, harm/strength measures (strength, tar, lightness, volume of smoke), draw effort and purchase intent. Cigarettes given a premium brand name were rated as having a better taste, were less harsh and less dry than identical cigarettes given a value brand name. This pattern was observed irrespective of whether the two packs actually contained premium or value cigarettes. These effects were specific: the brand name did not influence ratings of cigarette variant attributes (strength, tar, volume of smoke, lightness and draw effort). Despite the belief that brand names represent genuine differences between cigarette products, the results suggest that at least some of this perceived sensory difference is attributable to brand image. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

76 FR 67197 - Small Entity Compliance Guide: Required Warnings for Cigarette Packages and Advertisements...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-10-31

...The Food and Drug Administration (FDA) is correcting a notice that appeared in the Federal Register of October 25, 2011 (76 FR 66074). The document announced the availability of a guidance for industry entitled ``Required Warnings for Cigarette Packages and Advertisements--Small Entity Compliance Guide'' for a final rule that published in the Federal Register of June 22, 2011 (76 FR 36628). The notice published with an incorrect docket number. This document corrects that error.

Graphic warnings and text warning labels on cigarette packages in Riyadh Kingdom of Saudi Arabia: Awareness and perceptions

PubMed Central

Jradi, Hoda; Saddik, Basema

2018-01-01

BACKGROUND: Graphic warning labels have been shown to be effective in smoking initiation and cessation and were implemented in Saudi Arabia in 2012. To date, no study has assessed the effectiveness of these labels and the Saudi population's perceptions on the effectiveness of cigarette health warning labels. METHODS: We used a cross-sectional qualitative study comprising of nine focus groups among 3 different community group members including health-care workers, adult women and adult men. We conducted in-depth interviews among community leaders. Both focus groups and interviews assessed awareness levels and elicited perceptions about health warning labels on cigarette boxes currently used in the Kingdom of Saudi Arabia. RESULTS: While most participants in the study were aware and supported the use of graphic warning labels on cigarette packages, the awareness of the specific details on the labels was low. Participants perceived the effectiveness of current labels somewhat vague in smoking cessation and advocated for stronger and more aggressive graphics. Community leaders, however, preferred text-only labels and did not support aggressive labels which were deemed culturally and religiously inappropriate. CONCLUSIONS: The study suggests that while graphic warning labels are perceived as necessary on cigarette packages the currently used messages are not clear and therefore do not serve their intended purposes. Measures should be undertaken to ensure that pictorial cigarette labels used in Saudi Arabia are culturally and ethnically appropriate and are rotated on a regular basis to ensure salience among smokers and nonsmokers alike. PMID:29387252

Tobacco industry argues domestic trademark laws and international treaties preclude cigarette health warning labels, despite consistent legal advice that the argument is invalid.

PubMed

Crosbie, Eric; Glantz, Stanton A

2014-05-01

To analyse the tobacco industry's use of international trade agreements to oppose policies to strengthen health warning labels (HWLs). A review of tobacco industry documents, tobacco control legislation and international treaties. During the early 1990s, the tobacco industry became increasingly alarmed about the advancement of HWLs on cigarettes packages. In response, it requested legal opinions from British American Tobacco's law firms in Australia and England, Britain's Department of Trade and Industry and the World Intellectual Property Organisation on the legality of restricting and prohibiting the use of their trademarks, as embodied in cigarette packages. The consistent legal advice, privately submitted to the companies, was that international treaties do not shield trademark owners from government limitations (including prohibition) on the use of their trademarks. Despite receiving this legal advice, the companies publicly argued that requiring large HWLs compromised their trademark rights under international treaties. The companies successfully used these arguments as part of their successful effort to deter Canadian and Australian governments from enacting laws requiring the plan packaging of cigarettes, which helped delay large graphic HWLs, including 'plain' packaging, for over a decade. Governments should not be intimidated by tobacco company threats and unsubstantiated claims, and carefully craft HWL laws to withstand the inevitable tobacco industry lawsuits with the knowledge that the companies' own lawyers as well as authoritative bodies have told the companies that the rights they claim do not exist.

Consumer perceptions of cigarette pack design in France: a comparison of regular, limited edition and plain packaging.

PubMed

Gallopel-Morvan, Karine; Moodie, Crawford; Hammond, David; Eker, Figen; Beguinot, Emmanuelle; Martinet, Yves

2012-09-01

In the face of comprehensive bans on the marketing of tobacco products, packaging has become an increasingly important promotional tool for the tobacco industry. A ban on the use of branding on tobacco packaging, known as 'plain' packaging, has emerged as a promising regulatory strategy. The current study sought to examine perceptions of cigarette packaging among adults in France. Adult smokers and non-smokers (N=836) were surveyed using computer-assisted personal interviewing to assess perceptions of pack design by comparing 'regular' branded packs and 'limited edition' packs (with novel designs or innovations) with 'plain' versions of these packs with all branding, including colour, removed. Plain packs (PP) were less likely than regular packs, and particularly limited edition packs, to be considered attractive, attention grabbing and likely to motivate youth purchase. PPs were also rated as the most effective in convincing non-smokers not to start and smokers to reduce consumption and quit. Logistic regression showed that smokers motivated to quit, in comparison to smokers not motivated to quit, were significantly more likely to consider the PPs as the packs most likely to motivate cessation. Novel cigarette packaging, in the form of limited edition packs, had the highest ratings of consumer appeal, ahead of regular branded packs and also PPs. Interestingly, PPs were perceived to be the packs most likely to promote cessation among those adults with quitting intentions. Plain packaging, therefore, may be a means of helping existing adult smokers motivated to quit to do so.

The perceptions of UK youth of branded and standardized, 'plain' cigarette packaging.

PubMed

Hammond, David; White, Christine; Anderson, Will; Arnott, Deborah; Dockrell, Martin

2014-08-01

Tobacco packaging is an important form of promotion. Standardizing cigarette packages ('plain' packaging) represents a novel tobacco control policy. This study examined perceptions of branded and standardized cigarette packages among British youth. Seven hundred twelve youth aged 11-17 completed an online survey. Participants viewed pairs of packages altered using a 3 × 2 factorial design: health warning type (40% text, 40% pictorial or 80% pictorial) × standardized pack colour (white vs. brown). A discrete-choice task was used in which participants selected packs based on attractiveness, taste, tar, health risk, impact of health warning and enticement to start smoking. Participants also compared regular Silk Cut and 'Superslims' Silk Cut packs. Participants completed a final selection task from two standardized and two branded packs. Warning type was significantly associated with all six outcomes: packs with larger pictorial warnings were more likely to be perceived as less attractive, less smooth, greater health risk, higher tar delivery, more effective health warnings and less likely to encourage initiation. The same pattern was found for brown vs. white standardized packages, with the exception of attractiveness and initiation. Compared with the regular Silk Cut pack, the 'Superslims' Silk Cut pack was perceived as significantly more favourable on all six outcomes. Finally, among respondents who selected a pack in the pack selection task, 95.1% selected a branded pack vs. 4.9% who selected a standardized pack. Increasing the size of pictorial health warnings and standardizing the appearance and shape of packages may discourage smoking initiation among young people. © The Author 2013. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.

Effects of and attention to graphic warning labels on cigarette packages.

PubMed

Süssenbach, Philipp; Niemeier, Sarah; Glock, Sabine

2013-01-01

The present study investigates the effects of graphic cigarette warnings compared to text-only cigarette warnings on smokers' explicit (i.e. ratings of the packages, cognitions about smoking, perceived health risk, quit intentions) and implicit attitudes. In addition, participants' visual attention towards the graphic warnings was recorded using eye-tracking methodology. Sixty-three smokers participated in the present study and either viewed graphic cigarette warnings with aversive and non-aversive images or text-only warnings. Data were analysed using analysis of variance and correlation analysis. Especially, graphic cigarette warnings with aversive content drew attention and elicited high threat. However, whereas attention directed to the textual information of the graphic warnings predicted smokers' risk perceptions, attention directed to the images of the graphic warnings did not. Moreover, smokers' in the graphic warning condition reported more positive cognitions about smoking, thus revealing cognitive dissonance. Smokers employ defensive psychological mechanisms when confronted with threatening warnings. Although aversive images attract attention, they do not promote health knowledge. Implications for graphic health warnings and the importance of taking their content (i.e. aversive vs. non-aversive images) into account are discussed.

Potential Impact of Graphic Health Warnings on Cigarette Packages in Reducing Cigarette Demand and Smoking-Related Deaths in Vietnam.

PubMed

Minh, Hoang Van; Chung, Le Hong; Giang, Kim Bao; Duc, Duong Minh; Hinh, Nguyen Duc; Mai, Vu Quynh; Cuong, Nguyen Manh; Manh, Pham Duc; Duc, Ha Anh; Yang, Jui-Chen

2016-01-01

Two years after implementation of the graphic health warning intervention in Vietnam, it is very important to evaluate the intervention's potential impact. The objective of this paper was to predict effects of graphic health warnings on cigarette packages, particularly in reducing cigarette demand and smoking-associated deaths in Vietnam. In this study, a discrete choice experiment (DCE) method was used to evaluate the potential impact of graphic tobacco health warnings on smoking demand. To predict the impact of GHWs on reducing premature deaths associated with smoking, we constructed different static models. We adapted the method developed by University of Toronto, Canada and found that GHWs had statistically significant impact on reducing cigarette demand (up to 10.1% through images of lung damage), resulting in an overall decrease of smoking prevalence in Vietnam. We also found that between 428,417- 646,098 premature deaths would be prevented as a result of the GHW intervention. The potential impact of the GHW labels on reducing premature smoking-associated deaths in Vietnam were shown to be stronger among lower socio-economic groups.

[Graphic images on cigarette packages not effective].

PubMed

Kok, Gerjo; Peters, Gjalt-Jorn Y; Ruiter, Robert A C

2013-01-01

The Dutch Government intends to make graphic images on cigarette packages mandatory. However, contrary to other policy measures to reduce smoking, health warnings do not work. There is no acceptable evidence in favour of graphic images and behaviour change theories suggest methods of change that improve skills, self-efficacy and social support. Thus, theory- and evidence-based policy should focus on prohibiting the tobacco industry from glamourizing packaging and make health communications on packages mandatory. As to the type of communications to be used, theory and evidence suggest that warning of the negative consequences of smoking is not an effective approach. Rather, targeting the most important determinants of the initiation of smoking and its successful cessation - such as skills, self-efficacy and subjective norm - along with the most effective behaviour change methods appears to be the most expedient strategy.

Tobacco industry argues domestic trademark laws and international treaties preclude cigarette health warning labels, despite consistent legal advice that the argument is invalid

PubMed Central

Crosbie, Eric; Glantz, Stanton A

2013-01-01

Objectives To analyse the tobacco industry’s use of international trade agreements to oppose policies to strengthen health warning labels (HWLs). Design A review of tobacco industry documents, tobacco control legislation and international treaties. Results During the early 1990s, the tobacco industry became increasingly alarmed about the advancement of HWLs on cigarettes packages. In response, it requested legal opinions from British American Tobacco’s law firms in Australia and England, Britain’s Department of Trade and Industry and the World Intellectual Property Organisation on the legality of restricting and prohibiting the use of their trademarks, as embodied in cigarette packages. The consistent legal advice, privately submitted to the companies, was that international treaties do not shield trademark owners from government limitations (including prohibition) on the use of their trademarks. Despite receiving this legal advice, the companies publicly argued that requiring large HWLs compromised their trademark rights under international treaties. The companies successfully used these arguments as part of their successful effort to deter Canadian and Australian governments from enacting laws requiring the plan packaging of cigarettes, which helped delay large graphic HWLs, including ‘plain’ packaging, for over a decade. Conclusions Governments should not be intimidated by tobacco company threats and unsubstantiated claims, and carefully craft HWL laws to withstand the inevitable tobacco industry lawsuits with the knowledge that the companies’ own lawyers as well as authoritative bodies have told the companies that the rights they claim do not exist. PMID:23179728

Is consumer response to plain/standardised tobacco packaging consistent with framework convention on tobacco control guidelines? A systematic review of quantitative studies.

PubMed

Stead, Martine; Moodie, Crawford; Angus, Kathryn; Bauld, Linda; McNeill, Ann; Thomas, James; Hastings, Gerard; Hinds, Kate; O'Mara-Eves, Alison; Kwan, Irene; Purves, Richard I; Bryce, Stuart L

2013-01-01

Standardised or 'plain' tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm. Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted. Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample. The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm based upon package design; and will help make the legally required on-pack health warnings more salient.

Is Consumer Response to Plain/Standardised Tobacco Packaging Consistent with Framework Convention on Tobacco Control Guidelines? A Systematic Review of Quantitative Studies

PubMed Central

Stead, Martine; Moodie, Crawford; Angus, Kathryn; Bauld, Linda; McNeill, Ann; Thomas, James; Hastings, Gerard; Hinds, Kate; O'Mara-Eves, Alison; Kwan, Irene; Purves, Richard I.; Bryce, Stuart L.

2013-01-01

Background and Objectives Standardised or ‘plain’ tobacco packaging was introduced in Australia in December 2012 and is currently being considered in other countries. The primary objective of this systematic review was to locate, assess and synthesise published and grey literature relating to the potential impacts of standardised tobacco packaging as proposed by the guidelines for the international Framework Convention on Tobacco Control: reduced appeal, increased salience and effectiveness of health warnings, and more accurate perceptions of product strength and harm. Methods Electronic databases were searched and researchers in the field were contacted to identify studies. Eligible studies were published or unpublished primary research of any design, issued since 1980 and concerning tobacco packaging. Twenty-five quantitative studies reported relevant outcomes and met the inclusion criteria. A narrative synthesis was conducted. Results Studies that explored the impact of package design on appeal consistently found that standardised packaging reduced the appeal of cigarettes and smoking, and was associated with perceived lower quality, poorer taste and less desirable smoker identities. Although findings were mixed, standardised packs tended to increase the salience and effectiveness of health warnings in terms of recall, attention, believability and seriousness, with effects being mediated by the warning size, type and position on pack. Pack colour was found to influence perceptions of product harm and strength, with darker coloured standardised packs generally perceived as containing stronger tasting and more harmful cigarettes than fully branded packs; lighter coloured standardised packs suggested weaker and less harmful cigarettes. Findings were largely consistent, irrespective of location and sample. Conclusions The evidence strongly suggests that standardised packaging will reduce the appeal of packaging and of smoking in general; that it will go some way to reduce consumer misperceptions regarding product harm based upon package design; and will help make the legally required on-pack health warnings more salient. PMID:24146791

75 FR 75936 - Required Warnings for Cigarette Packages and Advertisements; Research Report

Federal Register 2010, 2011, 2012, 2013, 2014

2010-12-07

... on consumer attitudes, beliefs, perceptions, and intended behaviors related to cigarette smoking. The... that FDA was conducting research to: (1) Measure consumer attitudes, beliefs, and intended behaviors... warnings on smoking behavior and evaluating the communication effectiveness of such images. FDA worked with...

27 CFR 40.22 - Determination of sale price of large cigars.

Code of Federal Regulations, 2014 CFR

2014-04-01

..., CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Taxes § 40.22 Determination of sale price of large cigars... packaging. If different bona fide sale prices are applicable to different types of packaging (e. g., boxes...

27 CFR 40.22 - Determination of sale price of large cigars.

Code of Federal Regulations, 2013 CFR

2013-04-01

..., CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Taxes § 40.22 Determination of sale price of large cigars... packaging. If different bona fide sale prices are applicable to different types of packaging (e. g., boxes...

27 CFR 40.22 - Determination of sale price of large cigars.

Code of Federal Regulations, 2011 CFR

2011-04-01

..., CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Taxes § 40.22 Determination of sale price of large cigars... packaging. If different bona fide sale prices are applicable to different types of packaging (e. g., boxes...

27 CFR 40.22 - Determination of sale price of large cigars.

Code of Federal Regulations, 2012 CFR

2012-04-01

..., CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Taxes § 40.22 Determination of sale price of large cigars... packaging. If different bona fide sale prices are applicable to different types of packaging (e. g., boxes...

POLONIUM-210: A VOLATILE RADIOELEMENT IN CIGARETTES.

PubMed

RADFORD, E P; HUNT, V R

1964-01-17

Polonium-210, which emits alpha particles, is a natural contaminant of tobacco. For an individual smoking two packages of cigarettes a day, the radiation dose to bronchial epithelium from Po(210) inhaled in cigarette smoke probably is at least seven times that from background sources, and in localized areas may be up to 1000 rem or more in 25 years. Radiation from this source may, therefore, be significant in the genesis of bronchial cancer in smokers.

27 CFR 44.186 - Tax classification for cigars.

Code of Federal Regulations, 2010 CFR

2010-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... Products and Cigarette Papers and Tubes by Manufacturers and Export Warehouse Proprietors Packaging... classification of the product for tax purposes; (i.e., either “small” or “little”). (Sec. 202, Pub. L. 85-859, 72...

27 CFR 44.186 - Tax classification for cigars.

Code of Federal Regulations, 2011 CFR

2011-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... Products and Cigarette Papers and Tubes by Manufacturers and Export Warehouse Proprietors Packaging... classification of the product for tax purposes; (i.e., either “small” or “little”). (Sec. 202, Pub. L. 85-859, 72...

27 CFR 44.186 - Tax classification for cigars.

Code of Federal Regulations, 2013 CFR

2013-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... Products and Cigarette Papers and Tubes by Manufacturers and Export Warehouse Proprietors Packaging... classification of the product for tax purposes; (i.e., either “small” or “little”). (Sec. 202, Pub. L. 85-859, 72...

27 CFR 44.186 - Tax classification for cigars.

Code of Federal Regulations, 2012 CFR

2012-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... Products and Cigarette Papers and Tubes by Manufacturers and Export Warehouse Proprietors Packaging... classification of the product for tax purposes; (i.e., either “small” or “little”). (Sec. 202, Pub. L. 85-859, 72...

27 CFR 44.186 - Tax classification for cigars.

Code of Federal Regulations, 2014 CFR

2014-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... Products and Cigarette Papers and Tubes by Manufacturers and Export Warehouse Proprietors Packaging... classification of the product for tax purposes; (i.e., either “small” or “little”). (Sec. 202, Pub. L. 85-859, 72...

Dissuasive cigarette sticks: the next step in standardised ('plain') packaging?

PubMed

Hoek, Janet; Gendall, Philip; Eckert, Christine; Louviere, Jordan

2016-11-01

Standardised (or 'plain') packaging has reduced the appeal of smoking by removing imagery that smokers use to affiliate themselves with the brand they smoke. We examined whether changing the appearance of cigarette sticks could further denormalise smoking and enhance the negative impact of standardised packaging. We conducted an online study of 313 New Zealand smokers who comprised a Best-Worst Choice experiment and a rating task. The Best-Worst experiment used a 2×3×3×6 orthogonal design to test the following attributes: on-pack warning message, branding level, warning size and stick appearance. We identified three segments whose members' choice patterns were strongly influenced by the stick design, warning theme and size, and warning theme, respectively. Each of the dissuasive sticks tested was less preferred and rated as less appealing than the most common stick in use; a 'minutes of life lost' stick was the most aversive of the stimuli tested. Dissuasive sticks could enhance the effect of standardised packaging, particularly among older smokers who are often more heavily addicted and resistant to change. Countries introducing standardised packaging legislation should take the opportunity to denormalise the appearance of cigarette sticks, in addition to removing external tobacco branding from packs and increasing the warning size. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The effect of MPOWER scores on cigarette smoking prevalence and consumption.

PubMed

Ngo, Anh; Cheng, Kai-Wen; Chaloupka, Frank J; Shang, Ce

2017-12-01

The World Health Organization (WHO) introduced the MPOWER package to support policy implementation under the Framework Convention on Tobacco Control (FCTC). This study examined the effect of MPOWER policies on smoking prevalence and cigarette consumption in a global context. The MPOWER composite score was constructed by adding up the six MPOWER scores for each country and survey year 2007-2008, 2010, 2012, and 2014, with a possible range between 6 (1 in each of the six score) and 29 (4 in M score and 5 in POWER scores). MPOWER composite scores that measured policy implementation were then linked to cigarette smoking prevalence and consumption data from Euromonitor International. Fractional logit and OLS regressions were employed to examine the effect of the composite MPOWER score on adult smoking prevalence and cigarette consumption, respectively. Results indicate that a 1-unit increase in the composite score reduces smoking prevalence by 0.2 percentage points (p<0.05) among adults and 0.3 percentage points (p<0.01) among adult males; and a reduction of 23 sticks of cigarette (1 pack of cigarettes) in cigarette consumption per capita per year. At this rate, if countries had implemented the MPOWER package to the highest levels during 2007-2014, they would have experienced a reduction in smoking prevalence of 7.26% among adults and 7.87% among adult males and a reduction of 13.80% in cigarette consumption. MPOWER policies were effective in reducing cigarette smoking among adults. Parties should continue to implement MPOWER policies that have been recommended by the WHO FCTC to curb tobacco epidemic. Copyright © 2017 Elsevier Inc. All rights reserved.

Appalachian residents' perspectives on new U.S. cigarette warning labels.

PubMed

Reiter, Paul L; Broder-Oldach, Benjamin; Wewers, Mary Ellen; Klein, Elizabeth G; Paskett, Electra D; Katz, Mira L

2012-12-01

The U.S. Food and Drug Administration revealed new pictorial warning labels in June 2011 for cigarette packages, yet little is known about how these labels are perceived by U.S. residents. We examined the reactions to and attitudes about the new labels among residents of Appalachian Ohio, a region with a high smoking prevalence. We conducted focus groups with Appalachian Ohio residents between July and October 2011. Participants included healthcare providers (n = 30), community leaders (n = 26), parents (n = 28), and young adult men ages 18-26 (n = 18). Most participants supported the addition of the new labels to U.S. cigarette packages, though many were unaware of the labels prior to the focus groups. Participants did not think the labels would be effective in promoting smoking cessation among smokers in their communities, but they were more positive about the potential of the labels to reduce smoking initiation. Participants reported positive feedback about the more graphic labels, particularly those showing a man with a tracheal stoma or a person with severe oral disease. The labels that include a cartoon image of an ill infant and a man who quit smoking received the most negative feedback. Participants generally supported adding pictorial warning labels to U.S. cigarette packages, but only a few of labels received mostly positive feedback. Results offer early insight into how the new labels may be received if they are put into practice.

Smoking topography and biomarkers of exposure among Japanese smokers: associations with cigarette emissions obtained using machine smoking protocols.

PubMed

Matsumoto, Mariko; Inaba, Yohei; Yamaguchi, Ichiro; Endo, Osamu; Hammond, David; Uchiyama, Shigehisa; Suzuki, Gen

2013-03-01

Although the relative risk of lung cancer due to smoking is reported to be lower in Japan than in other countries, few studies have examined the characteristics of Japanese cigarettes or potential differences in smoking patterns among Japanese smokers. To examine tar, nicotine and carbon monoxide (TNCO) emissions from ten leading cigarettes in Japan, machine smoking tests were conducted using the International Organization for Standardization (ISO) protocol and the Health Canada Intense (HCI) protocol. Smoking topography and tobacco-related biomarkers were collected from 101 Japanese smokers to examine measures of exposure. The findings indicate considerable variability in the smoking behavior of Japanese smokers. On average, puffing behaviors observed among smokers were more similar to the parameters of the HCI protocol, and brands with greater ventilation that yielded lower machine values using the ISO protocol were smoked more intensely than brands with lower levels of ventilation. The smokers of "ultra-low/low" nicotine-yield cigarettes smoked 2.7-fold more intensively than those of "medium/high" nicotine-yield cigarette smokers to achieve the same level of salivary cotinine (p = 0.024). CO levels in expiratory breath samples were associated with puff volume and self-reported smoking intensity, but not with nominal values of nicotine-yield reported on cigarette packages. Japanese smokers engaged in "compensatory smoking" to achieve their desired nicotine intake, and levels of exposure were greater than those suggested by the nominal value of nicotine and tar yields reported on cigarette packages.

The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study.

PubMed

White, Christine M; Hammond, David; Thrasher, James F; Fong, Geoffrey T

2012-09-04

Tobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil has prohibited most forms of tobacco advertising; however, the cigarette pack remains a primary source of marketing. The current study examined how tobacco packaging influences brand appeal and perceptions of health risk among young women in Brazil. A between-subjects experiment was conducted in which 640 Brazilian women aged 16-26 participated in an online survey. Participants were randomized to view 10 cigarette packages according to one of three experimental conditions: standard branded packages, the same packs without brand imagery ("plain packaging"), or the same packs without brand imagery or descriptors (e.g., flavors). Participants rated packages on perceived appeal, taste, health risk, smoothness, and smoker attributes. Finally, participants were shown a range of branded and plain packs from which they could select one as a free gift, which constituted a behavioral measure of appeal. Branded packs were rated as significantly more appealing, better tasting, and smoother on the throat than plain packs. Branded packs were also associated with a greater number of positive smoker attributes including style and sophistication, and were perceived as more likely to be smoked by females than the plain packs. Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes. In the pack offer, participants were three times more likely to select branded packs than plain packs. Plain packaging and removal of descriptors may reduce the appeal of smoking for youth and young adults, and consequently reduce smoking susceptibility. Overall, the findings provide support for plain packaging regulations, such as those in Australia.

POLONIUM-210: A VOLATILE RADIOELEMENT IN CIGARETTES

DOE Office of Scientific and Technical Information (OSTI.GOV)

Radford, E.P. Jr.; Hunt, V.R.

Polonium-210, which emits alpha particles, is a natural contaminant of tobacco. For an individual smoking bvo packages of cigarettes a day, the radiation dose to bronchial epithelium from Po/sup 210/ inhaled in cigarette smoke probably is at least seven times that from background sources, and in localized areas may be up to 1000 rem or more in 25 years. Radiation from this source may, therefore, be significant in the genesis of bronchial cancer in smokers. (auth)

Cigarette pack design and perceptions of risk among UK adults and youth.

PubMed

Hammond, David; Dockrell, Martin; Arnott, Deborah; Lee, Alex; McNeill, Ann

2009-12-01

It is illegal in the EU for tobacco packaging to suggest that some cigarettes are safer than others. This study examined consumer perceptions of cigarette packs in the UK, including perceptions of 'plain packaging', in which colour and other design elements are removed, whilst retaining the brand name. 516 adult smokers and 806 youth aged 11-17 participated in an online survey. Participants were asked to compare pairs of cigarette packs on five measures: taste, tar delivery, health risk, attractiveness and either ease of quitting (adult smokers) or brand they would choose if trying smoking (youth). Adults and youth were significantly more likely to rate packs with the terms 'smooth', 'silver' and 'gold' as lower tar, lower health risk and either easier to quit smoking (adults) or their choice of pack if trying smoking (youth). For example, more than half of adults and youth reported that brands labelled as 'smooth' were less harmful compared with the 'regular' variety. The colour of packs was also associated with perceptions of risk and brand appeal: compared with Marlboro packs with a red logo, Marlboro packs with a gold logo were rated as lower health risk by 53% and easier to quit by 31% of adult smokers. Plain packs significantly reduced false beliefs about health risk and ease of quitting, and were rated as significantly less attractive and appealing to youth for trying smoking. Current regulations have failed to remove potentially misleading information from tobacco packaging. Removing colours from packs (plain packaging), as well as terms such as 'smooth' 'gold' and 'silver' would significantly reduce false beliefs and increase compliance with existing legislation.

Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors.

PubMed

Buettner-Schmidt, Kelly; Miller, Donald R; Balasubramanian, Narayanaganesh

2016-01-01

To determine the accuracy of the labeled quantity of the nicotine content of the e-liquids sold in unlicensed vape stores, whether the packaging of e-liquids sold within the vape stores was child-resistant, whether minors were present within vape stores, and whether sales to minors occurred. This study was conducted across North Dakota prior to implementation of a new e-cigarette state law and provided a baseline assessment before enactment of the new legal requirements. We tested samples of e-liquids and performed observations in 16 stores that were selling e-cigarettes but were not legally required to be licensed for tobacco retail. The e-liquids were analyzed for nicotine content using a validated high-performance liquid chromatography method for nicotine analysis. Of the 70 collected e-liquid samples that claimed to contain nicotine, 17% contained more than the labeled quantity and 34% contained less than the labeled quantity by 10% or more, with one sample containing 172% more than the labeled quantity. Of the 94 e-liquid containers sampled, only 35% were determined to be child-resistant. Minors were present in stores, although no sales to minors occurred. Mislabeling of nicotine in e-liquids is common and exposes the user to the harmful effects of nicotine. The lack of child-resistant packaging for this potentially toxic substance is a serious public health problem. E-cigarettes should be included in the legal definition of tobacco products, child-resistant packaging and nicotine labeling laws should be enacted and strictly enforced, and vape stores should be licensed by states. Copyright © 2016 Elsevier Inc. All rights reserved.

Electronic Cigarette Refill Liquids: Child-Resistant Packaging, Nicotine Content, and Sales to Minors2

PubMed Central

Buettner-Schmidt, Kelly; Miller, Donald R.; Balasubramanian, Narayanaganesh

2016-01-01

Purpose To determine the accuracy of the labeled quantity of the nicotine content of the e-liquids sold in unlicensed vape stores, whether the packaging of e-liquids sold within the vape stores was child-resistant, whether minors were present within vape stores, and whether sales to minors occurred. This study was conducted across North Dakota prior to implementation of a new e-cigarette state law and provided a baseline assessment before enactment of the new legal requirements. Design and Methods We tested samples of e-liquids and performed observations in 16 stores that were selling e-cigarettes but were not legally required to be licensed for tobacco retail. The e-liquids were analyzed for nicotine content using a validated high-performance liquid chromatography method for nicotine analysis. Results Of the 70 collected e-liquid samples that claimed to contain nicotine, 17% contained more than the labeled quantity and 34% contained less than the labeled quantity by 10% or more, with one sample containing 172% more than the labeled quantity. Of the 94 e-liquid containers sampled, only 35% were determined to be child-resistant. Minors were present in stores, although no sales to minors occurred. Conclusions Mislabeling of nicotine in e-liquids is common and exposes the user to the harmful effects of nicotine. The lack of child-resistant packaging for this potentially toxic substance is a serious public health problem. E-cigarettes should be included in the legal definition of tobacco products, child-resistant packaging and nicotine labeling laws should be enacted and strictly enforced, and vape stores should be licensed by states. PMID:27079973

Disparagement of Health Warning Labels on Cigarette Packages and Cessation Attempts: Results from Four Countries

ERIC Educational Resources Information Center

Osman, Amira; Thrasher, James F.; Yong, Hua-Hie; Arillo-Santillán, Edna; Hammond, David

2017-01-01

Health warning labels (HWLs) on cigarette packs that use strong fear appeals may evoke defensive responses including acts of disparaging the warnings. Whether warning disparagement undermines HWL effectiveness remains unclear. We assessed correlates of one type of HWL disparagement and its association with subsequent cessation attempts.…

[Impact of cigarette packages warning labels in relation to tobacco-smoking dependence and motivation to quit].

PubMed

Mannocci, Alice; Antici, Daniele; Boccia, Antonio; La Torre, Giuseppe

2012-01-01

the principal aim was to assess the impact of health warnings on cigarette packages in Italy, the reduction of daily number of cigarette smoked, in relationship to the tobacco-smoking dependence and motivation to quit. The second aim was to compare the impact of text warnings versus graphi depictions. cross-sectional study (survey). the study was conducted through interviews to an opportunistic sample of smokers.The subject enrolled were adult smokers (years ≥ 18), living in the province of Rome. Data were collected in two outpatient clinics located in Morlupo and Rome. Interviews were administered in the waiting rooms, to patients or to their relatives/ helpers. The survey was conducted in June-September 2010. The sample size (266 participants) was computed using a power of 80%, a confidence level of 95%, an expected frequency of smokers with a low motivation to quit who reduced number of cigarettes due to warnings of 15%, and a frequency of smokers with a higher motivation to quit who reduced number of cigarettes due to warnings of 30%. the effect of the health warnings used in Italy on smoking reduction was measured with the following self-reported items: "Are you or have you been influenced by the health warnings on cigarettes packages (in relation to the daily number of cigarettes smoked)?"; "Have you changed your smoking habits due to the warnings (for example: don't smoking after a coffee.)?"; "Have you ever stopped smoking due to the warnings?" The effect of labels that used shock images on cigarette boxes was measured using followed self-reported questions: "If shocking images were used on cigarette boxes, would they have greater effect than simple warning text currently used?"; "If your favourite cigarettes brand decide to change the look of its cigarette boxes with shocking images on smoking health damages, would you be driven to change it?" thanks to the health warnings, 95% of the 270 participants were informed on smoking damages, 14% (34 smokers) reduced the number cigarettes per day, and 5% (12 smokers) attempted to quit. Forty-five percent of smokers did not know the real impact of light cigarettes on their health, and 49% decided to smoke light cigarettes after having read the warnings. Women were more susceptible to immediate consequences of smoking (appearance of wrinkles; p<0.001), and were more prone to switch to light cigarettes (p=0.002). Smoking dependence, computed with Fagerstrom's test, showed significant differences by age groups (higher in smokers aged 30-45 years; p=0.001), and in smokers who were not interested to deepen knowledge of smoking effects (p=0.009). Individuals more motivated to quit were younger smokers (p=0.012). Smokers aged ≥ 45 years (OR=2.54; 95%CI 1.05-6.17), more motivated to quit (OR=2.92; 95%CI 1.17-7.30), those who reported they do not like the smoking smell on their own clothes (OR=3.6; 95%CI 1.4-9.0), those who reported warning messages are important (OR=4.93; 95%CI 1.55-15.71), those who changed their own smoking behavior due the warnings (OR=3.31; 95%CI 1.10-9.99) were more likely to reduce daily number of cigarettes due the health warnings. Forty-seven percent thought that health warnings with text and images could have a higher impact in comparison to text-only warnings. Moreover, women were more motivated to change cigarette brand if a brand should introduce pictorial warnings (OR=2.54; 95%CI 1.41-4.56). our study showed some positive effects of the introduction of health warnings on cigarette packages. In fact, almost all were informed on tobacco effects, 14% of them reduced the amount of daily smoking, and 5% attempted to quit. Many smokers still believe that switching to lighter cigarettes (e.g. those with less nicotine and tar contents) reduces smoking-related diseases. More than 50% of smokers recognized the importance of health warnings in communicating health risks of smoking, while women were more impressed than men by shocking pictorial warnings.

Influence of point-of-sale tobacco displays and plain black and white cigarette packaging and advertisements on adults: Evidence from a virtual store experimental study.

PubMed

Nonnemaker, James; Kim, Annice; Shafer, Paul; Loomis, Brett; Hill, Edward; Holloway, John; Farrelly, Matthew

2016-05-01

We examined the potential impact of banning tobacco displays and mandating plain packaging and cigarette advertisements at the point of sale (POS) on adult outcomes. A virtual convenience store was created with scenarios in which the tobacco product display was either fully visible (status quo) or enclosed behind a cabinet (display ban), and cigarette packs and advertisements were either in full color (status quo) or black and white, text only (plain). A national convenience sample of 1313 adult current smokers and recent quitters was randomized to 1 of 4 conditions and given a shopping task to complete in the virtual store. Main outcomes were participants' self-reported urge to smoke and tobacco purchase attempts in the virtual store. Compared with recent quitters in the status quo conditions, recent quitters in the display ban condition had lower urges to smoke (β=-4.82, 95% CI=-8.16--1.49, p<0.01). Compared with current smokers in the status quo conditions, smokers in the display ban conditions were less likely to attempt to purchase cigarettes in the virtual store (OR=0.05, 95% CI=0.03-0.08, P<0.01). Smokers exposed to plain packs and ads were significantly less likely to attempt to purchase cigarettes (OR=0.31, 95% CI=0.20-0.47, P<0.01) than those exposed to color packs and ads. Policies that ban the display of tobacco products or require plain packaging and advertising at the POS may help reduce adult smoking. Copyright © 2016 Elsevier Ltd. All rights reserved.

E-Cigarette use among children and young people: the need for regulation.

PubMed

Wasowicz, Adam; Feleszko, Wojciech; Goniewicz, Maciej L

2015-10-01

Electronic cigarettes (e-cigarettes) are devices designed to deliver nicotine to the body via the route of inhalation. The principle of operation is based on heating a nicotine solution in propylene glycol and/or glycerine (e-liquid), turning it into aerosol (commonly called 'vapour'), which is then inhaled by the user. The scientific evidence on the health consequences of long-term e-cigarette use is sparse and currently inconclusive. Young people are the most vulnerable group to initiate use of e-cigarettes. The novelty of the e-cigarette, perceptions about the harmlessness of the product, a wide variety of flavours (fruit, chocolate, peanut butter, bubble gum, gummy bear, amongst others), and peer-influence are just a few examples of factors contributing to the e-cigarette popularity among youth. The comprehensive e-cigarette regulations need to include rules on marketing, safety of newly introduced products (nicotine dosage, packaging, and labelling), marketing limitations, and banning the sale of e-cigarettes to minors.

The Use of Sports Imagery and Terminology on Cigarette Packs from Fourteen Countries.

PubMed

Kleb, Cerise; Welding, Kevin; Cohen, Joanna E; Smith, Katherine C

2018-04-16

Tobacco companies have historically associated their products with sports through event sponsorship and sports-themed advertising campaigns. Such linkages serve to enhance brand image by connecting cigarette brands to ideals associated with sports such as strength, individual accomplishment, and a healthy body. Public health policy progress has created restrictions for tobacco sponsorship and restricted traditional advertising avenues for tobacco products. Nonetheless, the pack itself remains as a mechanism by which to link cigarettes to sports and sporting prowess. Thus, we analyze depictions of sport and references to sports terminology on cigarette packs. To describe the sports-related marketing appeals on cigarette packages purchased in 14 low and middle income countries. In 2013, we collected and coded cigarette packs from 14 low and middle income countries and we returned to four of these countries for further data collection in 2015. Packs from both years were assessed for sports-related appeals (text and imagery) and sports-related brand names to identify sports appeals on cigarette packs. The analysis yielded 36 brands with distinct depictions of sport or sporting terminology on the pack. Text-based appeals were found on 24 of the 36 distinct "sports appeal" packs (e.g., "Polo," "Olympic," "Win," "iScore"). Sporting imagery was present on 22 packs (e.g., soccer ball, race car, wrestling match, trophy). The pack is a powerful medium through which tobacco companies continue to associate their products with idealized concepts associated with sports. These are potentially problematic associations that could be restricted through plain and standardized packaging policy initiatives.

The potential impact of plain packaging of cigarette products among Brazilian young women: an experimental study

PubMed Central

2012-01-01

Background Tobacco use is responsible for 5.4 million deaths every year worldwide and is a leading cause of preventable death. The burden of these deaths is rapidly shifting to low and middle-income countries, such as Brazil. Brazil has prohibited most forms of tobacco advertising; however, the cigarette pack remains a primary source of marketing. The current study examined how tobacco packaging influences brand appeal and perceptions of health risk among young women in Brazil. Methods A between-subjects experiment was conducted in which 640 Brazilian women aged 16–26 participated in an online survey. Participants were randomized to view 10 cigarette packages according to one of three experimental conditions: standard branded packages, the same packs without brand imagery (“plain packaging”), or the same packs without brand imagery or descriptors (e.g., flavors). Participants rated packages on perceived appeal, taste, health risk, smoothness, and smoker attributes. Finally, participants were shown a range of branded and plain packs from which they could select one as a free gift, which constituted a behavioral measure of appeal. Results Branded packs were rated as significantly more appealing, better tasting, and smoother on the throat than plain packs. Branded packs were also associated with a greater number of positive smoker attributes including style and sophistication, and were perceived as more likely to be smoked by females than the plain packs. Removing descriptors from the plain packs further decreased the ratings of appeal, taste and smoothness, and also reduced associations with positive attributes. In the pack offer, participants were three times more likely to select branded packs than plain packs. Conclusions Plain packaging and removal of descriptors may reduce the appeal of smoking for youth and young adults, and consequently reduce smoking susceptibility. Overall, the findings provide support for plain packaging regulations, such as those in Australia. PMID:22943135

Menthol Content in U.S. Marketed Cigarettes

PubMed Central

Ai, Jiu; Taylor, Kenneth M.; Lisko, Joseph G.; Tran, Hang; Watson, Clifford H.; Holman, Matthew R.

2015-01-01

Introduction In 2011 menthol cigarettes accounted for 32 percent of the market in the United States, but there are few literature reports that provide measured menthol data for commercial cigarettes. To assess current menthol application levels in the U.S. cigarette market, menthol levels in cigarettes labeled or not labeled to contain menthol was determined for a variety of contemporary domestic cigarette products. Method We measured the menthol content of 45whole cigarettes using a validated gas chromatography/mass spectrometry method (GC/MS). Results In 23 cigarette brands labeled as menthol products, the menthol levels of the whole cigarette ranged from 2.9 to 19.6 mg/cigarette, with three products having higher levels of menthol relative to the other menthol products. The menthol levels for 22 cigarette products not labeled to contain menthol ranged from 0.002 to 0.07 mg/cigarette. The type of packaging (soft vs. hard pack) for a given cigarette product does not appear to affect menthol levels based on the current limited data. Conclusion Menthol levels in cigarette products labeled as containing menthol are approximately 50 to 5,000-fold higher than those in cigarette products not labeled as containing menthol. In general, menthol content appears to occur within discrete ranges for both mentholated and non-mentholated cigarettes. PMID:26259988

The effects of variant descriptors on the potential effectiveness of plain packaging.

PubMed

Borland, Ron; Savvas, Steven

2014-01-01

To examine the effects that variant descriptor labels on cigarette packs have on smokers' perceptions of those packs and the cigarettes contained within. As part of two larger web-based studies (each involved 160 young adult ever-smokers 18-29 years old), respondents were shown a computer image of a plain cigarette pack and sets of related variant descriptors. The sets included terms that varied in terms of descriptors of colours as names, flavour strength, degrees of filter venting, filter types, quality, type of cigarette and numbers. For each set, respondents rated the highest and lowest of two or three of the following four characteristics: quality, strongest or weakest in taste, delivers most or least tar/nicotine, and most or least level of harm. There were significant differences on all four ratings. Quality ratings were the least differentiated. Except for colour descriptors, where 'Gold' rated high in quality but medium in other ratings, ratings of quality, harm, strength and delivery were all positively associated when rated on the same descriptors. Descriptor labels on cigarette packs, can affect smokers' perceptions of the characteristics of the cigarettes contained within. Therefore, they are a potential means by which product differentiation can occur. In particular, having variants differing in perceived strength while not differing in deliveries of harmful ingredients is particularly problematic. Any packaging policy should take into account the possibility that variant descriptors can mislead smokers into making inappropriate product attributions.

The Impact of Cigarette Plain Packaging on Health Warning Salience and Perceptions: Implications for Public Health Policy.

PubMed

Auemaneekul, Naruemon; Silpasuwan, Pimpan; Sirichotiratana, Nithat; Satitvipawee, Pratana; Sompopcharoen, Malinee; Viwatwongkasem, Chukiat; Sujirarat, Dusit

2015-11-01

The study employed a mixed methods design using focus group interviews with 6 student groups and self-administered questionnaires with 1239 students. The participants were nonsmoking, current smokers, and quit-smoking teenagers from secondary schools and colleges. Focus group revealed that although nonsmoking teenagers perceived fear appeals to warning messages, current smokers did not perceive fear appeals to health. Black and white backgrounds of the cigarette package were chosen as the best color for plain packaging. However, most participants suggested various pictorials and a bigger size of pictorial warnings for greater and more effective fear appeal. Odds ratio showed that males had 2.43 times the odds to perceive intention not to smoke. Teenagers who had never smoked and those who had quit smoking had 13.27 and 3.61 times the odds, respectively, to perceive intention not to smoke. © 2015 APJPH.

Design and marketing features influencing choice of e-cigarettes and tobacco in the EU.

PubMed

Laverty, Anthony A; Vardavas, Constantine I; Filippidis, Filippos T

2016-10-01

Data were analysed from the 2014 Special Eurobarometer for Tobacco survey. We estimated self-rated importance of various factors in the choice of both tobacco and electronic cigarettes (e-cigarettes) among tobacco smokers who had ever used an e-cigarette. Among ever users of tobacco and e-cigarettes (N = 2430), taste (39.4%), price (39.2%) and amount of nicotine (27.3%) were the most commonly cited reasons for choosing their brand of e-cigarettes. Those aged 15-24 were more likely to cite external packaging [adjusted prevalence ratio (aPR = 2.06, 95% CI 1.00-4.23)] and design features (aPR = 1.99, 1.20-3.29) as important. As further legislation is debated and enacted enhanced regulation of price, design and marketing features of e-cigarettes may help to reduce the appeal of e-cigarettes. © The Author 2016. Published by Oxford University Press on behalf of the European Public Health Association.

E-Cigarette Liquid Nicotine Ingestion in a Child: Case Report and Discussion.

PubMed

Gill, Natasha; Sangha, Gurinder; Poonai, Naveen; Lim, Rodrick

2015-11-01

Nicotine poisoning is well described in the pediatric population, and even small oral doses may result in toxic effects. The source of nicotine is usually tobacco products and nicotine replacement products such as gum and patches. With the more frequent use of novel products such as e-cigarettes, concern has arisen regarding liquid nicotine. As there are no regulations regarding childproof bottling and packaging, there may be increased potential for unintentional ingestion of these colorfully and appealingly packaged products by children. We present and discuss a case of this nature, as we feel emergency physicians should be aware of this new mode of poisoning, and public health efforts should be made to minimize such exposures.

Graphical review: The redox dark side of e-cigarettes; exposure to oxidants and public health concerns.

PubMed

Cai, Hua; Wang, Chen

2017-10-01

Since the initial marketing in 2005, the use of e-cigarettes has increased exponentially. Nonetheless, accumulating evidence has demonstrated the ineffectiveness of e-cigarettes in leading to smoking cessation, and decreasing the adverse health impacts of cigarette smoking. The number of adolescents adapted to e-cigarettes has been increasing substantially each year, and this adaptation has promoted openness to tobacco smoking. The present review discusses controversies regarding the smoking cessation effects of e-cigarettes, recent governmental policies and regulations of e-cigarette use, toxic components and vaporization products of e-cigarettes, and the novel molecular mechanisms underlying the adverse health impacts of e-cigarettes leading to oxidative stress in target tissues, and consequent development of cardiopulmonary diseases (i.e. COPD), neurodegenerative disorders (i.e. Alzheimer's' disease), and cancer. Health warning signs on the packaging and professional consultation to avoid adaptation in risk groups might be helpful solutions to control negative impacts of e-cigarettes. It is also recommended to further expand basic and clinical investigations to reveal more detailed oxidative stress mechanisms of e-cigarette induced damages, which would ultimately result in more effective protective strategies. Copyright © 2017 The Authors. Published by Elsevier B.V. All rights reserved.

Graphic Warning Labels in Cigarette Advertisements: Recall and Viewing Patterns

PubMed Central

Strasser, Andrew A.; Tang, Kathy Z.; Romer, Daniel; Jepson, Chris; Cappella, Joseph N.

2012-01-01

Background The Family Smoking Prevention and Control Act gave the U.S. Food and Drug Administration (FDA) legal authority to mandate graphic warning labels on cigarette advertising and packaging. The FDA requires that these graphic warning labels be embedded into cigarette advertising and packaging by September 2012. Purpose The aim of this study was to examine differences in recall and viewing patterns of text-only versus graphic cigarette warning labels; and, the association between viewing patterns and recall. Methods Participants (current daily smokers; N=200) were randomized to view a cigarette advertisement with either text-only or graphic warning labels. Viewing patterns were measured using eye-tracking, and recall was later assessed. Sessions were conducted between November 2008 and November 2009. Data analysis was conducted between March 2011 and July 2011. Results There was a significant difference in percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50% versus 83% (χ2 =23.74, p=0.0001). Time to first view of the graphic warning label text, and dwell time duration (i.e., time spent looking) on the graphic image were significantly associated with correct recall. Warning labels that drew attention more quickly and resulted in longer dwell times were associated with better recall. Conclusions Graphic warning labels improve smokers’ recall of warning and health risks; they do so by drawing and holding attention. PMID:22704744

76 FR 52862 - Time for Payment of Certain Excise Taxes, and Quarterly Excise Tax Payments for Small Alcohol...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-08-24

... 40 Cigars and cigarettes, Claims, Electronic fund transfers, Excise taxes, Labeling, Packaging and... that are not required to pay taxes through electronic funds transfer (EFT), this first payment period..., Electronic funds transfers, Excise taxes, Exports, Food additives, Fruit juices, Labeling, Liquors, Packaging...

Pictorial health warnings on cigarette packages in qatar: preimplementation awareness and perceptions of ever-smokers versus never-smokers.

PubMed

Awaisu, Ahmed; Hagi, Aisha; Ashour, Marwa Attia; Kheir, Nadir

2013-10-01

Studies have demonstrated that pictorial health warnings (PHWs) on cigarette packages were significantly associated with increased awareness of smoking-related health hazards and behavior change. A new legislation on PHWs was recently endorsed and PHWs have recently been introduced in Qatar. This study aims to evaluate the general public's awareness, beliefs, and perceptions on antitobacco PHW labels on cigarette packs prior to the implementation of the new regulation. A cross-sectional survey using a pretested 23-item questionnaire was conducted among randomly approached adults in Qatar. Data were analyzed using IBM SPSS(®) version 19. Demographic characteristics and other outcomes of interest were compared using chi-square or Fisher's exact tests. A total of 500 participants (59% male) responded to the survey. Most notably, ever-smokers did not significantly differ from never-smokers on awareness of PHW. About one third of the respondents had no idea about any specific text warning messages on tobacco products sold and nearly 45% of them did not know what a PHW was. Furthermore, a substantial proportion (more than 20%) of the respondents in both groups did not believe that introducing PHWs will enhance smoking behavior change. Nonsmokers generally tended to have more positive attitudes than smokers toward perceived impact of PHWs. These findings suggest the needs for increased awareness about the value of PHWs and call for further research to determine the effectiveness of PHW labels on cigarette packages in Qatar and greater Middle Eastern region, where legislations on PHWs are still at infancy.

The impact of structural packaging design on young adult smokers' perceptions of tobacco products.

PubMed

Borland, Ron; Savvas, Steven; Sharkie, Fiona; Moore, Karen

2013-03-01

To examine the extent that novel cigarette pack shapes and openings have on smokers' perceptions of those packs and the cigarettes contained within. Using a web-based survey, 160 young adult ever-smokers (18-29 years) were shown computer images of plain packaged cigarette packs in five different shapes. This was followed by packs illustrating five different methods of opening. Brand (prestige or budget) and size of the health warnings (30% or 70% warning size) were between-subject conditions. Respondents ranked packs on attractiveness, perceived quality of the cigarettes contained within and extent that the pack distracted from health warnings. Ratings of attractiveness and perceived quality were significantly associated in both substudies, but tendency to distract from warnings was more independent. Significant differences were found between the pack shapes on attractiveness, perceived quality and distraction from warnings. Standard, 2×10 and 4×5 packs were ranked less attractive than Bevelled and Rounded packs. 2×10 and 4×5 packs were also perceived as lower quality than Bevelled and Rounded packs. The Standard pack was less distracting to health warnings than all other shapes except the 2×10 pack. Pack openings were perceived as different on quality of cigarettes contained and extent of distraction to warnings. The Standard Flip-top was rated significantly lower in distracting from warnings than all other openings. Pack shape and pack opening affect ever-smokers' perceptions of the packs and the cigarettes they contain. This means that they have the potential to create appeal and differentiate products and thus should be regulated.

An Experimental Study of Effects on Schoolchildren of Exposure to Point-of-Sale Cigarette Advertising and Pack Displays

ERIC Educational Resources Information Center

Wakefield, Melanie; Germain, Daniella; Durkin, Sarah; Henriksen, Lisa

2006-01-01

By creating a sense of familiarity with tobacco, cigarette advertising and bold packaging displays in stores where children often visit may help to pre-dispose them to smoking. A total of 605 ninth-grade students were randomly allocated to view a photograph of a typical convenience store point-of-sale which had been digitally manipulated to show…

Standardised (plain) cigarette packaging increases attention to both text-based and graphical health warnings: experimental evidence.

PubMed

Shankleman, M; Sykes, C; Mandeville, K L; Di Costa, S; Yarrow, K

2015-01-01

To investigate whether standardised cigarette packaging increases the time spent looking at health warnings, regardless of the format of those warnings. A factorial (two pack styles x three warning types) within-subject experiment, with participants randomised to different orders of conditions, completed at a university in London, UK. Mock-ups of cigarette packets were presented to participants with their branded portion in either standardised (plain) or manufacturer-designed (branded) format. Health warnings were present on all packets, representing all three types currently in use in the UK: black & white text, colour text, or colour images with accompanying text. Gaze position was recorded using a specialised eye tracker, providing the main outcome measure, which was the mean proportion of a five-second viewing period spent gazing at the warning-label region of the packet. An opportunity sample of 30 (six male, mean age = 23) young adults met the following inclusion criteria: 1) not currently a smoker; 2) <100 lifetime cigarettes smoked; 3) gaze position successfully tracked for > 50% viewing time. These participants spent a greater proportion of the available time gazing at the warning-label region when the branded section of the pack was standardised (following current Australian guidelines) rather than containing the manufacturer's preferred design (mean difference in proportions = 0.078, 95% confidence interval 0.049 to 0.106, p < 0.001). There was no evidence that this effect varied based on the type of warning label (black & white text vs. colour text vs. colour image & text; interaction p = 0.295). During incidental viewing of cigarette packets, young adult never-smokers are likely to spend more time looking at health warnings if manufacturers are compelled to use standardised packaging, regardless of the warning design. Copyright © 2014 The Authors. Published by Elsevier Ltd.. All rights reserved.

US Smokers’ Beliefs, Experiences and Perceptions of Different Cigarette Variants Before and After the FSPTCA Ban on Misleading Descriptors Such as “Light,” “Mild,” or “Low”

PubMed Central

Borland, Ron; Cummings, K. Michael; Lindblom, Eric N.; Li, Lin; Bansal-Travers, Maansi; O’Connor, Richard J.; Elton-Marshall, Tara; Thrasher, James F.; Hammond, David; Thompson, Mary E.; Partos, Timea R.

2016-01-01

Introduction: In December 2008, the Federal Trade Commission (FTC) took action that prompted the removal of nicotine and tar listings from cigarette packs and ads. As of June 2010, the US Family Smoking Prevention and Tobacco Control Act prohibited the use of explicit or implicit descriptors on tobacco packaging or in advertising that convey messages of reduced risk or exposure, specifically including terms like “light,” “mild,” and “low” and similar descriptors. This study evaluates the effect of these two policy changes on smokers’ beliefs, experiences and perceptions of different cigarettes. Methods: Using generalized estimating equations models, this study analyzed survey data collected between 2002 and 2013 by the International Tobacco Control Policy Evaluation Study regarding US smokers’ beliefs, experiences, and perceptions of different cigarettes. Results: Between 2002 and 2013, smoker misperceptions about “light” cigarettes being less harmful did not change significantly and remained substantial, especially among those who reported using lower-strength cigarettes. After the two policy changes, reported reliance on pack colors, color terms, and other product descriptors like “smooth” to determine cigarette strength style trended upward. Conclusions: Policies implemented to reduce smoker misperceptions that some cigarettes are safer than others appear to have had little impact. Because of pack colors, color terms, descriptors such as “smooth,” cigarette taste or feel, and possibly other characteristics, millions of smokers continue to believe, inaccurately, that they can reduce their harms and risks by smoking one cigarette brand or sub-brand instead of another, which may be delaying or reducing smoking cessation. Implications: What this study adds: This study confirms that US policies to reduce smoker misperceptions that some cigarettes are less harmful than others have not been successful. Following the removal of light/low descriptors and tar and nicotine numbers from cigarette packs and ads, pack colors, color words, other descriptors (eg, smooth), and sensory experiences of smoother or lighter taste have helped smokers to continue to identify their preferred cigarette brand styles and otherwise distinguish between which brands and styles they consider “lighter” or lower in tar and, mistakenly, less harmful than others. These findings provide additional evidence to support new enforcement or regulatory action to stop cigarettes and their packaging from misleading smokers about relative risk, which may be reducing or delaying quit attempts. PMID:27083215

US Smokers' Beliefs, Experiences and Perceptions of Different Cigarette Variants Before and After the FSPTCA Ban on Misleading Descriptors Such as "Light," "Mild," or "Low".

PubMed

Yong, Hua-Hie; Borland, Ron; Cummings, K Michael; Lindblom, Eric N; Li, Lin; Bansal-Travers, Maansi; O'Connor, Richard J; Elton-Marshall, Tara; Thrasher, James F; Hammond, David; Thompson, Mary E; Partos, Timea R

2016-11-01

In December 2008, the Federal Trade Commission (FTC) took action that prompted the removal of nicotine and tar listings from cigarette packs and ads. As of June 2010, the US Family Smoking Prevention and Tobacco Control Act prohibited the use of explicit or implicit descriptors on tobacco packaging or in advertising that convey messages of reduced risk or exposure, specifically including terms like "light," "mild," and "low" and similar descriptors. This study evaluates the effect of these two policy changes on smokers' beliefs, experiences and perceptions of different cigarettes. Using generalized estimating equations models, this study analyzed survey data collected between 2002 and 2013 by the International Tobacco Control Policy Evaluation Study regarding US smokers' beliefs, experiences, and perceptions of different cigarettes. Between 2002 and 2013, smoker misperceptions about "light" cigarettes being less harmful did not change significantly and remained substantial, especially among those who reported using lower-strength cigarettes. After the two policy changes, reported reliance on pack colors, color terms, and other product descriptors like "smooth" to determine cigarette strength style trended upward. Policies implemented to reduce smoker misperceptions that some cigarettes are safer than others appear to have had little impact. Because of pack colors, color terms, descriptors such as "smooth," cigarette taste or feel, and possibly other characteristics, millions of smokers continue to believe, inaccurately, that they can reduce their harms and risks by smoking one cigarette brand or sub-brand instead of another, which may be delaying or reducing smoking cessation. What this study adds: This study confirms that US policies to reduce smoker misperceptions that some cigarettes are less harmful than others have not been successful. Following the removal of light/low descriptors and tar and nicotine numbers from cigarette packs and ads, pack colors, color words, other descriptors (eg, smooth), and sensory experiences of smoother or lighter taste have helped smokers to continue to identify their preferred cigarette brand styles and otherwise distinguish between which brands and styles they consider "lighter" or lower in tar and, mistakenly, less harmful than others. These findings provide additional evidence to support new enforcement or regulatory action to stop cigarettes and their packaging from misleading smokers about relative risk, which may be reducing or delaying quit attempts. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

27 CFR 40.22 - Determination of sale price of large cigars.

Code of Federal Regulations, 2010 CFR

2010-04-01

..., CIGARETTE PAPERS AND TUBES, AND PROCESSED TOBACCO Taxes § 40.22 Determination of sale price of large cigars... Bulletin in accordance with § 70.701(d) of this chapter. (2) Adjustments in sale price—(i) Reasons for... packaging. If different bona fide sale prices are applicable to different types of packaging (e. g., boxes...

Yields of tar, nicotine, and carbon monoxide in the sidestream smoke from 15 brands of Canadian cigarettes

DOE Office of Scientific and Technical Information (OSTI.GOV)

Rickert, W.S.; Robinson, J.C.; Collishaw, N.

Sidestream smoke yields for 15 brands of cigarettes were determined under conditions where mainstream yields were approximately equal to those used for determining the values which appear on packages of Canadian cigarettes. Sidestream yields of tar, nicotine, and carbon monoxide were much higher than mainstream yields for all brands tested. The average sidestream-to-mainstream ratios for the 15 brands were 3.5, 6.6, and 6.8 for tar, nicotine, and carbon monoxide, respectively. The highest yields of sidestream were obtained from the brands with the lowest mainstream yields.

Research and Development of Fully Automatic Alien Smoke Stack and Packaging System

NASA Astrophysics Data System (ADS)

Yang, Xudong; Ge, Qingkuan; Peng, Tao; Zuo, Ping; Dong, Weifu

2017-12-01

The problem of low efficiency of manual sorting packaging for the current tobacco distribution center, which developed a set of safe efficient and automatic type of alien smoke stack and packaging system. The functions of fully automatic alien smoke stack and packaging system adopt PLC control technology, servo control technology, robot technology, image recognition technology and human-computer interaction technology. The characteristics, principles, control process and key technology of the system are discussed in detail. Through the installation and commissioning fully automatic alien smoke stack and packaging system has a good performance and has completed the requirements for shaped cigarette.

Graphic warning labels in cigarette advertisements: recall and viewing patterns.

PubMed

Strasser, Andrew A; Tang, Kathy Z; Romer, Daniel; Jepson, Christopher; Cappella, Joseph N

2012-07-01

The Family Smoking Prevention and Control Act gave the U.S. Food and Drug Administration (FDA) legal authority to mandate graphic warning labels on cigarette advertising and packaging. The FDA requires that these graphic warning labels be embedded into cigarette advertising and packaging by September 2012. The aim of this study was to examine differences in recall and viewing patterns of text-only versus graphic cigarette warning labels and the association between viewing patterns and recall. Participants (current daily smokers; N=200) were randomized to view a cigarette advertisement with either text-only or graphic warning labels. Viewing patterns were measured using eye-tracking, and recall was later assessed. Sessions were conducted between November 2008 and November 2009. Data analysis was conducted between March 2011 and July 2011. There was a significant difference in percentage correct recall of the warning label between those in the text-only versus graphic warning label condition, 50% vs 83% (χ(2)=23.74, p=0.0001). Time to first viewing of the graphic warning label text and dwell time duration (i.e., time spent looking) on the graphic image were significantly associated with correct recall. Warning labels that drew attention more quickly and resulted in longer dwell times were associated with better recall. Graphic warning labels improve smokers' recall of warning and health risks; these labels do so by drawing and holding attention. Copyright © 2012 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Global Evidence on the Association between Cigarette Graphic Warning Labels and Cigarette Smoking Prevalence and Consumption

PubMed Central

Ngo, Anh; Cheng, Kai-Wen; Huang, Jidong; Chaloupka, Frank J.

2018-01-01

Background: In 2011, the courts ruled in favor of tobacco companies in preventing the implementation of graphic warning labels (GWLs) in the US, stating that FDA had not established the effectiveness of GWLs in reducing smoking. Methods: Data came from various sources: the WHO MPOWER package (GWLs, MPOWER policy measures, cigarette prices), Euromonitor International (smoking prevalence, cigarette consumption), and the World Bank database (countries’ demographic characteristics). The datasets were aggregated and linked using country and year identifiers. Fractional logit regressions and OLS regressions were applied to examine the associations between GWLs and smoking prevalence and cigarette consumption, controlling for MPOWER policy scores, cigarette prices, GDP per capita, unemployment, population aged 15–64 (%), aged 65 and over (%), year indicators, and country fixed effects. Results: GWLs were associated with a 0.9–3 percentage point decrease in adult smoking prevalence and were significantly associated with a reduction of 230–287 sticks in per capita cigarette consumption, compared to countries without GWLs. However, the association between GWLs and cigarette consumption became statistically insignificant once country indicators were included in the models. Conclusions: The implementation of GWLs may be associated with reduced cigarette smoking. PMID:29495581

Global Evidence on the Association between Cigarette Graphic Warning Labels and Cigarette Smoking Prevalence and Consumption.

PubMed

Ngo, Anh; Cheng, Kai-Wen; Shang, Ce; Huang, Jidong; Chaloupka, Frank J

2018-02-28

Background : In 2011, the courts ruled in favor of tobacco companies in preventing the implementation of graphic warning labels (GWLs) in the US, stating that FDA had not established the effectiveness of GWLs in reducing smoking. Methods : Data came from various sources: the WHO MPOWER package (GWLs, MPOWER policy measures, cigarette prices), Euromonitor International (smoking prevalence, cigarette consumption), and the World Bank database (countries' demographic characteristics). The datasets were aggregated and linked using country and year identifiers. Fractional logit regressions and OLS regressions were applied to examine the associations between GWLs and smoking prevalence and cigarette consumption, controlling for MPOWER policy scores, cigarette prices, GDP per capita, unemployment, population aged 15-64 (%), aged 65 and over (%), year indicators, and country fixed effects. Results : GWLs were associated with a 0.9-3 percentage point decrease in adult smoking prevalence and were significantly associated with a reduction of 230-287 sticks in per capita cigarette consumption, compared to countries without GWLs. However, the association between GWLs and cigarette consumption became statistically insignificant once country indicators were included in the models. Conclusions : The implementation of GWLs may be associated with reduced cigarette smoking.

Do larger graphic health warnings on standardised cigarette packs increase adolescents’ cognitive processing of consumer health information and beliefs about smoking-related harms?

PubMed Central

White, Victoria; Williams, Tahlia; Faulkner, Agatha; Wakefield, Melanie

2015-01-01

Objective To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on Australian adolescents’ cognitive processing of warnings and awareness of different health consequences of smoking. Methods Cross-sectional school-based surveys conducted in 2011 (prior to introduction of standardised packaging, n=6338) and 2013 (7–12 months afterwards, n=5915). Students indicated frequency of attending to, reading, thinking or talking about warnings. Students viewed a list of diseases or health effects and were asked to indicate whether each was caused by smoking. Two—‘kidney and bladder cancer’ and ‘damages gums and teeth’—were new while the remainder had been promoted through previous health warnings and/or television campaigns. The 60% of students seeing a cigarette pack in previous 6 months in 2011 and 65% in 2013 form the sample for analysis. Changes in responses over time are examined. Results Awareness that smoking causes bladder cancer increased between 2011 and 2013 (p=0.002). There was high agreement with statements reflecting health effects featured in previous warnings or advertisements with little change over time. Exceptions to this were increases in the proportion agreeing that smoking was a leading cause of death (p<0.001) and causes blindness (p<0.001). The frequency of students reading, attending to, thinking or talking about the health warnings on cigarette packs did not change. Conclusions Acknowledgement of negative health effects of smoking among Australian adolescents remains high. Apart from increased awareness of bladder cancer, new requirements for packaging and health warnings did not increase adolescents’ cognitive processing of warning information. PMID:28407612

Use of illicit tobacco following introduction of standardised packaging of tobacco products in Australia: results from a national cross-sectional survey.

PubMed

Scollo, Michelle; Zacher, Meghan; Coomber, Kerri; Wakefield, Melanie

2015-04-01

To assess whether following standardisation of tobacco packaging in Australia, smokers were, as predicted by the tobacco industry, more likely to use illicit tobacco. National cross-sectional telephone surveys conducted continuously from April 2012 (6 months before implementation of plain packaging (PP)) to March 2014 (15 months after) using responses from current cigarette smokers (n=8679). Changes between pre-PP, the transition to PP and PP phase were examined using logistic regression models. Among those whose factory-made cigarettes were purchased in Australia, compared with pre-PP, there were no significant increases in the PP phase in use of: 'cheap whites' (<0.1%; OR=0.24, 95% CI 0.04 to 1.56, p=0.134); international brands purchased for 20% or more below the recommended retail price (0.2%; OR=3.49, 95% CI 0.66 to 18.35, p=0.140); or packs purchased from informal sellers (<0.1%; OR=0.24, 95% CI 0.04 to 1.47, p=0.124). The prevalence of any use of unbranded illicit tobacco remained at about 3% (adjusted OR=0.79, 95% CI 0.58 to 1.08, p=0.141). While unable to quantify the total extent of use of illicit manufactured cigarettes, in this large national survey we found no evidence in Australia of increased use of two categories of manufactured cigarettes likely to be contraband, no increase in purchase from informal sellers and no increased use of unbranded illicit 'chop-chop' tobacco. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The advertised price of cigarette packs in retail outlets across Australia before and after the implementation of plain packaging: a repeated measures observational study

PubMed Central

Scollo, Michelle; Bayly, Megan; Wakefield, Melanie

2015-01-01

Objective This study monitored the advertised price of the most prominently promoted and the cheapest single packs of cigarettes in Australian retail outlets before and after the implementation of plain packaging. Methods A panel of 421 outlets in four large Australian cities was visited monthly from May 2012 to August 2013 and the brand, pack size and price of the most-prominently listed and lowest-priced single cigarette pack were recorded from each store's tobacco price board. Changes in the inflation-adjusted stick price were examined using linear mixed models, controlling for fixed effects of city, store type, area socioeconomic status and random effects of time. The adjusted stick price was also examined over time by tobacco manufacturer and pack size. Results The inflation-adjusted stick price of the most-prominently advertised single packs was significantly higher than in May–July 2012 from August–October 2012 for mainstream and premium brands and from February–April 2013 for value brands. Adjusted average stick prices of lowest-priced packs in August 2013 were $0.02 (95% CI $0.02 to $0.03, p<0.001) higher than in May–July 2012 ($Aug13). A large real increase in stick price was seen in February–April 2013 across all major manufacturers, market segments and pack size categories. Discussion The price of cigarettes most prominently promoted on price boards did not decrease in the months following implementation of Australia's plain packaging legislation. Retail prices continued to increase above the level resulting from automatic indexation of excise/customs duty even at the lowest-priced end of the Australian market. PMID:28407616

Ohio Appalachian residents' views on smoke-free laws and cigarette warning labels.

PubMed

Reiter, Paul L; Wewers, Mary E; Paskett, Electra D; Klein, Elizabeth G; Katz, Mira L

2012-01-01

Smoke-free laws and the addition of graphic warning labels to cigarette packages represent public health policies that can potentially reduce smoking and smoking-related disease. The attitudes and beliefs relating to these policies were examined among residents of Ohio Appalachia, a mostly rural region with high smoking prevalence among its residents. Focus groups were conducted with participants from Ohio Appalachia during the summer of 2007. Groups included healthcare providers (n=37), community leaders (n=31), parents (n=19), and young adult women aged 18-26 years (n=27). Most participants were female (94%), non-Hispanic White (94%), and married (65%). Participants believed that most non-smokers supported Ohio's enforced statewide comprehensive smoke-free law that began in 2007, while some smokers opposed the law due to a perceived infringement of their rights. They also reported that most residents and local businesses were abiding by and enforcing the law. Participants supported the addition of graphic warning labels to cigarette packages in the USA. They believed that such warning labels could help deter adolescents and adult non-smokers from smoking initiation, particularly if the negative aesthetic effects of smoking were emphasized. However, they felt the labels would be less effective among current smokers and older individuals living in their communities. Participants generally held positive views about both the smoke-free law and the addition of graphic warning labels to cigarette packages in the USA. These tobacco-related public health policies are promising strategies for potentially reducing smoking and its associated diseases among residents living in Appalachia. Additional research is needed to further examine support for these policies among more diverse Appalachian populations.

Cigarette design and marketing features are associated with increased smoking susceptibility and perception of reduced harm among smokers in 27 EU countries.

PubMed

Agaku, Israel T; Omaduvie, Uyoyo T; Filippidis, Filippos T; Vardavas, Constantine I

2015-12-01

This study assessed the role of cigarette design and marketing characteristics in initial smoking, cigarette brand choice and the perception of reduced harm of cigarette brands among adults in the European Union in 2012. Data were from the Eurobarometer 385 (V.77.1) survey conducted in 2012 (n=26 566). Multivariate logistic regression was used to assess associations between cigarette design/marketing features with aspects of initial smoking (among current and former smokers), cigarette brand choice and perception of reduced harm of cigarette brands (among current smokers; p<0.05). Respondents aged ≥55 years had lower OR than 15-24-year-olds of reporting initial smoking because of the presence of menthol flavour (adjusted OR (AOR)=0.42; 95% CI 0.24 to 0.72) or a specific sweet, fruity or spicy flavour (AOR=0.38; 95% CI 0.20 to 0.73). Females had higher OR than males of reporting initial smoking because of the presence of menthol flavour (AOR=2.89; 95% CI 2.07 to 4.02). Furthermore, female smokers were more likely to choose a cigarette brand based on specific tastes such as menthol or spicy, fruity or sweet flavours (AOR=1.33; 95% CI 1.14 to 1.56), or on the levels of tar, nicotine and carbon monoxide (AOR=1.30; 95% CI 1.11 to 1.52). Characteristics such as light-coloured packaging, the shape and size of cigarettes and the pack, the use of terms in the brand name such as 'silver' or 'blue' or descriptors such as 'natural' or 'organic' were all associated with perceptions of reduced harm among specific demographic groups. These findings call for a stronger regulation of tobacco ingredients, packaging features and other marketing strategies that may increase the attractiveness of tobacco products or promote perceptions of harm reduction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

27 CFR 40.217 - Repackaging.

Code of Federal Regulations, 2012 CFR

2012-04-01

... THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... the reason for wanting to repackage the products (e.g., packages soiled, damaged, or otherwise in a...

[Excise taxes on tobacco and the problem of smuggling - concerning the credibility of the tobacco industry's "Discarded-Cigarette-Packages-Study"].

PubMed

Adams, M; Effertz, T

2011-10-01

The consumption of tobacco products is one of the main causes of illnesses. An often neglected but highly effective instrument for fiscal and preventive purposes is higher taxes on tobacco products. The tobacco industry however claims that higher taxes have tremendous effects on smuggling activity with additional costs with regard to law enforcement. The claim appears to be substantiated by a study which collects and documents the amounts of discarded empty cigarette packs, and which is used to estimate the fraction of illegally imported cigarettes. We show that this study makes use of systematic misspecifications and impreciseness and thus seems to pursue the aim of showing an exaggerated high amount of illegally imported cigarettes. The industry's claim that two thirds of non-taxed cigarettes in Germany are imported illegally, thus lacks any sound, well-grounded empirical corroboration. © Georg Thieme Verlag KG Stuttgart · New York.

27 CFR 40.217 - Repackaging.

Code of Federal Regulations, 2010 CFR

2010-04-01

... the reason for wanting to repackage the products (e.g., packages soiled, damaged, or otherwise in a... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND...

27 CFR 40.217 - Repackaging.

Code of Federal Regulations, 2011 CFR

2011-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... the reason for wanting to repackage the products (e.g., packages soiled, damaged, or otherwise in a...

27 CFR 40.217 - Repackaging.

Code of Federal Regulations, 2014 CFR

2014-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... the reason for wanting to repackage the products (e.g., packages soiled, damaged, or otherwise in a...

27 CFR 40.217 - Repackaging.

Code of Federal Regulations, 2013 CFR

2013-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... the reason for wanting to repackage the products (e.g., packages soiled, damaged, or otherwise in a...

When health policy and empirical evidence collide: the case of cigarette package warning labels and economic consumer surplus.

PubMed

Song, Anna V; Brown, Paul; Glantz, Stanton A

2014-02-01

In its graphic warning label regulations on cigarette packages, the Food and Drug Administration severely discounts the benefits of reduced smoking because of the lost "pleasure" smokers experience when they stop smoking; this is quantified as lost "consumer surplus." Consumer surplus is grounded in rational choice theory. However, empirical evidence from psychological cognitive science and behavioral economics demonstrates that the assumptions of rational choice are inconsistent with complex multidimensional decisions, particularly smoking. Rational choice does not account for the roles of emotions, misperceptions, optimistic bias, regret, and cognitive inefficiency that are germane to smoking, particularly because most smokers begin smoking in their youth. Continued application of a consumer surplus discount will undermine sensible policies to reduce tobacco use and other policies to promote public health.

Smokers' knowledge and understanding of advertised tar numbers: health policy implications.

PubMed

Cohen, J B

1996-01-01

This article examines health policy implications of providing smokers with numerical tar yield information in cigarette advertising. Results of a national probability telephone survey regarding smokers' knowledge and understanding of numerical tar yields and deliveries are reported. Few smokers knew the tar level of their own cigarettes (the exception being smokers of 1- to 5-mg tar cigarettes), and a majority could not correctly judge the relative tar levels of cigarettes. Smokers were unsure whether switching to lower-tar cigarettes would reduce their personal health risks. Many smokers relied on absolute numbers in making trade-offs between number of cigarettes smoked and their tar levels, thus confusion machine-rated tar-yields with actual amounts ingested. The wisdom of the present method of providing tar and nicotine numbers in ads and recommendations for modifying the test protocol are now under discussion. This research indicates that these tar numbers and their implications are poorly understood. The paper recommends revisions in tar ratings to make them more useful and a required statement on cigarette packages to more explicitly relate tar levels to major health risks.

Smokers' knowledge and understanding of advertised tar numbers: health policy implications.

PubMed Central

Cohen, J B

1996-01-01

OBJECTIVES. This article examines health policy implications of providing smokers with numerical tar yield information in cigarette advertising. METHODS. Results of a national probability telephone survey regarding smokers' knowledge and understanding of numerical tar yields and deliveries are reported. RESULTS. Few smokers knew the tar level of their own cigarettes (the exception being smokers of 1- to 5-mg tar cigarettes), and a majority could not correctly judge the relative tar levels of cigarettes. Smokers were unsure whether switching to lower-tar cigarettes would reduce their personal health risks. Many smokers relied on absolute numbers in making trade-offs between number of cigarettes smoked and their tar levels, thus confusion machine-rated tar-yields with actual amounts ingested. CONCLUSIONS. The wisdom of the present method of providing tar and nicotine numbers in ads and recommendations for modifying the test protocol are now under discussion. This research indicates that these tar numbers and their implications are poorly understood. The paper recommends revisions in tar ratings to make them more useful and a required statement on cigarette packages to more explicitly relate tar levels to major health risks. PMID:8561236

Filter presence and tipping paper color influence consumer perceptions of cigarettes.

PubMed

O'Connor, Richard J; Bansal-Travers, Maansi; Cummings, K Michael; Hammond, David; Thrasher, James F; Tworek, Cindy

2015-12-22

Cigarettes are marketed in a wide array of packaging and product configurations, and these may impact consumers' perceptions of product health effects and attractiveness. Filtered cigarettes are typically perceived as less hazardous and white tipping paper (as opposed to cork) often conveys 'lightness'. This study examined cigarette-related perceptions among 1220 young adult (age 18-35) current, ever, and never smokers recruited from three eastern U.S. cities (Buffalo NY, Columbia SC, Morgantown WV). Participants rated three cigarette sticks: two filtered cigarettes 85 mm in length, differing only in tipping paper color (cork versus white), and an unfiltered 70 mm cigarette. Overall, the cork-tipped cigarette was most commonly selected on taste and attractiveness, the white-tipped on least dangerous, and the unfiltered on most dangerous. Current smokers were more likely to select white-tipped (OR = 1.98) and cork-tipped (OR = 3.42) cigarettes, while ever smokers more commonly selected the cork-tipped (OR = 1.96), as most willing to try over the other products. Those willing to try the filtered white-tipped cigarette were more likely to have rated that cigarette as best tasting (OR = 11.10), attracting attention (OR = 17.91), and lowest health risk (OR = 1.94). Similarly, those willing to try cork tipped or unfiltered cigarettes rated those as best testing, attracting attention, and lowest health risk, respectively. Findings from this study demonstrate that consumer product perceptions can be influenced by elements of cigarette design, such as the presence and color of the filter tip.

Implications of Tobacco Industry Research on Packaging Colors for Designing Health Warning Labels.

PubMed

Lempert, Lauren K; Glantz, Stanton A

2016-09-01

Health warning labels (HWLs) are an important way to educate the public about the dangers of tobacco products. Tobacco companies conducted research to understand how pack colors affect consumers' perceptions of the products and make packages and their labeling more visually prominent. We analyzed previously secret tobacco industry documents concerning the tobacco industry's internal research on how cigarette package colors and design influence the visual prominence of packages and consumers' perceptions of the harmfulness of the products. The companies found that black is visually prominent, placing dark pack elements on a contrasting light background makes them stand out more, and black text on a white background is more prominent than white text on a black background. Yellow most quickly and effectively seizes and holds consumers' attention and signals warning or danger, while white connotes health and safety. Using black text on a bright contrasting background color, particularly yellow, attracts consumers' attention to the message. Tobacco industry research on pack color choices that make pack elements more prominent, attract and keep consumers' attention, and convey danger instead of health should guide governments in specifying requirements for HWLs. These factors suggest that HWLs printed on a yellow background with black lettering and borders would most effectively seize and keep consumers' attention and signal the danger of cigarettes and other tobacco products. Tobacco companies' internal research on improving the prominence of pack elements suggests that HWLs using black lettering on a contrasting yellow background would most effectively seize and hold consumers' attention and signal the danger of cigarettes and other tobacco products. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Australian adult smokers’ responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey

PubMed Central

Wakefield, Melanie; Coomber, Kerri; Zacher, Meghan; Durkin, Sarah; Brennan, Emily; Scollo, Michelle

2015-01-01

Background We assessed whether the Australian plain packs with larger graphic health warnings (GHWs) achieved three specific objectives of reducing the appeal of tobacco, increasing health warning effectiveness and reducing the ability of packaging to mislead about smoking harms. Methods We compared responses from continuous cross-sectional telephone surveys of n=2176 cigarette smokers during pre-plain packaging (April–September 2012, pre-PP) with n=759 surveyed in the transition period (October–November 2012) and n=4240 during the first year of implementation (December 2012–November 2013, PP year 1), using multivariate logistic regression analyses. Results From pre-PP to PP year 1, more smokers disliked their pack (p<0.001), perceived lower pack appeal (p<0.001), lower cigarette quality (p<0.001), lower satisfaction (p<0.001) and lower value (p<0.001) and disagreed brands differed in prestige (p=0.003). There was no change in perceived differences in taste of different brands. More smokers noticed GHWs (p<0.001), attributed much motivation to quit to GHWs (p<0.001), avoided specific GHWs when purchasing (p<0.001), and covered packs (p<0.001), with no change in perceived exaggeration of harms. PP year 1 saw an increased proportion believing that brands do not differ in harmfulness (p=0.004), but no change in the belief that variants do not differ in strength or the perceived harmfulness of cigarettes compared with a year ago. Interactions signified greater change for four outcomes assessing aspects of appeal among young adults and two appeal outcomes among mid-aged adults. Conclusions The specific objectives of plain packaging were achieved and generally sustained among adult smokers up to 12 months after implementation. PMID:28407606

Effects of 30% and 50% Cigarette Pack Graphic Warning Labels on Visual Attention, Negative Affect, Quit Intentions, and Smoking Susceptibility among Disadvantaged Populations in the United States.

PubMed

Skurka, Chris; Kemp, Deena; Davydova, Julie; Thrasher, James F; Byrne, Sahara; Safi, Amelia Greiner; Avery, Rosemary J; Dorf, Michael C; Mathios, Alan D; Scolere, Leah; Niederdeppe, Jeff

2018-06-07

Though the WHO Framework Convention for Tobacco Control (FCTC) calls for the implementation of large graphic warning labels (GWLs) on cigarette boxes, the courts have blocked the implementation of 50% labels in the United States. We conducted an experiment to explore whether changing the size of GWLs is associated with changes in visual attention, negative affect, risk beliefs, and behavioral intentions. We recruited adult smokers (N = 238) and middle-school youth (N = 237) throughout the state of New York in May 2016. We randomly assigned participants to one of three between-subject conditions (no GWL [control], 30% GWL, 50% GWL). Adult and youth participants looked at the GWLs longer when the GWL covered 50% versus 30% of the pack's front. Increasing GWL size from 30% to 50% did not influence negative affect or risk beliefs, though both GWL sizes increased negative affect relative to the no-GWL control group. Exposure to 50% GWLs increased adult smokers' intentions to quit compared to no-GWL, but smokers exposed to 30% GWLs did not differ from control. There were no differences between 50% GWLs, 30% GWLs, and control on youth smoking susceptibility. Findings provide some evidence of the benefits of a 50% versus 30% GWL covering the front of the pack for adult smokers and at-risk youth from socioeconomically disadvantaged backgrounds-though not on all outcomes. This research shows that 30% GWLs on cigarette packages increase negative affect relative to packages without front-of-package GWLs. Larger GWLs on cigarette packages (50% vs. 30%) increase visual attention to the warning and its pictorial content among low-SES smokers and at-risk youth but do not further increase negative affect. A 50% GWL increased adults' quit intention compared to no GWL at all, but we were underpowered to detect modest differences in quit intentions between a 50% and 30% GWL. Future work should thus continue to explore the boundary conditions under which relatively larger GWLs influence cognitive, affective, and behavioral outcomes.

E-cigarettes: Considerations for the otolaryngologist.

PubMed

Biyani, Sneh; Derkay, Craig S

2015-08-01

To review the literature regarding electronic cigarettes and discuss potential implications and need for advocacy for the pediatric otolaryngologist. Electronic cigarettes (e-cigarettes) are battery-operated devices that deliver nicotine-containing vapors via inhalation. Research on the health related consequences of e-cigarettes is ongoing and safety has yet to be established. E-cigarettes are not presently under the regulation of any national governing body with wide accessibility to minors. Use of these products has substantially increased since arrival to the market, particularly within the adolescent population. These products are marketed via various platforms including television, Internet and social media. Hundreds of flavors are offered and e-cigarettes are packaged in various colors. Not only are the ill health effects and addictive quality of nicotine concerning, these products have the potential to serve as a gateway for minors to tobacco use. The relationship between tobacco use, secondhand smoke exposure and otolaryngology specific diseases has well been defined. As use of electronic cigarettes increases, pediatric otolaryngologists should be aware of the ongoing literature regarding these products and to be prepared to counsel families accordingly. The use of e-cigarettes among teenagers, potential implications of secondhand vapor exposure from parents and friends, and concerns this may encourage adolescents to utilize conventional tobacco products needs to be considered. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

27 CFR 44.253 - Tax classification for cigars.

Code of Federal Regulations, 2010 CFR

2010-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... in the package; and (c) For small cigars, the classification of the product for tax purposes (i.e...

27 CFR 44.253 - Tax classification for cigars.

Code of Federal Regulations, 2013 CFR

2013-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... in the package; and (c) For small cigars, the classification of the product for tax purposes (i.e...

27 CFR 44.253 - Tax classification for cigars.

Code of Federal Regulations, 2011 CFR

2011-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... in the package; and (c) For small cigars, the classification of the product for tax purposes (i.e...

27 CFR 44.253 - Tax classification for cigars.

Code of Federal Regulations, 2012 CFR

2012-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... in the package; and (c) For small cigars, the classification of the product for tax purposes (i.e...

27 CFR 44.253 - Tax classification for cigars.

Code of Federal Regulations, 2014 CFR

2014-04-01

... BUREAU, DEPARTMENT OF THE TREASURY (CONTINUED) TOBACCO EXPORTATION OF TOBACCO PRODUCTS AND CIGARETTE... in the package; and (c) For small cigars, the classification of the product for tax purposes (i.e...

Neural correlates of cigarette health warning avoidance among smokers.

PubMed

Stothart, George; Maynard, Olivia; Lavis, Rosie; Munafò, Marcus

2016-04-01

Eye-tracking technology has indicated that daily smokers actively avoid pictorial cigarette package health warnings. Avoidance may be due to a pre-cognitive perceptual bias or a higher order cognitive bias, such as reduced emotional processing. Using electroencephalography (EEG), this study aimed to identify the temporal point at which smokers' responses to health warnings begin to differ. Non-smokers (n=20) and daily smokers (n=20) viewed pictorial cigarette package health warnings and neutral control stimuli. These elicited Event Related Potentials reflecting early perceptual processing (visual P1), pre-attentive change detection (visual Mismatch Negativity), selective attentional orientation (P3) and a measure of emotional processing, the Late Positive Potential (LPP). There was no evidence for a difference in P1 responses between smokers and non-smokers. There was no difference in vMMN and P3 amplitude but some evidence for a delay in vMMN latency amongst smokers. There was strong evidence for delayed and reduced LPP to health warning stimuli amongst smokers compared to non-smokers. We find no evidence for an early perceptual bias in smokers' visual perception of health warnings but strong evidence that smokers are less sensitive to the emotional content of cigarette health warnings. Future health warning development should focus on increasing the emotional salience of pictorial health warning content amongst smokers. Copyright © 2016 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

Impact of the removal of light and mild descriptors from cigarette packages in Ontario, Canada: Switching to “light replacement” brand variants☆,☆☆

PubMed Central

Cohen, Joanna E.; Yang, Jingyan; Donaldson, Elisabeth A.

2015-01-01

Objective This study assessed cessation and brand switching among smokers in Ontario, Canada after tobacco companies’ voluntary removal of ‘light’ and ‘mild’ descriptors from cigarette packages. Method We analyzed longitudinal data on brand preference and cessation from a cohort of smokers (n = 632) in the Ontario Tobacco Survey in Canada from 2006 to 2008 with a longitudinal regression model. Results While cessation differed by brand variant prior to the ban (7% light vs. 3% regular; P < 0.05), it did not differ by brand variant after the ban was implemented. In 2008, when light cigarette brand variants were no longer available, 33% of the sample still reported smoking lights and 31% smoked light replacement brand variants. During each subsequent follow-up, light brand smokers had 2 times the odds of smoking regular brand variants (Adjusted OR: 2.03, 95% CI 1.80,2.29), and almost 5 times the odds of using light replacement brand variants (Adjusted OR: 4.87, 95% CI 4.07,5.84), respectively, compared to continuing to smoke lights. Conclusions Even after removing misleading descriptors from cigarette packs, smokers continued to report using light brand variants, and many switched to newly introduced light replacement brand variants. After full implementation of the ban, cessation did not vary by brand variant. PMID:25224153

Impact of the removal of light and mild descriptors from cigarette packages in Ontario, Canada: switching to "light replacement" brand variants.

PubMed

Cohen, Joanna E; Yang, Jingyan; Donaldson, Elisabeth A

2014-12-01

This study assessed cessation and brand switching among smokers in Ontario, Canada after tobacco companies' voluntary removal of 'light' and 'mild' descriptors from cigarette packages. We analyzed longitudinal data on brand preference and cessation from a cohort of smokers (n=632) in the Ontario Tobacco Survey in Canada from 2006 to 2008 with a longitudinal regression model. While cessation differed by brand variant prior to the ban (7% light vs. 3% regular; P<0.05), it did not differ by brand variant after the ban was implemented. In 2008, when light cigarette brand variants were no longer available, 33% of the sample still reported smoking lights and 31% smoked light replacement brand variants. During each subsequent follow-up, light brand smokers had 2 times the odds of smoking regular brand variants (Adjusted OR: 2.03, 95% CI 1.80,2.29), and almost 5 times the odds of using light replacement brand variants (Adjusted OR: 4.87, 95% CI 4.07,5.84), respectively, compared to continuing to smoke lights. Even after removing misleading descriptors from cigarette packs, smokers continued to report using light brand variants, and many switched to newly introduced light replacement brand variants. After full implementation of the ban, cessation did not vary by brand variant. Copyright © 2014. Published by Elsevier Inc.

Testing warning messages on smokers’ cigarette packages: A standardized protocol

PubMed Central

Brewer, Noel T.; Hall, Marissa G.; Lee, Joseph G. L.; Peebles, Kathryn; Noar, Seth M.; Ribisl, Kurt M.

2015-01-01

Purpose Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated warning exposure over several weeks may affect smokers. This proof of principle study sought to develop a new protocol for testing cigarette warnings that better reflects real-world exposure by presenting them on cigarette smokers’ own packs. Methods We tested a cigarette pack labeling protocol with 76 US smokers ages 18 and older. We applied graphic warnings to the front and back of smokers’ cigarette packs. Results Most smokers reported that at least 75% of the packs of cigarettes they smoked during the study had our warnings. Nearly all said they would participate in the study again. Using cigarette packs with the study warnings increased quit intentions (p<.05). Conclusion Our findings suggest a feasible pack labeling protocol with six steps: (1) schedule appointments at brief intervals; (2) determine typical cigarette consumption; (3) ask smokers to bring a supply of cigarette packs to study appointments; (4) apply labels to smokers’ cigarette packs; (5) provide participation incentives at the end of appointments; and (6) refer smokers to cessation services at end of the study. When used in randomized controlled trials in settings with real-world message exposure over time, this protocol may help identify the true impact of warnings and thus better inform tobacco product labeling policy. PMID:25564282

27 CFR 40.214 - Notice for cigars.

Code of Federal Regulations, 2010 CFR

2010-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 45.44 - Notice for cigars.

Code of Federal Regulations, 2010 CFR

2010-04-01

... OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 45.44 - Notice for cigars.

Code of Federal Regulations, 2013 CFR

2013-04-01

... OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 40.214 - Notice for cigars.

Code of Federal Regulations, 2012 CFR

2012-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 45.44 - Notice for cigars.

Code of Federal Regulations, 2014 CFR

2014-04-01

... OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 40.214 - Notice for cigars.

Code of Federal Regulations, 2011 CFR

2011-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 40.214 - Notice for cigars.

Code of Federal Regulations, 2013 CFR

2013-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 45.44 - Notice for cigars.

Code of Federal Regulations, 2011 CFR

2011-04-01

... OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 45.44 - Notice for cigars.

Code of Federal Regulations, 2012 CFR

2012-04-01

... OF THE TREASURY (CONTINUED) TOBACCO REMOVAL OF TOBACCO PRODUCTS AND CIGARETTE PAPERS AND TUBES... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

27 CFR 40.214 - Notice for cigars.

Code of Federal Regulations, 2014 CFR

2014-04-01

... OF THE TREASURY (CONTINUED) TOBACCO MANUFACTURE OF TOBACCO PRODUCTS, CIGARETTE PAPERS AND TUBES, AND... package; and (c) For small cigars, the classification of the product for tax purposes (i.e., either “small...

When Health Policy and Empirical Evidence Collide: The Case of Cigarette Package Warning Labels and Economic Consumer Surplus

PubMed Central

Song, Anna V.; Brown, Paul

2014-01-01

In its graphic warning label regulations on cigarette packages, the Food and Drug Administration severely discounts the benefits of reduced smoking because of the lost “pleasure” smokers experience when they stop smoking; this is quantified as lost “consumer surplus.” Consumer surplus is grounded in rational choice theory. However, empirical evidence from psychological cognitive science and behavioral economics demonstrates that the assumptions of rational choice are inconsistent with complex multidimensional decisions, particularly smoking. Rational choice does not account for the roles of emotions, misperceptions, optimistic bias, regret, and cognitive inefficiency that are germane to smoking, particularly because most smokers begin smoking in their youth. Continued application of a consumer surplus discount will undermine sensible policies to reduce tobacco use and other policies to promote public health. PMID:24328661

Systematic Review of the Effect of Pictorial Warnings on Cigarette Packages in Smoking Behavior

PubMed Central

Liu, Bojing; Greiner, Felix; Bremberg, Sven; Galanti, Rosaria

2014-01-01

We used a structured approach to assess whether active smokers presented with pictorial warnings on cigarette packages (PWCP) had a higher probability of quitting, reducing, and attempting to quit smoking than did unexposed smokers. We identified 21 articles from among nearly 2500 published between 1993 and 2013, prioritizing coverage over relevance or quality because we expected to find only a few studies with behavioral outcomes. We found very large heterogeneity across studies, poor or very poor methodological quality, and generally null or conflicting findings for any explored outcome. The evidence for or against the use of PWCP is insufficient, suggesting that any effect of PWCP on behavior would be modest. Determining the single impact of PWCP on behavior requires studies with strong methodological designs and longer follow-up periods. PMID:25122019

Gifting and sharing cigarettes in a rural Chinese village: a cross-sectional study.

PubMed

Rich, Zachary C; Hu, Mi; Xiao, Shuiyuan

2014-11-01

Quantitative measurement of the prevalence of cigarette sharing and gifting in a town in rural China and evaluation of the impact of these practices on individual smoking habits and family expenditures. An interview-based cross-sectional study of 105 households in rural Hunan, China tabulated household cigarette gifting and expenditures. Individual smoking and cigarette sharing activities were also recorded among 198 household members aged >15 years who were resident for at least 6 months. With regard to sharing cigarettes, 92% of men and 19% of women reported being offered a cigarette within the past week. Among previous and current smokers who had attempted to quit smoking, 90% reported that their friends had tried to dissuade them from quitting by tempting them with cigarettes. Concerning gifting cigarettes, 74% of households reported sending packaged cigarettes as gifts during the Chinese New Year Festival at an average expense of 2.8% of household annual income. Although households received an average of 12.4% of their annual cigarette consumption in the form of gifts during the Chinese New Year Festival, no association was found between the amount of cigarettes received by a household and the annual cigarette consumption for that household. Both gifting and sharing cigarettes are common in rural China. Gifting of cigarettes during the New Year Festival is a significant expenditure affecting both smoking and non-smoking households and may be an opportunity for additional mass media marketing. Among current and former smokers, sharing cigarettes in China is a major impediment to smoking cessation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Young adult smokers' perceptions of plain packaging: a pilot naturalistic study.

PubMed

Moodie, Crawford; Mackintosh, Anne Marie; Hastings, Gerard; Ford, Allison

2011-09-01

To explore the impact, if any, that using plain (non-branded) cigarette packs in real-life settings has on young adult smokers. Naturalistic-type research was employed, where smokers used brown 'plain' packs for 2 weeks and their regular packs for 2 weeks, in real-life settings. Participants were recruited in Glasgow, Scotland. Of the 140 smokers aged 18-35 years who participated in the naturalistic study, 48 correctly completed and returned all questionnaires. Over the 4-week study period, participants completed a questionnaire twice a week assessing pack perceptions and feelings, feelings about smoking, salience of health warnings and smoking-related behaviours. A subsample of 18 participated in a post-study interview, which employed a semistructured topic guide to assess perceptions and experiences of using plain packs. Trends in the data show that in comparison with branded packaging, plain packaging increased negative perceptions and feelings about the pack and about smoking. Plain packaging also increased avoidant behaviour (hiding the pack, covering the pack), certain smoking cessation behaviours, such as smoking less around others and forgoing cigarettes, and thinking about quitting. Almost half (n=8) of those in the post-study interview, predominantly women (n=6), reported that the use of plain packs had either increased avoidant behaviour or reduced consumption. This pilot naturalistic study suggests that plain packaging could potentially help reduce tobacco consumption among some young adult smokers, and women in particular. Employing an innovative research methodology, the findings of this study are consistent with, and indeed support, past plain packaging research.

A comprehensive toxicological evaluation of three adhesives using experimental cigarettes.

PubMed

Coggins, Christopher R E; Jerome, Ann M; Lilly, Patrick D; McKinney, Willie J; Oldham, Michael J

2013-01-01

Adhesives are used in several different manufacturing operations in the production of cigarettes. The use of new, "high-speed-manufacture" adhesives (e.g. vinyl acetate based) could affect the smoke chemistry and toxicology of cigarettes, compared with older "low-speed-manufacture" adhesives (e.g. starch based). This study was conducted to determine whether the inclusion of different levels of three adhesives (ethylene vinyl acetate, polyvinyl acetate and starch) in experimental cigarettes results in different smoke chemistry and toxicological responses in in vitro and in vivo assays. A battery of tests (analytical chemistry, in vitro and in vivo assays) was used to compare the chemistry and toxicology of smoke from experimental cigarettes made with different combinations of the three adhesives. Varying levels of the different side-seam adhesives, as well as the transfer of adhesives from packaging materials, were tested. There were differences in some mainstream cigarette smoke constituents as a function of the level of adhesive added to experimental cigarettes and between the tested adhesives. None of these differences translated into statistically significant differences in the in vitro or in vivo assays. The use of newer "high-speed-manufacture" vinyl acetate-based adhesives in cigarettes does not produce toxicological profiles that prevent the adhesives from replacing the older "low-speed-manufacture" adhesives (such as starch).

Electronic cigarette sales to minors via the internet.

PubMed

Williams, Rebecca S; Derrick, Jason; Ribisl, Kurt M

2015-03-01

Electronic cigarettes (e-cigarettes) entered the US market in 2007 and, with little regulatory oversight, grew into a $2-billion-a-year industry by 2013. The Centers for Disease Control and Prevention has reported a trend of increasing e-cigarette use among teens, with use rates doubling from 2011 to 2012. While several studies have documented that teens can and do buy cigarettes online, to our knowledge, no studies have yet examined age verification among Internet tobacco vendors selling e-cigarettes. To estimate the extent to which minors can successfully purchase e-cigarettes online and assess compliance with North Carolina's 2013 e-cigarette age-verification law. In this cross-sectional study conducted from February 2014 to June 2014, 11 nonsmoking minors aged 14 to 17 years made supervised e-cigarette purchase attempts from 98 Internet e-cigarette vendors. Purchase attempts were made at the University of North Carolina Internet Tobacco Vendors Study project offices using credit cards. Rate at which minors can successfully purchase e-cigarettes on the Internet. Minors successfully received deliveries of e-cigarettes from 76.5% of purchase attempts, with no attempts by delivery companies to verify their ages at delivery and 95% of delivered orders simply left at the door. All delivered packages came from shipping companies that, according to company policy or federal regulation, do not ship cigarettes to consumers. Of the total orders, 18 failed for reasons unrelated to age verification. Only 5 of the remaining 80 youth purchase attempts were rejected owing to age verification, resulting in a youth buy rate of 93.7%. None of the vendors complied with North Carolina's e-cigarette age-verification law. Minors are easily able to purchase e-cigarettes from the Internet because of an absence of age-verification measures used by Internet e-cigarette vendors. Federal law should require and enforce rigorous age verification for all e-cigarette sales as with the federal PACT (Prevent All Cigarette Trafficking) Act's requirements for age verification in Internet cigarette sales.

Testing warning messages on smokers' cigarette packages: a standardised protocol.

PubMed

Brewer, Noel T; Hall, Marissa G; Lee, Joseph G L; Peebles, Kathryn; Noar, Seth M; Ribisl, Kurt M

2016-03-01

Lab experiments on cigarette warnings typically use a brief one-time exposure that is not paired with the cigarette packs smokers use every day, leaving open the question of how repeated warning exposure over several weeks may affect smokers. This proof of principle study sought to develop a new protocol for testing cigarette warnings that better reflects real-world exposure by presenting them on cigarette smokers' own packs. We tested a cigarette pack labelling protocol with 76 US smokers ages 18 and older. We applied graphic warnings to the front and back of smokers' cigarette packs. Most smokers reported that at least 75% of the packs of cigarettes they smoked during the study had our warnings. Nearly all said they would participate in the study again. Using cigarette packs with the study warnings increased quit intentions (p<0.05). Our findings suggest a feasible pack labelling protocol with six steps: (1) schedule appointments at brief intervals; (2) determine typical cigarette consumption; (3) ask smokers to bring a supply of cigarette packs to study appointments; (4) apply labels to smokers' cigarette packs; (5) provide participation incentives at the end of appointments; and (6) refer smokers to cessation services at end of the study. When used in randomised controlled trials in settings with real-world message exposure over time, this protocol may help identify the true impact of warnings and thus better inform tobacco product labelling policy. NCT02247908. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Brand cigarillos--a cheap and less harmful alternative to cigarettes? Particulate matter emissions suggest otherwise.

PubMed

Gerber, Alexander; Bigelow, Alexander; Schulze, Michaela; Groneberg, David A

2015-01-06

Environmental tobacco smoke (ETS)-associated particulate matter (PM) constitutes a considerable health risk for passive smokers. It ought to be assessed separately from the other known toxic compounds of tobacco smoke. Brand-specific differences between cigarettes and particularly between cigarettes and favorably taxed cigarillos, are of public interest and therefore worth being investigated. An automatic environmental tobacco smoke emitter (AETSE) was developed to generate cigarette and cigarillo smoke in a reliable and reproducible way. John Player Special (JPS) Red cigarettes, JPS filter cigarillos and 3R4F standard research cigarettes were smoked automatically in a 2.88 m3 glass chamber according to a standardized protocol until 5 cm from the top were burned down. Mean concentrations (Cmean) and area of the curve (AUC) of PM2.5 were measured and compared. Cmean PM2.5 were found to be 804 µg/m3 for 3R4F reference cigarettes, 1633 µg/m3 for JPS cigarettes, and 1059 µg/m3 for JPS filter cigarillos. AUC PM2.5-values are 433,873 µg/m3×s for 3R4F reference cigarettes, 534,267 µg/m3×s for JPS Red cigarettes and 782,850 µg/m3×s for JPS filter cigarillos. Potential brand-specific differences of ETS-associated PM emissions among brands of cigarettes, and between cigarettes and cigarillos of the same brand and size should be investigated and published. Information about relative PM-emissions should be printed on the package.

Motivation to quit smoking and acceptability of shocking warnings on cigarette packages in Lebanon

PubMed Central

Layoun, Nelly; Salameh, Pascal; Waked, Mirna; Aoun Bacha, Z; Zeenny, Rony M; El Hitti, Eric; Godin, Isabelle; Dramaix, Michèle

2017-01-01

Introduction Health warnings on tobacco packages have been considered an essential pillar in filling the gap of knowledge and communicating the health risks of tobacco use to consumers. Our primary objective was to report the perception of smokers on the textual health warnings already appearing on tobacco packages in Lebanon versus shocking pictures about the health-related smoking consequences and to evaluate their impact on smoking behaviors and motivation. Methods A pilot cross-sectional study was undertaken between 2013 and 2015 in five hospitals in Lebanon. Participants answered a questionnaire inquiring about sociodemographic characteristics, chronic respiratory symptoms, smoking behavior and motivation to quit smoking. Only-text warning versus shocking pictures was shown to the smokers during the interview. Results Exactly 66% of the participants reported that they thought shocking pictorial warnings would hypothetically be more effective tools to reduce/quit tobacco consumption compared to only textual warnings. Also, 31.9% of the smokers who were motivated to stop smoking reported that they actually had stopped smoking for at least 1 month secondary to the textual warnings effects. A higher motivation to quit cigarette smoking was seen among the following groups of smokers: males (odds ratio [OR] =1.8, P=0.02), who had stopped smoking for at least 1 month during the last year due to textual warning (OR =2.79, P<0.001), who considered it very important to report health warning on cigarette packs (OR =1.92, P=0.01), who had chronic expectoration (OR =1.81, P=0.06) and who would change their favorite cigarette pack if they found shocking images on the pack (OR =1.95, P=0.004). Conclusion Low-dependent smokers and highly motivated to quit smokers appeared to be more hypothetically susceptible to shocking pictorial warnings. Motivation to quit was associated with sensitivity to warnings, but not with the presence of all chronic respiratory symptoms. PMID:28280306

Neural mechanisms underlying visual attention to health warnings on branded and plain cigarette packs

PubMed Central

Brooks, Jonathan C. W.; Munafò, Marcus R.; Leonards, Ute

2017-01-01

Abstract Aims To (1) test if activation in brain regions related to reward (nucleus accumbens) and emotion (amygdala) differ when branded and plain packs of cigarettes are viewed, (2) test whether these activation patterns differ by smoking status and (3) examine whether activation patterns differ as a function of visual attention to health warning labels on cigarette packs. Design Cross‐sectional observational study combining functional magnetic resonance imaging (fMRI) with eye‐tracking. Non‐smokers, weekly smokers and daily smokers performed a memory task on branded and plain cigarette packs with pictorial health warnings presented in an event‐related design. Setting Clinical Research and Imaging Centre, University of Bristol, UK. Participants Non‐smokers, weekly smokers and daily smokers (n = 72) were tested. After exclusions, data from 19 non‐smokers, 19 weekly smokers and 20 daily smokers were analysed. Measurements Brain activity was assessed in whole brain analyses and in pre‐specified masked analyses in the amygdala and nucleus accumbens. On‐line eye‐tracking during scanning recorded visual attention to health warnings. Findings There was no evidence for a main effect of pack type or smoking status in either the nucleus accumbens or amygdala, and this was unchanged when taking account of visual attention to health warnings. However, there was evidence for an interaction, such that we observed increased activation in the right amygdala when viewing branded as compared with plain packs among weekly smokers (P = 0.003). When taking into account visual attention to health warnings, we observed higher levels of activation in the visual cortex in response to plain packaging compared with branded packaging of cigarettes (P = 0.020). Conclusions Based on functional magnetic resonance imaging and eye‐tracking data, health warnings appear to be more salient on ‘plain’ cigarette packs than branded packs. PMID:27886656

Educational differences in the impact of pictorial cigarette warning labels on smokers: findings from the International Tobacco Control (ITC) Europe surveys.

PubMed

Nagelhout, Gera E; Willemsen, Marc C; de Vries, Hein; Mons, Ute; Hitchman, Sara C; Kunst, Anton E; Guignard, Romain; Siahpush, Mohammad; Yong, Hua-Hie; van den Putte, Bas; Fong, Geoffrey T; Thrasher, James F

2016-05-01

To examine (1) the impact of pictorial cigarette warning labels on changes in self-reported warning label responses: warning salience, cognitive responses, forgoing cigarettes and avoiding warnings, and (2) whether these changes differed by smokers' educational level. Longitudinal data of smokers from two survey waves of the International Tobacco Control (ITC) Europe Surveys were used. In France and the UK, pictorial warning labels were implemented on the back of cigarette packages between the two survey waves. In Germany and the Netherlands, the text warning labels did not change. Warning salience decreased between the surveys in France (OR=0.81, p=0.046) and showed a non-significant increase in the UK (OR=1.30, p=0.058), cognitive responses increased in the UK (OR=1.34, p<0.001) and decreased in France (OR=0.70, p=0.002), forgoing cigarettes increased in the UK (OR=1.65, p<0.001) and decreased in France (OR=0.83, p=0.047), and avoiding warnings increased in France (OR=2.93, p<0.001) and the UK (OR=2.19, p<0.001). Warning salience and cognitive responses decreased in Germany and the Netherlands, forgoing did not change in these countries and avoidance increased in Germany. In general, these changes in warning label responses did not differ by education. However, in the UK, avoidance increased especially among low (OR=2.25, p=0.001) and moderate educated smokers (OR=3.21, p<0.001). The warning labels implemented in France in 2010 and in the UK in 2008 with pictures on one side of the cigarette package did not succeed in increasing warning salience, but did increase avoidance. The labels did not increase educational inequalities among continuing smokers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Neural mechanisms underlying visual attention to health warnings on branded and plain cigarette packs.

PubMed

Maynard, Olivia M; Brooks, Jonathan C W; Munafò, Marcus R; Leonards, Ute

2017-04-01

To (1) test if activation in brain regions related to reward (nucleus accumbens) and emotion (amygdala) differ when branded and plain packs of cigarettes are viewed, (2) test whether these activation patterns differ by smoking status and (3) examine whether activation patterns differ as a function of visual attention to health warning labels on cigarette packs. Cross-sectional observational study combining functional magnetic resonance imaging (fMRI) with eye-tracking. Non-smokers, weekly smokers and daily smokers performed a memory task on branded and plain cigarette packs with pictorial health warnings presented in an event-related design. Clinical Research and Imaging Centre, University of Bristol, UK. Non-smokers, weekly smokers and daily smokers (n = 72) were tested. After exclusions, data from 19 non-smokers, 19 weekly smokers and 20 daily smokers were analysed. Brain activity was assessed in whole brain analyses and in pre-specified masked analyses in the amygdala and nucleus accumbens. On-line eye-tracking during scanning recorded visual attention to health warnings. There was no evidence for a main effect of pack type or smoking status in either the nucleus accumbens or amygdala, and this was unchanged when taking account of visual attention to health warnings. However, there was evidence for an interaction, such that we observed increased activation in the right amygdala when viewing branded as compared with plain packs among weekly smokers (P = 0.003). When taking into account visual attention to health warnings, we observed higher levels of activation in the visual cortex in response to plain packaging compared with branded packaging of cigarettes (P = 0.020). Based on functional magnetic resonance imaging and eye-tracking data, health warnings appear to be more salient on 'plain' cigarette packs than branded packs. © 2016 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.

28 CFR 0.45 - General functions.

Code of Federal Regulations, 2013 CFR

2013-07-01

... U.S.C. 1592 and common law fraud. (e) Gifts and bequests—handling matters arising out of devises and... Cigarette Labeling and Advertising Act (15 U.S.C. 1331 et seq.), the Poison Prevention Packaging Act of 1970...

28 CFR 0.45 - General functions.

Code of Federal Regulations, 2014 CFR

2014-07-01

... U.S.C. 1592 and common law fraud. (e) Gifts and bequests—handling matters arising out of devises and... Cigarette Labeling and Advertising Act (15 U.S.C. 1331 et seq.), the Poison Prevention Packaging Act of 1970...

2015 Legislative update of e-cigarette youth access and exposure laws.

PubMed

Dobbs, Page Daniel; Hammig, Bart; Sudduth, Abbie

2016-07-01

As of November 15, 2013, 22 states had passed laws explicitly addressing youth access to electronic cigarettes (e-cigarettes); by 2014, this increased to 41 states. Also in 2014, more than 13.4% of youth in the U.S. reported using e-cigarettes, making e-cigarette use more prevalent than conventional cigarette use (9.2%). We examined 221 bills addressing youth access and exposure to e-cigarettes between January 1 and November 1, 2015. Text searches on individual state general assembly websites and secondary sources were employed for data collection. Laws were analyzed using seven measures identified to protect adolescents from nicotine initiation and use. Two states (MI, PA) and Washington D.C. do not regulate the sale or distribution of e-cigarettes to youth as of November 1, 2015. Additionally, seventeen states have passed laws requiring e-cigarettes to use child-safety packaging to minimize unintended poisoning. As of July 1, 2016, four states (KS, LA, MN, and NC) will tax e-cigarettes. Oregon prohibits the use of e-cigarettes in cars with children under 18years of age, and Wyoming requires the public health department to develop educational campaigns to better educate the state on the risks of nicotine and tobacco products. While states are closing the gap of youth nicotine exposure, there remains a need to protect youth from e-cigarettes access, which can cause adverse health effects of brain development, lung function and potentially lead to addiction. Recommendation for the FDA to regulate e-cigarettes federally would close this regulation gap and protect youth across the U.S. Copyright © 2016 Elsevier Inc. All rights reserved.

Influence of premium vs masked cigarette brand names on the experienced taste of a cigarette after tobacco plain packaging in Australia: an experimental study.

PubMed

Skaczkowski, Gemma; Durkin, Sarah; Kashima, Yoshihisa; Wakefield, Melanie

2018-03-12

Few studies have experimentally assessed the contribution of branding to the experience of smoking a cigarette, compared with the inherent properties of the product. This study examined the influence of cigarette brand name on the sensory experience of smoking a cigarette. Seventy-five Australian smokers aged 18-39 years smoked two 'premium' cigarettes, one with the brand variant name shown and one with the brand variant name masked (which provided 'objective' ratings). Unknown to participants, the two cigarettes were identical. At recruitment, participants rated their expected enjoyment, quality and harshness of several premium cigarette brands. Branded cigarettes were rated as having a significantly more favorable taste (M(SE) = 64.14(2.21)) than masked cigarettes (M(SE) = 58.53(2.26), p = .031). Branded cigarettes were also rated as being less stale (M(SE) = 36.04(2.62)) than masked cigarettes (M(SE) = 43.90(2.60), p = .011). Purchase intent tended to be higher among those shown the branded cigarette compared to the masked cigarette (χ 2 (1) = 3.00, p = .083). Expected enjoyment and quality of the brand variant (enjoyment: b = 0.31, 95%CI = 0.11, 0.51, p < .01; quality: b = 0.46, 95%CI = 0.21, 0.72, p < .01) contributed to the perceived smoking experience more than the objective enjoyment and quality of the cigarette (enjoyment: b = 0.23, 95%CI = 0.05, 0.41, p < .05; quality: b = 0.08, 95%CI = - 0.13, 0.30, p > .05). This pattern was not observed for cigarette harshness. A premium brand variant name can enhance the subjective experience of a cigarette. Further, smokers' expectations of such brand variants contribute to the smoking experience as much, if not more than, the actual qualities of the product.

Electronic cigarettes: incorporating human factors engineering into risk assessments

PubMed Central

Yang, Ling; Rudy, Susan F; Cheng, James M; Durmowicz, Elizabeth L

2014-01-01

Objective A systematic review was conducted to evaluate the impact of human factors (HF) on the risks associated with electronic cigarettes (e-cigarettes) and to identify research gaps. HF is the evaluation of human interactions with products and includes the analysis of user, environment and product complexity. Consideration of HF may mitigate known and potential hazards from the use and misuse of a consumer product, including e-cigarettes. Methods Five databases were searched through January 2014 and publications relevant to HF were incorporated. Voluntary adverse event (AE) reports submitted to the US Food and Drug Administration (FDA) and the package labelling of 12 e-cigarette products were analysed. Results No studies specifically addressing the impact of HF on e-cigarette use risks were identified. Most e-cigarette users are smokers, but data on the user population are inconsistent. No articles focused specifically on e-cigarette use environments, storage conditions, product operational requirements, product complexities, user errors or misuse. Twelve published studies analysed e-cigarette labelling and concluded that labelling was inadequate or misleading. FDA labelling analysis revealed similar concerns described in the literature. AE reports related to design concerns are increasing and fatalities related to accidental exposure and misuse have occurred; however, no publications evaluating the relationship between AEs and HF were identified. Conclusions The HF impacting e-cigarette use and related hazards are inadequately characterised. Thorough analyses of user–product–environment interfaces, product complexities and AEs associated with typical and atypical use are needed to better incorporate HF engineering principles to inform and potentially reduce or mitigate the emerging hazards associated with e-cigarette products. PMID:24732164

Point of Sale Scanner Data for Rapid Surveillance of the E-cigarette Market.

PubMed

Day, Hannah R; Ambrose, Bridget K; Schroeder, Megan J; Corey, Catherine G

2017-01-01

Describe e-cigarette sales trends and market share from U.S. convenience stores and mass market retailers. We used Nielsen Scantrack to calculate U.S. e-cigarette sales market share from convenience and mass market channels during the 4-week period ending 1/19/13 through the period ending 12/19/15. Internet searches were used to supplement Nielsen product information. From 2013 to 2015, rechargeable e-cigarette brands VUSE and MarkTen experienced the largest growth in Nielsen channels. E-liquid and tank type brands Vapin Plus and Haus experienced growth although their Nielsen market share is small compared to other brands. Sales of brands with high labeled nicotine content (according to packaging or website) increased. Fruit-flavored sales increased rapidly in Nielsen, yet still represent a minority of market share in these channels. Market-leading e-cigarette brands changed substantially in Nielsen channels from 2013 to 2015. Brand leaders in these channels are now owned by tobacco companies. Changes in labelled nicotine content and fruit-flavored products and product types suggest that as e-cigarette use increases, convenience store and mass market channels are offering new products to meet consumer preferences; however, Nielsen channels do not represent the entire e-cigarette marketplace.

Australian adult smokers' responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey.

PubMed

Wakefield, Melanie; Coomber, Kerri; Zacher, Meghan; Durkin, Sarah; Brennan, Emily; Scollo, Michelle

2015-04-01

We assessed whether the Australian plain packs with larger graphic health warnings (GHWs) achieved three specific objectives of reducing the appeal of tobacco, increasing health warning effectiveness and reducing the ability of packaging to mislead about smoking harms. We compared responses from continuous cross-sectional telephone surveys of n=2176 cigarette smokers during pre-plain packaging (April-September 2012, pre-PP) with n=759 surveyed in the transition period (October-November 2012) and n=4240 during the first year of implementation (December 2012-November 2013, PP year 1), using multivariate logistic regression analyses. From pre-PP to PP year 1, more smokers disliked their pack (p<0.001), perceived lower pack appeal (p<0.001), lower cigarette quality (p<0.001), lower satisfaction (p<0.001) and lower value (p<0.001) and disagreed brands differed in prestige (p=0.003). There was no change in perceived differences in taste of different brands. More smokers noticed GHWs (p<0.001), attributed much motivation to quit to GHWs (p<0.001), avoided specific GHWs when purchasing (p<0.001), and covered packs (p<0.001), with no change in perceived exaggeration of harms. PP year 1 saw an increased proportion believing that brands do not differ in harmfulness (p=0.004), but no change in the belief that variants do not differ in strength or the perceived harmfulness of cigarettes compared with a year ago. Interactions signified greater change for four outcomes assessing aspects of appeal among young adults and two appeal outcomes among mid-aged adults. The specific objectives of plain packaging were achieved and generally sustained among adult smokers up to 12 months after implementation. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Electronic cigarette aerosol induces significantly less cytotoxicity than tobacco smoke

PubMed Central

Azzopardi, David; Patel, Kharishma; Jaunky, Tomasz; Santopietro, Simone; Camacho, Oscar M.; McAughey, John; Gaça, Marianna

2016-01-01

Abstract Electronic cigarettes (E-cigarettes) are a potential means of addressing the harm to public health caused by tobacco smoking by offering smokers a less harmful means of receiving nicotine. As e-cigarettes are a relatively new phenomenon, there are limited scientific data on the longer-term health effects of their use. This study describes a robust in vitro method for assessing the cytotoxic response of e-cigarette aerosols that can be effectively compared with conventional cigarette smoke. This was measured using the regulatory accepted Neutral Red Uptake assay modified for air–liquid interface (ALI) exposures. An exposure system, comprising a smoking machine, traditionally used for in vitro tobacco smoke exposure assessments, was adapted for use with e-cigarettes to expose human lung epithelial cells at the ALI. Dosimetric analysis methods using real-time quartz crystal microbalances for mass, and post-exposure chemical analysis for nicotine, were employed to detect/distinguish aerosol dilutions from a reference Kentucky 3R4F cigarette and two commercially available e-cigarettes (Vype eStick and ePen). ePen aerosol induced 97%, 94% and 70% less cytotoxicity than 3R4F cigarette smoke based on matched EC50 values at different dilutions (1:5 vs. 1:153 vol:vol), mass (52.1 vs. 3.1 μg/cm2) and nicotine (0.89 vs. 0.27 μg/cm2), respectively. Test doses where cigarette smoke and e-cigarette aerosol cytotoxicity were observed are comparable with calculated daily doses in consumers. Such experiments could form the basis of a larger package of work including chemical analyses, in vitro toxicology tests and clinical studies, to help assess the safety of current and next generation nicotine and tobacco products. PMID:27690199

Pediatric Exposure to E-Cigarettes, Nicotine, and Tobacco Products in the United States.

PubMed

Kamboj, Alisha; Spiller, Henry A; Casavant, Marcel J; Chounthirath, Thiphalak; Smith, Gary A

2016-06-01

To investigate the epidemiologic characteristics and outcomes of exposures to electronic cigarettes (e-cigarettes), nicotine, and tobacco products among young children in the United States. A retrospective analysis of exposures associated with nicotine and tobacco products among children younger than 6 years old was conducted by using National Poison Data System data. From January 2012 through April 2015, the National Poison Data System received 29 141 calls for nicotine and tobacco product exposures among children younger than 6 years, averaging 729 child exposures per month. Cigarettes accounted for 60.1% of exposures, followed by other tobacco products (16.4%) and e-cigarettes (14.2%). The monthly number of exposures associated with e-cigarettes increased by 1492.9% during the study period. Children <2 years old accounted for 44.1% of e-cigarette exposures, 91.6% of cigarette exposures, and 75.4% of other tobacco exposures. Children exposed to e-cigarettes had 5.2 times higher odds of a health care facility admission and 2.6 times higher odds of having a severe outcome than children exposed to cigarettes. One death occurred in association with a nicotine liquid exposure. The frequency of exposures to e-cigarettes and nicotine liquid among young children is increasing rapidly and severe outcomes are being reported. Swift government action is needed to regulate these products to help prevent child poisoning. Prevention strategies include public education; appropriate product storage and use away from children; warning labels; and modifications of e-cigarette devices, e-liquid, and e-liquid containers and packaging to make them less appealing and less accessible to children. Copyright © 2016 by the American Academy of Pediatrics.

Tobacco as a social currency: cigarette gifting and sharing in China.

PubMed

Rich, Zachary C; Xiao, Shuiyuan

2012-03-01

China produces and consumes more tobacco than any other country in the world and as such is at the forefront of the world tobacco epidemic. Many studies have recently emerged that directly or indirectly reference the acts of giving and sharing cigarettes as a major contributor to China's high tobacco usage. The goal of this report is to review relevant literature relating to sharing and gifting cigarettes as well as provide useful historic and cultural contexts. Important differences between the act of giving individual cigarettes and the gifting of packaged cigarettes are explored as well as explanations for how both these practices have influenced current tobacco control efforts. Available Chinese and English sources on gifting and sharing cigarettes in China published between 1991 and 2011 were reviewed and discussed with a cultural and historical background. The practices of gifting and sharing cigarettes strongly contribute to smoking initiation as well as failure to quit smoking among Chinese males. Historical and cultural roots have reinforced these practices and hampered efforts to reduce tobacco use in China. Traditional tobacco control efforts should be combined with culture-specific approaches to reduce tobacco usage in China. The regular exchange of cigarettes normalizes smoking across society and promotes tobacco's acceptability. Great efforts should be taken not only to minimize these practices among males but also to discourage their adoption by females.

Electronic Cigarette Sales to Minors via the Internet

PubMed Central

Williams, Rebecca S.; Derrick, Jason; Ribisl, Kurt M.

2015-01-01

Importance Electronic cigarettes (e-cigarettes) entered the US market in 2007 and, with little regulatory oversight, grew into a $2-billion-a-year industry by 2013. The Centers for Disease Control and Prevention has reported a trend of increasing e-cigarette use among teens, with use rates doubling from 2011 to 2012. While several studies have documented that teens can and do buy cigarettes online, to our knowledge, no studies have yet examined age verification among Internet tobacco vendors selling e-cigarettes. Objective To estimate the extent to which minors can successfully purchase e-cigarettes online and assess compliance with North Carolina's 2013 e-cigarette age-verification law. Design, Setting, and Participants In this cross-sectional study conducted from February 2014 to June 2014, 11 nonsmoking minors aged 14 to 17 years made supervised e-cigarette purchase attempts from 98 Internet e-cigarette vendors. Purchase attempts were made at the University of North Carolina Internet Tobacco Vendors Study project offices using credit cards. Main Outcome and Measure Rate at which minors can successfully purchase e-cigarettes on the Internet. Results Minors successfully received deliveries of e-cigarettes from 76.5% of purchase attempts, with no attempts by delivery companies to verify their ages at delivery and 95% of delivered orders simply left at the door. All delivered packages came from shipping companies that, according to company policy or federal regulation, do not ship cigarettes to consumers. Of the total orders, 18 failed for reasons unrelated to age verification. Only 5 of the remaining 80 youth purchase attempts were rejected owing to age verification, resulting in a youth buy rate of 93.7%. None of the vendors complied with North Carolina's e-cigarette age-verification law. Conclusions and Relevance Minors are easily able to purchase e-cigarettes from the Internet because of an absence of age-verification measures used by Internet e-cigarette vendors. Federal law should require and enforce rigorous age verification for all e-cigarette sales as with the federal PACT (Prevent All Cigarette Trafficking) Act's requirements for age verification in Internet cigarette sales. PMID:25730697

Can cigarette warnings counterbalance effects of smoking scenes in movies?

PubMed

Golmier, Isabelle; Chebat, Jean-Charles; Gélinas-Chebat, Claire

2007-02-01

Scenes in movies where smoking occurs have been empirically shown to influence teenagers to smoke cigarettes. The capacity of a Canadian warning label on cigarette packages to decrease the effects of smoking scenes in popular movies has been investigated. A 2 x 3 factorial design was used to test the effects of the same movie scene with or without electronic manipulation of all elements related to smoking, and cigarette pack warnings, i.e., no warning, text-only warning, and text+picture warning. Smoking-related stereotypes and intent to smoke of teenagers were measured. It was found that, in the absence of warning, and in the presence of smoking scenes, teenagers showed positive smoking-related stereotypes. However, these effects were not observed if the teenagers were first exposed to a picture and text warning. Also, smoking-related stereotypes mediated the relationship of the combined presentation of a text and picture warning and a smoking scene on teenagers' intent to smoke. Effectiveness of Canadian warning labels to prevent or to decrease cigarette smoking among teenagers is discussed, and areas of research are proposed.

The Moderating Effects of Self-Esteem and Self-Efficacy on Responses to Graphic Health Warnings on Cigarette Packages: A Comparison of Smokers and Nonsmokers.

PubMed

Chun, Seungwoo; Park, Joon Woo; Heflick, Nathan; Lee, Seon Min; Kim, Daejin; Kwon, Kyenghee

2018-08-01

Do graphic pictorial health warnings (GPHWs) on cigarette packaging work better for some people than others? According to the Extended Parallel Process Model (EPPM), fear appeals should heighten positive change only if a person believes he or she is capable of change (i.e., self-efficacy). We exposed 242 smokers and 241 nonsmokers (aged 18-29) in the Republic of Korea to either a GPHW or a text-only warning in a between-subjects experiment. Results indicated that the GPHW increased intentions and motivations to quit smoking (for smokers) and intentions and motivations to not start smoking (for nonsmokers). However, these effects were moderated by self-efficacy related to quitting or not starting smoking. For smokers, a GPHW was especially effective in increasing desires and intentions to quit for people high in self-efficacy and high in self-esteem. However, for nonsmokers, a GPHW was effective only when self-efficacy was high, regardless of self-esteem level. For smokers and nonsmokers, results were mediated by heightened perceived health estimation. Implications for understanding the effectiveness of warning labels on cigarettes, for the introduction of GPHWs in the Republic of Korea, and for the Extended Parallel Process Model, are discussed.

Testing Cessation Messages for Cigarette Package Inserts: Findings from a Best/Worst Discrete Choice Experiment

PubMed Central

Thrasher, James F.; Davis, Rachel E.; Popova, Lucy; Cho, Yoo Jin; Salloum, Ramzi G.; Louviere, Jordan; Hammond, David

2018-01-01

This study assessed smokers’ responses to different smoking cessation topics and imagery for cigarette package inserts. Adult smokers from Canada (n = 1000) participated in three discrete choice experiments (DCEs): DCE 1 assessed five cessation benefit topics and five imagery types; DCE 2 assessed five messages with tips to improve cessation success and five imagery types; DCE 3 assessed four reproductive health benefits of cessation topics and four imagery types. In each DCE, participants evaluated four or five sets of four inserts, selecting the most and least motivating (DCEs 1 & 3) or helpful (DCE 2) for quitting. Linear mixed models regressed choices on insert and smoker characteristics. For DCE 1, the most motivating messages involved novel disease topics and imagery of younger women. For DCE 2, topics of social support, stress reduction and nicotine replacement therapy were selected as most helpful, with no differences by imagery type. For DCE 3, imagery influenced choices more than topic, with imagery of a family or a mom and baby selected as most motivating. Statistically significant interactions for all three experiments indicated that the influence of imagery type on choices depended on the message topic. Messages to promote smoking cessation through cigarette pack inserts should consider specific combinations of message topic and imagery. PMID:29415523

Adolescent girls and young adult women's perceptions of superslims cigarette packaging: a qualitative study

PubMed Central

Ford, Allison; Moodie, Crawford; Purves, Richard; MacKintosh, Anne Marie

2016-01-01

Objectives To explore perceptions of superslims packaging, including compact ‘lipstick’ packs, in line with 3 potential impacts identified within the impact assessment of the European Union (EU) Tobacco Products Directive: appeal, harm perceptions and the seriousness of warning of health risks. Design Qualitative focus group study. Setting Informal community venues in Scotland, UK. Participants 75 female non-smokers and occasional smokers (age range 12–24). Results Compact ‘lipstick’-type superslims packs were perceived most positively and rated as most appealing. They were also viewed as less harmful than more standard sized cigarette packs because of their smaller size and likeness to cosmetics. Additionally, ‘lipstick’ packs were rated as less serious in terms of warning about the health risks associated with smoking, either because the small font size of the warnings was difficult to read or because the small pack size prevented the text on the warnings from being displayed properly. Bright pack colours and floral designs were also thought to detract from the health warning. Conclusions As superslims packs were found to increase appeal, mislead with respect to level of harm, and undermine the on-pack health warnings, this provides support for the decision to ban ‘lipstick’-style cigarette packs in the EU and has implications for policy elsewhere. PMID:26747040

Vapers' perspectives on electronic cigarette regulation in Australia.

PubMed

Fraser, Doug; Weier, Megan; Keane, Helen; Gartner, Coral

2015-06-01

The use of electronic cigarettes (e-cigarettes), also known as personal vaporisers (PVs), has increased rapidly in Australia despite legal barriers to the sale, possession and use of nicotine for non-therapeutic purposes. Australia is one of many countries in the process of developing regulations for these devices yet knowledge of consumers' views on e-cigarette regulation is lacking. An online survey was completed by 705 e-cigarette users recruited online. Participants answered questions about their smoking history, e-cigarette use, as well as their opinions on appropriate regulation of e-cigarettes. Most participants were male (71%), employed (72%), and highly educated (68% held post-school qualification). They tended to be former heavy smokers who had stopped smoking entirely and were currently vaping. Participants generally agreed that the government should enforce minimum labelling and packaging standards and there was majority support for minimum quality standards. Most supported making e-cigarettes available for sale to anyone over the age of 18, but expressed concern about the government's motivation for regulating e-cigarettes. There was strong opposition to restricting sales to a medicines framework (prescription only or pharmacy only sales). E-cigarette users in Australia are in favour of e-cigarettes being regulated as long as those regulations do not impede their ability to obtain devices and refill solutions, which they view as important for them to remain smoke free. These views align with some aspects of appropriate policy designed to maximise the public health potential of e-cigarettes in society, but conflict with some of the proposed regulatory models. Governments should consider how future regulation of e-cigarettes will affect current consumers while helping to maximise the number of smokers who switch to e-cigarettes and minimise the possibility of non-smokers becoming addicted to nicotine. Copyright © 2015 The Authors. Published by Elsevier B.V. All rights reserved.

Analysis of Counterfeit Coated Tablets and Multi-Layer Packaging Materials Using Infrared Microspectroscopic Imaging.

PubMed

Winner, Taryn L; Lanzarotta, Adam; Sommer, André J

2016-06-01

An effective method for detecting and characterizing counterfeit finished dosage forms and packaging materials is described in this study. Using attenuated total internal reflection Fourier transform infrared spectroscopic imaging, suspect tablet coating and core formulations as well as multi-layered foil safety seals, bottle labels, and cigarette tear tapes were analyzed and compared directly with those of a stored authentic product. The approach was effective for obtaining molecular information from structures as small as 6 μm.

Marketing to America's youth: evidence from corporate documents

PubMed Central

Cummings, K; Morley, C; Horan, J; Steger, C; Leavell, N

2002-01-01

Design: The data for this study come from tobacco industry documents collected from the tobacco industry's document websites, presently linked at http://www.tobaccoarchives.com. The websites were searched using "request for production" (RFP) codes, specified keyword searches, and serendipitous terms identified in document citations found with RFP and keyword searches. Results: Industry documents show that the cigarette manufacturers carefully monitored the smoking habits of teenagers over the past several decades. Candid quotes from industry executives refer to youth as a source of sales and as fundamental to the survival of the tobacco industry. The documents reveal that the features of cigarette brands (that is, use of filters, low tar, bland taste, etc), packaging (that is, size, colour and design), and advertising (that is, media placements and themes and imagery) were developed specifically to appeal to new smokers (that is, teenagers). Evidence also indicates that relevant youth oriented marketing documents may have been destroyed and that the language used in some of the more recent documents may have been sanitised to cover up efforts to market to youth. Conclusions: The tobacco industry's internal documents reveal an undeniable interest in marketing cigarettes to underage smokers. The industry's marketing approaches run counter to and predicate methods for tobacco prevention: (1) keep the price of the product high; (2) keep product placements and advertising away from schools and other areas with a high volume of youth traffic; (3) make cigarette advertising (that is, themes and visual images) unappealing to youth; (4) make product packaging unappealing to youth; and (5) design the product so it is not easy to inhale. PMID:11893810

Regulation profiles of e-cigarettes in the United States: a critical review with qualitative synthesis.

PubMed

Tremblay, Marie-Claude; Pluye, Pierre; Gore, Genevieve; Granikov, Vera; Filion, Kristian B; Eisenberg, Mark J

2015-06-03

Electronic cigarettes (e-cigarettes) have been steadily increasing in popularity since their introduction to US markets in 2007. Debates surrounding the proper regulatory mechanisms needed to mitigate potential harms associated with their use have focused on youth access, their potential for nicotine addiction, and the renormalization of a smoking culture. The objective of this study was to describe the enacted and planned regulations addressing this novel public health concern in the US. We searched LexisNexis Academic under Federal Regulations and Registers, as well as State Administrative Codes and Registers. This same database was also used to find information about planned regulations in secondary sources. The search was restricted to US documents produced between January 1(st), 2004, and July 14(th), 2014. We found two planned regulations at the federal level, and 74 enacted and planned regulations in 44 states. We identified six state-based regulation types, including i) access, ii) usage, iii) marketing and advertisement, iv) packaging, v) taxation, and vi) licensure. These were further classified into 10 restriction subtypes: sales, sale to minors, use in indoor public places, use in limited venues, use by minors, licensure, marketing and advertising, packaging, and taxation. Most enacted restrictions aimed primarily to limit youth access, while few regulations enforced comprehensive restrictions on product use and availability. Current regulations targeting e-cigarettes in the US are varied in nature and scope. There is greater consensus surrounding youth protection (access by minors and/or use by minors, and/or use in limited venues), with little consensus on multi-level regulations, including comprehensive use bans in public spaces.

Perceptions of plain packaging among young adult roll-your-own smokers in France: a naturalistic approach.

PubMed

Gallopel-Morvan, Karine; Moodie, Crawford; Eker, Figen; Beguinot, Emmanuelle; Martinet, Yves

2015-03-01

We explored, for the first time, young adult roll-your-own smokers' response to using plain packaging in real-world settings. Naturalistic research was employed, where 133 French young adult smokers (18-25 years of age) used plain roll-your-own packs for 10 days; the plain packs they were provided with contained their usual brand of rolling tobacco and displayed the name of their usual brand. Participants were recruited in five cities in France (Paris, Marseille, Metz, Nantes, Toulouse) and completed two questionnaires to measure their response to their own branded packs and the plain packs. Both questionnaires assessed pack perceptions, brand attachment, product perceptions (eg, taste, quality, natural), feelings about smoking (satisfying, pleasurable), feelings when using the pack in front of others (embarrassment, image), warning response (credibility, awareness of risks) and smoking-related behaviour (eg, consumption, quitting). Compared to their own fully branded packs, plain packs were associated with less positive pack and product perceptions, lower brand attachment and less positive feelings about smoking and feelings when using the pack in front of others. Participants were also more likely to report feeling like reducing consumption and quitting when using the plain packs, and more likely to feel like missing out on rolling a cigarette. No significant differences between the two pack types (plain and branded) were found in terms of credibility of warnings and perceptions of level of tar. The study suggests that the impacts of plain packaging for roll-your-own cigarette smokers are the same as for smokers of factory-made cigarettes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Evaluation of strategies to communicate harmful and potentially harmful constituent (HPHC) information through cigarette package inserts: a discrete choice experiment.

PubMed

Salloum, Ramzi G; Louviere, Jordan J; Getz, Kayla R; Islam, Farahnaz; Anshari, Dien; Cho, Yoojin; O'Connor, Richard J; Hammond, David; Thrasher, James F

2017-07-13

The US Food and Drug Administration (FDA) has regulatory authority to use inserts to communicate with consumers about harmful and potentially harmful constituents (HPHCs) in tobacco products; however, little is known about the most effective manner for presenting HPHC information. In a discrete choice experiment, participants evaluated eight choice sets, each of which showed two cigarette packages from four different brands and tar levels (high vs low), accompanied by an insert that included between-subject manipulations (ie, listing of HPHCs vs grouping by disease outcome and numeric values ascribed to HPHCs vs no numbers) and within-subject manipulations (ie, 1 of 4 warning topics; statement linking an HPHC with disease vs statement with no HPHC link). For each choice set, participants were asked: (1) which package is more harmful and (2) which motivates them to not smoke; each with a 'no difference' option. Alternative-specific logit models regressed choice on attribute levels. 1212 participants were recruited from an online consumer panel (725 18-29-year-old smokers and susceptible non-smokers and 487 30-64-year-old smokers). Participants were more likely to endorse high-tar products as more harmful than low-tar products, with a greater effect when numeric HPHC information was present. Compared with a simple warning statement, the statement linking HPHCs with disease encouraged quit motivation. Numeric HPHC information on inserts appears to produce misunderstandings that some cigarettes are less harmful than others. Furthermore, brief narratives that link HPHCs to smoking-related disease may promote cessation versus communications that do not explicitly link HPHCs to disease. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Effects of stick design features on perceptions of characteristics of cigarettes.

PubMed

Borland, Ron; Savvas, Steven

2013-09-01

To examine the extent (if any) that cigarette stick dimension, tipping paper design and other decorative design/branding have on Australian smokers' perceptions of those cigarettes. An internet survey of 160 young Australian adult ever-smokers who were shown computer images of three sets of cigarette sticks--five sticks of different lengths and diameters (set A), five sticks with different tipping paper design (set B) and four sticks of different decorative design (set C). Branding was a between-subjects randomised condition for set C. For each set, respondents ranked sticks on most and least attractive, highest and lowest quality and strongest and weakest taste. Cigarette sticks were perceived as different on attractiveness, quality and strength of taste. Standard stick length/diameter was perceived as the most attractive and highest quality stick, with men more inclined to rate a slim stick as less attractive. A stick with a cork-patterned tipping paper and a gold band was seen as most attractive, of highest quality and strongest in taste compared to other tipping designs. Branded sticks were seen as more attractive, higher in quality and stronger tasting than non-branded designs, regardless of brand, although the effects were stronger for a prestige compared with a budget brand. Characteristics of the cigarette stick affect smokers' perceptions of the attributes of those cigarettes and thus are a potential means by which product differentiation can occur. A comprehensive policy to eliminate promotional aspects of cigarette design and packaging needs to include rules about stick design.

Use of flavored cigarettes among older adolescent and adult smokers: United States, 2004--2005.

PubMed

Klein, Sarah M; Giovino, Gary A; Barker, Dianne C; Tworek, Cindy; Cummings, K Michael; O'Connor, Richard J

2008-07-01

Cigarettes with candy, fruit and alcohol flavors have been introduced in recent years as extensions to popular cigarette brands, raising concerns in the public health community that the enticing names, creative packaging, and intense flavorings of these products may be especially appealing to youth. This study used two national surveys to examine the prevalence of use of Camel Exotic Blends, Kool Smooth Fusion, and Salem Silver Label brands during 2004--2005 among older adolescents and young adult smokers aged 17-26 years and adult smokers aged > or =25 years. Overall use of any of these flavored brands in the past 30 days was 11.9% among smokers aged 17-26 years and 6.7% among smokers aged > or =25 years. A significant gradient in use was seen across age, with the highest rates of utilization among 17-year-old (22.8%) and 18-19-year-old smokers (21.7%) (p<.001). Uniquely flavored cigarette brands seem to be most attractive to the youngest smokers and should be prohibited.

Relationship of Cigarette-Related Perceptions to Cigarette Design Features: Findings From the 2009 ITC U.S. Survey

PubMed Central

2013-01-01

Introduction: Many governments around the world have banned the use of misleading cigarette descriptors such as “light” and “mild” because the cigarettes so labeled were found not to reduce smokers’ health risks. However, underlying cigarette design features, which are retained in many brands, likely contribute to ongoing belief that these cigarettes are less harmful by producing perceptions of lightness/smoothness through lighter taste and reduced harshness and irritation. Methods: Participants (N = 320) were recruited from the International Tobacco Control U.S. Survey conducted in 2009 and 2010, when they answered questions about smoking behavior, attitudes and beliefs about tobacco products, and key mediators and moderators of tobacco use behaviors. Participants also submitted an unopened pack of their usual brand of cigarettes for analysis using established methods. Results: Own-brand filter ventilation level (M 29%, range 0%–71%) was consistently associated with perceived lightness (p < .001) and smoothness (p = .005) of own brand. Those whose brand bore a light/mild label (55% of participants) were more likely to report their cigarettes were lighter [71.9% vs. 41.9%; χ2(2) = 38.1, p < .001] and smoother than other brands [75.5% vs. 68.7%; χ2(2) = 7.8, p = .020]. Conclusion: Product design features, particularly filter ventilation, influence smokers’ beliefs about product attributes such as lightness and smoothness, independent of package labels. Regulation of cigarette design features such as filter ventilation should be considered as a complement to removal of misleading terms in order to reduce smokers’ misperceptions regarding product risks. PMID:23943847

Electronic Cigarette and Electronic Hookah: A Pilot Study Comparing Two Vaping Products.

PubMed

Dube, Shanta R; Pathak, Sarita; Nyman, Amy L; Eriksen, Michael P

Since the introduction of e-cigarettes into the U.S. market, the number and variety of vaping products has proliferated. E-hookahs are long, pen-like vaping devices that debuted in U.S. markets in 2014. By applying the Host, Agent, Vector, Environment (HAVE) Model, the objective of this exploratory study was to assess differences between e-cigarettes and e-hookahs to help inform tobacco regulatory science and practice. In June-August 2014, a total of 54 unique manufactured e-cigarette and e-hookah products were identified at point of sales (POS) around three college campuses in Southeast U.S. Documented characteristics included brand name, disposable, rechargeable, nicotine containing, packaging, and flavor type. Statistical analyses were conducted October to November 2014 to assess frequency and percent of product type across POS and specific characteristics. Among 54 products, 70.4% were e-cigarettes and 29.6% were e-hookahs. Across POS, drug stores and grocery stores carried e-cigarettes exclusively, while gas stations carried the greatest proportion of e-hookahs. Compared to e-hookahs, a greater proportion of e-cigarettes were non-disposable and contained nicotine; a greater proportion of e-hookahs came in fruit and other types of flavors compared to e-cigarettes. The present study suggests that e-cigarettes and e-hookahs differ by specific product characteristics and by places where they are sold. Despite these differences, the products are used for similar purposes warranting careful monitoring of industry manufacturing and marketing, because the safety of both products is still undetermined. Additional research is needed to understand the uptake and continued use of these products.

Mobilizing for Policy: Using Community-Based Participatory Research to Impose Minimum Packaging Requirements on Small Cigars

PubMed Central

Milam, Adam J.; Bone, Lee; Furr-Holden, Debra; Coylewright, Megan; Dachille, Kathleen; Owings, Kerry; Clay, Eric; Holmes, William; Lambropoulos, Soula; Stillman, Frances

2013-01-01

The Problem Cigarette sales have declined in the United States over the past decade; however, small cigar sales have been rapidly increasing. In most urban areas, small cigars are inexpensive and are sold as singles without health warnings. Purpose of Article This paper describes a community–academic–practice partnership’s (CAPP) efforts to decrease small cigar use in young adults living in Baltimore, Maryland, through legislative strategies. Key Points Survey data among young adults not in school indicated that 20% of individuals reported current small cigar use, often in combination with cigarettes. The community–academic partnership engaged the community in discussion about small cigar use in the fall of 2007. In collaboration with partners, bills were submitted to the legislative bodies for the city and state to impose minimum packaging requirements on small cigars. Conclusion Collaborative partnerships between community-based organizations, public health agencies, and academic institutions can lead to policy initiatives with the potential to improve public health. PMID:22820230

Rolling Tobacco in Banana Leaves, Newspaper, or Copybook Paper Associated With Significant Reduction in Lung Function in Vanuatu.

PubMed

Weitz, Charles A; Olszowy, Kathryn M; Dancause, Kelsey N; Sun, Cheng; Pomer, Alysa; Silverman, Howard; Lee, G; Tarivonda, Len; Chan, Chim W; Kaneko, Akira; Lum, J K; Garruto, Ralph M

2017-04-01

In addition to the widespread availability of packaged cigarettes, the inhabitants of island nations of the Southwest Pacific frequently smoke commercially available loose tobacco using manufactured rolling papers, as well as locally grown tobacco rolled in manufactured rolling paper or wrapped in leaves, copybook paper, and newspaper. In this study, Vanuatu men who smoked local tobacco rolled in leaves, copybook paper, or newspaper showed significantly lower forced vital capacity (FVC), forced expiratory volume in 1 second (FEV 1 ), and FEV 1 /FVC ratios than men who smoked packaged cigarettes, store-bought tobacco rolled in manufactured rolling paper, or who smoked locally grown tobacco rolled in manufactured rolling papers. The addition of toxins from these unusual tobacco-wrapping media produces lung function deficits similar to the pattern noted among tobacco smokers who also inhale smoke from burning biomass. Thus, public health initiatives should consider including strategies addressing the use of wrapping media among smokers in South Pacific island societies.

Effect of price changes in little cigars and cigarettes on little cigar sales: USA, Q4 2011–Q4 2013

PubMed Central

Gammon, Doris G; Loomis, Brett R; Dench, Daniel L; King, Brian A; Fulmer, Erika B; Rogers, Todd

2016-01-01

Introduction Little cigars are comparable to cigarettes in terms of shape, size, filters and packaging. Disproportionate tobacco excise taxes, which directly affect purchase price, may lead consumers to substitute cigarettes with less expensive little cigars. This study estimated the effects of little cigar and cigarette prices on little cigar sales. Methods Sales data from a customised retail scanner database were used to model a log–log equation to infer own-price and cross-price elasticity of demand for little cigars relative to little cigar and cigarette prices, respectively, from quarter 4 of 2011 to quarter 4 of 2013. Data were available for convenience stores (C-stores) (n=29 states); food, drug and mass merchandisers (FDMs) (n=44 states); and C-stores and FDMs combined (n=27 states). The dependent variable was per capita little cigar pack sales, and key independent variables were the price index for little cigars and cigarettes. Results A 10% increase in little cigar price was associated with a 25% (p<0.01) decrease in little cigar sales in C-stores alone, and a 31.7% (p<0.01) decrease in C-stores and FDMs combined. A 10% increase in cigarette price was associated with a 21.5% (p<0.05) increase in little cigar sales in C-stores, and a 27.3% (p<0.01) increase in C-stores and FDMs combined. Conclusions Our results suggest that US cigarette smokers are avoiding the high cost of cigarettes by switching to lower priced little cigars. Increasing and equalising prices among comparable products, like cigarettes and little cigars, may motivate cost-conscious smokers to quit. PMID:26357952

Research of grasping algorithm based on scara industrial robot

NASA Astrophysics Data System (ADS)

Peng, Tao; Zuo, Ping; Yang, Hai

2018-04-01

As the tobacco industry grows, facing the challenge of the international tobacco giant, efficient logistics service is one of the key factors. How to complete the tobacco sorting task of efficient economy is the goal of tobacco sorting and optimization research. Now the cigarette distribution system uses a single line to carry out the single brand sorting task, this article adopts a single line to realize the cigarette sorting task of different brands. Using scara robot special algorithm for sorting and packaging, the optimization scheme significantly enhances the indicators of smoke sorting system. Saving labor productivity, obviously improve production efficiency.

The public health benefit of increasing tobacco taxes in New York State.

PubMed

Cummings, K M; Sciandra, R

1990-04-01

The 1989-1990 New York State budget increased the tax on a package of cigarettes from 21 to 33 cents. In this paper we estimate the impact of this tax increase on smoking prevalence and smoking-induced deaths in New York State. Findings show that 115,967 New Yorkers will be encouraged to quit or not start smoking as a result of the increased cigarette tax. The reduced prevalence of smoking attributed to the tax will result in the avoidance of approximately 28,992 premature smoking-induced deaths over the next generation.

Product retrieval time in small tobacco retail outlets before and after the Australian plain packaging policy: real-world study.

PubMed

Wakefield, Melanie; Bayly, Megan; Scollo, Michelle

2014-01-01

We aimed to assess change in cigarette pack retrieval time in small retail outlets following the introduction of plain packaging in Australia in 1 December 2012. A sample of 303 milk bars, convenience stores, petrol stations and newsagents was selected in four capital cities, stratified by area socioeconomic status. In June and September (baseline months), the first 2 weeks of December 2012, and February 2013, stores were visited by trained fieldworkers who requested a cigarette pack of a pre-determined brand, variant and pack size, unobtrusively recording the time from the end of the request to when the pack was scanned or placed on the counter. In multivariate analysis, December retrieval time (12.43 s) did not differ from June (10.91 s; p=0.410) or February (10.37 s; p=0.382), but was slower than September (9.84 s; p=0.024). In December, retrieval time declined as days after plain packaging implementation increased (β=-0.21, p=0.011), returning to the baseline range by the second week of implementation. This pattern was not observed in baseline months or in February. Sensitivity analyses showed that results were robust to the variability in purchasing circumstances in tobacco retail outlets. Retailers quickly gained experience with the new plain packaging legislation, evidenced by retrieval time having returned to the baseline range by the second week of implementation and remaining so several months later. The long retrieval times predicted by tobacco industry-funded retailer groups and the consequent costs they predicted would fall upon small retailers from plain packaging are unlikely to eventuate.

The Use of Cigarette Package Inserts to Supplement Pictorial Health Warnings: An Evaluation of the Canadian Policy.

PubMed

Thrasher, James F; Osman, Amira; Abad-Vivero, Erika N; Hammond, David; Bansal-Travers, Maansi; Cummings, K Michael; Hardin, James W; Moodie, Crawford

2015-07-01

Canada is the first country in the world to require cigarette manufacturers to enclose package inserts to supplement the exterior pictorial health warning label (HWL). In June 2012, Canada implemented new HWL package inserts that include cessation tips accompanied by a pictorial image. This study aims to assess the extent to which adult smokers report reading the newly mandated HWL inserts and to see whether reading them is associated with making a quit attempt. Data were analyzed from an online consumer panel of Canadian adult smokers, aged 18-64 years. Five waves of data were collected between September 2012 and January 2014, separated by 4-months intervals (n = 1,000 at each wave). Logistic generalized estimating equation (GEE) models were estimated to assess correlates of reading inserts and whether doing so is associated with making a quit attempt by the subsequent wave. At each wave, between 26% and 31% of the sample reported having read HWL package inserts at least once in the prior month. Smokers who read them were more likely to be younger, female, have higher income, intend to quit, have recently tried to quit, and thought more frequently about health risks because of warning labels. In models that adjusted for these and other potential confounders, smokers who read the inserts a few times or more in the past month were more likely to make a quit attempt at the subsequent wave compared to smokers who did not read the inserts. HWL package inserts with cessation-related tips and messages appear to increase quit attempts made by smokers. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Influence of Health Warnings on Beliefs about the Health Effects of Cigarette Smoking, in the Context of an Experimental Study in Four Asian Countries.

PubMed

Reid, Jessica L; Mutti-Packer, Seema; Gupta, Prakash C; Li, Qiang; Yuan, Jiang; Nargis, Nigar; Hussain, A K M Ghulam; Hammond, David

2017-08-02

Cigarette package health warnings can be an important and low-cost means of communicating the health risks of smoking. We examined whether viewing health warnings in an experimental study influenced beliefs about the health effects of smoking, by conducting surveys with ~500 adult male smokers and ~500 male and female youth (age 16-18) in Beijing, China ( n = 1070), Mumbai area, India ( n = 1012), Dhaka, Bangladesh ( n = 1018), and Republic of Korea ( n = 1362). Each respondent was randomly assigned to view and rate pictorial health warnings for 2 of 15 different health effects, after which they reported beliefs about whether smoking caused 12 health effects. Respondents who viewed relevant health warnings (vs. other warnings) were significantly more likely to believe that smoking caused that particular health effect, for several health effects in each sample. Approximately three-quarters of respondents in China (Beijing), Bangladesh (Dhaka), and Korea (which had general, text-only warnings) thought that cigarette packages should display more health information, compared to approximately half of respondents in the Mumbai area, India (which had detailed pictorial warnings). Pictorial health warnings that convey the risk of specific health effects from smoking can increase beliefs and knowledge about the health consequences of smoking, particularly for health effects that are lesser-known.

Influence of Health Warnings on Beliefs about the Health Effects of Cigarette Smoking, in the Context of an Experimental Study in Four Asian Countries

PubMed Central

Mutti-Packer, Seema; Gupta, Prakash C.; Li, Qiang; Yuan, Jiang; Nargis, Nigar; Hussain, A. K. M. Ghulam; Hammond, David

2017-01-01

Cigarette package health warnings can be an important and low-cost means of communicating the health risks of smoking. We examined whether viewing health warnings in an experimental study influenced beliefs about the health effects of smoking, by conducting surveys with ~500 adult male smokers and ~500 male and female youth (age 16–18) in Beijing, China (n = 1070), Mumbai area, India (n = 1012), Dhaka, Bangladesh (n = 1018), and Republic of Korea (n = 1362). Each respondent was randomly assigned to view and rate pictorial health warnings for 2 of 15 different health effects, after which they reported beliefs about whether smoking caused 12 health effects. Respondents who viewed relevant health warnings (vs. other warnings) were significantly more likely to believe that smoking caused that particular health effect, for several health effects in each sample. Approximately three-quarters of respondents in China (Beijing), Bangladesh (Dhaka), and Korea (which had general, text-only warnings) thought that cigarette packages should display more health information, compared to approximately half of respondents in the Mumbai area, India (which had detailed pictorial warnings). Pictorial health warnings that convey the risk of specific health effects from smoking can increase beliefs and knowledge about the health consequences of smoking, particularly for health effects that are lesser-known. PMID:28767068

The Association between Warning Label Requirements and Cigarette Smoking Prevalence by Education-Findings from the Global Adult Tobacco Survey (GATS).

PubMed

Shang, Ce; Huang, Jidong; Cheng, Kai-Wen; He, Yanyun; Chaloupka, Frank J

2017-01-21

The Guidelines for the implementation of Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) require that cigarette health warning labels should include pictures and take up 50% or more of the principal display area. This study examined how the association between large pictorial warnings, those covering ≥50% of the front and back of the package, and the prevalence of cigarette smoking varies by educational attainment. We pooled individual-level tobacco use data from the Global Adult Tobacco Survey (GATS) in 18 countries between 2008 and 2013 and linked them with warning label requirements during the same period from the MPOWER database and reports regarding warnings. The respondents' self-reported exposure to warnings was examined according to education. Logistic regressions were further employed to analyze education-specific associations between large pictorial warnings and smoking prevalence, and whether such association differed by education was examined using an interaction test. At the time of the survey, eight out of 18 countries had imposed graphic warning labels that covered ≥50% of the package. These warnings were associated with a 10.0% (OR = 0.89; 95% CI: 0.81, 0.97; p ≤ 0.01) lower cigarette smoking prevalence among adults with less than a secondary education or no formal education, but not among respondents with at least a secondary education. Less educated respondents were also less likely to be exposed to warnings in all 18 countries. The association between strong warnings and lower smoking prevalence among less educated respondents could be greater if their exposure to warnings increases. Prominent pictorial warning labels can potentially reduce health disparities resulting from smoking across different education levels.

Marketing to America's youth: evidence from corporate documents.

PubMed

Cummings, K M; Morley, C P; Horan, J K; Steger, C; Leavell, N-R

2002-03-01

To evaluate the claim that the tobacco industry does not market its products to youth. The data for this study come from tobacco industry documents collected from the tobacco industry's document websites, presently linked at http://www.tobaccoarchives.com. The websites were searched using "request for production" (RFP) codes, specified keyword searches, and serendipitous terms identified in document citations found with RFP and keyword searches. Industry documents show that the cigarette manufacturers carefully monitored the smoking habits of teenagers over the past several decades. Candid quotes from industry executives refer to youth as a source of sales and as fundamental to the survival of the tobacco industry. The documents reveal that the features of cigarette brands (that is, use of filters, low tar, bland taste, etc), packaging (that is, size, colour and design), and advertising (that is, media placements and themes and imagery) were developed specifically to appeal to new smokers (that is, teenagers). Evidence also indicates that relevant youth oriented marketing documents may have been destroyed and that the language used in some of the more recent documents may have been sanitised to cover up efforts to market to youth. The tobacco industry's internal documents reveal an undeniable interest in marketing cigarettes to underage smokers. The industry's marketing approaches run counter to and predicate methods for tobacco prevention: (1) keep the price of the product high; (2) keep product placements and advertising away from schools and other areas with a high volume of youth traffic; (3) make cigarette advertising (that is, themes and visual images) unappealing to youth; (4) make product packaging unappealing to youth; and (5) design the product so it is not easy to inhale.

Non-smoking male adolescents' reactions to cigarette warnings.

PubMed

Pepper, Jessica K; Cameron, Linda D; Reiter, Paul L; McRee, Annie-Laurie; Brewer, Noel T

2013-01-01

The U.S. Food and Drug Administration (FDA) is working to introduce new graphic warning labels for cigarette packages, the first change in cigarette warnings in more than 25 years. We sought to examine whether warnings discouraged participants from wanting to smoke and altered perceived likelihood of harms among adolescent males and whether these warning effects varied by age. A national sample of 386 non-smoking American males ages 11-17 participated in an online experiment during fall 2010. We randomly assigned participants to view warnings using a 2 × 2 between-subjects design. The warnings described a harm of smoking (addiction or lung cancer) using text only or text plus an image used on European cigarette package warnings. Analyses tested whether age moderated the warnings' impact on risk perceptions and smoking motivations. The warnings discouraged most adolescents from wanting to smoke, but lung cancer warnings discouraged them more than addiction warnings did (60% vs. 34% were "very much" discouraged, p<.001). Including an image had no effect on discouragement. The warnings affected several beliefs about the harms from smoking, and age moderated these effects. Adolescents said addiction was easier to imagine and more likely to happen to them than lung cancer. They also believed that their true likelihood of experiencing any harm was lower than what an expert would say. Our findings suggest that warnings focusing on lung cancer, rather than addiction, are more likely to discourage wanting to smoke among adolescent males and enhance their ability to imagine the harmful consequences of smoking. Including images on warnings had little effect on non-smoking male adolescents' discouragement or beliefs, though additional research on the effects of pictorial warnings for this at-risk population is needed as the FDA moves forward with developing new graphic labels.

The Association between Warning Label Requirements and Cigarette Smoking Prevalence by Education-Findings from the Global Adult Tobacco Survey (GATS)

PubMed Central

Shang, Ce; Huang, Jidong; Cheng, Kai-Wen; He, Yanyun; Chaloupka, Frank J.

2017-01-01

Introduction: The Guidelines for the implementation of Article 11 of the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) require that cigarette health warning labels should include pictures and take up 50% or more of the principal display area. This study examined how the association between large pictorial warnings, those covering ≥50% of the front and back of the package, and the prevalence of cigarette smoking varies by educational attainment. Methods: We pooled individual-level tobacco use data from the Global Adult Tobacco Survey (GATS) in 18 countries between 2008 and 2013 and linked them with warning label requirements during the same period from the MPOWER database and reports regarding warnings. The respondents’ self-reported exposure to warnings was examined according to education. Logistic regressions were further employed to analyze education-specific associations between large pictorial warnings and smoking prevalence, and whether such association differed by education was examined using an interaction test. Results: At the time of the survey, eight out of 18 countries had imposed graphic warning labels that covered ≥50% of the package. These warnings were associated with a 10.0% (OR = 0.89; 95% CI: 0.81, 0.97; p ≤ 0.01) lower cigarette smoking prevalence among adults with less than a secondary education or no formal education, but not among respondents with at least a secondary education. Less educated respondents were also less likely to be exposed to warnings in all 18 countries. The association between strong warnings and lower smoking prevalence among less educated respondents could be greater if their exposure to warnings increases. Conclusions: Prominent pictorial warning labels can potentially reduce health disparities resulting from smoking across different education levels. PMID:28117729

Tracking MPOWER in 14 countries: results from the Global Adult Tobacco Survey, 2008-2010.

PubMed

Song, Yang; Zhao, Luhua; Palipudi, Krishna Mohan; Asma, Samira; Morton, Jeremy; Talley, Brandon; Hsia, Jason; Ramanandraibe, Nivo; Caixeta, Roberta; Fouad, Heba; Khoury, Rula; Sinha, Dhirendra; Rarick, James; Bettcher, Douglas; Peruga, Armando; Deland, Katherine; D'Espaignet, Edouard Tursan

2016-06-01

The World Health Organization (WHO) MPOWER is a technical package of six tobacco control measures that assist countries in meeting their obligations of the WHO Framework Convention Tobacco Control and are proven to reduce tobacco use. The Global Adult Tobacco Survey (GATS) systematically monitors adult tobacco use and tracks key tobacco control indicators. GATS is a nationally representative household survey of adults aged 15 and older, using a standard and consistent protocol across countries; it includes information on the six WHO MPOWER measures. GATS Phase I was conducted from 2008-2010 in 14 high-burden low- and middle-income countries. We selected one key indicator from each of the six MPOWER measures and compared results across 14 countries. Current tobacco use prevalence rates ranged from 16.1% in Mexico to 43.3% in Bangladesh. We found that the highest rate of exposure to secondhand smoke in the workplace was in China (63.3%). We found the highest 'smoking quit attempt' rates in the past 12 months among cigarette smokers in Viet Nam (55.3%) and the lowest rate was in the Russian Federation (32.1%). In five of the 14 countries, more than one-half of current smokers in those 5 countries said they thought of quitting because of health warning labels on cigarette packages. The Philippines (74.3%) and the Russian Federation (68.0%) had the highest percentages of respondents noticing any cigarette advertising, promotion and sponsorship. Manufactured cigarette affordability ranged from 0.6% in Russia to 8.0% in India. Monitoring tobacco use and tobacco control policy achievements is crucial to managing and implementing measures to reverse the epidemic. GATS provides internationally-comparable data that systematically monitors and tracks the progress of the other five MPOWER measures. © The Author(s) 2013.

21 CFR 1140.10 - General responsibilities of manufacturers, distributors, and retailers.

Code of Federal Regulations, 2012 CFR

2012-04-01

... 21 Food and Drugs 8 2012-04-01 2012-04-01 false General responsibilities of manufacturers, distributors, and retailers. 1140.10 Section 1140.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... ensuring that the cigarettes or smokeless tobacco it manufactures, labels, advertises, packages...

21 CFR 1140.10 - General responsibilities of manufacturers, distributors, and retailers.

Code of Federal Regulations, 2013 CFR

2013-04-01

... 21 Food and Drugs 8 2013-04-01 2013-04-01 false General responsibilities of manufacturers, distributors, and retailers. 1140.10 Section 1140.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... ensuring that the cigarettes or smokeless tobacco it manufactures, labels, advertises, packages...

21 CFR 1140.10 - General responsibilities of manufacturers, distributors, and retailers.

Code of Federal Regulations, 2014 CFR

2014-04-01

... 21 Food and Drugs 8 2014-04-01 2014-04-01 false General responsibilities of manufacturers, distributors, and retailers. 1140.10 Section 1140.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... ensuring that the cigarettes or smokeless tobacco it manufactures, labels, advertises, packages...

21 CFR 1140.10 - General responsibilities of manufacturers, distributors, and retailers.

Code of Federal Regulations, 2011 CFR

2011-04-01

... 21 Food and Drugs 8 2011-04-01 2011-04-01 false General responsibilities of manufacturers, distributors, and retailers. 1140.10 Section 1140.10 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... ensuring that the cigarettes or smokeless tobacco it manufactures, labels, advertises, packages...

21 CFR 1140.3 - Definitions.

Code of Federal Regulations, 2010 CFR

2010-04-01

... filler, or its packaging and labeling, is likely to be offered to, or purchased by, consumers as a... any point from the original place of manufacture to the person who sells or distributes the product to... cigarettes or smokeless tobacco are offered for sale, sold, or otherwise distributed to consumers. (g) Point...

Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco

PubMed Central

Scollo, Michelle; Zacher, Meghan; Durkin, Sarah; Wakefield, Melanie

2014-01-01

Objectives To test for early evidence whether, following the standardisation of tobacco packaging, smokers in Australia were—as predicted by the tobacco industry—less likely to purchase from small mixed business retailers, more likely to purchase cheap brands imported from Asia and more likely to use illicit tobacco. Design Serial cross-sectional population telephone surveys in November 2011 (a year prior to implementation), 2012 (during roll-out) and 2013 (a year after implementation). Setting/participants Smokers aged 18 years and over identified in an annual population survey in the Australian state of Victoria (2011: n=754; 2012: n=590; 2013: n=601). Main outcome measures Changes between 2011 and 2013 in: proportions of current smokers who purchased their last cigarette from discount outlets such as supermarkets compared with small mixed business retail outlets; prevalence of regular use of low-cost brands imported from Asia and use of unbranded tobacco. Results The proportion of smokers purchasing from supermarkets did not increase between 2011 (65.4%) and 2013 (65.7%; p=0.98), and the percentage purchasing from small mixed business outlets did not decline (2011: 9.2%; 2012: 11.2%; p=0.32). The prevalence of low-cost Asian brands was low and did not increase between 2011 (1.1%) and 2013 (0.9%; p=0.98). The proportion reporting current use of unbranded illicit tobacco was 2.3% in 2011 and 1.9% in 2013 (p=0.46). In 2013, 2.6% of cigarette smokers reported having purchased one or more packets of cigarettes in non-compliant packaging in the past 3 months; 1.7% had purchased one or more packets from an informal seller in the past year. Conclusions One year after implementation, this study found no evidence of the major unintended consequences concerning loss of smoker patrons from small retail outlets, flooding of the market by cheap Asian brands and use of illicit tobacco predicted by opponents of plain packaging in Australia. PMID:25168041

Assessing tobacco marketing receptivity among youth: integrating point of sale marketing, cigarette package branding and branded merchandise.

PubMed

Braun, Sandra; Kollath-Cattano, Christy; Barrientos, Inti; Mejía, Raúl; Morello, Paola; Sargent, James D; Thrasher, James F

2016-11-01

As countries prohibit tobacco marketing through traditional channels, marketing at point of sale (PoS) and through tobacco packaging is increasingly important for promoting tobacco consumption. Assess the validity of a novel marketing receptivity index that considers frequency of PoS exposures, tobacco brand recall and ownership of branded merchandise. Data come from a cross-sectional survey of 3172 secondary school students in Argentina. Questions assessed frequency of going to stores where tobacco is often sold; cued recall of brand names for 3 cigarette packages with brand name removed and ownership of branded merchandise. A four-level marketing receptivity index was derived: low PoS exposure only; high PoS exposure or recall of 1 brand; recall of 2 or more brands; and ownership of branded merchandise. Indicators of marketing receptivity and smoking involvement were regressed on the index, including in adjusted models that controlled for sociodemographics, social influences and sensation seeking. Among never-smokers, the index had independent positive associations with smoking susceptibility (ie, adjusted OR (AOR) 2v1 =1.66; AOR 3v1 =1.64; AOR 4v1 =2.95), willingness to try a specific brand (ie, AOR 2v1 =1.45; AOR 3v1 =2.38; AOR 4v1 =2.20) and positive smoking expectancies (ie, B adj 2v1 =0.09; B adj 3v1 =0.18; B adj 4v1 =0.34). A more marked dose-response independent association was found with current smoking behaviour (ie, AOR 2v1 =2.47; AOR 3v1 =3.16; AOR 4v1 =3.62). The marketing receptivity index was associated with important variation in smoking-related perceptions, intentions and behaviour among Argentine adolescents. Future research should determine the predictive validity and generalisability of this measure to other contexts, including the explanatory power gained by integrating cigarette package brand recognition tasks. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Cigarette tax avoidance and evasion: findings from the International Tobacco Control Policy Evaluation (ITC) Project.

PubMed

Guindon, G Emmanuel; Driezen, Pete; Chaloupka, Frank J; Fong, Geoffrey T

2014-03-01

Decades of research have produced overwhelming evidence that tobacco taxes reduce tobacco use and increase government tax revenue. The magnitude and effectiveness of taxes in reducing tobacco use provide an incentive for tobacco users, manufacturers and others, most notably criminal networks, to devise ways to avoid or evade tobacco taxes. Consequently, tobacco tax avoidance and tax evasion can reduce the public health and fiscal benefit of tobacco taxes. First, this study aims to document, using data from the International Tobacco Control Policy Evaluation Project (ITC), levels and trends in cigarette users' tax avoidance and tax evasion behaviour in a sample of 16 low-, middle- and high-income countries. Second, this study explores factors associated with cigarette tax avoidance and evasion. We used data from ITC surveys conducted in 16 countries to estimate the extent and type of cigarette tax avoidance/evasion between countries and across time. We used self-reported information about the source of a smoker's last purchase of cigarettes or self-reported packaging information, or similar information gathered by the interviewers during face-to-face interviews to measure tax avoidance/evasion behaviours. We used generalised estimating equations to explore individual-level factors that may affect the likelihood of cigarette tax avoidance or evasion in Canada, the USA, the UK and France. We found prevalence estimates of cigarette tax avoidance/evasion vary substantially between countries and across time. In Canada, France and the UK, more than 10% of smokers reported last purchasing cigarettes from low or untaxed sources, while in Malaysia some prevalence estimates suggested substantial cigarette tax avoidance/evasion. We also found important associations between household income and education and the likelihood to engage in tax avoidance/evasion. These associations, however, varied both in direction and magnitude across countries.

Electronic Cigarette and Electronic Hookah: A Pilot Study Comparing Two Vaping Products☆

PubMed Central

Dube, Shanta R.; Pathak, Sarita; Nyman, Amy L.; Eriksen, Michael P.

2015-01-01

Since the introduction of e-cigarettes into the U.S. market, the number and variety of vaping products have proliferated. E-hookahs are long, pen-like vaping devices that debuted in U.S. markets in 2014. By applying the Host, Agent, Vector, Environment (HAVE) model, the objective of this exploratory study was to assess differences between e-cigarettes and e-hookahs to help inform tobacco regulatory science and practice. In June–August 2014, a total of 54 unique manufactured e-cigarette and e-hookah products were identified at point of sales (POS) around three college campuses in Southeast U.S. Documented characteristics included brand name, disposable, rechargeable, nicotine containing, packaging, and flavor type. Descriptive analyses were conducted October to November 2014 to assess frequency and percent of product type across POS and specific characteristics. Among 54 products, 70.4% was e-cigarettes and 29.6% was e-hookahs. Across POS, drug stores and grocery stores carried e-cigarettes exclusively, while gas stations carried the greatest proportion of e-hookahs. Compared to e-hookahs, a greater proportion of e-cigarettes were non-disposable and contained nicotine; a greater proportion of e-hookahs came in fruit and other types of flavors compared to e-cigarettes. The present study suggests that e-cigarettes and e-hookahs differ by specific product characteristics and by places where they are sold. Despite these differences, the products are used for similar purposes warranting careful monitoring of industry manufacturing and marketing, because the safety of both products is still undetermined. Additional research is needed to understand the uptake and continued use of these products. PMID:26740911

75 FR 29662 - Treatment of Cigarettes and Smokeless Tobacco as Nonmailable Matter

Federal Register 2010, 2011, 2012, 2013, 2014

2010-05-27

... Postal Service and would result in delays. The commenter offered similar observations on the consumer... Service to tailor the training it must give to personnel involved in the delivery of packages, which in... the Postal Service with verifying the eligibility of a customer using the business/regulatory purposes...

19 CFR 144.37 - Withdrawal for exportation.

Code of Federal Regulations, 2010 CFR

2010-04-01

... Form 7512 or CBP Form 7501 must contain all of the statistical information as provided in § 141.61(e... exportation. (e) Weight, gauge, or measure. Merchandise in bulk and packaged articles which are customarily... excess of 4 liters and cigarettes in quantities in excess of 3 cartons. Also, the address requirement is...

19 CFR 144.37 - Withdrawal for exportation.

Code of Federal Regulations, 2013 CFR

2013-04-01

... Form 7512 or CBP Form 7501 must contain all of the statistical information as provided in § 141.61(e... exportation. (e) Weight, gauge, or measure. Merchandise in bulk and packaged articles which are customarily... excess of 4 liters and cigarettes in quantities in excess of 3 cartons. Also, the address requirement is...

19 CFR 144.37 - Withdrawal for exportation.

Code of Federal Regulations, 2014 CFR

2014-04-01

... Form 7512 or CBP Form 7501 must contain all of the statistical information as provided in § 141.61(e... exportation. (e) Weight, gauge, or measure. Merchandise in bulk and packaged articles which are customarily... excess of 4 liters and cigarettes in quantities in excess of 3 cartons. Also, the address requirement is...

19 CFR 144.37 - Withdrawal for exportation.

Code of Federal Regulations, 2012 CFR

2012-04-01

... Form 7512 or CBP Form 7501 must contain all of the statistical information as provided in § 141.61(e... exportation. (e) Weight, gauge, or measure. Merchandise in bulk and packaged articles which are customarily... excess of 4 liters and cigarettes in quantities in excess of 3 cartons. Also, the address requirement is...

19 CFR 144.37 - Withdrawal for exportation.

Code of Federal Regulations, 2011 CFR

2011-04-01

... Form 7512 or CBP Form 7501 must contain all of the statistical information as provided in § 141.61(e... exportation. (e) Weight, gauge, or measure. Merchandise in bulk and packaged articles which are customarily... excess of 4 liters and cigarettes in quantities in excess of 3 cartons. Also, the address requirement is...

The mutagenic assessment of an electronic-cigarette and reference cigarette smoke using the Ames assay in strains TA98 and TA100.

PubMed

Thorne, D; Crooks, I; Hollings, M; Seymour, A; Meredith, C; Gaca, M

2016-12-01

Salmonella typhimurium strains TA98 and TA100 were used to assess the mutagenic potential of the aerosol from a commercially available, rechargeable, closed system electronic-cigarette. Results obtained were compared to those for the mainstream smoke from a Kentucky reference (3R4F) cigarette. Two different test matrices were assessed. Aerosol generated from the e-cigarette was trapped on a Cambridge filter pad, eluted in DMSO and compared to cigarette smoke total particulate matter (TPM), which was generated in the same manner for mutagenicity assessment in the Salmonella assay. Fresh e-cigarette and cigarette smoke aerosols were generated on the Vitrocell ® VC 10 smoking robot and compared using a modified scaled-down 35mm air agar interface (AAI) methodology. E-cigarette aerosol collected matter (ACM) was found to be non-mutagenic in the 85mm plate incorporation Ames assay in strains TA98 and TA100 conducted in accordance with OECD 471, when tested up to 2400μg/plate. Freshly generated e-cigarette aerosol was also found to be negative in both strains after an AAI aerosol exposure, when tested up to a 1L/min dilution for up to 3h. Positive control responses were observed in both strains, using benzo[a]pyrene, 2-nitrofluorene, sodium azide and 2-aminoanthracene in TA98 and TA100 in the presence and absence of metabolic activation respectively. In contrast, cigarette smoke TPM and aerosol from 3R4F reference cigarettes were found to be mutagenic in both tester strains, under comparable test conditions to that of e-cigarette exposure. Limited information exists on the mutagenic activity of captured e-cigarette particulates and whole aerosol AAI approaches. With the lower toxicant burden of e-cigarette aerosols compared to cigarette smoke, it is clear that a more comprehensive Ames package of data should be generated when assessing e-cigarettes, consisting of the standard OECD-five, TA98, TA100, TA1535, TA1537 (or TA97) and E. coli (or TA102). In addition, TA104 which is more sensitive to the carbonyl based compounds found in e-cigarette aerosols under dry-wicking conditions may also prove a useful addition in a testing battery. Regulatory standard product testing approaches as used in this study will become important when determining whether e-cigarette aerosols are in fact less biologically active than cigarette smoke, as this study suggests. Future studies should be supported by in vitro dosimetry approaches to draw more accurate comparisons between cigarette smoke, e-cigarette aerosol exposure and human use. Copyright © 2016 The Authors. Published by Elsevier B.V. All rights reserved.

Effect of price changes in little cigars and cigarettes on little cigar sales: USA, Q4 2011-Q4 2013.

PubMed

Gammon, Doris G; Loomis, Brett R; Dench, Daniel L; King, Brian A; Fulmer, Erika B; Rogers, Todd

2016-09-01

Little cigars are comparable to cigarettes in terms of shape, size, filters and packaging. Disproportionate tobacco excise taxes, which directly affect purchase price, may lead consumers to substitute cigarettes with less expensive little cigars. This study estimated the effects of little cigar and cigarette prices on little cigar sales. Sales data from a customised retail scanner database were used to model a log-log equation to infer own-price and cross-price elasticity of demand for little cigars relative to little cigar and cigarette prices, respectively, from quarter 4 of 2011 to quarter 4 of 2013. Data were available for convenience stores (C-stores) (n=29 states); food, drug and mass merchandisers (FDMs) (n=44 states); and C-stores and FDMs combined (n=27 states). The dependent variable was per capita little cigar pack sales, and key independent variables were the price index for little cigars and cigarettes. A 10% increase in little cigar price was associated with a 25% (p<0.01) decrease in little cigar sales in C-stores alone, and a 31.7% (p<0.01) decrease in C-stores and FDMs combined. A 10% increase in cigarette price was associated with a 21.5% (p<0.05) increase in little cigar sales in C-stores, and a 27.3% (p<0.01) increase in C-stores and FDMs combined. Our results suggest that US cigarette smokers are avoiding the high cost of cigarettes by switching to lower priced little cigars. Increasing and equalising prices among comparable products, like cigarettes and little cigars, may motivate cost-conscious smokers to quit. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

Nicotine and the Developing Human: A Neglected Element in the Electronic Cigarette Debate.

PubMed

England, Lucinda J; Bunnell, Rebecca E; Pechacek, Terry F; Tong, Van T; McAfee, Tim A

2015-08-01

The elimination of cigarettes and other combusted tobacco products in the U.S. would prevent tens of millions of tobacco-related deaths. It has been suggested that the introduction of less harmful nicotine delivery devices, such as electronic cigarettes or other electronic nicotine delivery systems, will accelerate progress toward ending combustible cigarette use. However, careful consideration of the potential adverse health effects from nicotine itself is often absent from public health debates. Human and animal data support that nicotine exposure during periods of developmental vulnerability (fetal through adolescent stages) has multiple adverse health consequences, including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents. Measures to protect the health of pregnant women and children are needed and could include (1) strong prohibitions on marketing that increase youth uptake; (2) youth access laws similar to those in effect for other tobacco products; (3) appropriate health warnings for vulnerable populations; (4) packaging to prevent accidental poisonings; (5) protection of non-users from exposure to secondhand electronic cigarette aerosol; (6) pricing that helps minimize youth initiation and use; (7) regulations to reduce product addiction potential and appeal for youth; and (8) the age of legal sale. Published by Elsevier Inc.

How effective is the plain packaging of tobacco policy on rates of intention to quit smoking and changing attitudes to smoking?

PubMed

Lilic, Nick; Stretton, Matthew; Prakash, Minesh

2018-06-05

The aim of this study is to critically appraise the evidence for the effectiveness of the plain packaging of tobacco products policy. A systematic approach to a literature review was undertaken using five databases: PubMed, MEDLINE, Google Scholar, Global Health and Legacy Tobacco Documents Library. Quantitative and qualitative studies that evaluate attitudes towards smoking, starting smoking and quitting intentions when plain packaging use is compared with standard cigarette packaging use were included. A total of 1923 studies were identified. After inclusion and exclusion criteria were applied, nine studies were included in the review. The overall quality of the data was variable but a significant number of the studies had major methodological flaws. However, data analysed in the literature review suggest that exposure to plain packaging increases intention to quit amongst exposed individuals, increases negative attitudes to both smoking and starting smoking. Although the evidence for plain packaging of tobacco is not strong, the evidence that is available indicates that it is an effective tobacco cessation policy. © 2018 Royal Australasian College of Surgeons.

Adolescent girls and young adult women's perceptions of superslims cigarette packaging: a qualitative study.

PubMed

Ford, Allison; Moodie, Crawford; Purves, Richard; MacKintosh, Anne Marie

2016-01-08

To explore perceptions of superslims packaging, including compact 'lipstick' packs, in line with 3 potential impacts identified within the impact assessment of the European Union (EU) Tobacco Products Directive: appeal, harm perceptions and the seriousness of warning of health risks. Qualitative focus group study. Informal community venues in Scotland, UK. 75 female non-smokers and occasional smokers (age range 12-24). Compact 'lipstick'-type superslims packs were perceived most positively and rated as most appealing. They were also viewed as less harmful than more standard sized cigarette packs because of their smaller size and likeness to cosmetics. Additionally, 'lipstick' packs were rated as less serious in terms of warning about the health risks associated with smoking, either because the small font size of the warnings was difficult to read or because the small pack size prevented the text on the warnings from being displayed properly. Bright pack colours and floral designs were also thought to detract from the health warning. As superslims packs were found to increase appeal, mislead with respect to level of harm, and undermine the on-pack health warnings, this provides support for the decision to ban 'lipstick'-style cigarette packs in the EU and has implications for policy elsewhere. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The impact of cigarette pack shape, size and opening: evidence from tobacco company documents.

PubMed

Kotnowski, Kathy; Hammond, David

2013-09-01

To use tobacco industry documents on cigarette pack shape, size and openings to identify industry findings on associations with brand imagery, product attributes, consumer perceptions and behaviour. Internal tobacco industry research and marketing documents obtained through court disclosure contained in the Legacy Tobacco Documents Library were searched using keywords related to pack shapes, sizes and opening methods. The search identified 66 documents related to consumer research and marketing plans on pack shape, size and openings, drawn from 1973 to 2002. Industry research consistently found that packs that deviated from the traditional flip-top box projected impressions of 'modern', 'elegant' and 'unique' brand imagery. Alternative pack shape and openings were identified as an effective means to communicate product attributes, particularly with regard to premium quality and smooth taste. Consumer studies consistently found that pack shape, size and opening style influenced perceptions of reduced product harm, and were often used to communicate a 'lighter' product. Slim, rounded, oval and booklet packs were found to be particularly appealing among young adults, and several studies demonstrated increased purchase interest for tobacco products presented in novel packaging shape or opening. Evidence from consumer tracking reports and company presentations indicate that pack innovations in shape or opening method increased market share of brands. Consumer research by the tobacco industry between 1973 and 2002 found that variations in packaging shape, size and opening method could influence brand appeal and risk perceptions and increase cigarette sales. © 2013 Society for the Study of Addiction.

The national and international regulatory environment in tobacco control.

PubMed

Warner, Kenneth E

2015-07-09

Despite their lethality, cigarettes are subject to little regulation that directly restricts their contents or their legality. This may change in the near future with the Framework Convention on Tobacco Control (FCTC), the world's first global health treaty, now in force, as well as developments in a few individual countries. Cigarettes are subject to a substantial number of country-specific regulations regarding their conditions of sale: their price (mostly through taxation), the places where they can be consumed (clean indoor air laws), who can smoke them (prohibitions on their use by or sales to minors), how they can be advertised or promoted (if at all), and how they must be packaged (minimum pack sizes, warning labels, plain packaging). Such policies constitute the core of successful tobacco control. The FCTC has been ratified by 180 countries representing 90% of the world's population. The FCTC requires compliance with numerous provisions relating to the kinds of regulations noted above. The treaty also mandates explicit attention to direct product regulation. Several countries have such authority, at least in limited forms. In the US, for example, the Food and Drug Administration (FDA) now has the legal authority to regulate tobacco products, including their contents. The possibility exists that, in the foreseeable future, a country will mandate product standards that will substantially reduce the appeal of cigarettes and other combusted tobacco products, which are by far the leading sources of the death and disease associated with tobacco.

Changes in use of types of tobacco products by pack sizes and price segments, prices paid and consumption following the introduction of plain packaging in Australia.

PubMed

Scollo, Michelle; Zacher, Meghan; Coomber, Kerri; Bayly, Megan; Wakefield, Melanie

2015-04-01

To describe changes among smokers in use of various types of tobacco products, reported prices paid and cigarette consumption following the standardisation of tobacco packaging in Australia. National cross-sectional telephone surveys of adult smokers were conducted from April 2012 (6 months before transition to plain packaging (PP)) to March 2014 (15 months afterwards). Multivariable logistic regression assessed changes in products, brands and pack types/sizes; multivariable linear regression examined changes in inflation-adjusted prices paid and reported cigarette consumption between the pre-PP and three subsequent periods-the transition phase, PP year 1 and PP post-tax (post a 12.5% tax increase in December 2013). The proportion of current smokers using roll-your-own (RYO) products fluctuated over the study period. Proportions using value brands of factory-made (FM) cigarettes increased from pre-PP (21.4%) to PP year 1 (25.5%; p=0.002) and PP post-tax (27.8%; p<0.001). Inflation-adjusted prices paid increased in the PP year 1 and PP post-tax phases; the largest increases were among premium FM brands, the smallest among value brands. Consumption did not change in PP year 1 among daily, regular or current smokers or among smokers of brands in any market segment. Consumption among regular smokers declined significantly in PP post-tax (mean=14.0, SE=0.33) compared to PP year 1 (mean=14.8, SE=0.17; p=0.037). Introduction of PP was associated with an increase in use of value brands, likely due to increased numbers available and smaller increases in prices for value relative to premium brands. Reported consumption declined following the December 2013 tax increase. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cigarette pack design and adolescent smoking susceptibility: a cross-sectional survey

PubMed Central

Ford, Allison; MacKintosh, Anne Marie; Moodie, Crawford; Richardson, Sol; Hastings, Gerard

2013-01-01

Objectives To compare adolescents’ responses to three different styles of cigarette packaging: novelty (branded packs designed with a distinctive shape, opening style or bright colour), regular (branded pack with no special design features) and plain (brown pack with a standard shape and opening and all branding removed, aside from brand name). Design Cross-sectional in-home survey. Setting UK. Participants Random location quota sample of 1025 never smokers aged 11–16 years. Main outcome measures Susceptibility to smoking and composite measures of pack appraisal and pack receptivity derived from 11 survey items. Results Mean responses to the three pack types were negative for all survey items. However, ‘novelty’ packs were rated significantly less negatively than the ‘regular’ pack on most items, and the novelty and regular packs were rated less negatively than the ‘plain’ pack. For the novelty packs, logistic regressions, controlling for factors known to influence youth smoking, showed that susceptibility was associated with positive appraisal and also receptivity. For example, those receptive to the innovative Silk Cut Superslims pack were more than four times as likely to be susceptible to smoking than those not receptive to this pack (AOR=4.42, 95% CI 2.50 to 7.81, p<0.001). For the regular pack, an association was found between positive appraisal and susceptibility but not with receptivity and susceptibility. There was no association with pack appraisal or receptivity for the plain pack. Conclusions Pack structure (shape and opening style) and colour are independently associated, not just with appreciation of and receptivity to the pack, but also with susceptibility to smoke. In other words, those who think most highly of novelty cigarette packaging are also the ones who indicate that they are most likely to go on to smoke. Plain packaging, in contrast, was found to directly reduce the appeal of smoking to adolescents. PMID:24056481

Dealing With an Innovative Industry: A Look at Flavored Cigarettes Promoted by Mainstream Brands

PubMed Central

Lewis, M. Jane; Wackowski, Olivia

2006-01-01

Product and marketing innovation is key to the tobacco industry’s success. One recent innovation was the development and marketing of flavored cigarettes as line extensions of 3 popular brands (Camel, Salem, and Kool). These products have distinctive blends and marketing as well as innovative packaging and have raised concerns in the public health community that they are targeted at youths. Several policy initiatives have aimed at banning or limiting these types of products on that basis. We describe examples of the products and their marketing and discuss their potential implications (including increased smoking experimentation, consumption, and “someday smoking”), as well as their potential impact on young adults. PMID:16380563

The impacts of cigarette packaging pictorial warning labels on smokers in the city of tehran.

PubMed

Heydari, Gholam Reza; Ramezankhani, Ali; Talischi, Firoozeh

2011-01-01

Cigarette smoking is considered the first preventable cause of death in the world. Social, familial, and personal factors play an important role in prevention or cessation of smoking. Educating the public in order to enhance their knowledge, change their attitude and improve their habits is also effective in this respect. In 2007, the executive protocol of the Comprehensive Law on Smoking Control was compiled in the Ministry of Health and according to the Article 5 of this law pictorial health warning labels had to be applied on cigarette packaging. This study was designed and conducted in 2 phases of before and 9 months after the implementation of this law and evaluated the effect of it on smokers' knowledge, attitude and pattern of smoking. This was a cross-sectional descriptive study conducted to evaluate the effect of cigarette packs' pictorial health warning labels on the knowledge, attitude and smoking pattern of smokers residing in Tehran. After calculating the size of understudy population and estimation of the exclusions, 1731 subjects were randomly selected using the multiphase cluster method from the 22 districts of Tehran. Data were collected using a questionnaire designed according to the standard questionnaire of the World Health Organization (WHO) and International Union Against Tuberculosis and Lung Disease (IUATLD). Qualitative and quantitative value and reliability of the variables including cigarette consumption, knowledge about the law, and pattern of smoking were evaluated in 2 phases and the quality of pictures and their effects on the mentioned variables were assessed in the 2(nd) phase. Before adopting the pictorial warning labels in the first phase of the study, 1731 respondents were evaluated out of which 71.8% were males and 28.2% were females. These cases had an average of 17.6±12.3 years history of smoking. A total of 38% (675 subjects) used Iranian cigarette brands and 39.5% were aware of the implementation of pictorial health warning labels on cigarette packs. In terms of smokers' attitude towards the implementation of this law, they mostly had no opinion about it. A total of 33.3% stated that they may cut down on smoking as the result of this law. Men had a higher percentage of smoking a cigarette first thing in the morning before breakfast and women had a higher rate of consuming foreign cigarette brands (P < 0.001). In the second phase of the study, 1590 cases of the phase 1 subjects participated. Subjects had a significantly higher knowledge about the implementation of pictorial health warning labels on cigarette packs (P < 0.001). Attitude towards this law did not change significantly compared to the first phase although the mean score improved by 0.07%. Enforcement of this law resulted in decreased consumption in 7.6% of the participants. However, the Wilcoxon test did not show any significant difference. In terms of the quality of pictures, 61.6% had no opinion, and 28.7% expressed that the pictures had poor quality. No significant difference was observed between the Iranian or foreign brands in terms of smoking rate after applying the pictorial warning labels. We believed that the smoking rate would decrease after applying the pictorial health warning labels on cigarette packs. However, it did not happen. Also, adopting these labels did not have a significant effect on smokers changing their favorite brand from Iranian to foreign brands or vice versa. Type and quality of pictures require major revision and corrections.

Tobacco Health Warning Messages on Plain Cigarette Packs and in Television Campaigns: A Qualitative Study with Australian Socioeconomically Disadvantaged Smokers

ERIC Educational Resources Information Center

Guillaumier, Ashleigh; Bonevski, Billie; Paul, Christine

2015-01-01

Television advertisements, packaging regulations and health warning labels (HWLs) are designed to communicate anti-smoking messages to large number of smokers. However, only a few studies have examined how high smoking prevalence groups respond to these warnings. This study explored how socioeconomically disadvantaged smokers engage with health…

76 FR 3584 - Time for Payment of Certain Excise Taxes, and Quarterly Excise Tax Payments for Small Alcohol...

Federal Register 2010, 2011, 2012, 2013, 2014

2011-01-20

... 40 Cigars and cigarettes, Claims, Electronic fund transfers, Excise taxes, Labeling, Packaging and..., Regulations.gov , we will post, and you may view, copies of this notice, any electronic or mailed comments we... material that we consider unsuitable for posting. You also may view copies of this notice, any electronic...

Availability of illicit tobacco in small retail outlets before and after the implementation of Australian plain packaging legislation.

PubMed

Scollo, Michelle; Bayly, Megan; Wakefield, Melanie

2015-03-01

We aimed to assess change in the availability of illicit tobacco in small mixed business retail outlets following the December 2012 introduction of plain packaging in Australia. 303 small retail outlets were visited in June and September 2012 (baseline months), and in December 2012 and February, April and July 2013. Fieldworkers requested a particular low-cost brand of cigarettes and then pressed the retailer for an 'even cheaper' brand. The cheapest pack of cigarettes offered was purchased and later examined to assess any divergence from prescribed Australian packaging regulations. The price paid was compared with tax liability and recommended retail price for the particular brand and pack size. In a sub-set of 179 stores, fieldworkers then asked the retailer about availability of unbranded (chop-chop) tobacco. Thirteen (2.2%) of 598 packs purchased pre-plain packaging were either non-compliant with Australian health warnings and/or suspiciously priced. Four packs (1.3%) of 297 met either or both criteria in the December implementation month, and five (0.6%) of 878 did so in the three collection months following implementation. Chop-chop was offered upon enquiry on 0.6% (n=2) of 338 occasions prior to implementation, 0.6% (n=1) of 170 occasions in the December 2012 implementation month, and 0.6% (n=3) of 514 occasions postimplementation. The likelihood of a 'positive' response (either an offer to sell or information about where unbranded tobacco may be purchased) did not differ across preimplementation, during-implementation and postimplementation waves. Overall, packs judged likely to be illicit were sold in response to requests for cheapest available packs on fewer than one percent of occasions. Offers to sell unbranded tobacco were rare. No change in availability of illicit tobacco was observed following implementation of plain packaging. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Cigarette tax avoidance and evasion: findings from the International Tobacco Control Policy Evaluation Project

PubMed Central

Guindon, G. Emmanuel; Driezen, Pete; Chaloupka, Frank J.; Fong, Geoffrey T.

2014-01-01

Background Decades of research have produced overwhelming evidence that tobacco taxes reduce tobacco use and increase government tax revenue. The magnitude and effectiveness of taxes at reducing tobacco use provide an incentive for tobacco users, manufacturers and others, most notably criminal networks, to devise ways to avoid or evade tobacco taxes. Consequently, tobacco tax avoidance and tax evasion can reduce the public health and fiscal benefit of tobacco taxes. Objectives First, this study aims to document, using data from the International Tobacco Control Policy Evaluation Project (ITC), levels and trends in cigarette users’ tax avoidance and tax evasion behaviour in a sample of sixteen low-, middle- and high-income countries. Second, this study explores factors associated with cigarette tax avoidance and evasion. Methods We use data from ITC surveys conducted in 16 countries to estimate the extent and the type of cigarette tax avoidance/evasion between countries and across time. We use self-reported information about the source of a smoker’s last purchase of cigarettes or self-reported packaging information, or similar information gathered by the interviewers during face-to-face interviews to measure tax avoidance/evasion behaviours. We use generalized estimating equations (GEE) to explore individual-level factors that may affect the likelihood of cigarette tax avoidance or evasion in Canada, United States, United Kingdom and France. Findings We find prevalence estimates of cigarette tax avoidance/evasion vary substantially between countries and across time. In Canada, France and the United Kingdom, more than 10% of smokers report last purchasing cigarettes from low or untaxed sources while in Malaysia, some prevalence estimates suggest substantial cigarette tax avoidance/evasion. We also find important associations between household income and education and the likelihood to engage in tax avoidance/evasion. These associations, however, vary both in direction and magnitude across countries. PMID:24227541

Early evidence about the predicted unintended consequences of standardised packaging of tobacco products in Australia: a cross-sectional study of the place of purchase, regular brands and use of illicit tobacco.

PubMed

Scollo, Michelle; Zacher, Meghan; Durkin, Sarah; Wakefield, Melanie

2014-07-18

To test for early evidence whether, following the standardisation of tobacco packaging, smokers in Australia were--as predicted by the tobacco industry--less likely to purchase from small mixed business retailers, more likely to purchase cheap brands imported from Asia and more likely to use illicit tobacco. Serial cross-sectional population telephone surveys in November 2011 (a year prior to implementation), 2012 (during roll-out) and 2013 (a year after implementation). Smokers aged 18 years and over identified in an annual population survey in the Australian state of Victoria (2011: n=754; 2012: n=590; 2013: n=601). Changes between 2011 and 2013 in: proportions of current smokers who purchased their last cigarette from discount outlets such as supermarkets compared with small mixed business retail outlets; prevalence of regular use of low-cost brands imported from Asia and use of unbranded tobacco. The proportion of smokers purchasing from supermarkets did not increase between 2011 (65.4%) and 2013 (65.7%; p=0.98), and the percentage purchasing from small mixed business outlets did not decline (2011: 9.2%; 2012: 11.2%; p=0.32). The prevalence of low-cost Asian brands was low and did not increase between 2011 (1.1%) and 2013 (0.9%; p=0.98). The proportion reporting current use of unbranded illicit tobacco was 2.3% in 2011 and 1.9% in 2013 (p=0.46). In 2013, 2.6% of cigarette smokers reported having purchased one or more packets of cigarettes in non-compliant packaging in the past 3 months; 1.7% had purchased one or more packets from an informal seller in the past year. One year after implementation, this study found no evidence of the major unintended consequences concerning loss of smoker patrons from small retail outlets, flooding of the market by cheap Asian brands and use of illicit tobacco predicted by opponents of plain packaging in Australia. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Nicotine and the Developing Human

PubMed Central

England, Lucinda J.; Bunnell, Rebecca E.; Pechacek, Terry F.; Tong, Van T.; McAfee, Tim A.

2015-01-01

The elimination of cigarettes and other combusted tobacco products in the U.S. would prevent tens of millions of tobacco-related deaths. It has been suggested that the introduction of less harmful nicotine delivery devices, such as electronic cigarettes or other electronic nicotine delivery systems, will accelerate progress toward ending combustible cigarette use. However, careful consideration of the potential adverse health effects from nicotine itself is often absent from public health debates. Human and animal data support that nicotine exposure during periods of developmental vulnerability (fetal through adolescent stages) has multiple adverse health consequences, including impaired fetal brain and lung development, and altered development of cerebral cortex and hippocampus in adolescents. Measures to protect the health of pregnant women and children are needed and could include (1) strong prohibitions on marketing that increase youth uptake; (2) youth access laws similar to those in effect for other tobacco products; (3) appropriate health warnings for vulnerable populations; (4) packaging to prevent accidental poisonings; (5) protection of non-users from exposure to secondhand electronic cigarette aerosol; (6) pricing that helps minimize youth initiation and use; (7) regulations to reduce product addiction potential and appeal for youth; and (8) the age of legal sale. PMID:25794473

Analysing compliance of cigarette packaging with the FCTC and national legislation in eight former Soviet countries.

PubMed

Mir, Hassan; Roberts, Bayard; Richardson, Erica; Chow, Clara; McKee, Martin

2013-07-01

To analyse compliance of cigarette packets with the Framework Convention on Tobacco Control (FCTC) and national legislation and the policy actions that are required in eight former Soviet Union countries. We obtained cigarette packets of each of the 10 most smoked cigarette brands in Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Moldova, Russia and Ukraine. The packets were then analysed using a standardised data collection instrument. The analysis included the placing, size and content of health warning labels and deceptive labels (eg, 'Lights'). Findings were assessed for compliance with the FCTC and national legislation. Health warnings were on all packets from all countries and met the FCTC minimum recommendations on size and position except Azerbaijan and Georgia. All countries used a variety of warnings except Azerbaijan. No country had pictorial health warnings, despite them being mandatory in Georgia and Moldova. All of the countries had deceptive labels despite being banned in all countries except Russia and Azerbaijan where still no such legislation exists. Despite progress in the use of health warning messages, gaps still remain-particularly with the use of deceptive labels. Stronger surveillance and enforcement mechanisms are required to improve compliance with the FCTC and national legislation.

[Trends of tobacco demand in Mexico: 1992-1998].

PubMed

Sesma-Vázquez, Sergio; Campuzano-Rincón, Julio César; Carreón-Rodríguez, Víctor Gerardo; Knaul, Felicia; López-Antuñano, Francisco Javier; Hernández-Avila, Mauricio

2002-01-01

This paper aims at describing the behavior of tobacco's demand in Mexico across four one-year periods: 1992, 1994, 1996, and 1998, as well as to estimate a cigarette demand function. A cross-sectional study with longitudinal analysis was conducted. Information sources were the Encuesta Nacional de Ingreso y Gasto de los Hogares (ENIGH) (National Survey of Household Income and Spending) (NHSIS) and the tobacco pack prices reported by the Procuraduría Federal del Consumidor (Profeco) (Federal Office of Consumer's Protection) (FOCP). Spending, income, and prices were deflated to 1994 prices; the population was stratified into quintiles of real income, by rural and urban areas. Indicators of daily consumption of cigarettes and packs were constructed and prices per pack calculated. Adjusted prevalence figures were estimated. Logistic and linear regression models were used for statistical inference; a cigarette demand function was estimated using multivariate logistic regression, to find socioeconomic determinants of cigarette consumption. The adjusted prevalence of household tobacco spending fell from 22.4 to 9.9% between 1992 and 1998. Households allocated more than 4% of their income to tobacco consumption. A trend between income level and cigarette spending was observed, with the first quintile (the poorest population) allocated a greater share of their income than higher quintiles. The average daily consumption of cigarettes increased from 7.5 to 9.8 between 1992 and 1998. It was estimated that 90% of "smoker homes" consumed up to one package per day. The proportion of non-filter cigarettes increased from 0.4 to 4.8% between 1992-1998, with a bigger increase in 1996. Finally, it was found that the most important determinants of spending were prices and income. Policies focusing on tobacco prices would help to reduce tobacco consumption and improve the health of the Mexican population.

Alcohol Warning Label Perceptions: Do Warning Sizes and Plain Packaging Matter?

PubMed

Al-Hamdani, Mohammed; Smith, Steven M

2017-01-01

There is a dearth of research on the effectiveness of stringent alcohol warning labels. Our experiment tested whether increasing the size of an alcohol health warning lowers product-based ratings. We examined whether plain packaging lowers ratings of alcohol products and the consumers who use them, increases ratings of bottle "boringness," and enhances warning recognition compared with branded packaging. A total of 440 adults (51.7% female) viewed one of three warning sizes (50%, 75%, or 90% of label surface) on either a plain or branded bottle of distilled spirits, wine, and beer. Participants also rated alcohol bottles on product-based (assessing the product itself), consumer-based (assessing perceptions of consumers of the product), and bottle boringness ratings, and then attempted to recognize the correct warning out of four choices. As expected, the size of warning labels lowered product-based ratings. Similarly, plain packaging lowered product-based and consumer-based ratings and increased bottle boringness but only for wine bottles. Further, plain packaging increased the odds of warning recognition on bottles of distilled spirits. This study shows that plain packaging and warning size (similar to the graphic warnings on cigarette packages) affect perceptions about alcohol bottles. It also shows that plain packaging increases the likelihood for correct health warning recognition, which builds the case for alcohol warning and packaging research and policy.

Plain cigarette packs do not exert Pavlovian to instrumental transfer of control over tobacco-seeking

PubMed Central

Hogarth, Lee; Maynard, Olivia M; Munafò, Marcus R

2015-01-01

Aims To gain insight into the potential impact of plain tobacco packaging policy, two experiments were undertaken to test whether ‘prototype’ plain compared with branded UK cigarette pack stimuli would differentially elicit instrumental tobacco-seeking in a nominal Pavlovian to instrumental transfer (PIT) procedure. Design, Setting and Participants Two experiments were undertaken at the University of Bristol UK, with a convenience sample of adult smokers (experiment 1, n = 23, experiment 2, n = 121). Measurement In both experiments, smokers were trained on a concurrent choice procedure in which two responses earned points for cigarettes and chocolate, respectively, before images of branded and plain packs were tested for capacity to elicit the tobacco-seeking response in extinction. The primary outcome was percentage choice of the tobacco- over the chocolate-seeking response in plain pack, branded pack and no-stimulus conditions. Findings Both experiments found that branded packs primed a greater percentage of tobacco-seeking (overall mean = 62%) than plain packs (overall mean = 53%) and the no-stimulus condition (overall mean = 52%; Ps ≤ 0.01, ŋp2s ≥ 0.16), and that there was no difference in percentage tobacco-seeking between plain packs and the no-stimulus condition (Ps ≥ 0.17, ŋp2s ≤ 0.04). Plain tobacco packs showed an overall 9% reduction in the priming of a tobacco choice response compared to branded tobacco packs. Conclusions Plain packaging may reduce smoking in current smokers by degrading cue-elicited tobacco-seeking. PMID:25292280

Rotational Analysis of FTIR Spectra from Cigarette Smoke: An Application of Chem Spec II Software in the Undergraduate Laboratory

ERIC Educational Resources Information Center

Ford, Alan R.; Burns, William A.; Reeve, Scott W.

2004-01-01

A version of the classic gas phase infrared experiment was developed for students at Arkansas State University based on the shortcomings of the rotationally resolved infrared experiment. Chem Spec II is a noncommercial Windows-based software package developed to aid in the potentially complicated problem of assigning quantum numbers to observed…

Smoke signals: The decline of brand identity predicts reduced smoking behaviour following the introduction of plain packaging.

PubMed

Webb, Hugh; Jones, Benjamin M; McNeill, Kathleen; Lim, Li; Frain, Andrew J; O'Brien, Kerry J; Skorich, Daniel P; Hoffmann, Peta; Cruwys, Tegan

2017-06-01

This study tests a social identity based mechanism for the effectiveness of plain tobacco packaging legislation, introduced in Australia in December 2012, to reduce cigarette smoking. 178 Australian smokers rated their sense of identification with fellow smokers of their brand, positive brand stereotypes, quitting behaviours and intentions, and smoking intensity, both before and seven months after the policy change. Mediation analyses showed that smokers, especially those who initially identified strongly with their brand, experienced a significant decrease in their brand identity following the introduction of plain packaging and this was associated with lower smoking behaviours and increased intentions to quit. The findings provide the first quantitative evidence that brand identities may help maintain smoking behaviour, and suggest the role of social-psychological processes in the effectiveness of public health policy.

[Testing of the composition of e-cigarette liquids - Manufacturer-declared vs. true contents in a selected series of products].

PubMed

Kucharska, Małgorzata; Wesołowski, Wiktor; Czerczak, Sławomir; Soćko, Renata

Electronic cigarettes are currently in common use. However, in Poland there is no specific legislation governing the sale of these products. At the same time, no information has been made public about the hazards e-cigarettes pose to the users and bystanders - passive smokers. The aim of the study was to determine the qualitative composition of the analyzed liquid, which is an essential element of regulating the distribution of such cigarettes. Under this study the method for determining the composition of e-cigarette liquids was developed. This method employs gas chromatography with mass spectrometry (GC-MS). Levels of nicotine and flavoring components were determined in 50 e-liquid samples. The results were compared with the information provided by the manufacturer on the packaging. The applied method of qualitative determination helped to identify the main ingredients, such as nicotine and propylene glycol (PG). Propylene glycol was found to be present in all liquids, because it was used as the solvent for nicotine and flavors. There was a good agreement between the declared and the determined content of nicotine in the analyzed samples. The agreement was considerably poorer for the remaining e-liquid ingredients, mainly flavors. There was no agreement between the flavor substances specified by the manufacturer and aroma identified in the e-cigarette liquid, which may pose a risk to users of e-cigarettes, particularly those susceptible to allergies. Several unsaturated aliphatic alcohols and aldehydes found to be present in the liquids, unstable at elevated temperatures, may be more harmful to the smoker than the original compounds. Therefore, it is essential to implement in Poland the legal provisions regarding e-cigarettes. Med Pr 2016;67(2):239-253. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings: findings from a national cohort study with Australian adult smokers.

PubMed

Durkin, Sarah; Brennan, Emily; Coomber, Kerri; Zacher, Meghan; Scollo, Michelle; Wakefield, Melanie

2015-04-01

Plain packaging (PP) with larger graphic health warnings (GHWs) was implemented in Australia in late 2012. This study examined effects of these packaging changes on short-term changes in quitting-related cognitions and behaviours. We used a series of cohorts of Australian adult cigarette smokers originally sourced from a nationally representative cross-sectional tracking survey, followed up approximately 1 month after their baseline interview (n(weighted)=5441). Logistic regression analyses compared changes in seven quitting-related outcomes over this 1-month follow-up period for the cohorts surveyed before PP, over the period of transition to PP, and during the first year of PP, adjusting for baseline levels of the outcome and covariates. Compared to the referent group of smokers who completed their follow-up survey pre-PP, those who were followed-up in the early transition period showed significantly greater increases in rates of stopping themselves from smoking (OR=1.51, 95% CI (1.08 to 2.10)) and higher quit attempt rates (OR=1.43, 95% CI (1.00 to 2.03)), those followed-up in the late transition period showed greater increases in intentions to quit (OR=1.42, 95% CI (1.06 to 1.92)) and pack concealment (OR=1.55, 95% CI (1.05 to 2.31)), and those followed-up in the first year of PP showed higher levels of pack concealment (OR=1.65, 95% CI (1.01 to 2.72)), more premature stubbing out of cigarettes (OR=1.55, 95% CI (1.01 to 2.36)), and higher quit attempt rates (OR=1.52, 95% CI (1.01 to 2.30)). These findings provide some of the strongest evidence to date that implementation of PP with larger GHWs was associated with increased rates of quitting cognitions, microindicators of concern and quit attempts among adult cigarette smokers. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Tobacco Control Policies in Vietnam: Review on MPOWER Implementation Progress and Challenges.

PubMed

Minh, Hoang Van; Ngan, Tran Thu; Mai, Vu Quynh; My, Nguyen Thi Tuyet; Chung, Le Hong; Kien, Vu Duy; Anh, Tran Tuan; Ngoc, Nguyen Bao; Giap, Vu Van; Cuong, Nguyen Manh; Manh, Pham Duc; Giang, Kim Bao

2016-01-01

In Vietnam, the WHO Framework Convention on Tobacco Control (WHO FCTC) took effect in March 2005 while MPOWER has been implemented since 2008. This paper describes the progress and challenges of implementation of the MPOWER package in Vietnam. We can report that, in term of monitoring, Vietnam is very active in the Global Tobacco Surveillance System, completing two rounds of the Global Adult Tobacco Survey (GATS) and three rounds of the Global Youth Tobacco Survey (GYTS). To protect people from tobacco smoke, Vietnam has issued and enforced a law requiring comprehensive smoking bans at workplaces and public places since 2013. Tobacco advertising and promotion are also prohibited with the exception of points of sale displays of tobacco products. Violations come in the form of promotion girls, corporate social responsibility activities from tobacco manufacturers and packages displayed by retail vendors. Vietnam is one of the 77 countries that require pictorial health warnings to be printed on cigarette packages to warn about the danger of tobacco and the warnings have been implemented effectively. Cigarette tax is 70% of factory price which is equal to less than 45% of retail price and much lower than the recommendation of WHO. However, Vietnam is one of the very few countries that require manufacturers and importers to make "compulsory contributions" at 1-2% of the factory price of cigarettes sold in Vietnam for the establishment of a Tobacco Control Fund (TCF). The TCF is being operated well. In 2015, 67 units of 63 provinces/cities, 22 ministries and political-social organizations and 6 hospitals received funding from TCF to implement a wide range of tobacco control activities. Cessation services have been starting with a a toll-free quit-line but need to be further strengthened. In conclusion, Vietnam has constantly put efforts into the tobacco control field with high commitment from the government, scientists and activists. Though several remarkable achievements have been gained, many challenges remain. To overcome those challenges, implementation strategies that take into account the contextual factors and social determinants of tobacco use in Vietnam are needed.

Impact of Australia's introduction of tobacco plain packs on adult smokers' pack-related perceptions and responses: results from a continuous tracking survey.

PubMed

Dunlop, Sally M; Dobbins, Timothy; Young, Jane M; Perez, Donna; Currow, David C

2014-12-18

To investigate the impact of Australia's plain tobacco packaging policy on two stated purposes of the legislation--increasing the impact of health warnings and decreasing the promotional appeal of packaging--among adult smokers. Serial cross-sectional study with weekly telephone surveys (April 2006-May 2013). Interrupted time-series analyses using ARIMA modelling and linear regression models were used to investigate intervention effects. 15,745 adult smokers (aged 18 years and above) in New South Wales (NSW), Australia. Random selection of participants involved recruiting households using random digit dialling and selecting the nth oldest smoker for interview. The introduction of the legislation on 1 October 2012. Salience of tobacco pack health warnings, cognitive and emotional responses to warnings, avoidance of warnings, perceptions regarding one's cigarette pack. Adjusting for background trends, seasonality, antismoking advertising activity and cigarette costliness, results from ARIMA modelling showed that, 2-3 months after the introduction of the new packs, there was a significant increase in the absolute proportion of smokers having strong cognitive (9.8% increase, p=0.005), emotional (8.6% increase, p=0.01) and avoidant (9.8% increase, p=0.0005) responses to on-pack health warnings. Similarly, there was a significant increase in the proportion of smokers strongly disagreeing that the look of their cigarette pack is attractive (57.5% increase, p<0.0001), says something good about them (54.5% increase, p<0.0001), influences the brand they buy (40.6% increase, p<0.0001), makes their pack stand out (55.6% increase, p<0.0001), is fashionable (44.7% increase, p<0.0001) and matches their style (48.1% increase, p<0.0001). Changes in these outcomes were maintained 6 months postintervention. The introductory effects of the plain packaging legislation among adult smokers are consistent with the specific objectives of the legislation in regard to reducing promotional appeal and increasing effectiveness of health warnings. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Eye movement responses to health messages on cigarette packages

PubMed Central

2012-01-01

Background While the majority of the health messages on cigarette packages contain threatening health information, previous studies indicate that risk information can trigger defensive reactions, especially when the information is self-relevant (i.e., smokers). Providing coping information, information that provides help for quitting smoking, might increase attention to health messages instead of triggering defensive reactions. Methods Eye-movement registration can detect attention preferences for different health education messages over a longer period of time during message exposure. In a randomized, experimental study with 23 smoking and 41 non-smoking student volunteers, eye-movements were recorded for sixteen self-created cigarette packages containing health texts that presented either high risk or coping information combined with a high threat or a low threat smoking-related photo. Results Results of the eye movement data showed that smokers tend to spend more time looking (i.e., more unique fixations and longer dwell time) at the coping information than at the high risk information irrespective of the content of the smoking-related photo. Non-smokers tend to spend more time looking at the high risk information than at the coping information when the information was presented in combination with a high threat smoking photo. When a low threat photo was presented, non-smokers paid more attention to the coping information than to the high risk information. Results for the smoking photos showed more attention allocation for low threat photos that were presented in combination with high risk information than for low threat photos in combination with coping information. No attention differences were found for the high threat photos. Conclusions Non-smokers demonstrated an attention preference for high risk information as opposed to coping information, but only when text information was presented in combination with a high threat photo. For smokers, however, our findings suggest more attention allocation for coping information than for health risk information. This preference for coping information is not reflected in current health messages to motivate smokers to quit smoking. Coping information should be more frequently implemented in health message design to increase attention for these messages and thus contribute to effective persuasion. PMID:22583956

Eye movement responses to health messages on cigarette packages.

PubMed

Kessels, Loes T E; Ruiter, Robert A C

2012-05-14

While the majority of the health messages on cigarette packages contain threatening health information, previous studies indicate that risk information can trigger defensive reactions, especially when the information is self-relevant (i.e., smokers). Providing coping information, information that provides help for quitting smoking, might increase attention to health messages instead of triggering defensive reactions. Eye-movement registration can detect attention preferences for different health education messages over a longer period of time during message exposure. In a randomized, experimental study with 23 smoking and 41 non-smoking student volunteers, eye-movements were recorded for sixteen self-created cigarette packages containing health texts that presented either high risk or coping information combined with a high threat or a low threat smoking-related photo. Results of the eye movement data showed that smokers tend to spend more time looking (i.e., more unique fixations and longer dwell time) at the coping information than at the high risk information irrespective of the content of the smoking-related photo. Non-smokers tend to spend more time looking at the high risk information than at the coping information when the information was presented in combination with a high threat smoking photo. When a low threat photo was presented, non-smokers paid more attention to the coping information than to the high risk information. Results for the smoking photos showed more attention allocation for low threat photos that were presented in combination with high risk information than for low threat photos in combination with coping information. No attention differences were found for the high threat photos. Non-smokers demonstrated an attention preference for high risk information as opposed to coping information, but only when text information was presented in combination with a high threat photo. For smokers, however, our findings suggest more attention allocation for coping information than for health risk information. This preference for coping information is not reflected in current health messages to motivate smokers to quit smoking. Coping information should be more frequently implemented in health message design to increase attention for these messages and thus contribute to effective persuasion.

Tobacco packaging and labeling policies under the U.S. Tobacco Control Act: research needs and priorities.

PubMed

Hammond, David

2012-01-01

The Family Smoking Prevention and Tobacco Control Act (the "Act"), enacted in June 2009, gave the U.S. Food and Drug Administration authority to regulate tobacco products. The current paper reviews the provisions for packaging and labeling, including the existing evidence and research priorities. Narrative review using electronic literature search of published and unpublished sources in 3 primary areas: health warnings, constituent labeling, and prohibitions on the promotional elements of packaging. The Act requires 9 pictorial health warnings covering half of cigarette packages and 4 text warnings covering 30% of smokeless tobacco packages. The Act also prohibits potentially misleading information on packaging, including the terms "light" and "mild," and provides a mandate to require disclosure of chemical constituents on packages. Many of the specific regulatory provisions are based on the extent to which they promote "greater public understanding of the risks of tobacco." As a result, research on consumer perceptions has the potential to shape the design and renewal of health warnings and to determine what, if any, information on product constituents should appear on packages. Research on consumer perceptions of existing and novel tobacco products will also be critical to help identify potentially misleading information that should be restricted under the Act. Packaging and labeling regulations required under the Act will bring the United States in line with international standards. There is an immediate need for research to evaluate these measures to guide future regulatory action.

To sell or not to sell: cigarette sales in alcohol-licenced premises.

PubMed

Burton, Suzan; Ludbrooke, Mark; Williams, Kelly; Walsberger, Scott C; Egger, Sam

2017-11-27

To obtain insight into tobacco retailing by alcohol-licenced premises, in order to understand the financial importance of tobacco sales for such retailers. Data were collected by a telephone survey of 1042 clubs, hotels and packaged liquor outlets in New South Wales, Australia. The response rate was 86.1%. Qualitative and quantitative data were obtained. Logistic and linear regression were used to determine factors associated with the probability of selling and stopping selling and the importance of cigarette sales. More than a third (36.4%) of premises contacted did not sell cigarettes. 147 (an estimated 18.1% of those who had ever sold) had stopped selling. There were significant differences in the probability of selling, in the reported importance of cigarette sales and in the probability of stopping selling, between different outlet types and other outlet characteristics (number of gaming machines, proximity of nearest alternative tobacco retailer and remoteness). Outlets where alcohol can be consumed were more likely to rate cigarette sales as 'not important' than 'important'. Despite claims by tobacco companies that tobacco sales are important for many Australian retailers, tobacco sales appear to be of limited importance for alcohol-licenced premises. This means that opposition to stopping tobacco sales where alcohol is consumed and/or sold may be less than expected. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Deadly Attraction - Attentional Bias toward Preferred Cigarette Brand in Smokers.

PubMed

Domaradzka, Ewa; Bielecki, Maksymilian

2017-01-01

Numerous studies have shown that biases in visual attention might be evoked by affective and personally relevant stimuli, for example addiction-related objects. Despite the fact that addiction is often linked to specific products and systematic purchase behaviors, no studies focused directly on the existence of bias evoked by brands. Smokers are characterized by high levels of brand loyalty and everyday contact with cigarette packaging. Using the incentive-salience mechanism as a theoretical framework, we hypothesized that this group might exhibit a bias toward the preferred cigarette brand. In our study, a group of smokers ( N = 40) performed a dot probe task while their eye movements were recorded. In every trial a pair of pictures was presented - each of them showed a single cigarette pack. The visual properties of stimuli were carefully controlled, so branding information was the key factor affecting subjects' reactions. For each participant, we compared gaze behavior related to the preferred vs. other brands. The analyses revealed no attentional bias in the early, orienting phase of the stimulus processing and strong differences in maintenance and disengagement. Participants spent more time looking at the preferred cigarettes and saccades starting at the preferred brand location had longer latencies. In sum, our data shows that attentional bias toward brands might be found in situations not involving choice or decision making. These results provide important insights into the mechanisms of formation and maintenance of attentional biases to stimuli of personal relevance and might serve as a first step toward developing new attitude measurement techniques.

Effectiveness of pictorial health warning on cigarette packages: A cross-sectional study in Sarawak, Malaysia.

PubMed

Rahman, M M; Arif, M T; Abd, Razak Mf; Suhaili, M R; Tambi, Z; Akoi, C; Gabriel Bain, M; Hussain, H

2015-01-01

Specific health warning placed on the tobacco product packages is considered as an effective and low-cost method for increasing the knowledge and awareness among the community. Thus, a study was conducted to assess the perception of pictorial health warnings (PHWs) against smoking among the adult rural population of Sarawak. Cross-sectional data were collected from 10 villages in Kota Samarahan and Kuching Division by face to face interview using modified Global Adult Tobacco Survey questionnaire. Nonprobability sampling method was adopted to select the villages. All the households of the selected villages were visited and an adult member was selected randomly from each house irrespective of the sex. After missing value imputation, 1000 data were analysed using statistical software IBM SPSS 20.0 version. Analysis showed that 28.8% of the respondents were current smokers, 7.8% were past smokers and the rest were non-smokers. Six items of pictorial health warnings were evaluated with five point Likert's scales for attractiveness, fearfulness and adequacy of the information. Analysis revealed that the majority of the respondents had perceived awareness on PHWs, but the smokers believed that this was not adequate to make them quit smoking. Only one-fifth (19.7%) of them reported that current pictorial health warnings were sufficient to motivate people to quit smoking. Though the PHWs on cigarette packages are appealing, it is not sufficient as a reason to stop smoking. Thus, an approach using an integrated anti-tobacco public health programme should be focused into the specific targeted community.

Access to Anti-smoking Information among School Children and its Potential Impact on Preventing Smoking Initiation: Results from the Global Youth Tobacco Use Survey (GYTS) 2014 in Viet Nam.

PubMed

Minh, Hoang Van; Minh, Hoang Van; Giang, Kim Bao; Hai, Phan Thi; Hoang, Trinh Dinh; Huyen, Doan Thu; Khue, Luong Ngoc; Linh, Nguyen Thuy; Lam, Nguyen Tuan; Nga, Pham Thi Quynh

2016-01-01

Scientific evidence on all aspects of smoking amongst youth is very important for designing appropriate interventions to reduce smoking among this vulnerable population. This paper describes current access to antismoking information among school children aged 13 to 15 years in Vietnam in 2014 and examines its potential impact on preventing smoking initiation. The data used in this paper were obtained from the 2014 Global Youth Tobacco Survey (GYTS) in Vietnam. Students were asked questions about their level of awareness of anti-smoking information from various sources in the past 30 days and about lessons in school regarding the dangers of tobacco use during the last 12 months. Those who have never smoked were asked "whether or not they thought about avoiding cigarettes because of health warnings on cigarette packages" and answers were analyzed in combination with data on access to anti-smoking information from other sources. The prevalence of exposure to antismoking campaigns was high among school children in Viet Nam: 55.3% of current smokers reported thoughts of smoking cessation because of health warnings on cigarette packages; 60.5% of never smokers avoided initiating smoking because of the same health warnings. The potential impact of graphic health warnings to prevent school-aged children from smoking initiation would be stronger if there was concurrent access to anti-smoking programs on the dangers of tobacco use in schools. However, school education for tobacco prevention and control has not been as strong as expected. A more comprehensive school curriculum on tobacco prevention and control is recommended to reinforce antismoking messages among school children.

Predictive and External Validity of a Pre-Market Study to Determine the Most Effective Pictorial Health Warning Label Content for Cigarette Packages

PubMed Central

Thrasher, James F.; Reid, Jessica L.; Hammond, David

2016-01-01

Abstract Introduction: Studies examining cigarette package pictorial health warning label (HWL) content have primarily used designs that do not allow determination of effectiveness after repeated, naturalistic exposure. This research aimed to determine the predictive and external validity of a pre-market evaluation study of pictorial HWLs. Methods: Data were analyzed from: (1) a pre-market convenience sample of 544 adult smokers who participated in field experiments in Mexico City before pictorial HWL implementation (September 2010); and (2) a post-market population-based representative sample of 1765 adult smokers in the Mexican administration of the International Tobacco Control Policy Evaluation Survey after pictorial HWL implementation. Participants in both samples rated six HWLs that appeared on cigarette packs, and also ranked HWLs with four different themes. Mixed effects models were estimated for each sample to assess ratings of relative effectiveness for the six HWLs, and to assess which HWL themes were ranked as the most effective. Results: Pre- and post-market data showed similar relative ratings across the six HWLs, with the least and most effective HWLs consistently differentiated from other HWLs. Models predicting rankings of HWL themes in post-market sample indicated: (1) pictorial HWLs were ranked as more effective than text-only HWLs; (2) HWLs with both graphic and “lived experience” content outperformed symbolic content; and, (3) testimonial content significantly outperformed didactic content. Pre-market data showed a similar pattern of results, but with fewer statistically significant findings. Conclusions: The study suggests well-designed pre-market studies can have predictive and external validity, helping regulators select HWL content. PMID:26377516

Predictive and External Validity of a Pre-Market Study to Determine the Most Effective Pictorial Health Warning Label Content for Cigarette Packages.

PubMed

Huang, Li-Ling; Thrasher, James F; Reid, Jessica L; Hammond, David

2016-05-01

Studies examining cigarette package pictorial health warning label (HWL) content have primarily used designs that do not allow determination of effectiveness after repeated, naturalistic exposure. This research aimed to determine the predictive and external validity of a pre-market evaluation study of pictorial HWLs. Data were analyzed from: (1) a pre-market convenience sample of 544 adult smokers who participated in field experiments in Mexico City before pictorial HWL implementation (September 2010); and (2) a post-market population-based representative sample of 1765 adult smokers in the Mexican administration of the International Tobacco Control Policy Evaluation Survey after pictorial HWL implementation. Participants in both samples rated six HWLs that appeared on cigarette packs, and also ranked HWLs with four different themes. Mixed effects models were estimated for each sample to assess ratings of relative effectiveness for the six HWLs, and to assess which HWL themes were ranked as the most effective. Pre- and post-market data showed similar relative ratings across the six HWLs, with the least and most effective HWLs consistently differentiated from other HWLs. Models predicting rankings of HWL themes in post-market sample indicated: (1) pictorial HWLs were ranked as more effective than text-only HWLs; (2) HWLs with both graphic and "lived experience" content outperformed symbolic content; and, (3) testimonial content significantly outperformed didactic content. Pre-market data showed a similar pattern of results, but with fewer statistically significant findings. The study suggests well-designed pre-market studies can have predictive and external validity, helping regulators select HWL content. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Protection motivation theory and cigarette smoking among vocational high school students in China: a cusp catastrophe modeling analysis.

PubMed

Xu, Yunan; Chen, Xinguang

2016-01-01

Tobacco use is one of the greatest public health problems worldwide and the hazards of cigarette smoking to public health call for better recognition of cigarette smoking behaviors to guide evidence-based policy. Protection motivation theory (PMT) provides a conceptual framework to investigate tobacco use. Evidence from diverse sources implies that the dynamics of smoking behavior may be quantum in nature, consisting of an intuition and an analytical process, challenging the traditional linear continuous analytical approach. In this study, we used cusp catastrophe, a nonlinear analytical approach to test the dual-process hypothesis of cigarette smoking. Data were collected from a random sample of vocational high school students in China ( n = 528). The multivariate stochastic cusp modeling was used and executed with the Cusp Package in R. The PMT-based Threat Appraisal and Coping Appraisal were used as the two control variables and the frequency of cigarette smoking (daily, weekly, occasional, and never) in the past month was used as the outcome variable. Consistent with PMT, the Threat Appraisal (asymmetry, α 1 = 0.1987, p < 0.001) and Coping Appraisal (bifurcation, β 2 = 0.1760, p < 0.05) significantly predicted the smoking behavior after controlling for covariates. Furthermore, the cusp model performed better than the alternative linear and logistic regression models with regard to higher R 2 (0.82 for cusp, but 0.21 for linear and 0.25 for logistic) and smaller AIC and BIC. Study findings support the conclusion that cigarette smoking in adolescents is a quantum process and PMT is relevant to guide studies to understand smoking behavior for smoking prevention and cessation.

The contribution of excise cigarette taxes on the decline in youth smoking in Canada during the time of the Federal Tobacco Control Strategy (2002-2012).

PubMed

Manivong, Phongsack; Harper, Sam; Strumpf, Erin

2017-06-16

To evaluate the impact of changes in cigarette taxes on smoking for youths aged 15-18 in Canada during the time of the Federal Tobacco Control Strategy (FTCS). We used a difference-in-differences framework and leveraged the variation in cigarette taxes across Canada and over time. We used regression models with province and year fixed effects, and individual-level and provincial-level covariates on 2002-2012 data from the Canadian Tobacco Use Monitoring Survey. Tax increases generally did not affect smoking outcomes. Each increase of CAD $1.00 (adjusted to year 2000 dollars) in excise cigarette taxes per package of 20 was associated with a 0.2 percentage point (95% CI: -1.8; 2.2) change in smoking prevalence, and a change of 0.3 in mean cigarettes smoked in the past week (95% CI: -1.2; 1.8). From 2002 to 2012, smoking prevalence and mean smoking frequency were in steady decline among youths in Canada. This decline, however, was evident even among provinces with stable or decreasing cigarette tax levels. Tobacco taxes have mostly increased since the 1980s, and so, tax levels were already quite high by the launch of the FTCS. Province fixed effects and common temporal changes accounted for 83.7% of the variation in smoking prevalence. We derived similar results for smoking frequency. The cumulative tax increase during our study period was at least $1.00 for only three provinces. Thus, our findings suggest that factors driving down tobacco use among youths in all provinces appear to outweigh any impact of small tax increases at already high tax levels.

Cigarette characteristic and emission variations across high-, middle- and low-income countries.

PubMed

O'Connor, R J; Wilkins, K J; Caruso, R V; Cummings, K M; Kozlowski, L T

2010-12-01

The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. Multicountry observational study. Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank's per capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ(2)(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. This study showed that as a country's income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries. Copyright © 2010 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

Cigarette characteristic and emission variations across high-, middle- and low-income countries

PubMed Central

O’Connor, R.J.; Wilkins, K.J.; Caruso, R.V.; Cummings, K.M.; Kozlowski, L.T.

2010-01-01

SUMMARY Objectives The public health burden of tobacco use is shifting to the developing world, and the tobacco industry may apply some of its successful marketing tactics, such as allaying health concerns with product modifications. This study used standard smoking machine tests to examine the extent to which the industry is introducing engineering features that reduce tar and nicotine to cigarettes sold in middle- and low-income countries. Study design Multicountry observational study. Methods Cigarettes from 10 different countries were purchased in 2005 and 2007 with low-, middle- and high-income countries identified using the World Bank’s per-capita gross national income metric. Physical measurements of each brand were tested, and tobacco moisture and weight, paper porosity, filter ventilation and pressure drop were analysed. Tar, nicotine and carbon monoxide emission levels were determined for each brand using International Organization for Standardization and Canadian Intensive methods. Statistical analyses were performed using Statistical Package for the Social Sciences. Results Among cigarette brands with filters, more brands were ventilated in high-income countries compared with middle- and low-income countries [χ2(4)=25.92, P<0.001]. Low-income brands differed from high- and middle-income brands in engineering features such as filter density, ventilation and paper porosity, while tobacco weight and density measures separated the middle- and high-income groups. Smoke emissions differed across income groups, but these differences were largely negated when one accounted for design features. Conclusions This study showed that as a country’s income level increases, cigarettes become more highly engineered and the emissions levels decrease. In order to reduce the burden of tobacco-related disease and further effective product regulation, health officials must understand cigarette design and function within and between countries. PMID:21030055

Death by heroin intoxication in a body pusher with an innovative packaging technique: case report and review of the literature.

PubMed

Visentin, Sindi; Bevilacqua, Greta; Giraudo, Chiara; Dengo, Caterina; Nalesso, Alessandro; Montisci, Massimo

2017-11-01

Death due to mechanical or chemical intoxication of heroin body packers, thanks to the continuous improvement in packaging techniques, are increasingly rare, and almost all the cases reported in the literature refer to drug swallowers. A case of fatal acute heroin intoxication in a body pusher with an unreported packaging technique is presented, and previous deaths due to heroin body packing are reviewed, taking into consideration imaging techniques performed, cause of death, toxicological analysis on biological and non-biological samples, as well as number, position and type of drug packages identified at the dissection of the body. The innovative packaging technique found in the present case, constituted by an external multilayer cellophane casing containing 16 smaller packages of hardened heroin powder, each one covered with cigarette paper and multiple layers of heat-sealed cellophane, was probably used to avoid both chemical complications of package rupture and to create a package with morphological and radiological features different from those reported by previous studies. Drug dealers, in fact, are continually looking for packaging methods that, besides being safer, minimize the risk of detection at the radiological examinations performed, thus increasing the number of false negative findings. The identification of new types of package is therefore important, in order to identify packages that do not have the typical radiological signs, both in order to protect the patient's health and to avoid the non-recognition of a drug carrier. Despite the presence of multilayer composition of both the smaller and the bigger external coverage, these new types of package did not guarantee the greater safety of the drug dealer. Copyright © 2017 Elsevier B.V. All rights reserved.

"The world's most hostile environment": how the tobacco industry circumvented Singapore's advertising ban

PubMed Central

Assunta, M; Chapman, S

2004-01-01

Objective: To review how tobacco transnational companies conducted their business in the hostile environment of Singapore, attempting to counter some of the government's tobacco control measures; to compare the Malaysian and the Singaporean governments' stance on tobacco control and the direct bearing of this on the way the tobacco companies conduct their business. Methods: Systematic keyword and opportunistic website searches of formerly private internal industry documents. Results: The comprehensive prohibition on advertising did not prevent the companies from advertising cigarettes to Singaporeans. Both British American Tobacco and Philip Morris used Malaysian television to advertise into Singapore. To launch a new brand of cigarettes, Alpine, Philip Morris used a non-tobacco product, the Alpine wine cooler. Other creative strategies such as innovative packaging and display units at retailers were explored to overcome the restrictions. Philip Morris experimented with developing a prototype cigarette using aroma and sweetened tipping paper to target the young and health conscious. The industry sought to weaken the strong pack warnings. The industry distributed anti-smoking posters for youth to retailers but privately salivated over their market potential. PMID:15564221

"The world's most hostile environment": how the tobacco industry circumvented Singapore's advertising ban.

PubMed

Assunta, M; Chapman, S

2004-12-01

To review how tobacco transnational companies conducted their business in the hostile environment of Singapore, attempting to counter some of the government's tobacco control measures; to compare the Malaysian and the Singaporean governments' stance on tobacco control and the direct bearing of this on the way the tobacco companies conduct their business. Systematic keyword and opportunistic website searches of formerly private internal industry documents. The comprehensive prohibition on advertising did not prevent the companies from advertising cigarettes to Singaporeans. Both British American Tobacco and Philip Morris used Malaysian television to advertise into Singapore. To launch a new brand of cigarettes, Alpine, Philip Morris used a non-tobacco product, the Alpine wine cooler. Other creative strategies such as innovative packaging and display units at retailers were explored to overcome the restrictions. Philip Morris experimented with developing a prototype cigarette using aroma and sweetened tipping paper to target the young and health conscious. The industry sought to weaken the strong pack warnings. The industry distributed anti-smoking posters for youth to retailers but privately salivated over their market potential.

Interpretations of cigarette advertisement warning labels by Philadelphia Puerto Ricans.

PubMed

Morris, Nancy; Gilpin, Dawn R; Lenos, Melissa; Hobbs, Renee

2011-09-01

This study examined Philadelphia Puerto Ricans' interpretations of the Surgeon General's warnings that appear on cigarette packaging and in advertisements. In-home family focus groups in which participants were asked to comment on magazine cigarette advertisements showed a great variety of interpretations of the legally mandated warning labels. These findings (a) corroborate and add to research in public health and communications regarding the possibility of wide variations in message interpretations and (b) support the call for public health messages to be carefully tested for effectiveness among different social groups. The article's focus on Puerto Ricans addresses the problem of misleading conclusions that can arise from aggregating all Latino subpopulations into one group. The use of a naturalistic setting to examine interpretations of messages about smoking departs from the experimental methods typically used for such research and provides new evidence that even a seemingly straightforward message can be interpreted in multiple ways. Understanding and addressing differences in message interpretation can guide public health campaigns aimed at reducing health disparities. Copyright © Taylor & Francis Group, LLC

Was the media campaign that supported Australia's new pictorial cigarette warning labels and plain packaging policy associated with more attention to and talking about warning labels?

PubMed

Nagelhout, Gera E; Osman, Amira; Yong, Hua-Hie; Huang, Li-Ling; Borland, Ron; Thrasher, James F

2015-10-01

Population-level interventions can possibly enhance each other's effects when they are implemented simultaneously. When the plain packaging policy was implemented in Australia, pictorial health warning labels (HWLs) on cigarette packages were also updated and a national mass media campaign was aired. This study examined whether smokers who recalled the media campaign reported more attention to and talking about HWLs. Longitudinal survey data was obtained among Australian adult smokers, aged 18 years and older, from an online consumer panel. One survey wave was conducted before (September 2012) and two waves were conducted after (January 2013 and May 2013) the interventions. The sample was replenished to maintain a sample size of 1000 participants at each wave. Generalized Estimating Equations analyses were performed. Compared to wave 1, attention to HWLs increased at wave 2 (b=0.32, SE=0.06, p<0.001), but not at wave 3 (b=0.10, SE=0.08, p=0.198). Talking about HWLs increased over time (IRR=1.82, 95% CI=1.58-2.09 and IRR=1.25, 95% CI=1.05-1.47, at wave 2 and wave 3 respectively). Campaign recall was significantly associated with more attention to HWLs (b=0.29, SE=0.05, p<0.001) and with more talking about HWLs (IRR=1.17, 95% CI=1.06-1.29) with similar effects across waves 2 and 3. Recall of the campaign was associated with more attention to and talking about HWLs. When adjusting for campaign recall, there was still an increasing trend in attention and talking. This suggests that the media campaign and the new packaging and labeling policies had independent and positive effects on attention to and talking about HWLs. Copyright © 2015 Elsevier Ltd. All rights reserved.

Was the media campaign that supported Australia’s new pictorial cigarette warning labels and plain packaging policy associated with more attention to and talking about warning labels?

PubMed Central

Nagelhout, Gera E.; Osman, Amira; Yong, Hua-Hie; Huang, Li-Ling; Borland, Ron; Thrasher, James F.

2016-01-01

Background Population-level interventions can possibly enhance each other’s effects when they are implemented simultaneously. When the plain packaging policy was implemented in Australia, pictorial health warning labels (HWLs) on cigarette packages were also updated and a national mass media campaign was aired. This study examined whether smokers who recalled the media campaign reported more attention to and talking about HWLs. Methods Longitudinal survey data was obtained among Australian adult smokers, aged 18 years and older, from an online consumer panel. One survey wave was conducted before (September 2012) and two waves were conducted after (January 2013 and May 2013) the interventions. The sample was replenished to maintain a sample size of 1000 participants at each wave. Generalized Estimating Equations analyses were performed. Results Compared to wave 1, attention to HWLs increased at wave 2 (b = 0.32, SE = 0.06, p < 0.001), but not at wave 3 (b = 0.10, SE = 0.08, p = 0.198). Talking about HWLs increased over time (IRR = 1.82, 95% CI = 1.58–2.09 and IRR = 1.25, 95% CI = 1.05–1.47, at wave 2 and wave 3 respectively). Campaign recall was significantly associated with more attention to HWLs (b = 0.29, SE = 0.05, p < 0.001) and with more talking about HWLs (IRR = 1.17, 95% CI = 1.06–1.29) with similar effects across waves 2 and 3. Conclusions Recall of the campaign was associated with more attention to and talking about HWLs. When adjusting for campaign recall, there was still an increasing trend in attention and talking. This suggests that the media campaign and the new packaging and labeling policies had independent and positive effects on attention to and talking about HWLs. PMID:26050643

Retail price and point of sale display of tobacco in the UK: a descriptive study of small retailers.

PubMed

Spanopoulos, Dionysis; Ratschen, Elena; McNeill, Ann; Britton, John

2012-01-01

Since the implementation of the 2002 Tobacco Advertising and Promotion Act, point-of-sale (PoS) tobacco displays are one of few remaining means of communication between the tobacco industry and customers in the UK. This study aimed to explore the characteristics of tobacco displays in a UK city, and particularly to assess the tobacco prices and promotional offers, types and pack sizes on display. Digital pictures of PoS displays were taken in 117 small retail shops in Nottingham in mid 2010. Data were analysed using Windows Photo Gallery software and SPSS version 16. Just over half (52%) of cigarette packs on display were packs of 20, and 43% packs of 10. Cigarette prices differed substantially between brands, ranging from £4.19 to £6.85 for 20-packs, and from £2.12 to £3.59 for 10-packs. Forty four percent of cigarette packs and 40% of RYO (Roll-Your-Own) tobacco pouches, almost exclusively lower priced brands, were displayed with a pricemark, implying a promotional price offer. Eighty percent of 20-pack cigarette brand or brand variants on sale were priced below the EU-defined Most Popular Price Category (MPPC) for the UK in 2010; 45% were priced below the Weighted Average Price (WAP), which replaced the MPPC in 2011. PoS displays communicate value by displaying a high proportion of lower cost brands, and smaller and hence lower-cost packs, and by displaying price discounts on packs. The MPPC substantially overestimated the prices at which most 20-cigarette packs were available. Removal of PoS displays will prevent this means of price marketing but our study also suggests that minimum pricing of 20-pack cigarettes, prohibition of sale of cigarettes in packs less than 20, and plain packaging to prevent pricemarking are necessary if price is to be used effectively as a tobacco control measure.

Retail Price and Point of Sale Display of Tobacco in the UK: A Descriptive Study of Small Retailers

PubMed Central

Spanopoulos, Dionysis; Ratschen, Elena; McNeill, Ann; Britton, John

2012-01-01

Background Since the implementation of the 2002 Tobacco Advertising and Promotion Act, point-of-sale (PoS) tobacco displays are one of few remaining means of communication between the tobacco industry and customers in the UK. This study aimed to explore the characteristics of tobacco displays in a UK city, and particularly to assess the tobacco prices and promotional offers, types and pack sizes on display. Methods Digital pictures of PoS displays were taken in 117 small retail shops in Nottingham in mid 2010. Data were analysed using Windows Photo Gallery software and SPSS version 16. Results Just over half (52%) of cigarette packs on display were packs of 20, and 43% packs of 10. Cigarette prices differed substantially between brands, ranging from £4.19 to £6.85 for 20-packs, and from £2.12 to £3.59 for 10-packs. Forty four percent of cigarette packs and 40% of RYO (Roll-Your-Own) tobacco pouches, almost exclusively lower priced brands, were displayed with a pricemark, implying a promotional price offer. Eighty percent of 20-pack cigarette brand or brand variants on sale were priced below the EU-defined Most Popular Price Category (MPPC) for the UK in 2010; 45% were priced below the Weighted Average Price (WAP), which replaced the MPPC in 2011. Conclusion PoS displays communicate value by displaying a high proportion of lower cost brands, and smaller and hence lower-cost packs, and by displaying price discounts on packs. The MPPC substantially overestimated the prices at which most 20-cigarette packs were available. Removal of PoS displays will prevent this means of price marketing but our study also suggests that minimum pricing of 20-pack cigarettes, prohibition of sale of cigarettes in packs less than 20, and plain packaging to prevent pricemarking are necessary if price is to be used effectively as a tobacco control measure. PMID:22242183

Tobacco Packaging and Labeling Policies Under the U.S. Tobacco Control Act: Research Needs and Priorities

PubMed Central

2012-01-01

Introduction: The Family Smoking Prevention and Tobacco Control Act (the “Act”), enacted in June 2009, gave the U.S. Food and Drug Administration authority to regulate tobacco products. The current paper reviews the provisions for packaging and labeling, including the existing evidence and research priorities. Methods: Narrative review using electronic literature search of published and unpublished sources in 3 primary areas: health warnings, constituent labeling, and prohibitions on the promotional elements of packaging. Results: The Act requires 9 pictorial health warnings covering half of cigarette packages and 4 text warnings covering 30% of smokeless tobacco packages. The Act also prohibits potentially misleading information on packaging, including the terms “light” and “mild,” and provides a mandate to require disclosure of chemical constituents on packages. Many of the specific regulatory provisions are based on the extent to which they promote “greater public understanding of the risks of tobacco.” As a result, research on consumer perceptions has the potential to shape the design and renewal of health warnings and to determine what, if any, information on product constituents should appear on packages. Research on consumer perceptions of existing and novel tobacco products will also be critical to help identify potentially misleading information that should be restricted under the Act. Conclusion: Packaging and labeling regulations required under the Act will bring the United States in line with international standards. There is an immediate need for research to evaluate these measures to guide future regulatory action. PMID:22039072

Real-Time Pattern Recognition - An Industrial Example

NASA Astrophysics Data System (ADS)

Fitton, Gary M.

1981-11-01

Rapid advancements in cost effective sensors and micro computers are now making practical the on-line implementation of pattern recognition based systems for a variety of industrial applications requiring high processing speeds. One major application area for real time pattern recognition is in the sorting of packaged/cartoned goods at high speed for automated warehousing and return goods cataloging. While there are many OCR and bar code readers available to perform these functions, it is often impractical to use such codes (package too small, adverse esthetics, poor print quality) and an approach which recognizes an item by its graphic content alone is desirable. This paper describes a specific application within the tobacco industry, that of sorting returned cigarette goods by brand and size.

Deadly Attraction – Attentional Bias toward Preferred Cigarette Brand in Smokers

PubMed Central

Domaradzka, Ewa; Bielecki, Maksymilian

2017-01-01

Numerous studies have shown that biases in visual attention might be evoked by affective and personally relevant stimuli, for example addiction-related objects. Despite the fact that addiction is often linked to specific products and systematic purchase behaviors, no studies focused directly on the existence of bias evoked by brands. Smokers are characterized by high levels of brand loyalty and everyday contact with cigarette packaging. Using the incentive-salience mechanism as a theoretical framework, we hypothesized that this group might exhibit a bias toward the preferred cigarette brand. In our study, a group of smokers (N = 40) performed a dot probe task while their eye movements were recorded. In every trial a pair of pictures was presented – each of them showed a single cigarette pack. The visual properties of stimuli were carefully controlled, so branding information was the key factor affecting subjects’ reactions. For each participant, we compared gaze behavior related to the preferred vs. other brands. The analyses revealed no attentional bias in the early, orienting phase of the stimulus processing and strong differences in maintenance and disengagement. Participants spent more time looking at the preferred cigarettes and saccades starting at the preferred brand location had longer latencies. In sum, our data shows that attentional bias toward brands might be found in situations not involving choice or decision making. These results provide important insights into the mechanisms of formation and maintenance of attentional biases to stimuli of personal relevance and might serve as a first step toward developing new attitude measurement techniques. PMID:28848479

A Qualitative Content Analysis of Cigarette Health Warning Labels in Australia, Canada, the United Kingdom, and the United States

PubMed Central

Bell, Kirsten; Dennis, Simone

2015-01-01

The legislation of health warning labels on cigarette packaging is a major focus for tobacco control internationally and is a key component of the World Health Organization’s Framework Convention on Tobacco Control. This population-level intervention is broadly supported as a vital measure for warning people about the health consequences of smoking. However, some components of this approach warrant close critical inspection. Through a qualitative content analysis of the imagery used on health warning labels from 4 countries, we consider how this imagery depicts people that smoke. By critically analyzing this aspect of the visual culture of tobacco control, we argue that this imagery has the potential for unintended consequences, and obscures the social and embodied contexts in which smoking is experienced. PMID:25521883

Young adult smokers' perceptions of plain packs, numbered packs and pack inserts in Turkey: a focus group study.

PubMed

Mucan, Burcu; Moodie, Crawford

2017-11-09

The Turkish Government's 'National Tobacco Control Program 2015-2018' included plans to introduce plain packaging and also a ban on brand names on cigarette packs, allowing only assigned numbers on packs. We explored perceptions of these proposed measures, and also pack inserts with cessation messages, another novel way of using the packaging to communicate with consumers. Eight focus groups were conducted with 47 young adult smokers in Manisa and Kutahya (Turkey) in December 2016. Participants were shown three straight-edged plain cigarette packs, as required in Australia, and then three bevelled-edged plain packs, as permitted in the UK. They were then shown plain packs with numbers rather than brand names, and finally three pack inserts with messages encouraging quitting or offering tips on how to do so. Participants were asked about their perceptions of each. Plain packs were considered unappealing and off-putting, although the bevelled-edged packs were viewed more favourably than the straight-edged packs. Numbered packs were thought by some to diminish the appeal created by the brand name and potentially decrease interest among never smokers and newer smokers. Pack inserts were thought to have less of an impact than the on-pack warnings, but could potentially help discourage initiation and encourage cessation. That bevelled-edged plain packs were perceived more positively than straight-edged plain packs is relevant to countries planning to introduce plain packaging. The study provides a first insight into smokers' perceptions of a ban on brand names, which was perceived to reduce appeal among young people. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Examining the role of unmeasured confounding in mediation analysis with genetic and genomic applications.

PubMed

Lutz, Sharon M; Thwing, Annie; Schmiege, Sarah; Kroehl, Miranda; Baker, Christopher D; Starling, Anne P; Hokanson, John E; Ghosh, Debashis

2017-07-19

In mediation analysis if unmeasured confounding is present, the estimates for the direct and mediated effects may be over or under estimated. Most methods for the sensitivity analysis of unmeasured confounding in mediation have focused on the mediator-outcome relationship. The Umediation R package enables the user to simulate unmeasured confounding of the exposure-mediator, exposure-outcome, and mediator-outcome relationships in order to see how the results of the mediation analysis would change in the presence of unmeasured confounding. We apply the Umediation package to the Genetic Epidemiology of Chronic Obstructive Pulmonary Disease (COPDGene) study to examine the role of unmeasured confounding due to population stratification on the effect of a single nucleotide polymorphism (SNP) in the CHRNA5/3/B4 locus on pulmonary function decline as mediated by cigarette smoking. Umediation is a flexible R package that examines the role of unmeasured confounding in mediation analysis allowing for normally distributed or Bernoulli distributed exposures, outcomes, mediators, measured confounders, and unmeasured confounders. Umediation also accommodates multiple measured confounders, multiple unmeasured confounders, and allows for a mediator-exposure interaction on the outcome. Umediation is available as an R package at https://github.com/SharonLutz/Umediation A tutorial on how to install and use the Umediation package is available in the Additional file 1.

Reaching smokers with lower educational attainment.

PubMed

Millar, W J

1996-01-01

Between 1977 and 1994, smoking rates declined among men and women, but the decline was steeper for men. While smoking rates fell among people at all levels of education, the smallest drop was among those with high school graduation or less, particularly women. For those who had stopped smoking, health concerns had been the overriding factor. Smokers with lower education reported encountering fewer smoking restrictions in their daily activities than did those with higher education. All smokers cited the mass media as their major source of information about smoking, but those with lower education reported the mass media less often than did smokers with higher levels of attainment, and were less likely to obtain information from books, pamphlets or magazines. In addition, smaller percentages of smokers with lower education recalled printed warnings about heart disease on cigarette packages. Variations in the decline of smoking suggest that health promotion and smoking cessation programs should consider sex and educational differences when targeting the smoking population. Differences in rates of smoking among people aged 20 and over were examined by educational attainment using selected health surveys conducted between 1977 and 1994. A Health Canada-sponsored supplement to Statistics Canada's National Population Health Survey was used for data on other aspects of smoking such as cutting back or attempting to quit, sources of health information, and awareness of smoking restrictions and cigarette package warnings.

The appeal of smokeless tobacco products among young Canadian smokers: the impact of pictorial health warnings and relative risk messages.

PubMed

Callery, William E; Hammond, David; O'Connor, Richard J; Fong, Geoffrey T

2011-05-01

Although the health risks from smokeless tobacco (ST) are lower than cigarettes, it remains unclear how smokers might use ST products, including as a substitute, a cessation aid, or concurrently with cigarette use, if at all. Additionally, there is little evidence examining the impact of health warning labels (HWL) on ST use and perceptions. The current study investigated perceptions of ST products with and without HWL and a relative health risk (RHR) message. The study consisted of a full-factorial "between-subjects" experiment in which 3 HWL and a RHR message were systematically varied. Canadian smokers aged 18-30 years (N = 611) completed an online survey where they viewed four brands of ST packages altered according to the experimental conditions. Approximately half of the smokers indicated that they were willing to try ST as a substitute and to help quit smoking. More than one quarter (28%) of smokers were unaware that using ST is less harmful than smoking. Pictorial HWL increased false beliefs about the RHR of ST and decreased smokers' willingness to try ST, whereas text warnings did not. Adding a RHR message communicating the lower risk of ST compared with cigarettes increased willingness to try ST when added to text HWL but decreased willingness to try ST even further when added to pictorial HWL. The findings indicate relatively high levels of appeal for ST among young adult Canadian cigarette smokers. Pictorial HWL reduced the appeal of ST products and increased perceived risks, including the false belief that ST is equally harmful as cigarettes. Further research could consider evaluating designs of HWL on ST products that better balance absolute and RHR.

Graphic Health Warnings on Cigarette Packs: How Long Before the Effects on Adolescents Wear Out?

PubMed

White, Victoria; Bariola, Emily; Faulkner, Agatha; Coomber, Kerri; Wakefield, Melanie

2015-07-01

To examine the long-term impact of graphic health-warning labels (GHWL) on adolescents' cognitive processing of warning labels and cigarette pack perceptions. Cross-sectional school-based surveys of students aged 13-17 years residing in urban centers, conducted prior to GHWL introduction (2005) and 6 months (2006), 2 years (2008), and 5 years (2011) post-GHWL introduction. Students who had seen a cigarette pack in the previous 6 months or in 2006, who had seen GHWL were included in analyses (2005 n = 2,560; 2006 n = 1,306; 2008 n = 2,303; 2011 n = 2,716). Smoking stage, reported exposure to cigarette packs, cognitive processing of GHWL, and positive and negative perceptions of pack image were assessed. While cognitive processing of GHWL in 2006 and 2008 was greater than 2005 (p < .01), by 2011 scores had returned to 2005 levels. This pattern of change was consistent across smoking status groups. Pack image perceptions became more negative over time among all students, irrespective of smoking experience. While positive pack image ratings were lower in all subsequent years than 2005, the 2008 rating was higher than 2006 (p < .01). A significant interaction between survey time and smoking status (p < .01) showed that significant increases in positive pack ratings after 2006 only occurred among current and experimental smokers. When novel, GHWL on cigarette packs increase cognitive processing among adolescents. However, this effect diminishes after 5 years, suggesting more regular message refreshment is needed. Australia's adoption of plain packaging is intended to undermine positive pack appeal and increase warning salience. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Perceptions and Perceived Impact of Graphic Cigarette Health Warning Labels on Smoking Behavior Among U.S. Young Adults

PubMed Central

2014-01-01

Introduction: In 2011, the Food and Drug Administration published a final rule requiring cigarette packages and advertisements to include graphic health warning labels (HWLs) with new warning statements. Implementation of this rule has been stalled by legal challenge. This study assessed correlates of smoking-related intentions related to graphic HWLs among current cigarette smokers and nonsmokers in a national sample of U.S. young adults aged 18–34. Methods: Data were collected from 4,236 participants aged 18–34 using an online panel in January 2012 for the Legacy Young Adult Cohort Study. Analyses were weighted to provide nationally representative estimates. Our main outcome was assessed with a single item: “Do you think that new warning labels with graphic pictures would make you think about not smoking?” Results: Twenty-two percent of the young adults were current cigarette smokers. Fifty-three percent endorsed that new graphic HWLs would make them think about not smoking (40% among current smokers compared with 56% among nonsmokers). Among nonsmokers, those aged 18–24, females, Hispanics, and those who were aware of graphic cigarette HWLs were more likely to report intention to not smoke related to graphic HWLs. Among current smokers, intending to quit within the next 6 months was correlated with intention resulting from graphic HWLs. Hispanic ethnicity and intention to quit within 30 days were strong correlates of intention in light, nondaily, and self-identified social/occasional smokers. Conclusions: This study supports previous findings that graphic HWLs play an important role in preventing smoking, in addition to encouraging cessation in young adults. PMID:24212476

Attitudes and behavioral response toward key tobacco control measures from the FCTC among Chinese urban residents.

PubMed

Yang, Tingzhong; Wu, Yanwei; Abdullah, Abu Saleh M; Dai, Di; Li, Fuzhong; Wu, Junqing; Xiang, Haiqing

2007-09-18

The Chinese National People's Congress ratified the WHO Framework Convention on Tobacco Control (FCTC) on 27 August 2005, signaling China's commitment to implement tobacco control policies and legislation consistent with the treaty. This study was designed to examine attitudes towards four WHO FCTC measures among Chinese urban residents. In a cross-sectional design study, survey data were collected from two Chinese urban cities involving a sample of 3,003 residents aged 15 years or older. Through a face-to-face interview, respondents were asked about attitudes toward four tobacco control measures developed by the WHO FCTC. Data on the four dependent measures were analyzed using multivariate logistic regression analyses. Using descriptive statistics, potential change in smoking behavior that smokers might make in response to increasing cigarette prices is also reported. 81.8% of the respondents in the study sample supported banning smoking in public places, 68.8% favored increasing the cigarette tax, 85.1% supported health warnings on cigarette packages, and 85.7% favored banning tobacco advertising. The likelihood to support these measures was associated with gender, educational level, and personal income. Smokers were less likely to support these measures than non-smokers, with decreased support expressed by daily smokers compared to occasional smokers, and heavy smokers compared to light smokers. The proportion of switching to cheaper cigarette brands, decreasing smoking, and quitting smoking altogether with increased cigarette prices were 29.1%, 30.90% and 40.0% for occasional smokers, respectively; and 30.8%, 32.7% and 36.5% for daily smokers, respectively. Results from this study indicate strong public support in key WHO FCTC measures and that increases in cigarette price may reduce tobacco consumption among Chinese urban residents. Findings from this study have implications with respect to policymaking and legislation for tobacco control in China.

A store cohort study of compliance with a point-of-sale cigarette display ban in Melbourne, Australia.

PubMed

Zacher, Meghan; Germain, Daniella; Durkin, Sarah; Hayes, Linda; Scollo, Michelle; Wakefield, Melanie

2013-02-01

This study aimed to evaluate compliance with legislation which restricted cigarette displays in retail outlets, and to assess prevalence of pro- and anti-tobacco elements in stores pre- and post-legislation. METHODS Three audits of 302 stores in Melbourne, Australia by trained observers who gathered information on point-of-sale tobacco displays 2-3 months before and 3-4 and 11-12 months after the enactment of new restrictions. Between the first and second audits, nine stores stopped selling tobacco and three stores had either shut down or were closed for renovations. Of the remaining 290 stores, 94.1% observed the full ban on cigarette package visibility, while new restrictions on price board size and new requirements for graphic health warnings were followed in 85.9% and 67.2% of stores, respectively. Between the second and third audits, another seven stores ended tobacco sales and two stores closed. In Audit 3, 89.7% of the remaining 281 stores complied with price board restrictions, and 82.2% of stores followed requirements for graphic health warnings. Overall, the prevalence of anti-tobacco signage increased and pro-tobacco features decreased between audits for every store type and neighborhood socio-economic status. Tobacco retailers were almost universally compliant with placing cigarettes out of sight and a substantial majority were compliant with regulations on price board size and display of graphic health warnings, demonstrating that such legislation can be implemented successfully.

Tobacco industry manipulation of data on and press coverage of the illicit tobacco trade in the UK

PubMed Central

Rowell, A; Evans-Reeves, K; Gilmore, A B

2014-01-01

Background In the UK, transnational tobacco companies (TTCs) have been arguing that levels of illicit trade are high and increasing and will rise further if standardised packaging is implemented. This paper examines trends in and accuracy of media reporting of, and industry data on, illicit tobacco in the UK. Methods Quantification of the volume, nature and quality of press articles citing industry data on illicit tobacco in UK newspapers from March 2008 to March 2013. Examination of published TTC data on illicit, including a comparison with independent data and of TTC reporting of Her Majesty's Revenue and Customs data on illicit. Results Media stories citing industry data on illicit tobacco began in June 2011, 2 months after the Tobacco Control Plan for England, which heralded standardised packaging, was published. The majority of data cited are based on industry Empty Pack Surveys for which no methodology is available. For almost all parts of the country where repeat data were cited in press stories, they indicated an increase, often substantial, in non-domestic/illicit cigarettes that is not supported by independent data. Similarly, national data from two published industry sources show a sudden large increase in non-domestic product between 2011 and 2012. Yet the methodology of one report changes over this period and the other provides no published methodology. In contrast, independent data show steady declines in non-domestic and illicit cigarette penetration from 2006 to 2012 and either a continued decline or small increase to 2013. Conclusions Industry claims that use of Non-UK Duty Paid/illicit cigarettes in the UK is sharply increasing are inconsistent with historical trends and recent independent data. TTCs are exaggerating the threat of illicit tobacco by commissioning surveys whose methodology and validity remain uncertain, planting misleading stories and misquoting government data. Industry data on levels of illicit should be treated with extreme caution. PMID:24614041

Larger and More Prominent Graphic Health Warnings on Plain-Packaged Tobacco Products and Avoidant Responses in Current Smokers: a Qualitative Study.

PubMed

Hardcastle, Sarah J; Chan, Derwin C K; Caudwell, Kim M; Sultan, Sarwat; Cranwell, Jo; Chatzisarantis, Nikos L D; Hagger, Martin S

2016-02-01

The introduction of tobacco plain packaging legislation in Australia meant that all tobacco products were to be sold in plain dark-brown packaging with 75% front-of-pack graphic health warnings and standardised font type and size for brand name and product variant. The change in the size and prominence of the warnings has been proposed as a reason for behaviour change in smokers in terms of increased intentions to quit and quit attempts. The current research examined attitudes and beliefs of cigarette smokers toward the increased size and prominence of the warnings and effects on their behaviour. Participants (N = 160) completed open-ended responses to questions on beliefs, attitudes and responses to plain packaging. Responses were subjected to inductive thematic content analysis for key themes. Four themes emerged from the analysis: emotional response to packaging, scepticism of health warnings, warnings and cessation behaviour, and avoidant coping behaviours. Participants reported increased negative emotional responses to the packaging and made specific reference to the graphic health warnings. Some participants attempted to discredit the messages. Others reported increased intentions to quit or quitting attempts. There were pervasive reports of avoidant responses including covering or hiding the warnings. Consistent with theories of illness perceptions and coping, current findings indicate that the larger, prominent graphic health warnings on plain-packaged tobacco products had pervasive effects on threat perceptions and subsequent behavioural responses. While some of the reported responses were adaptive (e.g. attempts to quit), others were maladaptive (e.g. avoiding the warnings).

Echo's Legacy

NASA Technical Reports Server (NTRS)

1980-01-01

The Echo 1 Satellite is simply a very large balloon, the diameter of a 10 story building. Metallized Products, Inc. developed a special material for NASA used for the balloons's skin. For "bouncing signals," material had to be reflective, lightweight, and thin enough to be folded into a beach ball size canister for delivery into orbit, where it would automatically inflate. Material selected was mylar polyester, with a reflective layer of tiny aluminum particles so fine that Echo's skin had a thickness half that of cellophane on a cigarette package.

The Australian experience following plain packaging: the impact on tobacco branding.

PubMed

Greenland, Steven J

2016-12-01

Brands are critical to tobacco marketing. Industry stakeholders predicted that plain packaging, by removing key tangible branding dimensions, would restrict new products and brand differentiation. However, manufacturers respond innovatively to limit regulatory impact. This study investigates brand strategy following plain packaging's introduction to Australia. Brand portfolios were determined using 2006-15 tobacco ingredient reports. These detail the brand and variant names sold and are provided annually as part of a voluntary agreement between the Australian Government and leading manufacturers. Post-plain packaging brand ranges were verified using retail price lists and a supermarket retail audit using a method used previously to verify a period of pre-plain packaging data. The verification process identified some data inaccuracies from one manufacturer which resulted in the issuing of corrected data. After plain packaging the leading manufacturers continued with extensive brand ranges differentiated by price. All launched new products. While total brand numbers fell from 29 to 24, the mean number of variants for the leading 12 brands grew from 8.9 to 9.7. Substantial variant name modifications occurred with 50 new or modified names in 2012-13. Among leading brands, the incidence of variant colour names increased from 49.5 to 79.3%. New brands and variants were not inhibited by the introduction of plain packaging in Australia. After plain packaging, leading brand variant numbers expanded by 9 to 116 and colour variant names increased by 73.6% and became the norm-lighter colours (blue, gold and silver) dominated, perpetuating notions of less harmful cigarettes. [Correction added on 09 September 2016, after first online publication: The figures in the last sentence of the Abstract are now corrected from 'expanded by 116' to 'expanded by 9 to 116'.]. © 2016 Society for the Study of Addiction.

Compliance with Uruguay’s single presentation requirement

PubMed Central

DeAtley, Teresa; Bianco, Eduardo; Welding, Kevin; Cohen, Joanna E

2018-01-01

Introduction Tobacco companies vary pack colours, designs, descriptors, flavours and brand names on cigarette packs to target a multitude of consumers. These different brand variants can falsely imply that some brand variants are less harmful than others. Uruguay is the only country that requires cigarette companies to adhere to a single presentation (one brand variant) per brand family. Methods An existing, systematic pack purchasing protocol was adapted for data collection. Neighbourhoods in Montevideo were categorised into five strata by percentage of poor households. Five neighbourhoods within each stratum were selected based on geographical variation. In each neighbourhood, a ‘starting hub’ was identified and a systematic walking protocol was implemented to purchase unique packs at four key vendor types. Results Unique packs were purchased in 9 out of 25 neighbourhoods. Fifty-six unique packs were purchased, representing 30 brands. Of these, 51 packs were legal, representing 26 brands. The majority of the legal brands (n=16; 62%) were compliant with the requirement. The remaining packs were non-compliant due to differences in colour, design element, brand name, crest and descriptors. Although not prohibited by the single presentation requirement, 16 legal brands had more than one stick count (10, 11, 14 or 20 sticks), and packs from four brands had more than one packaging type (hard, soft or tin). Conclusion Overall, compliance with Uruguay’s single presentation requirement was good. In addition to the current restrictions, future single presentation requirements could expand to include packs in more than one stick count and packaging type. PMID:28416710

Can pictorial warning labels on cigarette packages address smoking-related health disparities?: Field experiments in Mexico to assess warning label content

PubMed Central

Thrasher, James F.; Arillo-Santillán, Edna; Villalobos, Victor; Pérez-Hernández, Rosaura; Hammond, David; Carter, Jarvis; Sebrié, Ernesto; Sansores, Raul; Regalado-Piñeda, Justino

2012-01-01

Objective This study aimed to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. Methods Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers), wherein participants reported responses to different HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs didactic) and the other involved manipulating imagery type (diseased organs vs human suffering). Results Tests of mean ratings and rankings indicated that HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance and impact was found for graphic imagery of diseased organs than imagery of human suffering. Conclusions Pictorial HWLs with didactic textual forms appear to work better than with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases. PMID:22350859

Can pictorial warning labels on cigarette packages address smoking-related health disparities? Field experiments in Mexico to assess pictorial warning label content.

PubMed

Thrasher, James F; Arillo-Santillán, Edna; Villalobos, Victor; Pérez-Hernández, Rosaura; Hammond, David; Carter, Jarvis; Sebrié, Ernesto; Sansores, Raul; Regalado-Piñeda, Justino

2012-03-01

The objective of this study was to determine the most effective content of pictorial health warning labels (HWLs) and whether educational attainment moderates these effects. Field experiments were conducted with 529 adult smokers and 530 young adults (258 nonsmokers; 271 smokers). Participants reported responses to different pictorial HWLs printed on cigarette packages. One experiment involved manipulating textual form (testimonial narrative vs. didactic) and the other involved manipulating image type (diseased organs vs. human suffering). Tests of mean ratings and rankings indicated that pictorial HWLs with didactic textual forms had equivalent or significantly higher credibility, relevance, and impact than pictorial HWLs with testimonial forms. Results from mixed-effects models confirmed these results. However, responses differed by participant educational attainment: didactic forms were consistently rated higher than testimonials among participants with higher education, whereas the difference between didactic and testimonial narrative forms was weaker or not statistically significant among participants with lower education. In the second experiment, with textual content held constant, greater credibility, relevance, and impact was found for graphic imagery of diseased organs than imagery of human suffering. Pictorial HWLs with didactic textual forms seem to work better than those with testimonial narratives. Future research should determine which pictorial HWL content has the greatest real-world impact among consumers from disadvantaged groups, including assessment of how HWL content should change to maintain its impact as tobacco control environments strengthen and consumer awareness of smoking-related risks increases.

Cigarette package inserts can promote efficacy beliefs and sustained smoking cessation attempts: A longitudinal assessment of an innovative policy in Canada

PubMed Central

Thrasher, James F.; Swayampakala, Kamala; Cummings, K. Michael; Hammond, David; Anshari, Dien; Krugman, Dean M.; Hardin, James W.

2016-01-01

Background In June 2012, Canada implemented new pictorial warnings on cigarette packages, along with package inserts with messages to promote response efficacy (i.e., perceived quitting benefits) and self-efficacy (i.e., confidence to quit). This study assessed smokers’ attention towards warnings and inserts and its relationship with efficacy beliefs, risk perceptions and cessation at follow-up. Methods Data were analysed in 2015 from a prospective online consumer panel of adult Canadian smokers surveyed every four months between September 2012 and September 2014. Generalized Estimating Equation models assessed associations between reading inserts, reading warnings and efficacy beliefs (self-efficacy, response efficacy), risk perceptions, quit attempts of any length, and sustained quit attempts (i.e., 30 days or more) at follow-up. Models adjusted for socio-demographics, smoking-related variables, and time-in-sample effects. Results Over the study period, reading warnings significantly decreased (p<0.0001) while reading inserts increased (p=0.004). More frequent reading of warnings was associated independently with stronger response efficacy (Boften/very often vs never=0.28, 95% CI: 0.11–0.46) and risk perceptions at follow-up (Boften/very often vs never=0.31, 95% CI: 0.06–0.56). More frequent reading of inserts was associated independently with stronger self-efficacy to quit at follow-up (Btwice or more vs none=0.30, 95% CI: 0.14–0.47), quit attempts (ORtwice or more vs none= 1.68, 95% CI: 1.28–2.19), and quit attempts lasting 30 days or longer (ORtwice or more vs none=1.48, 95% CI: 1.01 – 2.17). Conclusions More frequent reading of inserts was associated with self-efficacy to quit, quit attempts, and sustained quitting at follow-up, suggesting that inserts complement pictorial HWLs. PMID:26970037

Tobacco control campaign in Uruguay: Impact on smoking cessation during pregnancy and birth weight.

PubMed

Harris, Jeffrey E; Balsa, Ana Inés; Triunfo, Patricia

2015-07-01

We analyzed a nationwide registry of all pregnancies in Uruguay during 2007-2013 to assess the impact of three types of tobacco control policies: (1) provider-level interventions aimed at the treatment of nicotine dependence, (2) national-level increases in cigarette taxes, and (3) national-level non-price regulation of cigarette packaging and marketing. We estimated models of smoking cessation during pregnancy at the individual, provider and national levels. The rate of smoking cessation during pregnancy increased from 15.4% in 2007 to 42.7% in 2013. National-level non-price policies had the largest estimated impact on cessation. The price response of the tobacco industry attenuated the effects of tax increases. While provider-level interventions had a significant effect, they were adopted by relatively few health centers. Quitting during pregnancy increased birth weight by an estimated 188 g. Tobacco control measures had no effect on the birth weight of newborns of non-smoking women. Copyright © 2015 Elsevier B.V. All rights reserved.

[Monitoring strategy for control of tobacco in Mexico: advertising, promotion and sponsorship, packaging and labeling].

PubMed

Rodríguez-Bolaños, Rosibel; Reynales-Shigematsu, Luz Myriam; Ibañez-Hernández, Norma A; Santos-Luna, René; Valdés-Salgado, Raydel; Avila-Tang, Erika; Stillman, Frances

2010-01-01

To describe strategies used in the publicity, marketing, and sale, of tobacco products in 12 cities in Mexico. Tobacco products points of sale (POS) were identified within a 500 m radius of Global Youth Tobacco Survey (2005-2006) schools. We used observational surveys and an online Geographic Information System (GIS). In the 257 schools visited, we found, on average, 8.3 stores and 5 street vendors around each of them. Forty-four percent of the stores had interior tobacco publicity, 8.3% had tobacco products at children's eye level, 6.5% had some promotion, 33.6% had a no selling to minors sign, and 44.4% of stores and 58.8% of street vendors sold single cigarettes. Tobacco products are largely publicized and marketed around schools. There is no compliance of tobacco control legislation in regards to selling to minors and single cigarettes. It is necessary to implement a surveillance system to monitor strategies for tobacco control and the tobacco industry.

Worldwide effort against smoking.

PubMed

1986-07-01

The 39th World Health Assembly, which met in May 1986, recognized the escalating health problem of smoking-related diseases and affirmed that tobacco smoking and its use in other forms are incompatible with the attainment of "Health for All by the Year 2000." If properly implemented, antismoking campaigns can decrease the prevalence of smoking. Nations as a whole must work toward changing smoking habits, and governments must support these efforts by officially stating their stand against smoking. Over 60 countries have introduced legislation affecting smoking. The variety of policies range from adopting a health education program designed to increase peoples' awareness of its dangers to increasing taxes to deter smoking by increasing tobacco prices. Each country must adopt an antismoking campaign which works most effectively within the cultural parameters of the society. Other smoking policies include: printed warnings on cigarette packages; health messages via radio, television, mobile teams, pamphlets, health workers, clinic walls, and newspapers; prohibition of smoking in public areas and transportation; prohibition of all advertisement of cigarettes and tobacco; and the establishment of upper limits of tar and nicotine content in cigarettes. The tobacco industry spends about $2000 million annually on worldwide advertising. According to the World Health Organization (WHO), controlling this overabundance of tobacco advertisements is a major priority in preventing the spread of smoking. Cigarette and tobacco advertising can be controlled to varying degrees, e.g., over a dozen countries have enacted a total ban on advertising on television or radio, a mandatory health warning must accompany advertisements in other countries, and tobacco companies often are prohibited from sponsoring sports events. Imposing a substantial tax on cigarettes is one of the most effective means to deter smoking. However, raising taxes and banning advertisements is not enough because smokers need to be aware of the dangers of smoking. Health education projects and public information should address the hazards of smoking and discourage smoking from becoming the social norm.

Tobacco industry manipulation of data on and press coverage of the illicit tobacco trade in the UK.

PubMed

Rowell, A; Evans-Reeves, K; Gilmore, A B

2014-05-01

In the UK, transnational tobacco companies (TTCs) have been arguing that levels of illicit trade are high and increasing and will rise further if standardised packaging is implemented. This paper examines trends in and accuracy of media reporting of, and industry data on, illicit tobacco in the UK. Quantification of the volume, nature and quality of press articles citing industry data on illicit tobacco in UK newspapers from March 2008 to March 2013. Examination of published TTC data on illicit, including a comparison with independent data and of TTC reporting of Her Majesty's Revenue and Customs data on illicit. Media stories citing industry data on illicit tobacco began in June 2011, 2 months after the Tobacco Control Plan for England, which heralded standardised packaging, was published. The majority of data cited are based on industry Empty Pack Surveys for which no methodology is available. For almost all parts of the country where repeat data were cited in press stories, they indicated an increase, often substantial, in non-domestic/illicit cigarettes that is not supported by independent data. Similarly, national data from two published industry sources show a sudden large increase in non-domestic product between 2011 and 2012. Yet the methodology of one report changes over this period and the other provides no published methodology. In contrast, independent data show steady declines in non-domestic and illicit cigarette penetration from 2006 to 2012 and either a continued decline or small increase to 2013. Industry claims that use of Non-UK Duty Paid/illicit cigarettes in the UK is sharply increasing are inconsistent with historical trends and recent independent data. TTCs are exaggerating the threat of illicit tobacco by commissioning surveys whose methodology and validity remain uncertain, planting misleading stories and misquoting government data. Industry data on levels of illicit should be treated with extreme caution. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Impact of Australia's introduction of tobacco plain packs on adult smokers’ pack-related perceptions and responses: results from a continuous tracking survey

PubMed Central

Dunlop, Sally M; Dobbins, Timothy; Young, Jane M; Perez, Donna; Currow, David C

2014-01-01

Objectives To investigate the impact of Australia's plain tobacco packaging policy on two stated purposes of the legislation—increasing the impact of health warnings and decreasing the promotional appeal of packaging—among adult smokers. Design Serial cross-sectional study with weekly telephone surveys (April 2006–May 2013). Interrupted time-series analyses using ARIMA modelling and linear regression models were used to investigate intervention effects. Participants 15 745 adult smokers (aged 18 years and above) in New South Wales (NSW), Australia. Random selection of participants involved recruiting households using random digit dialling and selecting the nth oldest smoker for interview. Intervention The introduction of the legislation on 1 October 2012. Outcomes Salience of tobacco pack health warnings, cognitive and emotional responses to warnings, avoidance of warnings, perceptions regarding one's cigarette pack. Results Adjusting for background trends, seasonality, antismoking advertising activity and cigarette costliness, results from ARIMA modelling showed that, 2–3 months after the introduction of the new packs, there was a significant increase in the absolute proportion of smokers having strong cognitive (9.8% increase, p=0.005), emotional (8.6% increase, p=0.01) and avoidant (9.8% increase, p=0.0005) responses to on-pack health warnings. Similarly, there was a significant increase in the proportion of smokers strongly disagreeing that the look of their cigarette pack is attractive (57.5% increase, p<0.0001), says something good about them (54.5% increase, p<0.0001), influences the brand they buy (40.6% increase, p<0.0001), makes their pack stand out (55.6% increase, p<0.0001), is fashionable (44.7% increase, p<0.0001) and matches their style (48.1% increase, p<0.0001). Changes in these outcomes were maintained 6 months postintervention. Conclusions The introductory effects of the plain packaging legislation among adult smokers are consistent with the specific objectives of the legislation in regard to reducing promotional appeal and increasing effectiveness of health warnings. PMID:25524542

Comparing perceived effectiveness of FDA-proposed cigarette packaging graphic health warnings between sexual and gender minorities and heterosexual adults.

PubMed

Tan, Andy S L; Bigman, Cabral A; Nagler, Rebekah H; Minsky, Sara; Viswanath, Kasisomayajula

2017-10-01

In 2012, the U.S. Food and Drug Administration proposed nine graphic health warnings (GHWs) on cigarette packaging that were rated equally effective across racial/ethnic, education, or income groups of adult smokers. However, data on GHW effectiveness among sexual and gender minority (SGM) adults, who have higher smoking prevalence, are currently lacking. This study analyzed whether perceived effectiveness of GHWs differed by gender and sexual orientation. Data came from a randomized experiment among 1,200 adults with an oversample from low socioeconomic status groups, conducted between 2013 and 2014 in three Massachusetts communities. Participants viewed and rated the effectiveness of nine GHWs. Mixed effects regression models predicted perceived effectiveness with gender and sexual orientation, adjusting for repeated measurements, GHWs viewed, age, race, ethnicity, smoking status, and health status. Female heterosexuals rated GHWs as more effective than male heterosexual, lesbian, and transgender and other gender respondents. There was no significant difference between female and male heterosexuals versus gay, male bisexual, or female bisexual respondents. Differences by gender and sexual orientation were consistent across all nine GHWs. Significant correlates of higher perceived effectiveness included certain GHWs, older age, being African-American (vs white), being Hispanic (vs non-Hispanic), having less than high school education (vs associate degree or higher), and being current smokers (vs non-smokers). Perceived effectiveness of GHWs was lower in certain SGM groups. We recommend further studies to understand the underlying mechanisms for these findings and investments in research and policy to communicate anti-smoking messages more effectively to SGM populations.

[Understand the tobacco industry's strategy for recruiting teens: Lessons from a 1973 marketing document].

PubMed

Dautzenberg, B

2018-06-01

For years, the tobacco industry has organized the inoculation of tobacco addiction to adolescents. The analysis of a 1973 RJReynols ® document identified ten physical and psychological factors in order to increase the number of young users for a brand of cigarettes. These young people are classified into three groups: pre-smokers, learners and smokers. The taste for pre-smokers and learners and nicotine for smokers are main physical parameters. The industry clearly knows that tobacco is mainly consumed because of nicotine addiction, so it is necessary to make adolescents addict. It is interesting to note that cigarette pack was in 1973 a positive factor to attract young smokers, whereas now with the arrival of the neutral packaging, the tobacco industry declares that packaging has no influence to attract teenagers ! Of the psychological factors, the only negative factor is the self-image of the smoker. The tobacco industry already recognized in 1973 that smokers were unhappy about smoking. For learners, self-image and the experience of adults are most important factor, which is why the industry strives to create a positive image and convey message that smoking initiation is a ritual to become adult. According to the tobacco industry, stress and alleviation of boredom are also important points in turning pre-smokers into learners and learners into smokers. This article aims to provide practical tools for understanding industry initiatives targeting adolescents. The attached tool can be used by the teens or adults involved to understand the optimization of teenagers tobacco marketing. Copyright © 2018 Elsevier Masson SAS. All rights reserved.

Global and regional estimates of the effectiveness and cost-effectiveness of price increases and other tobacco control policies.

PubMed

Ranson, M Kent; Jha, Prabhat; Chaloupka, Frank J; Nguyen, Son N

2002-08-01

The objective of this study was to provide conservative estimates of the global and regional effectiveness and cost-effectiveness of tobacco control policies. Using a static model of the cohort of smokers alive in 1995, we estimated the number of smoking-attributable deaths that could be averted by: (1) price increases, (2) nicotine replacement therapy (NRT), and (3) a package of non-price interventions other than NRT. We calculated the cost-effectiveness of these policy interventions by weighing the approximate public-sector costs against the years of healthy life saved, measured in disability-adjusted life years, or DALYs. Even with deliberately conservative assumptions, tax increases that would raise the real price of cigarettes by 10% worldwide would prevent between 5 and 16 million tobacco-related deaths, and could cost 3-70 US dollars per DALY saved in low-income and middle-income regions. NRT and a package of non-price interventions other than NRT are also cost-effective in low-income and middle-income regions, at 280-870 US dollars per DALY and 36-710 US dollars per DALY, respectively. In high-income countries, price increases were found to have a cost-effectiveness of 83-2771 US dollars per DALY, NRT 750-7206 US dollars per DALY and other non-price interventions 696-13,924 US dollars per DALY. Tobacco control policies, particularly tax increases on cigarettes, are cost-effective relative to other health interventions. Our estimates are subject to considerable variation in actual settings; thus, local cost-effectiveness studies are required to guide local policy.

Responses of young adults to graphic warning labels for cigarette packages

PubMed Central

Cameron, Linda D.; Pepper, Jessica K.; Brewer, Noel T.

2013-01-01

Background In 2010, the US Food and Drug Administration (FDA) proposed a series of 36 graphic warning labels for cigarette packages. We sought to evaluate the effects of the labels on fear-related emotions about health consequences of smoking and smoking motivations of young adults. Methods We conducted an experimental study in 2010–2011 with 325 smokers and non-smokers ages 18–30 years whom we recruited through community distribution lists in North Carolina and through a national survey company. Each participant viewed 27 labels (18 of the proposed labels with graphic images and text warnings and 9 with text-only warnings) in a random order, evaluating each label on understandability and its effects on fear-related reactions and discouragement from wanting to smoke. Results Respondents found most of the proposed labels easy to understand. Of the 36 labels, 64% induced greater fear-related reactions and 58% discouraged respondents from wanting to smoke more than the corresponding text-only labels did. Labels with the greatest effects had photographs (as compared with drawings or other art graphics) or depicted diseased body parts or suffering or dead people. In almost every comparison, smokers reported lower fear-related reactions and feeling less discouraged from wanting to smoke relative to non-smokers. Conclusions Most of the proposed labels enhanced fear-related reactions about health consequences of smoking and reduced motivations to smoke relative to text-only labels, although some had larger effects than others. All but one of the nine warning labels recently adopted by the FDA enhanced fear-related reactions and reduced smoking motivations. PMID:23624558

Linking mass media campaigns to pictorial warning labels on cigarette packages: a cross-sectional study to evaluate effects among Mexican smokers.

PubMed

Thrasher, James F; Murukutla, Nandita; Pérez-Hernández, Rosaura; Alday, Jorge; Arillo-Santillán, Edna; Cedillo, Claudia; Gutierrez, Juan Pablo

2013-05-01

This study assessed the effects of pictorial health warning labels (HWLs) and a linked media campaign in Mexico. Cross-sectional data were collected from a population-based sample of 1756 adult smokers, aged 18-55 years, during the initial implementation of pictorial HWLs, which some smokers had seen on cigarette packages while others had seen only the text-based HWLs. Exposure to the campaign and pictorial HWLs was assessed with aided recall methods, and other questions addressed attention and cognitive impact of HWLs, knowledge related to HWL and campaign content, and quit-related thoughts and behaviours. Logistic and linear regression models were estimated to determine associations between key outcomes and intervention exposure. In bivariate and multivariate adjusted models, recall of pictorial HWLs and of the campaign were positively associated with greater attention to and cognitive impact of HWLs, whereas only pictorial HWL exposure was associated with having refrained from smoking due to HWLs. Both recall of pictorial HWLs and of the campaign were independently associated with greater knowledge of secondhand smoke harms and toxic tobacco constituents. Smokers who recalled only the pictorial HWLs were more likely to try to quit than smokers who recalled neither the pictorial HWLs nor the campaign (17% vs 6%, p<0.001). Consistent with other studies, adult smokers' exposure to new pictorial HWLs in Mexico was associated with psychosocial and behavioural responses related to quit behaviour. Exposure to the complementary media campaign was associated with independent additive effects on campaign-related knowledge, and it enhanced psychosocial responses to pictorial HWLs.

Emotional salience of the image component facilitates recall of the text of cigarette warning labels.

PubMed

Wang, An-Li; Shi, Zhenhao; Fairchild, Victoria P; Aronowitz, Catherine A; Langleben, Daniel D

2018-04-26

Graphic warning labels (GWLs) on cigarette packages, that combine textual warnings with emotionally salient images depicting the adverse health consequences of smoking, have been adopted in most European countries. In the US, the courts deemed the evidence justifying the inclusion of emotionally salient images in GWLs insufficient and put the implementation on hold. We conducted a controlled experimental study examining the effect of emotional salience of GWL's images on the recall of their text component. Seventy-three non-treatment-seeking daily smokers received cigarette packs carrying GWLs for a period of 4 weeks. Participants were randomly assigned to receive packs with GWLs previously rated as eliciting high or low level of emotional reaction (ER). The two conditions differed in respect to images but used the same textual warning statements. Participants' recognition of GWL images and statements were tested separately at baseline and again after the 4-week repetitive exposure. Textual warning statements were recognized more accurately when paired with high ER images than when paired with low ER images, both at baseline and after daily exposure to GWLs over a 4-week period. The results suggest that emotional salience of GWLs facilitates cognitive processing of the textual warnings, resulting in better remembering of the information about the health hazards of smoking. Thus, high emotional salience of the pictorial component of GWLs is essential for their overall effectiveness.

Assessing Health Impacts of Pictorial Health Warning Labels on Cigarette Packs in Korea Using DYNAMO-HIA

PubMed Central

2017-01-01

Objectives This study aimed to predict the 10-year impacts of the introduction of pictorial warning labels (PWLs) on cigarette packaging in 2016 in Korea for adults using DYNAMO-HIA. Methods In total, four scenarios were constructed to better understand the potential health impacts of PWLs: two for PWLs and the other two for a hypothetical cigarette tax increase. In both policies, an optimistic and a conservative scenario were constructed. The reference scenario assumed the 2015 smoking rate would remain the same. Demographic data and epidemiological data were obtained from various sources. Differences in the predicted smoking prevalence and prevalence, incidence, and mortality from diseases were compared between the reference scenario and the four policy scenarios. Results It was predicted that the optimistic PWLs scenario (PWO) would lower the smoking rate by 4.79% in males and 0.66% in females compared to the reference scenario in 2017. However, the impact on the reduction of the smoking rate was expected to diminish over time. PWO will prevent 85 238 cases of diabetes, 67 948 of chronic obstructive pulmonary disease, 31 526 of ischemic heart disease, 21 036 of lung cancer, and 3972 prevalent cases of oral cancer in total over the 10-year span due to the reductions in smoking prevalence. The impacts of PWO are expected to be between the impact of the optimistic and the conservative cigarette tax increase scenarios. The results were sensitive to the transition probability of smoking status. Conclusions The introduction of PWLs in 2016 in Korea is expected reduce smoking prevalence and disease cases for the next 10 years, but regular replacements of PWLs are needed for persistent impacts. PMID:28768403

Assessing Health Impacts of Pictorial Health Warning Labels on Cigarette Packs in Korea Using DYNAMO-HIA.

PubMed

Kang, Eunjeong

2017-07-01

This study aimed to predict the 10-year impacts of the introduction of pictorial warning labels (PWLs) on cigarette packaging in 2016 in Korea for adults using DYNAMO-HIA. In total, four scenarios were constructed to better understand the potential health impacts of PWLs: two for PWLs and the other two for a hypothetical cigarette tax increase. In both policies, an optimistic and a conservative scenario were constructed. The reference scenario assumed the 2015 smoking rate would remain the same. Demographic data and epidemiological data were obtained from various sources. Differences in the predicted smoking prevalence and prevalence, incidence, and mortality from diseases were compared between the reference scenario and the four policy scenarios. It was predicted that the optimistic PWLs scenario (PWO) would lower the smoking rate by 4.79% in males and 0.66% in females compared to the reference scenario in 2017. However, the impact on the reduction of the smoking rate was expected to diminish over time. PWO will prevent 85 238 cases of diabetes, 67 948 of chronic obstructive pulmonary disease, 31 526 of ischemic heart disease, 21 036 of lung cancer, and 3972 prevalent cases of oral cancer in total over the 10-year span due to the reductions in smoking prevalence. The impacts of PWO are expected to be between the impact of the optimistic and the conservative cigarette tax increase scenarios. The results were sensitive to the transition probability of smoking status. The introduction of PWLs in 2016 in Korea is expected reduce smoking prevalence and disease cases for the next 10 years, but regular replacements of PWLs are needed for persistent impacts.

Adolescents' response to pictorial warnings on the reverse panel of cigarette packs: a repeat cross-sectional study.

PubMed

Moodie, Crawford; Mackintosh, Anne M; Hastings, Gerard

2015-03-01

The UK (UK) became the third country in the European Union to require pictorial warnings on the back of cigarette packs, in October 2008. A repeat cross-sectional survey was conducted with 11-16-year-olds in the UK between August and September 2008 (N=1401) and August and September 2011 (N=1373). At both waves the same text warnings appeared on the front and back of packs, with the only difference being the inclusion of images on the back of packs to support the text warnings in 2011. Warning related measures assessed were salience (noticing, looking closely at warnings), depth of processing (thinking about warnings, discussing them with others), comprehension and credibility (warning comprehensibility, believability and truthfulness), unaided recall, persuasiveness (warnings as a deterrent to smoking), avoidance techniques (eg, hiding packs) and a behavioural indicator (forgoing cigarettes due to warnings). For never smokers, warning persuasiveness and thinking about what warnings are telling them when the pack is in sight significantly increased from 2008 to 2011, but warning comprehensibility significantly decreased. For experimental smokers, there was a significant increase from 2008 to 2011 for warning persuasiveness, believing warnings and considering them truthful. For regular smokers, there were no significant changes from 2008 to 2011, except for an increase in hiding packs to avoid warnings and a decrease in warning salience. Including pictorial images on the back of cigarette packaging improved warning persuasiveness for never and experimental smokers, but had a negligible impact on regular smokers. The findings have implications for warning design. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Knowledge of and attitudes towards tobacco control among smoking and non-smoking physicians in 2 Gulf Arab states.

PubMed

Behbehani, Nasser N; Hamadeh, Randah R; Macklai, Nejma S

2004-05-01

The global health professional survey is a project organized by the World Health Organization, to determine the smoking habits, knowledge and attitude towards tobacco control of health professionals in several countries around the world. This paper presents data from Kuwait and Bahrain. The survey period was between May 2000 and March 2001. A questionnaire was distributed to all physicians in Bahrain and to a random sample from Kuwait. The responses to knowledge and attitude questions were on a scale of 1-5, (1 strongly agree, 2 agree, 3 unsure, 4 disagree and 5 strongly disagree). Four hundred and seventy physicians from Bahrain and 1095 from Kuwait completed the questionnaire. The prevalence of cigarette smoking in Kuwait was: current smokers 18.4%, previous smokers 15.8%, Bahrain 14.6% and 14.3%. The prevalence of shisha smoking was 12% and 6.4% for Kuwait and Bahrain, (p=0.004). The mean scores of agreement with the association between passive smoking and lung diseases, lower respiratory tract infections in children were 1.6, 1.7 and 1.8, 1.9 for non smoking physicians and smoking physicians (P<0.01). The mean scores of agreement with the following policies: large health warning on cigarette packages, complete ban on tobacco advertisement and an increase in the price of cigarette were 1.3, 1.4, 1.7 and 1.7, 1.7, 2.5 for smoking and non-smoking physicians (p<0.01). Smoking physicians have less knowledge and less favorable attitude towards tobacco control compared to non-smokers. There was no difference in the prevalence of cigarette smoking between Kuwait and Bahrain, but the prevalence of shisha smoking was higher in Kuwait.

Promotions on Newport and Marlboro Cigarette Packages: A National Study.

PubMed

Lee, Joseph G L; Richardson, Amanda; Golden, Shelley D; Ribisl, Kurt M

2017-10-01

While cigarette pack designs are part of integrated marketing efforts, it is unclear the degree to which packs are used to advertise promotions and whether the tobacco retailers' neighborhood characteristics influence the likelihood and type of pack-based promotion in the United States. Between June and October 2012, data collectors purchased packs of either Marlboro Red (n = 1090) or Newport Green (n = 1057) cigarettes at 2147 stores that were part of a national sample of tobacco retailers in the contiguous US. Coders rated packs for the presence of an exterior and interior pack promotion, placement of exterior promotion (eg, front, back), presentation of exterior promotion (eg, onsert, tear strip), and nature of the promotion (eg, contest/give/away). Using Census tract data, we examined the association of pack promotions with tobacco retailers' neighborhood demographic characteristics. Marlboro packs were approximately twice as likely to have promotions as Newport packs (31.7% vs. 14.7%). Fewer Marlboro packs (14.6%) and no Newport packs had interior promotions. The majority of exterior promotions were for contests (>80% for both brands), while almost all interior Marlboro promotions (97.5%) were for a discounted price. There were few differences in presence or type of promotion by tobacco retailers' neighborhood characteristics. Exterior packs promotions, in particular, were fairly common and may contribute to the allure of tobacco products. Use of promotions on the interior and exterior of cigarette packs are a mechanism that the tobacco industry uses to sell its products and should be continually assessed for their influence on consumer behavior. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay and Mexico.

PubMed

Thrasher, James F; Villalobos, Victor; Szklo, André; Fong, Geoffrey T; Pérez, Cristina; Sebrié, Ernesto; Sansone, Natalie; Figueiredo, Valeska; Boado, Marcelo; Arillo-Santillán, Edna; Bianco, Eduardo

2010-01-01

To assess the impact of different health warning labels (HWL). Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact. HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment. This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking.

Public support for tobacco control policy extensions in Western Australia: a cross-sectional study

PubMed Central

Rosenberg, Michael; Wood, Lisa; Ferguson, Renee; Houghton, Stephen

2012-01-01

Objectives Policy makers seeking to introduce new tobacco control measures need to anticipate community support to assist them in planning appropriate implementation strategies. This study assessed community support for plain packaging and smoking bans in outdoor locations in Australia. Design Analytical cross-sectional survey. Setting and participants 2005 Western Australian adults participated in a computer-assisted telephone interview. Random household telephone numbers were used to obtain a representative sample. Outcome measures Support for plain packaging of cigarettes and smoking bans at outdoor venues by demographic characteristics. Results Around half of the survey respondents supported plain packaging and almost a further quarter reported being neutral on the issue. Only one in three smokers disagreed with the introduction of a plain packaging policy. A majority of respondents supported smoking bans at five of the six nominated venues, with support being strongest among those with children under the age of 15 years. The venues with the highest levels of support were those where smoke-free policies had already been voluntarily introduced by the venue managers, where children were most likely to be in attendance, and that were more limited in size. Conclusions The study results demonstrate community support for new tobacco control policies. This evidence can be used by public policy makers in their deliberations relating to the introduction of more extensive tobacco control regulations. PMID:22382124

[Impact of cigarette package health warnings with pictures in Mexico: results from a survey of smokers in Guadalajara].

PubMed

Thrasher, James F; Pérez-Hernández, Rosaura; Arillo-Santillán, Edna; Barrientos-Gutiérrez, Inti

2012-06-01

Evaluate the impact of the first pictorial health warning labels (HWLs) on cigarette packs in Mexico. Cross-sectional survey of a representative sample of 1 765 adult smokers from Guadalajara, Mexico, 2010. Logistic regression models were estimated to determine the association between recall of having purchased a pack with a pictorial HWL and psychosocial variables indicating their impact. 58% reported having purchased a pack with one of the pictorial HWLs, and these were considered the exposed population. Exposed smokers reported a greater frequency of thinking about smoking-related risks (34 vs. 25% p=0.003), and thinking about quitting smoking (23 vs. 14% p=0.001). Exposure to pictorial HWLs was also associated with a greater acceptability of HWLs as a means of communicating with smokers (93 vs. 87% p<0.001), as was the perception that the government communicates well about tobacco-related health risks (68 vs. 55% p<0.001). Pictorial HWLs have made smokers think more about these risks and about quitting smoking. This policy should continue to be exploited as a cost-effective educational intervention.

Comprehensive tobacco marketing restrictions: promotion, packaging, price and place

PubMed Central

Henriksen, Lisa

2014-01-01

Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers. PMID:22345238

Comprehensive tobacco marketing restrictions: promotion, packaging, price and place.

PubMed

Henriksen, Lisa

2012-03-01

Evidence of the causal role of marketing in the tobacco epidemic and the advent of the WHO Framework Convention on Tobacco Control have inspired more than half the countries in the world to ban some forms of tobacco marketing. This paper briefly describes the ways in which cigarette marketing is restricted and the tobacco industry's efforts to subvert restrictions. It reviews what is known about the impact of marketing regulations on smoking by adults and adolescents. It also addresses what little is known about the impact of marketing bans in relation to concurrent population-level interventions, such as price controls, anti-tobacco media campaigns and smoke-free laws. Point of sale is the least regulated channel and research is needed to address the immediate and long-term consequences of policies to ban retail advertising and pack displays. Comprehensive marketing restrictions require a global ban on all forms of promotion, elimination of packaging and price as marketing tools, and limitations on the quantity, type and location of tobacco retailers.

Responses of young adults to graphic warning labels for cigarette packages.

PubMed

Cameron, Linda D; Pepper, Jessica K; Brewer, Noel T

2015-03-01

In 2010, the US Food and Drug Administration (FDA) proposed a series of 36 graphic warning labels for cigarette packages. We sought to evaluate the effects of the labels on fear-related emotions about health consequences of smoking and smoking motivations of young adults. We conducted an experimental study in 2010-2011 with 325 smokers and non-smokers ages 18-30 years whom we recruited through community distribution lists in North Carolina and through a national survey company. Each participant viewed 27 labels (18 of the proposed labels with graphic images and text warnings and 9 with text-only warnings) in a random order, evaluating each label on understandability and its effects on fear-related reactions and discouragement from wanting to smoke. Respondents found most of the proposed labels easy to understand. Of the 36 labels, 64% induced greater fear-related reactions and 58% discouraged respondents from wanting to smoke more than the corresponding text-only labels did. Labels with the greatest effects had photographs (as compared with drawings or other art graphics) or depicted diseased body parts or suffering or dead people. In almost every comparison, smokers reported lower fear-related reactions and feeling less discouraged from wanting to smoke relative to non-smokers. Most of the proposed labels enhanced fear-related reactions about health consequences of smoking and reduced motivations to smoke relative to text-only labels, although some had larger effects than others. All but one of the nine warning labels recently adopted by the FDA enhanced fear-related reactions and reduced smoking motivations. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Awareness of Standardised Tobacco Packaging among Adults and Young People during the Final Phase of Policy Implementation in Great Britain.

PubMed

Bogdanovica, Ilze; Opazo Breton, Magdalena; Langley, Tessa; Britton, John

2017-07-31

Background : In May 2016, along with the latest European Tobacco Products Directive (TPD), standardised packaging legislation was implemented in the UK. During the following 12-month transition period, both new and old types of packaging were allowed on the market. This study aimed to assess awareness of standardised packaging and other TPD changes in the UK population in March 2017, when both forms of packaging were in widespread use. Methods : We conducted two surveys-one in adults and one in young people-investigating awareness of plain packaging legislation. In young people, we also measured susceptibility to smoking using previously validated questions. We asked smokers whether they had recently changed the product they used and also whether they used any of the products that are banned by the new legislation. Results : In the adult survey, 73.5% (95% CI: 71.5-75.5%) of the participants were aware of the new legislation and 32.4% (95% CI: 30.3-34.5%) had noticed changes in tobacco packaging, this proportion being considerably higher among smokers (83.7%; 95% CI: 78.9-87.5%) than never smokers (20.7%; 95% CI: 18.2-23.4%). More than half (52.4%; 95% CI: 46.5-58.4%) were using pack sizes or shapes (typically less than 20 cigarettes or 30 g loose tobacco), that would become illegal after full TPD implementation, and 31.4% (95% CI: 26.2-37.1%) reported switching to a different product since October 2016, in most cases to a cheaper brand. Among young people, 20.2% (95% CI: 17.8-22.7%) reported that they had noticed standardised packaging, comprising 16.2% (95% CI: 13.7-19.0%) of non-susceptible never smokers, 25.6% (95% CI: 18.0-35%) of susceptible never smokers, and 49% (95% CI: 37.8-60.2%) of ever smokers. Conclusions : In the final stages of implementation, awareness of the introduction of standardised packs was highest among smokers. The TPD will cause nearly half of adult smokers to purchase larger packs, and may cause many smokers to switch to cheaper brands.

Assessing the impact of cigarette package health warning labels: a cross-country comparison in Brazil, Uruguay, and Mexico

PubMed Central

Thrasher, James F; Villalobos, Victor; Szklo, André; Fong, Geoffrey T; Pérez, Cristina; Sebrié, Ernesto; Sansone, Natalie; Figueiredo, Valeska; Boado, Marcelo; Arillo-Santillán, Edna; Bianco, Eduardo

2015-01-01

Objective To assess the impact of different health warning labels (HWL). Material and Methods Data from the International Tobacco Control Survey (ITC Survey) were analyzed from adult smokers in Brazil, Uruguay and Mexico, each of which used a different HWL strategy (pictures of human suffering and diseased organs; abstract pictorial representations of risk; and text-only messages, respectively). Main outcomes were HWL salience and cognitive impact. Results HWLs in Uruguay (which was the only country with a HWL on the front of the package) had higher salience than either Brazilian or Mexican packs. People at higher levels of educational attainment in Mexico were more likely to read the text-only HWLs whereas education was unassociated with salience in Brazil or Uruguay. Brazilian HWLs had greater cognitive impacts than HWLs in either Uruguay or Mexico. HWLs in Uruguay generated lower cognitive impacts than the text-only HWLs in Mexico. In Brazil, cognitive impacts were strongest among smokers with low educational attainment. Conclusions This study suggests that HWLs have the most impact when they are prominent (i.e., front and back of the package) and include emotionally engaging imagery that illustrates negative bodily impacts or human suffering due to smoking. PMID:21243191

The effect of cigarillo packaging elements on young adult perceptions of product flavor, taste, smell, and appeal.

PubMed

Meernik, Clare; Ranney, Leah M; Lazard, Allison J; Kim, KyungSu; Queen, Tara L; Avishai, Aya; Boynton, Marcella H; Sheeran, Paschal J; Goldstein, Adam O

2018-01-01

Product packaging has long been used by the tobacco industry to target consumers and manipulate product perceptions. This study examines the extent to which cigarillo packaging influences perceptions of product flavor, taste, smell, and appeal. A web-based experiment was conducted among young adults. Participants viewed three randomly selected cigarillo packs, varying on pack flavor descriptor, color, type, branding, and warning-totaling 180 pack images. Mixed-effects models were used to estimate the effect of pack elements on product perceptions. A total of 2,664 current, ever, and never little cigar and cigarillo users participated. Cigarillo packs with a flavor descriptor were perceived as having a more favorable taste (β = 0.21, p < .001) and smell (β = 0.14, p < .001) compared to packs with no flavor descriptor. Compared to packs with no color, pink and purple packs were more likely to be perceived as containing a flavor (β = 0.11, p < .001), and were rated more favorably on taste (β = 0.17, p < .001), smell (β = 0.15, p < .001), and appeal (β = 0.16, p < .001). While warnings on packs decreased favorable perceptions of product taste (pictorial: β = -0.07, p = .03) and smell (text-only: β = -0.08, p = .01; pictorial: β = -0.09, p = .007), warnings did not moderate the effects of flavor descriptor or color. To our knowledge, this study provides the first quantitative evidence that cigarillo packaging alters consumers' cognitive responses, and warnings on packs do not suffice to overcome the effects of product packaging. The findings support efforts at federal, state, and local levels to prohibit flavor descriptors and their associated product flavoring in non-cigarette products such as cigarillos, along with new data that supports restrictions on flavor cues and colors.

Brand appearances in contemporary cinema films and contribution to global marketing of cigarettes.

PubMed

Sargent, J D; Tickle, J J; Beach, M L; Dalton, M A; Ahrens, M B; Heatherton, T F

2001-01-06

The appearance of a cigarette brand in a cinema film gives the brand a certain distinction through its association with the characters and general tone of the film. Through the worldwide distribution of films, brands are promoted globally. We assessed the tobacco-brand appearances in a 10-year sample of contemporary films. We viewed the contents of the top 25 US box-office films for each year of release, from 1988 to 1997 (250 films in total). We compared the prevalence of brand appearances for films produced before a voluntary ban on paid product placement by the tobacco industry (1988-90) with films produced after the ban (1991-97). Tobacco-brand appearance was defined as the screen appearance of a brand name, logo, or identifiable trademark on products or product packaging, billboards, store-front advertising, or tobacco promotional items. We defined actor endorsement of a brand as the display of a brand while being handled or used by an actor. More than 85% of the films contained tobacco use. Tobacco brands appeared in 70 (28%) films. Brand appearances were as common in films suitable for adolescent audiences as they were in films for adult audiences (32 vs 35%), and were also present in 20% of those rated for children. Prevalence of brand appearance did not change overall in relation to the ban. However, there was a striking increase in the type of brand appearance depicted, with actor endorsement increasing from 1% of films before the ban to 11% after. Four US cigarette brands accounted for 80% of brand appearances. Revenues outside the USA accounted for 49% of total revenues for these films, indicating a large international audience. Tobacco-brand appearances are common in films and are becoming increasingly endorsed by actors. The most highly advertised US cigarette brands account for most brand appearances, which suggests an advertising motive to this practice.

Metal and silicate particles including nanoparticles are present in electronic cigarette cartomizer fluid and aerosol.

PubMed

Williams, Monique; Villarreal, Amanda; Bozhilov, Krassimir; Lin, Sabrina; Talbot, Prue

2013-01-01

Electronic cigarettes (EC) deliver aerosol by heating fluid containing nicotine. Cartomizer EC combine the fluid chamber and heating element in a single unit. Because EC do not burn tobacco, they may be safer than conventional cigarettes. Their use is rapidly increasing worldwide with little prior testing of their aerosol. We tested the hypothesis that EC aerosol contains metals derived from various components in EC. Cartomizer contents and aerosols were analyzed using light and electron microscopy, cytotoxicity testing, x-ray microanalysis, particle counting, and inductively coupled plasma optical emission spectrometry. The filament, a nickel-chromium wire, was coupled to a thicker copper wire coated with silver. The silver coating was sometimes missing. Four tin solder joints attached the wires to each other and coupled the copper/silver wire to the air tube and mouthpiece. All cartomizers had evidence of use before packaging (burn spots on the fibers and electrophoretic movement of fluid in the fibers). Fibers in two cartomizers had green deposits that contained copper. Centrifugation of the fibers produced large pellets containing tin. Tin particles and tin whiskers were identified in cartridge fluid and outer fibers. Cartomizer fluid with tin particles was cytotoxic in assays using human pulmonary fibroblasts. The aerosol contained particles >1 µm comprised of tin, silver, iron, nickel, aluminum, and silicate and nanoparticles (<100 nm) of tin, chromium and nickel. The concentrations of nine of eleven elements in EC aerosol were higher than or equal to the corresponding concentrations in conventional cigarette smoke. Many of the elements identified in EC aerosol are known to cause respiratory distress and disease. The presence of metal and silicate particles in cartomizer aerosol demonstrates the need for improved quality control in EC design and manufacture and studies on how EC aerosol impacts the health of users and bystanders.

How do international trade obligations affect policy options for obesity prevention? Lessons from recent developments in trade and tobacco control.

PubMed

von Tigerstrom, Barbara

2013-06-01

Regulatory measures, including taxes and subsidies on food and beverage products, food labelling requirements, regulation of food content and regulation of food marketing, have been proposed to encourage healthier eating and prevent obesity. The objective of this article is to explore the extent to which international trade agreements affect governments' choices to use such regulatory measures. It reviews key provisions of relevant World Trade Organization (WTO) agreements and their implications. Some insights can be gained by examining 2 recent developments in the WTO regarding tobacco control: a current dispute involving Australia's plain packaging law and its effect on trademarks, and a recent decision involving the United States law banning flavoured cigarettes. This decision said that the ban did not restrict trade more than necessary to fulfil its legitimate health objective, but it was discriminatory because it banned imported products (clove cigarettes) while exempting domestic products (menthol cigarettes) with similar characteristics. The conclusion we can draw from this decision is that WTO member states probably enjoy a significant degree of latitude in developing food regulations as part of an obesity prevention strategy, so long as those do not disproportionately affect imported products and therefore raise questions of discrimination. The approach taken in this case encourages the adoption of public health policies that are consistent with strong scientific evidence, but may restrict governments' ability to make political compromises, which could frustrate some proposals. The ongoing development of WTO law will continue to affect policy choices in public health. Copyright © 2013 Canadian Diabetes Association. Published by Elsevier Inc. All rights reserved.

An evaluation of the FDA's analysis of the costs and benefits of the graphic warning label regulation

PubMed Central

Chaloupka, Frank J; Warner, Kenneth E; Acemoğlu, Daron; Gruber, Jonathan; Laux, Fritz; Max, Wendy; Newhouse, Joseph; Schelling, Thomas; Sindelar, Jody

2015-01-01

The Family Smoking Prevention and Tobacco Control Act of 2009 gave the Food and Drug Administration (FDA) regulatory authority over cigarettes and smokeless tobacco products and authorised it to assert jurisdiction over other tobacco products. As with other Federal agencies, FDA is required to assess the costs and benefits of its significant regulatory actions. To date, FDA has issued economic impact analyses of one proposed and one final rule requiring graphic warning labels (GWLs) on cigarette packaging and, most recently, of a proposed rule that would assert FDA’s authority over tobacco products other than cigarettes and smokeless tobacco. Given the controversy over the FDA's approach to assessing net economic benefits in its proposed and final rules on GWLs and the importance of having economic impact analyses prepared in accordance with sound economic analysis, a group of prominent economists met in early 2014 to review that approach and, where indicated, to offer suggestions for an improved analysis. We concluded that the analysis of the impact of GWLs on smoking substantially underestimated the benefits and overestimated the costs, leading the FDA to substantially underestimate the net benefits of the GWLs. We hope that the FDA will find our evaluation useful in subsequent analyses, not only of GWLs but also of other regulations regarding tobacco products. Most of what we discuss applies to all instances of evaluating the costs and benefits of tobacco product regulation and, we believe, should be considered in FDA's future analyses of proposed rules. PMID:25550419

Deeming Tobacco Products To Be Subject to the Federal Food, Drug, and Cosmetic Act, as Amended by the Family Smoking Prevention and Tobacco Control Act; Restrictions on the Sale and Distribution of Tobacco Products and Required Warning Statements for Tobacco Products. Final rule.

PubMed

2016-05-10

The Food and Drug Administration (FDA) is issuing this final rule to deem products meeting the statutory definition of "tobacco product,'' except accessories of the newly deemed tobacco products, to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). The Tobacco Control Act provides FDA authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products that the Agency by regulation deems to be subject to the law. With this final rule, FDA is extending the Agency's "tobacco product'' authorities in the FD&C Act to all other categories of products that meet the statutory definition of "tobacco product" in the FD&C Act, except accessories of such newly deemed tobacco products. This final rule also prohibits the sale of "covered tobacco products" to individuals under the age of 18 and requires the display of health warnings on cigarette tobacco, roll-your own tobacco, and covered tobacco product packages and in advertisements. FDA is taking this action to reduce the death and disease from tobacco products. In accordance with the Tobacco Control Act, we consider and intend the extension of our authorities over tobacco products and the various requirements and prohibitions established by this rule to be severable.

Do cigarette health warning labels comply with requirements: A 14-country study.

PubMed

Cohen, Joanna E; Brown, Jennifer; Washington, Carmen; Welding, Kevin; Ferguson, Jacqueline; Smith, Katherine C

2016-12-01

The Framework Convention on Tobacco Control, a global health treaty ratified by over 175 countries, calls on countries to ensure that tobacco packages carry health warning labels (HWLs) describing the harmful effects of tobacco use. We assessed the extent of compliance with 14 countries' HWL requirements. Unique cigarette packs were purchased in 2013 using a systematic protocol in 12 distinct neighborhoods within three of the ten most populous cities in the 14 low- and middle-income countries with the greatest number (count) of smokers. HWL compliance codebooks were developed for each country based on the details of country-specific HWL requirements, with up to four common compliance indicators assessed for each country (location, size, label elements, text size). Packs (n=1859) were double coded for compliance. Compliance was examined by country and pack characteristics, including parent company and brand family. Overall, 72% of coded cigarette packs were compliant with all relevant compliance indicators, ranging from 17% in the Philippines to 94% in Mexico. Compliance was highest for location of the warning (ranging from 75%-100%) and lowest for warning size (ranging from 46%-99%). Compliance was higher for packs bought in high SES neighborhoods, and varied by parent company and brand family. This multi-country study found at least one pack in every country - and many packs in some countries - that were not compliant with key requirements for health warning labels in the country of purchase. Non-compliance may be exacerbating health disparities. Tobacco companies should be held accountable for complying with country HWL requirements. Copyright © 2016 The Authors. Published by Elsevier Inc. All rights reserved.

Examining the relationship between psychosocial and behavioral proxies for future consumption behavior: self-reported impact and bidding behavior in an experimental auction study on cigarette labeling

PubMed Central

Rousu, Matthew C.; Thrasher, James F.

2014-01-01

Experimental and observational research often involves asking consumers to self-report the impact of some proposed option. Because self-reported responses involve no consequence to the respondent for falsely revealing how he or she feels about an issue, self-reports may be subject to social desirability and other influences that bias responses in important ways. In this article, we analyzed data from an experiment on the impact of cigarette packaging and pack warnings, comparing smokers’ self-reported impact (four-item scale) and the bids they placed in experimental auctions to estimate differences in demand. The results were consistent across methods; however, the estimated effect size associated with different warning labels was two times greater for the four-item self-reported response scale when compared to the change in demand as indicated by auction bids. Our study provides evidence that self-reported psychosocial responses provide a valid proxy for behavioral change as reflected by experimental auction bidding behavior. More research is needed to better understand the advantages and disadvantages of behavioral economic methods and traditional self-report approaches to evaluating health behavior change interventions. PMID:24399267

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

PubMed

Braillon, Alain

2015-04-01

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. Copyright © 2015 Elsevier Inc. All rights reserved.

Parental and retail supply of tobacco to minors: findings from a community-based social supply intervention study.

PubMed

Gautam, Jeny; Glover, Marewa; Scragg, Robert; Bullen, Chris; Gentles, Dudley; Nosa, Vili; McCool, Judith

2014-07-01

We report on findings from a quasi-experimental community trial of a complex intervention aimed at reducing social and commercial supply of cigarettes to young people. The intervention comprised a package of school, community and home-based smokefree strategies implemented over three years from 2007 to 2009 in a low-income area of Auckland, New Zealand, with another area serving as the control population. The main outcome measures were relative change in parental and retailer behaviour and in attitudes to the provision of tobacco to youth. We analysed baseline and follow-up data from questionnaires administered to parents and children living in the intervention and control areas using PASW Statistics 18. No difference was found between groups in parents' permissiveness of smoking and in retailer compliance to the tobacco sale legislation over the course of the study, either because our intervention had no or only a limited effect, or alternatively because limitations in the study design diluted any effect. Nevertheless, a key finding was that parents and retailers persisted as important sources of cigarettes for young people. Further study is required to identify effective interventions to address this issue. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Smokeless tobacco: a gateway to smoking or a way away from smoking.

PubMed

Melikian, Assieh A; Hoffmann, Dietrich

2009-07-01

Recently, tobacco companies have been marketing moist smokeless tobacco products that are 'spitless'. These products have lower concentrations of tobacco-specific nitrosamines and of other harmful chemicals than other tobacco products, but can deliver relatively high doses of nicotine. They are packaged in small sachets, similar to tea bags that are placed between cheek and gum. Global promotion of smokeless tobacco products is hotly debated among tobacco control and public health experts. Proponents point to the Swedish experience where snus (Swedish moist snuff) is widely used as an alternative to cigarette smoking among men. Meanwhile, Sweden has low rates of smoking and a lower rate of respiratory diseases and lung cancers by comparison to other developed countries. The opponents argue that snus has its own risks, that no form of tobacco should ever be promoted; and that 'snus is culture-bound and not transferable to other settings'. Critics also suspect that the tobacco industry will use snus marketing as a 'gateway' to promote cigarettes among young people. Research on the effects of marketing snus to smokers is too limited to support using snus as a harm-reduction tool, and the epidemiological data are not conclusive.

Awareness of health effects of exposure to secondhand smoke from cigarettes: A cross-sectional study of never-smoked adult primary care patients in Eastern Nigeria

PubMed Central

Pascal Iloh, Gabriel Uche; Collins, Peace Ifeoma

2017-01-01

Background: Cigarette smoking whether actively or passively is a growing public health problem. Despite the wealth of information on the hazards of active cigarette smoking, awareness of the health effects of passive smoking on human population is often neglected in Nigeria. Aim: The study was aimed at describing the awareness of health effects of exposure to secondhand smoke from cigarettes among never-smoked adult primary care patients in Eastern Nigeria. Materials and Methods: A hospital-based study carried out on a cross-section of 500 adult patients in a primary care clinic in Nigeria. Data were collected using pretested, structured, and interviewer-administered questionnaire. Exposure to secondhand smoke was defined as exposure to cigarette smoke in a never-smoked adult patient in the previous 1 year. Data were analyzed using Statistical Package for Social Sciences version 21 for the calculation of percentages for categorical variables. Bivariate analysis involving Chi-square test was used to test for significance of association between categorical variables at P < 0.05. Results: The age of the respondents ranged from 18 to 74 years, with a mean age of 36 ± 12.4 years. There were 180 (36.0%) males with 320 (64%) females, with a sex ratio of 1.8. Awareness of general health effects of secondhand smoke on adults, children, and pregnant women was 95.6%, 92.8%, and 65.2%, respectively. The most common specific health effects the respondents were aware for adults, children, and obstetric population were lung cancer (95.6%), precipitation of asthmatic condition (92.8%), and delivery of small babies (65.2%), respectively. The predominant source of awareness of information was radio (93.6%). Awareness of general health effects of exposure to secondhand smoke on adults (P = 0.041), children (P = 0.031), and obstetrics population (P = 0.02) was significantly associated with exposure status. Conclusion: The most common health effects of secondhand smoke the respondents had highest awareness were lung cancer, precipitation of asthmatic attacks, and delivery of small babies in adults, children, and obstetric population, respectively. Awareness of general health effects on adults, children, and obstetrics population was significantly associated with exposure status. The current level of awareness should be improved while effort should be intensified to address identified areas of low level of awareness. PMID:29119083

Toxicological responses in SW mice exposed to inhaled pyrolysates of polymer/tobacco mixtures and blended tobacco.

PubMed

Werley, Michael S; Lee, K Monika; Lemus-Olalde, Ranulfo

2009-12-01

Modern cigarette manufacturing is highly automated and produces millions of cigarettes per day. The potential for small inclusions of non-cigarette materials such as wood, cardboard packaging, plastic, and other materials exists as a result of bulk handling and high-speed processing of tobacco. Many non-tobacco inclusions such as wood, paper, and cardboard would be expected to yield similar pyrolysis products as a burning cigarette. The aircraft industry has developed an extensive literature on the pyrolysis products of plastics, however, that have been reported to yield toxic by-products upon burning, by-products that have been lethal in animals and humans upon acute exposure under some exposure conditions. Some of these smoke constituents have also been reported in cigarette smoke. Five synthetic polymers, nylon 6, acrylonitrile-butadiene-styrene (ABS), nylon 12, nylon 6,6, and acrylonitrile-butadiene (AB), and the natural polymer wool were evaluated by adding them to tobacco at a 3, 10, and 30% inclusion level and then pyrolyzing the mixture. The validated smoke generation and exposure system have been described previously. We used the DIN 53-436 tube furnace and nose-only exposure chamber in combination to conduct exposures in Swiss-Webster mice. Potentially useful biological endpoints for predicting hazards in humans included sensory irritation and pulmonary irritation, respiratory function, clinical signs, body weights, bronchoalveolar lavage (BAL) fluid analysis, carboxyhemoglogin, blood cyanide concentrations, and histopathology of the respiratory tract. Chemical analysis of selected smoke constituents in the test atmosphere was also performed in order to compare the toxicological responses with exposure to the test atmospheres. Under the conditions of these studies, biological responses considered relevant and useful for prediction of effects in humans were found for sensory irritation, body weights, BAL fluid analysis, and histopathology of the nose. There was a marked sensory irritation response that recovered slowly for some polymers. Sustained body weight depression, lesions of the respiratory epithelium of the nose, and morphological changes in pulmonary alveolar macrophages (PAM) were observed after exposure to some polymer/tobacco pyrolysates. These responses were increased compared to exposure to tobacco pyrolysate alone. No moribundity or mortality occurred during the study. The data suggest that polymeric inclusions pose a minimal additional toxicologic hazard in humans.

Portable Cooler/Warmers

NASA Technical Reports Server (NTRS)

1994-01-01

Early in the space program, NASA recognized the need to replace bulky coils, compressers, and motors for refrigeration purposes by looking at existing thermoelectric technology. This effort resulted in the development of miniaturized thermoelectric components and packaging to accommodate tight confines of spacecraft. Koolatron's portable electronic refrigerators incorporate this NASA technology. Each of the cooler/warmers employs one or two miniaturized thermoelectric modules. Although each module is only the size of a book of matches, it delivers the cooling power of a 10-pound block of ice. In some models, the cooler can be converted to a warmer. There are no moving parts. The Koolatrons can be plugged into auto cigarette lighters, recreational vehicles, boats or motel outlets.

The effect of cigarillo packaging elements on young adult perceptions of product flavor, taste, smell, and appeal

PubMed Central

Ranney, Leah M.; Lazard, Allison J.; Kim, KyungSu; Queen, Tara L.; Avishai, Aya; Boynton, Marcella H.; Sheeran, Paschal J.; Goldstein, Adam O.

2018-01-01

Introduction Product packaging has long been used by the tobacco industry to target consumers and manipulate product perceptions. This study examines the extent to which cigarillo packaging influences perceptions of product flavor, taste, smell, and appeal. Methods A web-based experiment was conducted among young adults. Participants viewed three randomly selected cigarillo packs, varying on pack flavor descriptor, color, type, branding, and warning—totaling 180 pack images. Mixed-effects models were used to estimate the effect of pack elements on product perceptions. Results A total of 2,664 current, ever, and never little cigar and cigarillo users participated. Cigarillo packs with a flavor descriptor were perceived as having a more favorable taste (β = 0.21, p < .001) and smell (β = 0.14, p < .001) compared to packs with no flavor descriptor. Compared to packs with no color, pink and purple packs were more likely to be perceived as containing a flavor (β = 0.11, p < .001), and were rated more favorably on taste (β = 0.17, p < .001), smell (β = 0.15, p < .001), and appeal (β = 0.16, p < .001). While warnings on packs decreased favorable perceptions of product taste (pictorial: β = -0.07, p = .03) and smell (text-only: β = -0.08, p = .01; pictorial: β = -0.09, p = .007), warnings did not moderate the effects of flavor descriptor or color. Conclusions To our knowledge, this study provides the first quantitative evidence that cigarillo packaging alters consumers’ cognitive responses, and warnings on packs do not suffice to overcome the effects of product packaging. The findings support efforts at federal, state, and local levels to prohibit flavor descriptors and their associated product flavoring in non-cigarette products such as cigarillos, along with new data that supports restrictions on flavor cues and colors. PMID:29672604

No difference in striatal dopamine transporter availability between active smokers, ex-smokers and non-smokers using [123I]FP-CIT (DaTSCAN) and SPECT.

PubMed

Thomsen, Gerda; Knudsen, Gitte Moos; Jensen, Peter S; Ziebell, Morten; Holst, Klaus K; Asenbaum, Susanne; Booij, Jan; Darcourt, Jacques; Dickson, John C; Kapucu, Ozlem L; Nobili, Flavio; Sabri, Osama; Sera, Terez; Tatsch, Klaus; Tossici-Bolt, Livia; Laere, Koen Van; Borght, Thierry Vander; Varrone, Andrea; Pagani, Marco; Pinborg, Lars Hageman

2013-05-20

Mesolimbic and nigrostriatal dopaminergic pathways play important roles in both the rewarding and conditioning effects of drugs. The dopamine transporter (DAT) is of central importance in regulating dopaminergic neurotransmission and in particular in activating the striatal D2-like receptors. Molecular imaging studies of the relationship between DAT availability/dopamine synthesis capacity and active cigarette smoking have shown conflicting results. Through the collaboration between 13 SPECT centres located in 10 different European countries, a database of FP-CIT-binding in healthy controls was established. We used the database to test the hypothesis that striatal DAT availability is changed in active smokers compared to non-smokers and ex-smokers. A total of 129 healthy volunteers were included. Subjects were divided into three categories according to past and present tobacco smoking: (1) non-smokers (n = 64), (2) ex-smokers (n = 39) and (3) active smokers (n = 26). For imaging of the DAT availability, we used [123I]FP-CIT (DaTSCAN) and single photon emission computed tomography (SPECT). Data were collected in collaboration between 13 SPECT centres located in 10 different European countries. The striatal measure of DAT availability was analyzed in a multiple regression model with age, SPECT centre and smoking as predictor. There was no statistically significant difference in DAT availability between the groups of active smokers, ex-smokers and non-smokers (p = 0.34). Further, we could not demonstrate a significant association between striatal DAT and the number of cigarettes per day or total lifetime cigarette packages in smokers and ex-smokers. Our results do not support the hypothesis that large differences in striatal DAT availability are present in smokers compared to ex-smokers and healthy volunteers with no history of smoking.

The impact of cigarette pack design, descriptors, and warning labels on risk perception in the U.S.

PubMed

Bansal-Travers, Maansi; Hammond, David; Smith, Philip; Cummings, K Michael

2011-06-01

In the U.S., limited evidence exists on the impact of colors and brand imagery used in cigarette pack design. This study examined the impact of pack design, product descriptors, and health warnings on risk perception and brand appeal. A cross-sectional mall-intercept study was conducted with 197 adult smokers and 200 nonsmokers in Buffalo NY from June to July 2009 (data analysis from July 2009 to December 2010). Participants were shown 12 sets of packs randomly; each set varied by a particular design feature (color, descriptor) or warning label style (text versus graphic, size, attribution, message framing). Packs were rated on criteria including risk perceptions, quit motivation, and purchase interest. Participants selected larger, pictorial, and loss-framed warning labels as more likely to attract attention, encourage thoughts about health risks, motivate quitting, and be most effective. Participants were more likely to select packs with lighter color shading and descriptors such as light, silver, and smooth as delivering less tar, smoother taste, and lower health risk, compared to darker-shaded or full-flavor packs. Additionally, participants were more likely to select the branded compared to plain white pack when asked which delivered the most tar, smoothest taste, was more attractive, appealed to youth aged <18 years, and contained cigarettes of better quality. The findings support larger, graphic health warnings that convey loss-framed messages as most effective in communicating health risks to U.S. adults. The results also indicate that color and product descriptors are associated with false beliefs about risks. Plain packaging may reduce many of the erroneous misperceptions of risk communicated through pack design features. Copyright © 2011 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

The prevalence of and factors associated with current smoking among College of Health Sciences students, Mekelle University in northern Ethiopia.

PubMed

Eticha, Tadele; Kidane, Feven

2014-01-01

Tobacco smoking is one of the greatest causes of preventable morbidity and mortality globally, and is responsible for many causes of untimely deaths. This survey was aimed to determine prevalence and factors associated with current smoking among the students of College of Health Sciences, Mekelle University, Ethiopia. A cross-sectional study was employed using a structured self-administered questionnaire among College of Health Sciences students in March 2013. A stratified random sampling method was employed to select study participants. Data were entered and analysed using of Statistical Package for Social Sciences (SPSS) version 20.0. Of the 193 students, 57 (29.5%) of the students were current smokers. Most of the current smokers (89.4%) smoked between 1-10 sticks of cigarette per day. The two main reasons cited for smoking cigarettes were peer pressure (43.9%) and to relieve stress (36.8%). Being female (adjusted OR [AOR] = 0.49; 95% CI: 0.25, 0.95) and Tigre by ethnicity (AOR = 0.32; 95% CI: 0.14, 0.74) were significantly less associated with current smoking. On the other hand, being second year students (AOR = 3.84; 95% CI: 1.41, 10.46), khat chewing (AOR = 8.36; 95% CI: 2.60, 26.85) and taking illicit drugs (AOR = 10.59; 95% CI: 2.77, 40.51) were positively associated with current smoking cigarettes. The current smoking prevalence among students in College of Health Sciences, Mekelle University is high and therefore, effective smoking prevention and cessation intervention programs are required to reduce smoking among university students.

Implicit motivational impact of pictorial health warning on cigarette packs.

PubMed

Volchan, Eliane; David, Isabel A; Tavares, Gisella; Nascimento, Billy M; Oliveira, Jose M; Gleiser, Sonia; Szklo, Andre; Perez, Cristina; Cavalcante, Tania; Pereira, Mirtes G; Oliveira, Leticia

2013-01-01

The use of pictorial warning labels on cigarette packages is one of the provisions included in the first ever global health treaty by the World Health Organization against the tobacco epidemic. There is substantial evidence demonstrating the effectiveness of graphic health warning labels on intention to quit, thoughts about health risks and engaging in cessation behaviors. However, studies that address the implicit emotional drives evoked by such warnings are still underexplored. Here, we provide experimental data for the use of pictorial health warnings as a reliable strategy for tobacco control. Experiment 1 pre-tested nineteen prototypes of pictorial warnings to screen for their emotional impact. Participants (n = 338) were young adults balanced in gender, smoking status and education. Experiment 2 (n = 63) tested pictorial warnings (ten) that were stamped on packs. We employed an innovative set-up to investigate the impact of the warnings on the ordinary attitude of packs' manipulation, and quantified judgments of warnings' emotional strength and efficacy against smoking. Experiment 1 revealed that women judged the warning prototypes as more aversive than men, and smokers judged them more aversive than non-smokers. Participants with lower education judged the prototypes more aversive than participants with higher education. Experiment 2 showed that stamped warnings antagonized the appeal of the brands by imposing a cost to manipulate the cigarette packs, especially for smokers. Additionally, participants' judgments revealed that the more aversive a warning, the more it is perceived as effective against smoking. Health warning labels are one of the key components of the integrated approach to control the global tobacco epidemic. The evidence presented in this study adds to the understanding of how implicit responses to pictorial warnings may contribute to behavioral change.

Influences of Self-Efficacy, Response Efficacy, and Reactance on Responses to Cigarette Health Warnings: A Longitudinal Study of Adult Smokers in Australia and Canada

PubMed Central

Thrasher, James F.; Swayampakala, Kamala; Borland, Ron; Nagelhout, Gera; Yong, Hua-Hie; Hammond, David; Bansal-Travers, Maansi; Thompson, Mary; Hardin, James

2016-01-01

ABSTRACT Guided by the extended parallel process model (EPPM) and reactance theory, this study examined the relationship between efficacy beliefs, reactance, and adult smokers’ responses to pictorial health warning labels (HWL) on cigarette packaging, including whether efficacy beliefs or reactance modify the relationship between HWL responses and subsequent smoking cessation behavior. Four waves of data were analyzed from prospective cohorts of smokers in Australia and Canada (n = 7,120 observations) over a period of time after implementation of more prominent, pictorial HWLs. Three types of HWL responses were studied: psychological threat responses (i.e., thinking about risks from smoking), forgoing cigarettes due to HWLs, and avoiding HWLs. The results from Generalized Estimating Equation models indicated that stronger efficacy beliefs and lower trait reactance were significantly associated with greater psychological threat responses to HWLs. Similar results were found for models predicting forgoing behavior, although response efficacy was inversely associated with it. Only response efficacy was significantly associated with avoiding HWLs, showing a positive relationship. Higher self-efficacy and stronger responses to HWLs, no matter the type, were associated with attempting to quit in the follow-up period; reactance was unassociated. No statistically significant interactions were found. These results suggest that stronger efficacy beliefs and lower trait reactance are associated with some stronger responses to fear-arousing HWL responses; however, these HWL responses appear no less likely to lead to cessation attempts among smokers with different levels of self-efficacy to quit, of response efficacy beliefs, or of trait reactance against attempts to control their behavior. PMID:27135826

Implicit Motivational Impact of Pictorial Health Warning on Cigarette Packs

PubMed Central

Volchan, Eliane; David, Isabel A.; Tavares, Gisella; Nascimento, Billy M.; Oliveira, Jose M.; Gleiser, Sonia; Szklo, Andre; Perez, Cristina; Cavalcante, Tania; Pereira, Mirtes G.; Oliveira, Leticia

2013-01-01

Objective The use of pictorial warning labels on cigarette packages is one of the provisions included in the first ever global health treaty by the World Health Organization against the tobacco epidemic. There is substantial evidence demonstrating the effectiveness of graphic health warning labels on intention to quit, thoughts about health risks and engaging in cessation behaviors. However, studies that address the implicit emotional drives evoked by such warnings are still underexplored. Here, we provide experimental data for the use of pictorial health warnings as a reliable strategy for tobacco control. Methods Experiment 1 pre-tested nineteen prototypes of pictorial warnings to screen for their emotional impact. Participants (n = 338) were young adults balanced in gender, smoking status and education. Experiment 2 (n = 63) tested pictorial warnings (ten) that were stamped on packs. We employed an innovative set-up to investigate the impact of the warnings on the ordinary attitude of packs’ manipulation, and quantified judgments of warnings’ emotional strength and efficacy against smoking. Findings Experiment 1 revealed that women judged the warning prototypes as more aversive than men, and smokers judged them more aversive than non-smokers. Participants with lower education judged the prototypes more aversive than participants with higher education. Experiment 2 showed that stamped warnings antagonized the appeal of the brands by imposing a cost to manipulate the cigarette packs, especially for smokers. Additionally, participants’ judgments revealed that the more aversive a warning, the more it is perceived as effective against smoking. Conclusions Health warning labels are one of the key components of the integrated approach to control the global tobacco epidemic. The evidence presented in this study adds to the understanding of how implicit responses to pictorial warnings may contribute to behavioral change. PMID:23977223

An evaluation of the FDA's analysis of the costs and benefits of the graphic warning label regulation.

PubMed

Chaloupka, Frank J; Warner, Kenneth E; Acemoğlu, Daron; Gruber, Jonathan; Laux, Fritz; Max, Wendy; Newhouse, Joseph; Schelling, Thomas; Sindelar, Jody

2015-03-01

The Family Smoking Prevention and Tobacco Control Act of 2009 gave the Food and Drug Administration (FDA) regulatory authority over cigarettes and smokeless tobacco products and authorised it to assert jurisdiction over other tobacco products. As with other Federal agencies, FDA is required to assess the costs and benefits of its significant regulatory actions. To date, FDA has issued economic impact analyses of one proposed and one final rule requiring graphic warning labels (GWLs) on cigarette packaging and, most recently, of a proposed rule that would assert FDA's authority over tobacco products other than cigarettes and smokeless tobacco. Given the controversy over the FDA's approach to assessing net economic benefits in its proposed and final rules on GWLs and the importance of having economic impact analyses prepared in accordance with sound economic analysis, a group of prominent economists met in early 2014 to review that approach and, where indicated, to offer suggestions for an improved analysis. We concluded that the analysis of the impact of GWLs on smoking substantially underestimated the benefits and overestimated the costs, leading the FDA to substantially underestimate the net benefits of the GWLs. We hope that the FDA will find our evaluation useful in subsequent analyses, not only of GWLs but also of other regulations regarding tobacco products. Most of what we discuss applies to all instances of evaluating the costs and benefits of tobacco product regulation and, we believe, should be considered in FDA's future analyses of proposed rules. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

The Impact of Cigarette Pack Design, Descriptors, and Warning Labels on Risk Perception in the U.S

PubMed Central

Bansal-Travers, Maansi; Hammond, David; Smith, Philip; Cummings, K. Michael

2011-01-01

Background In the U.S., limited evidence exists on the impact of colors and brand imagery used in cigarette pack design. Purpose This study examined the impact of pack design, product descriptors, and health warnings on risk perception and brand appeal. Methods A cross-sectional mall-intercept study was conducted with 197 adult smokers and 200 nonsmokers in Buffalo, NY from June to July 2009 (data analysis from July 2009 to December 2010). Participants were shown 12 sets of packs randomly; each set varied by a particular design feature (color, descriptor) or warning label style (text vs graphic, size, attribution, message framing). Packs were rated on criteria including risk perceptions, quit motivation, and purchase interest. Results Participants selected larger, pictorial, and loss-framed warning labels as more likely to attract attention, encourage thoughts about health risks, motivate quitting, and most effective. Participants were more likely to select packs with lighter color shading and descriptors such as light, silver, and smooth as delivering less tar, smoother taste, and lower health risk, compared to darker-shaded or full flavor packs. Additionally, participants were more likely to select the branded compared to plain white pack when asked which delivered the most tar, smoothest taste, was more attractive, appealed to youth aged <18 years, and contained cigarettes of better quality. Conclusions The findings support larger, graphic health warnings that convey loss-framed messages as most effective in communicating health risks to U.S. adults. The results also indicate that color and product descriptors are associated with false beliefs about risks. Plain packaging may reduce many of the erroneous misperceptions of risk communicated through pack design features. PMID:21565661

Tobacco advertising in the United States: a proposal for a constitutionally acceptable form of regulation.

PubMed

Bayer, Ronald; Gostin, Lawrence O; Javitt, Gail H; Brandt, Allan

2002-06-12

Lorillard Tobacco Co. v Reilly is the latest in a series of Supreme Court cases striking down public health regulation of advertising as a violation of the First Amendment. In its decision, the Supreme Court significantly reduced the scope of constitutionally acceptable forms of regulation of tobacco advertising and created an almost insoluble dilemma for public health authorities. Control over advertising, along with taxes and restrictions on smoking in public settings, plays an important role in the public health response to tobacco. Those committed to reducing the patterns of cigarette-related morbidity and mortality should broaden their advertising-related strategies and consider the role that greater disclosure of the health harms of tobacco can have on reducing consumption. Toward this end, we propose a comprehensive system of taxation and regulation designed to increase public appreciation and comprehension of the health risks of cigarettes. First, we consider a tax to be levied on tobacco advertising and promotion or, as an alternative, a new excise tax, the proceeds of which would be used exclusively to fund a Centers for Disease Control and Prevention-directed national antitobacco campaign. Second, all print advertising should be required to carry public health warnings equivalent to 50% of the space devoted to the advertisement. Third, manufacturers should be required to devote one full side of cigarette packages to graphic pictorials displaying the dangers of smoking. The tobacco industry would no doubt respond by declaring such efforts an unwarranted burden, an example of constitutionally suspect compelled speech. However, this would be a battle worth engaging, because it might have an impact on tobacco-related morbidity and mortality in the United States.

Has the tobacco industry evaded the FDA's ban on ‘Light’ cigarette descriptors?

PubMed Central

Connolly, Gregory N; Alpert, Hillel R

2014-01-01

Background Under the Family Smoking Prevention and Tobacco Control Act (FSPTCA), the Food and Drug Administration (FDA) banned the use of “Lights” descriptors or similar terms on tobacco products that convey messages of reduced risk. Manufacturers eliminated terms explicitly stated and substituted colour name descriptors corresponding to the banned terms. This paper examines whether the tobacco industry complied with or circumvented the law and potential FDA regulatory actions. Methods Philip Morris retailer manuals, manufacturers' annual reports filed with the Massachusetts Department of Public Health, a national public opinion survey, and market-wide cigarette sales data were examined. Results Manufacturers substituted “Gold” for “Light” and “Silver” for “Ultra-light” in the names of Marlboro sub-brands, and “Blue”, “Gold”, and “Silver” for banned descriptors in sub-brand names. Percent filter ventilation levels, used to generate the smoke yield ranges associated with “Lights” categories, appear to have been reassigned to the new colour brand name descriptors. Following the ban, 92% of smokers reported they could easily identify their usual brands, and 68% correctly named the package colour associated with their usual brand, while sales for “Lights” cigarettes remained unchanged. Conclusions Tobacco manufacturers appear to have evaded a critical element of the FSPTCA, the ban on misleading descriptors that convey reduced health risk messages. The FPSTCA provides regulatory mechanisms, including banning these products as adulterated (Section 902). Manufacturers could then apply for pre-market approval as new products and produce evidence for FDA evaluation and determination whether or not sales of these products are in the public health interest. PMID:23485704

The influence of threatening visual warnings on tobacco packaging: Measuring the impact of threat level, image size, and type of pack through psychophysiological and self-report methods

PubMed Central

Droulers, Olivier; Lacoste-Badie, Sophie; Lajante, Mathieu

2017-01-01

The first aim of this research was to assess the effectiveness, in terms of emotional and behavioral reactions, of moderately vs. highly TVWs (Threatening Visual Warnings) displayed on tobacco packs. Given the key role that emotional reactions play in explaining the effect of TVWs on behaviors, psychophysiological and self-report methods were used–for the first time in this context–to measure the emotions provoked by TVWs. The second aim of this research was to determine whether increasing the size of warnings, and their display on plain packaging (compared with branded packaging) would improve their effectiveness. A within-subjects experiment was conducted. Three variables were manipulated: health warning threat level (high vs. moderate), image size (40% vs. 75%) and pack type (plain vs. branded). A convenience sample of 48 French daily smokers participated. They were exposed to eight different packs of cigarettes in a research lab at the University of Rennes. Smokers’ emotions and behavioral intentions were recorded through self-reports. Emotions were also evaluated using psychophysiological measurements: electrodermal activity and facial electromyography. The results revealed that TVWs with a high threat level are the most effective in increasing negative emotions (fear, disgust, valence, arousal) and behavioral intentions conducive to public health (desire to quit, etc.). They also highlight the appeal of increasing the size of the warnings and displaying them on plain packs, because this influences emotions, which is the first step toward behavioral change. Increasing the threat level of TVWs from moderate to high seems beneficial for public health. Our results also confirm the relevance of recent governmental decisions to adopt plain packaging and larger TVWs (in the UK, France, Ireland, Canada, New Zealand, Hungary, etc.). PMID:28910317

The influence of threatening visual warnings on tobacco packaging: Measuring the impact of threat level, image size, and type of pack through psychophysiological and self-report methods.

PubMed

Droulers, Olivier; Gallopel-Morvan, Karine; Lacoste-Badie, Sophie; Lajante, Mathieu

2017-01-01

The first aim of this research was to assess the effectiveness, in terms of emotional and behavioral reactions, of moderately vs. highly TVWs (Threatening Visual Warnings) displayed on tobacco packs. Given the key role that emotional reactions play in explaining the effect of TVWs on behaviors, psychophysiological and self-report methods were used-for the first time in this context-to measure the emotions provoked by TVWs. The second aim of this research was to determine whether increasing the size of warnings, and their display on plain packaging (compared with branded packaging) would improve their effectiveness. A within-subjects experiment was conducted. Three variables were manipulated: health warning threat level (high vs. moderate), image size (40% vs. 75%) and pack type (plain vs. branded). A convenience sample of 48 French daily smokers participated. They were exposed to eight different packs of cigarettes in a research lab at the University of Rennes. Smokers' emotions and behavioral intentions were recorded through self-reports. Emotions were also evaluated using psychophysiological measurements: electrodermal activity and facial electromyography. The results revealed that TVWs with a high threat level are the most effective in increasing negative emotions (fear, disgust, valence, arousal) and behavioral intentions conducive to public health (desire to quit, etc.). They also highlight the appeal of increasing the size of the warnings and displaying them on plain packs, because this influences emotions, which is the first step toward behavioral change. Increasing the threat level of TVWs from moderate to high seems beneficial for public health. Our results also confirm the relevance of recent governmental decisions to adopt plain packaging and larger TVWs (in the UK, France, Ireland, Canada, New Zealand, Hungary, etc.).

Defending strong tobacco packaging and labelling regulations in Uruguay: transnational tobacco control network versus Philip Morris International.

PubMed

Crosbie, Eric; Sosa, Particia; Glantz, Stanton A

2018-03-01

Describe the process of enacting and defending strong tobacco packaging and labelling regulations in Uruguay amid Philip Morris International's (PMI) legal threats and challenges. Triangulated government legislation, news sources and interviews with policy-makers and health advocates in Uruguay. In 2008 and 2009, the Uruguayan government enacted at the time the world's largest pictorial health warning labels (80% of front and back of package) and prohibited different packaging or presentations for cigarettes sold under a given brand. PMI threatened to sue Uruguay in international courts if these policies were implemented. The Vazquez administration maintained the regulations, but a week prior to President Vazquez's successor, President Mujica, took office on 1 March 2010 PMI announced its intention to file an investment arbitration dispute against Uruguay in the International Centre for the Settlement of Investment Disputes. Initially, the Mujica administration announced it would weaken the regulations to avoid litigation. In response, local public health groups in Uruguay enlisted former President Vazquez and international health groups and served as brokers to develop a collaboration with the Mujica administration to defend the regulations. This united front between the Uruguayan government and the transnational tobacco control network paid off when Uruguay defeated PMI's investment dispute in July 2016. To replicate Uruguay's success, other countries need to recognise that strong political support, an actively engaged local civil society and financial and technical support are important factors in overcoming tobacco industry's legal threats to defend strong public health regulations. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Psychosocial Factors Associated With Adolescent Electronic Cigarette and Cigarette Use

PubMed Central

Berhane, Kiros; Unger, Jennifer B.; Cruz, Tess Boley; Huh, Jimi; Leventhal, Adam M.; Urman, Robert; Wang, Kejia; Howland, Steve; Gilreath, Tamika D.; Chou, Chih-Ping; Pentz, Mary Ann; McConnell, Rob

2015-01-01

BACKGROUND: Use of electronic cigarettes (e-cigarettes) among adolescents has increased since their introduction into the US market in 2007. Little is known about the role of e-cigarette psychosocial factors on risk of e-cigarette or cigarette use in adolescence. METHODS: Information on e-cigarette and cigarette psychosocial factors (use and attitudes about use in the home and among friends) was collected from 11th- and 12th-grade participants in the Southern California Children’s Health Study during the spring of 2014. RESULTS: Of 2084 participants, 499 (24.0%) had used an e-cigarette, including 200 (9.6%) current users (past 30 days); 390 participants (18.7%) had smoked a combustible cigarette, and 119 (5.7%) were current cigarette smokers. Cigarette and e-cigarette use were correlated. Nevertheless, 40.5% (n = 81) of current e-cigarette users had never smoked a cigarette. Psychosocial factors (home use of each product, friends’ use of and positive attitudes toward e-cigarettes and cigarettes) and participant perception of the harm of e-cigarettes were strongly positively associated both with e-cigarette and cigarette use. Most youth who reported e-cigarette use had friends who used e-cigarettes, and almost half of current users reported that they did not believe there were health risks associated with e-cigarette use. CONCLUSIONS: Longitudinal studies of adolescents are needed to determine whether the strong association of e-cigarette psychosocial factors with both e-cigarette and cigarette use will lead to increased cigarette use or dual use of cigarettes and e-cigarettes, or whether e-cigarettes will serve as a gateway to cigarette use. PMID:26216326

[Pulmonary carcinoma nowadays: notes on epidemiology, primary prevention, and therapeutic planning].

PubMed

Motta, G

1995-01-01

Among the solid malignancies, lung cancer is today the most common cancer in the world (850,000 new cases during 1990). Moreover, with an estimated increase of about 5 percent a year, it now represents the first cause of mortality for cancer in both sexes. The evidence of a close relationship between lung cancer and cigarette smoking was first pointed out by E. Graham in 1950. Since then, the responsibility of active cigarette smoking in determining lung cancer as well as that of nicotine causing addictiveness, have been assessed clearly. Nevertheless primary prevention, mainly through the campaign against cigarette smoking, has always faced great difficulties because it clashes with the economic power and interests of tobacco companies. Moreover the epidemiologic trends show a progressive increase of the disease with a silent epidemic-like worldwide diffusion, in close similarity to AIDS. So, more than 5 million new cases a year of lung cancer are expected to appear at the beginning of 2000. The primary prevention against the major factor of risk-the cigarette-is mainly based, in developed countries, through the following official measures: i) a heavy taxation on the finished goods; ii) the conversion of the tobacco growing to other crops and iii) the package-based health information for all tobacco products. On the other side, while waiting for new effective chemoprevention methods, the need of getting a true early clinical diagnosis of tumor is emphasised. Only by this means is it indeed possible to improve the rate of cure through performing conventional resections of those cancers which could be discovered in still limited clinical stage. In the same time, a strong effort for radically operating Stage III locally advanced cancers, is also attempted through the newer tracheobronchoplastic procedures as well as the other over extended resections done directly in the mediastinal area. The neoadjuvant radio and/or chemotherapy combined treatments preceding surgery are also of great clinical interest. Finally the active palliative support aimed at improving the quality of life in patients affected by incurable tumors, represents a fast developing clinical project where a great ethical meaning is pre-eminent above all.

Psychoactive substances use and associated factors among Axum university students, Axum Town, North Ethiopia

PubMed Central

2013-01-01

Background The use of substances such as alcohol, khat leaves and tobacco have long been recognized as one of the leading causes of human suffering and become one of the rising major public health and socio-economic problems worldwide. Even though substances use occurs in all segments of all societies, it is more spreading in an alarming rate among the young generation. This study aimed to establish the prevalence and associated factors of substances use among undergraduate students in Axum University. Methods Institution based quantitative cross sectional study design was conducted among Axum University students in April 2012. A sample of 764 students was selected by using multi- stage sampling technique. Data were collected using pre- tested self- administered questionnaires. The data were cleaned, coded, entered into EPI-INFO version 3.5.1 and transferred and analysed using SPSS computer soft ware package version 20. Results The lifetime prevalence of khat chewing, alcohol drinking and cigarette smoking among the study participants were 28.7%, 34.5% and 9.5% respectively. Similarly, the current prevalence of khat chewing, alcohol drinking and cigarette smoking were 27.9%, 32.8% and 9.3% respectively. The commonest reasons for khat, alcohol and cigarette using were to keep alert while reading 40.6%, for relaxation 65.5% and to relief stress 37.7% respectively. Having peer friends who chew khat was strongly and positively associated with khat use [AOR: 10.18, 95%CI: (5.59, 18.54)].Family members and peer friends alcohol use were strongly associated with alcohol drinking [AOR: 2.61, 95%CI: (1.56, 4.34) and [AOR: 14, 95%CI: (8.09, 24.24)] respectively. Ever alcohol use was strongly associated with cigarette smoking [AOR: 6.54, 95%CI: (2.66, 16.05)]. Conclusion This study revealed that psychoactive substances use became an urgent problem among undergraduate university students. Universities need to monitor and teach their students with special focus on fresh man students, about the health risks and socioeconomic problems associated with psychoactive substances use. PMID:23895376

Neural Correlates of Graphic Cigarette Warning Labels Predict Smoking Cessation Relapse

PubMed Central

Owens, Max M.; MacKillop, James; Gray, Joshua C.; Hawkshead, Brittany E.; Murphy, Cara M.; Sweet, Lawrence H.

2017-01-01

Exposure to graphic warning labels (GWLs) on cigarette packaging has been found to produce heightened activity in brain regions central to emotional processing and higher-order cognitive processes. The current study extends this literature by using functional magnetic resonance imaging (fMRI) to investigate neural activation in response to GWLs and use it to predict relapse in an evidence-based smoking cessation treatment program. Participants were 48 treatment-seeking nicotine-dependent smokers who completed an fMRI paradigm in which they were exposed to GWLs, text-only warning labels (TOLs), and matched control stimuli. Subsequently, they enrolled in smoking cessation treatment and their smoking behavior was monitored. Activation in bilateral amygdala, right dorsolateral prefrontal cortex, right inferior frontal gyrus, left medial temporal gyrus, bilateral occipital lobe, and bilateral fusiform gyrus was greater during GWLs than TOLs. Neural response in the ventromedial prefrontal cortex (vmPFC) during exposure to GWLs (relative to a visual control image) predicted relapse during treatment beyond baseline demographic and dependence severity, but response in the amygdala to GWLs did not. These findings suggest that neurocognitive processes in the vmPFC may be critical to understanding how GWL’s induce behavior change and may be useful as a predictor of smoking cessation treatment prognosis. PMID:28236714

Factors Affecting the Perceived Effectiveness of Pictorial Health Warnings on Cigarette Packages in Gulf Countries: A Cross-sectional Study.

PubMed

Mansour, Ameerah Y; Bakhsh, Zuhair

2017-01-01

To explore the perceived effectiveness of pictorial health warning (PHW) labels required by the Gulf Cooperation Council, to compare them with the Food and Drug Administration-approved PHW labels, and to determine factors affecting their perceived effectiveness. A cross-sectional study using a convenience sample of adult smokers and nonsmokers was conducted. The data were collected through a self-administered online questionnaire. The perceived effectiveness scores of PHW labels were calculated and compared among different subgroups using the Kruskal-Wallis test and the Dunn multiple comparison test at a .05 significance level. Of the 90 people invited to participate in the survey, 77 (86%) completed it, with 39 (50%) nonsmokers, 22 (29%) smokers, and 16 (21%) former smokers. Overall, labels having graphic images of illness or pathology are perceived to be most effective. Smokers generally perceived labels significantly less effective compared with former smokers and nonsmokers. Also, 55 respondents (71%) suggested that the presence of a telephone quit-line would be effective. Smoking status and image type had the most effect on the perceived effectiveness of the PHW labels on cigarette packs. Pictorial health warning labels with graphic images of pathology and a telephone quit-line are perceived to be most effective.

Smoking behaviors and intentions among current e-cigarette users, cigarette smokers, and dual users: A national survey of U.S. high school seniors.

PubMed

McCabe, Sean Esteban; Veliz, Phil; McCabe, Vita V; Boyd, Carol J

2017-06-01

E-cigarette use among adolescents has increased significantly in recent years, but it remains unclear whether cigarette smoking behaviors and intentions for future cigarette smoking differ among current (i.e., 30-day) non-users, only e-cigarette users, only cigarette smokers, and dual users. A nationally representative sample of 4385 U.S. high school seniors were surveyed during the spring of their senior year via self-administered questionnaires in 2014. An estimated 9.6% of U.S. high school seniors reported current e-cigarette use only, 6.3% reported current cigarette smoking only, and 7.2% reported current dual use of e-cigarettes and cigarette smoking. There were no significant differences between current only cigarette smokers and dual users in the odds of early onset of cigarette smoking, daily cigarette smoking, intentions for future cigarette smoking, friends' cigarette smoking behaviors, attempts to quit cigarette smoking, or the inability to quit cigarette smoking. Adolescents who only used e-cigarettes had higher odds of intentions for future cigarette smoking in the next 5years (AOR=2.57, 95% CI: 1.21-5.24) than current non-users. Dual users and only cigarette smokers had higher odds of cigarette smoking behaviors and intentions for future cigarette smoking than non-users or only e-cigarette users. Adolescents who engage in current dual use have cigarette smoking behaviors and intentions for future cigarette smoking that more closely resemble cigarette smokers than e-cigarette users. Adolescents who only use e-cigarettes have higher intentions to engage in future cigarette smoking relative to their peers who do not engage in e-cigarette use or cigarette smoking. Copyright © 2017 Elsevier Inc. All rights reserved.

Visual attention to health warnings on plain tobacco packaging in adolescent smokers and non-smokers.

PubMed

Maynard, Olivia M; Munafò, Marcus R; Leonards, Ute

2013-02-01

Previous research with adults indicates that plain packaging increases visual attention to health warnings in adult non-smokers and weekly smokers, but not daily smokers. The present research extends this study to adolescents aged 14-19 years. Mixed-model experimental design, with smoking status as a between-subjects factor and pack type (branded or plain pack) and eye gaze location (health warning or branding) as within-subjects factors. Three secondary schools in Bristol, UK. A convenience sample of adolescents comprising never-smokers (n = 26), experimenters (n = 34), weekly smokers (n = 13) and daily smokers (n = 14). Number of eye movements to health warnings and branding on plain and branded packs. Analysis of variance, irrespective of smoking status revealed more eye movements to health warnings than branding on plain packs, but an equal number of eye movements to both regions on branded packs (P = 0.033). This was observed among experimenters (P < 0.001) and weekly smokers (P = 0.047), but not among never-smokers or daily smokers. Among experimenters and weekly smokers, plain packaging increases visual attention to health warnings and away from branding. Daily smokers, even relatively early in their smoking careers, seem to avoid the health warnings on cigarette packs. Adolescent never-smokers attend the health warnings preferentially on both types of packs, a finding which may reflect their decision not to smoke. © 2012 The Authors, Addiction © 2012 Society for the Study of Addiction.

Smoking Behaviors and Intentions among Current E-Cigarette Users, Cigarette Smokers, and Dual Users: A National Survey of U.S. High School Seniors

PubMed Central

McCabe, Sean Esteban; Veliz, Phil; McCabe, Vita V.; Boyd, Carol J.

2017-01-01

E-cigarette use among adolescents has increased significantly in recent years, but it remains unclear whether cigarette smoking behaviors and intentions differ among current (i.e., 30-day) non-users, only e-cigarette users, only cigarette smokers, and dual users. A nationally representative sample of 4385 U.S. high school seniors (modal age 18 years) were surveyed during the spring of their senior year via self-administered questionnaires in 2014. An estimated 9.6% of U.S. high school seniors reported current (30-day) e-cigarette use only, 6.3% reported current cigarette smoking only, and 7.2% reported current dual use of e-cigarettes and cigarette smoking. There were no significant differences between current only cigarette smokers and dual users in the odds of early onset of cigarette smoking, daily cigarette smoking, future cigarette smoking intentions, friends’ cigarette smoking behaviors, attempts to quit cigarette smoking, or the inability to quit cigarette smoking. Adolescents who only used e-cigarettes had higher odds of cigarette smoking behaviors and intentions than current non-users, including intentions for future cigarette smoking in the next 5 years (AOR = 2.57, 95% CI: 1.21—5.24). Dual users and only cigarette smokers had higher odds of cigarette smoking behaviors and intentions than non-users or only e-cigarette users. Adolescents who engage in current dual use appear to have cigarette smoking behaviors and intentions that more closely resemble cigarette smokers than e-cigarette users. Adolescents who only use e-cigarettes have higher intentions to engage in cigarette smoking in the future relative to their peers who do not engage in e-cigarette use or cigarette smoking. PMID:28257785

Electronic-cigarette use by individuals in treatment for substance abuse: A survey of 24 treatment centers in the United States.

PubMed

Gubner, Noah R; Andrews, K Blakely; Mohammad-Zadeh, Ana; Lisha, Nadra E; Guydish, Joseph

2016-12-01

Prevalence and reasons for using electronic cigarettes (e-cigarettes) was examined among patients enrolled in 24 substance abuse treatment centers in the United States (N=1113). Prevalence of e-cigarette use was assessed for the full sample. Bivariate analyses and multivariate logistic regression were used to identify characteristics associated with e-cigarette use among current cigarette smokers (the majority of e-cigarette users). Overall 55.5% of the sample reported lifetime use of e-cigarettes, and 30.5% reported using e-cigarettes in the past 30days (current users). The main reasons for using e-cigarettes were (a) at times/places when smoking was prohibited (53.5%), and (b) as a way to quit/reduce cigarette smoking (50.3%). Daily vs non-daily e-cigarette users were more likely to use e-cigarettes both as a way to reduce health risks, and as a way to quit/reduce cigarette smoking. A majority of e-cigarette users (87.1%) reported dual use of e-cigarettes and tobacco cigarettes during the past month. Among current cigarette smokers, those that also used e-cigarettes smoked more cigarettes per day, were more likely to have made a past year cigarette quit attempt, and to have tried nicotine replacement therapy compared to cigarette only smokers. There was a high rate of dual e-cigarette and cigarette use by persons enrolled in addiction treatment. E-cigarette users may be heavier cigarette smokers trying to quit or reduce their cigarette smoking. However, e-cigarettes were also used at times when individuals could not smoke cigarettes. Substance abuse treatment centers developing tobacco policies need to consider these potentially conflicting reasons for using e-cigarettes. Copyright © 2016 Elsevier Ltd. All rights reserved.

E-Cigarette Marketing and Communication: How E-Cigarette Companies Market E-Cigarettes and the Public Engages with E-cigarette Information.

PubMed

Collins, Lauren; Glasser, Allison M; Abudayyeh, Haneen; Pearson, Jennifer L; Villanti, Andrea C

2018-01-05

Given the lack of regulation on marketing of electronic cigarettes (e-cigarettes) in the U.S. and the increasing exchange of e-cigarette-related information online, it is critical to understand how e-cigarette companies market e-cigarettes and how the public engages with e-cigarette information. Results are from a systematic review of peer-reviewed literature on e-cigarettes via a PubMed search through June 1, 2017. Search terms included: "e-cigarette*" OR "electronic cigarette" OR "electronic cigarettes" OR "electronic nicotine delivery" OR "vape" OR "vaping." Experimental studies, quasi-experimental studies, observational studies, qualitative studies, and mixed methods studies providing empirical findings on e-cigarette marketing and communication (i.e., non-marketing communication in the public) were included. One hundred twenty-four publications on e-cigarette marketing and communication were identified. They covered topics including e-cigarette advertisement claims/promotions and exposure/receptivity, the effect of e-cigarette advertisements on e-cigarette and cigarette use, public engagement with e-cigarette information, and the public's portrayal of e-cigarettes. Studies show increases in e-cigarette marketing expenditures and online engagement through social media over time, that e-cigarettes are often framed as an alternative to combustible cigarettes, and that e-cigarette advertisement exposure may be associated with e-cigarette trial in adolescents and young adults. Few studies examine the effects of e-cigarette marketing on perceptions and e-cigarette and cigarette use. Evidence suggests that exposure to e-cigarette advertisements affects perceptions and trial of e-cigarettes, but there is no evidence that exposure affects cigarette use. No studies examined how exposure to e-cigarette communication, particularly misleading or inaccurate information, impacts e-cigarette and tobacco use behaviors. The present article provides a comprehensive review of e-cigarette marketing and how the public engages with e-cigarette information. Studies suggest an association between exposure to e-cigarette marketing and lower harm perceptions of e-cigarettes, intention to use e-cigarettes, and e-cigarette trial, highlighting the need to for advertising regulations that support public health goals. Findings from this review also present the methodological limitations of the existing research (primarily due to cross-sectional and correlational analyses) and underscore the need for timely, rigorous research to provide an accurate understanding of e-cigarette marketing and communication and its impact on e-cigarette and tobacco product use. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Perceptions of the Harm and Addictiveness of Conventional Cigarette Smoking Among Adolescent E-Cigarette Users.

PubMed

Owotomo, Olusegun; Maslowsky, Julie; Loukas, Alexandra

2018-01-01

Although existing evidence indicates that e-cigarette use is a risk factor for cigarette smoking initiation, mechanisms of this association are not yet known. E-cigarette users perceive e-cigarette use to be less harmful relative to conventional cigarettes, but their absolute perceptions of addictiveness of conventional cigarette smoking are unknown. This study examines how e-cigarette users compare with nonusers (non-e-cigarette users/nonconventional cigarette smokers), conventional cigarette smokers, and dual users on perceptions of harm and the addictiveness of conventional cigarette smoking and on other known predictors of cigarette smoking such as peer smoking, influence of antismoking ads, and risk-taking propensity. National samples of 8th- and 10th-grade students from 2014 and 2015 (N = 14,151) were obtained from the Monitoring the Future Study. Multivariate logistic regression models were used to examine relationships between adolescent smoking status and perceptions of harm and the addictiveness of conventional cigarette smoking while controlling for potential confounders. E-cigarette users had lower perceptions of the addictiveness of conventional cigarette smoking compared with nonusers but higher than cigarette smokers and dual users. E-cigarette users reported lower influence by antismoking ads, more conventional cigarette-smoking peers, and greater risk-taking propensity than nonusers. E-cigarette users and cigarette smokers did not differ in their perceived harm of conventional cigarette smoking or in their risk-taking propensity. E-cigarette users' attitudes and perceptions regarding conventional cigarette smoking may leave them vulnerable to becoming conventional cigarette smokers. Future studies should explore the prospective relationship between smoking-related perceptions of conventional cigarette smoking among e-cigarette users and the onset of cigarette smoking. Copyright © 2017 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

The e-cigarette psychosocial environment, e-cigarette use, and susceptibility to cigarette smoking

PubMed Central

Barrington-Trimis, Jessica L.; Berhane, Kiros; Unger, Jennifer B.; Cruz, Tess Boley; Urman, Robert; Chou, Chih Ping; Howland, Steve; Wang, Kejia; Pentz, Mary Ann; Gilreath, Tamika D.; Huh, Jimi; Leventhal, Adam M.; Samet, Jonathan M.; McConnell, Rob

2016-01-01

Purpose One concern regarding the recent increase in adolescent e-cigarette use is the possibility that e-cigarettes may be used by those who might not otherwise have used cigarettes, and that dual use, or transition to cigarette use alone, may follow. Methods Questionnaire data were obtained in 2014 from 11th/12th grade students attending schools in 12 communities included in the Southern California Children’s Health Study (CHS). We evaluated the cross-sectional association between e-cigarette use, the psychosocial environment (family and friends’ use and approval of e-cigarettes and cigarettes) and susceptibility to future cigarette use among never cigarette smokers (N=1694), using previously validated measures based on reported absence of a definitive commitment not to smoke. Results Among adolescents who had never used cigarettes, 31.8% of past e-cigarette users and 34.6% of current (past 30 day) e-cigarette users indicated susceptibility to cigarette use, compared to 21.0% of never e-cigarette users. The odds of indicating susceptibility to cigarette use were two times higher for current e-cigarette users compared to never users (OR=1.97; 95%CI: 1.21, 3.22). A social environment favorable to e-cigarettes (friends’ use of and positive attitudes toward use of e-cigarettes) was also associated with greater likelihood of susceptibility to cigarette use, independent of an individual’s e-cigarette use. Conclusions E-cigarette use in adolescence, and a pro-e-cigarette social environment, may put adolescents at risk for future use of cigarettes. E-cigarettes may contribute to subsequent cigarette use via nicotine addiction or social normalization of smoking behaviors. PMID:27161417

The E-cigarette Social Environment, E-cigarette Use, and Susceptibility to Cigarette Smoking.

PubMed

Barrington-Trimis, Jessica L; Berhane, Kiros; Unger, Jennifer B; Cruz, Tess Boley; Urman, Robert; Chou, Chih Ping; Howland, Steve; Wang, Kejia; Pentz, Mary Ann; Gilreath, Tamika D; Huh, Jimi; Leventhal, Adam M; Samet, Jonathan M; McConnell, Rob

2016-07-01

One concern regarding the recent increase in adolescent e-cigarette use is the possibility that electronic (e-) cigarettes may be used by those who might not otherwise have used cigarettes, and that dual use, or transition to cigarette use alone, may follow. Questionnaire data were obtained in 2014 from 11th/12th grade students attending schools in 12 communities included in the Southern California Children's Health Study. We evaluated the cross-sectional association between e-cigarette use, the social environment (family and friends' use and approval of e-cigarettes and cigarettes), and susceptibility to future cigarette use among never cigarette smokers (N = 1,694), using previously validated measures based on reported absence of a definitive commitment not to smoke. Among adolescents who had never used cigarettes, 31.8% of past e-cigarette users and 34.6% of current (past 30-day) e-cigarette users indicated susceptibility to cigarette use, compared with 21.0% of never e-cigarette users. The odds of indicating susceptibility to cigarette use were two times higher for current e-cigarette users compared with never users (odds ratio = 1.97; 95% confidence interval: 1.21-3.22). A social environment favorable to e-cigarettes (friends' use of and positive attitudes toward the use of e-cigarettes) was also associated with greater likelihood of susceptibility to cigarette use, independent of an individual's e-cigarette use. E-cigarette use in adolescence, and a pro-e-cigarette social environment, may put adolescents at risk for future use of cigarettes. E-cigarettes may contribute to subsequent cigarette use via nicotine addiction or social normalization of smoking behaviors. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Self-reported smoking effects and comparative value between cigarettes and high dose e-cigarettes in nicotine-dependent cigarette smokers.

PubMed

McPherson, Sterling; Howell, Donelle; Lewis, Jennifer; Barbosa-Leiker, Celestina; Bertotti Metoyer, Patrick; Roll, John

2016-04-01

The objective of this experiment was to evaluate the comparative value of cigarettes versus high dose e-cigarettes among nicotine-dependent cigarette smokers when compared with money or use of their usual cigarette brand. The experiment used a within-subject design with four sessions. After baseline assessment, participants attended two 15-min unrestricted smoking sessions: one cigarette smoking session and one e-cigarette smoking session. Participants then attended two multiple-choice procedure (MCP) sessions: a session comparing cigarettes and money and a session comparing e-cigarettes and money. Participants (n=27) had used cigarettes regularly, had never used e-cigarettes, and were not currently attempting to quit smoking. The sample consisted primarily of males (72%), with a mean age of 34 years. When given the opportunity to choose between smoking a cigarette or an e-cigarette, participants chose the cigarette 73.9% of the time. Findings from the MCP demonstrated that after the first e-cigarette exposure sessions, the crossover value for cigarettes ($3.45) was significantly higher compared with the crossover value for e-cigarettes ($2.73). The higher participant preference, self-reported smoking effects, and higher MCP crossover points indicate that cigarettes have a higher comparative value than high dose e-cigarettes among e-cigarette naive smokers.

Adolescents' attitudes towards e-cigarette ingredients, safety, addictive properties, social norms, and regulation.

PubMed

Gorukanti, Anuradha; Delucchi, Kevin; Ling, Pamela; Fisher-Travis, Raymond; Halpern-Felsher, Bonnie

2017-01-01

E-cigarette use has dramatically increased. While studies have examined adolescents' attitudes towards smoking, few have extended this research to adolescents' attitudes towards e-cigarettes. The goal of this study was to examine adolescents' attitudes regarding e-cigarette ingredients, safety, addictive properties, social norms, accessibility, price, and regulation; and determine whether attitudes differ by past cigarette/e-cigarette use. Participants were 786 9th and 12th graders from California (63.21% females; mean age=16.10years [SD=1.6]; 26.61% White, 21.98% Asian/Pacific Islander, 29.82% Hispanic, and 21.59% other). Results indicated that 19.05% of participants believed smoke from e-cigarettes is water; 23.03% believed e-cigarettes aren't a tobacco product; 40.36% considered e-cigarettes to be for cessation, and 43.13% felt they were safer than cigarettes. Participants felt it was more acceptable to use e-cigarettes indoors and outdoors compared to cigarettes (p<0.0001), 23.13% felt raising e-cigarette taxes is a bad idea, 63.95% thought e-cigarettes were easier to get than cigarettes, 54.42% felt e-cigarettes cost too much, 64.33% felt the age for buying e-cigarettes should be raised, and 64.37% favored e-cigarette regulation. Adolescents who used e-cigarettes and/or cigarettes had significantly more favorable e-cigarette attitudes than non-users. This study indicates that adolescents are aware of some of the risks of e-cigarettes, although many harbor misperceptions and hold more favorable attitudes towards e-cigarettes than cigarettes. Of concern is the relationship between favorable e-cigarette attitudes and use. Findings suggest the need to provide adolescents with correct information about e-cigarette ingredients, risks, and the insufficient evidence of their role in cigarette cessation. Copyright © 2016 Elsevier Inc. All rights reserved.

Adolescents' Attitudes towards E-cigarette Ingredients, Safety, Addictive Properties, Social Norms, and Regulation

PubMed Central

Gorukanti, Anuradha; Delucchi, Kevin; Ling, Pamela; Fisher-Travis, Raymond; Halpern-Felsher, Bonnie

2017-01-01

E-cigarette use has dramatically increased. While studies have examined adolescents’ attitudes towards smoking, few have extended this research to adolescents’ attitudes towards e-cigarettes. The goal of this study was to examine adolescents' attitudes regarding e-cigarette ingredients, safety, addictive properties, social norms, accessibility, price, and regulation; and determine whether attitudes differ by past cigarette/e-cigarette use. Participants were 786 9th and 12th graders from California (63.21% females; mean age = 16.10 years [SD = 1.6]; 26.61% White, 21.98% Asian/Pacific Islander, 29.82% Hispanic, and 21.59% other). Results indicated that 19.05% of participants believed smoke from e-cigarettes is water; 23.03% believed e-cigarettes aren't a tobacco product; 40.36% considered e-cigarettes to be for cessation, and 43.13% felt they were safer than cigarettes. Participants felt it was more acceptable to use e-cigarettes indoors and outdoors compared to cigarettes (p < .0001), 23.13% felt raising e-cigarette taxes is a bad idea, 63.95% thought e-cigarettes were easier to get than cigarettes, 54.42% felt e-cigarettes cost too much, 64.33% felt the age for buying e-cigarettes should be raised, and 64.37% favored e-cigarette regulation. Adolescents who used e-cigarettes and/or cigarettes had significantly more favorable e-cigarette attitudes than non-users. This study indicates that adolescents are aware of some of the risks of e-cigarettes, although many harbor misperceptions and hold more favorable attitudes towards e-cigarettes than cigarettes. Of concern is the relationship between favorable e-cigarette attitudes and use. Findings suggest the need to provide adolescents with correct information about e-cigarette ingredients, risks, and the insufficient evidence of their role in cigarette cessation. PMID:27773711

Modeling the Health Effects of Expanding e-Cigarette Sales in the United States and United Kingdom: A Monte Carlo Analysis.

PubMed

Kalkhoran, Sara; Glantz, Stanton A

2015-10-01

The prevalence of electronic cigarette (e-cigarette) use is increasing. Population health effects will depend on cigarette smoking behaviors, levels of dual use with conventional cigarettes, and e-cigarette toxicity. To evaluate potential health effects of various scenarios of increasing promotion and use of e-cigarettes. A base case model was developed using data on actual cigarette and e-cigarette use patterns that quantifies transitions from an initial state of no cigarette or e-cigarette use to 1 of 5 final states: never use of cigarettes or e-cigarettes, cigarette use, e-cigarette use, dual use of cigarettes and e-cigarettes, or quit. Seven scenarios were created that cover a range of use patterns, depending on how the e-cigarette market might develop, as well as a range of possible long-term health effects of e-cigarette use. Scenarios for changes from the base case were evaluated using Monte Carlo simulations. Separate sets of base case model parameters were evaluated for the US and UK populations. We assigned unitless health "costs" for each final state on a scale of 0 to 100. Population health "costs" were compared with the base case (status quo) assuming e-cigarette use health "costs" from 1% to 50% as dangerous as conventional cigarette use health costs. Compared with the base case, a harm reduction scenario in which e-cigarette use increases only among smokers who are interested in quitting with more quit attempts and no increased initiation of e-cigarette use among nonsmokers, and another scenario in which e-cigarettes are taken up only by youth who would have smoked conventional cigarettes, had population-level health benefits regardless of e-cigarette health costs in both the United States and United Kingdom. Conversely, scenarios in which e-cigarette promotion leads to renormalization of cigarette smoking or e-cigarettes are used primarily by youth who never would have smoked showed net health harms across all e-cigarette health costs. In other scenarios, the net health effect varied on the basis of the health cost of e-cigarettes. According to this analysis, widespread promotion of e-cigarettes may have a wide range of population-level health effects, depending on both e-cigarette health risks and patterns of use. Absent the primary effect of e-cigarette promotion being only to divert current or future conventional cigarette smokers to e-cigarette use, the current uncertainty about the health risks of e-cigarettes, increasing e-cigarette use among youth, and the varying health effects at different e-cigarette health costs suggest a potential for harm.

Modeling the Health Effects of Expanding e-Cigarette Sales in the United States and United Kingdom

PubMed Central

Kalkhoran, Sara; Glantz, Stanton A.

2015-01-01

IMPORTANCE The prevalence of electronic cigarette (e-cigarette) use is increasing. Population health effects will depend on cigarette smoking behaviors, levels of dual use with conventional cigarettes, and e-cigarette toxicity. OBJECTIVE To evaluate potential health effects of various scenarios of increasing promotion and use of e-cigarettes. DESIGN, SETTING, AND PARTICIPANTS A base case model was developed using data on actual cigarette and e-cigarette use patterns that quantifies transitions from an initial state of no cigarette or e-cigarette use to 1 of 5 final states: never use of cigarettes or e-cigarettes, cigarette use, e-cigarette use, dual use of cigarettes and e-cigarettes, or quit. Seven scenarios were created that cover a range of use patterns, depending on how the e-cigarette market might develop, as well as a range of possible long-term health effects of e-cigarette use. Scenarios for changes from the base case were evaluated using Monte Carlo simulations. Separate sets of base case model parameters were evaluated for the US and UK populations. MAIN OUTCOMES AND MEASURES We assigned unitless health “costs” for each final state on a scale of 0 to 100. Population health “costs” were compared with the base case (status quo) assuming e-cigarette use health “costs” from 1% to 50% as dangerous as conventional cigarette use health costs. RESULTS Compared with the base case, a harm reduction scenario in which e-cigarette use increases only among smokers who are interested in quitting with more quit attempts and no increased initiation of e-cigarette use among nonsmokers, and another scenario in which e-cigarettes are taken up only by youth who would have smoked conventional cigarettes, had population-level health benefits regardless of e-cigarette health costs in both the United States and United Kingdom. Conversely, scenarios in which e-cigarette promotion leads to renormalization of cigarette smoking or e-cigarettes are used primarily by youth who never would have smoked showed net health harms across all e-cigarette health costs. In other scenarios, the net health effect varied on the basis of the health cost of e-cigarettes. CONCLUSIONS AND RELEVANCE According to this analysis, widespread promotion of e-cigarettes may have a wide range of population-level health effects, depending on both e-cigarette health risks and patterns of use. Absent the primary effect of e-cigarette promotion being only to divert current or future conventional cigarette smokers to e-cigarette use, the current uncertainty about the health risks of e-cigarettes, increasing e-cigarette use among youth, and the varying health effects at different e-cigarette health costs suggest a potential for harm. PMID:26322924

A longitudinal study of the relationship between receptivity to e-cigarette advertisements and e-cigarette use among baseline non-users of cigarettes and e-cigarettes, United States.

PubMed

Agaku, Israel T; Davis, Kevin; Patel, Deesha; Shafer, Paul; Cox, Shanna; Ridgeway, William; King, Brian A

2017-01-01

We investigated the relationship between receptivity to electronic cigarette (e-cigarette) advertisements at baseline and e-cigarette use at follow-up among adult baseline non-users of cigarettes and e-cigarettes. A nationally representative online panel was used to survey non-users of cigarettes and e-cigarettes ( n  = 2191) at baseline and 5-month follow-up. At baseline, respondents were shown an e-cigarette advertisement and asked if they were aware of it (exposure). Among those exposed, receptivity was self-rated for each ad using a validated scale of 1 to 5 for agreement with each of six items: "worth remembering," "grabbed my attention," "powerful," "informative," "meaningful," and "convincing." Logistic regression was used to measure the relationship between receptivity at baseline and e-cigarette use at follow-up. Among baseline non-users of cigarettes and e-cigarettes, 16.6% reported exposure to e-cigarette advertisements at baseline; overall mean receptivity score was 2.77. Among baseline non-users who reported exposure to e-cigarette advertisements, incidence of e-cigarette use at follow-up was 2.7%; among baseline non-users who reported not being exposed to e-cigarette advertisements, incidence of e-cigarette use at follow-up was 1.3%. The attributable risk percentage for e-cigarette initiation from e-cigarette advertisement exposure was 59.3%; the population attributable risk percentage from e-cigarette advertisement exposure was 22.6%. Receptivity at baseline was associated with e-cigarette use at follow-up (aOR = 1.57; 95% CI = 1.04-2.37). Receptivity to e-cigarette advertisements at baseline was associated with greater odds of e-cigarette use at follow-up among baseline non-users of cigarettes and e-cigarettes. Understanding the role of advertising in e-cigarette initiation could help inform public health policy.

Perceptions of the Relative Harm of Cigarettes and E-cigarettes Among U.S. Youth

PubMed Central

Ambrose, Bridget K.; Rostron, Brian L.; Johnson, Sarah E.; Portnoy, David B.; Apelberg, Benjamin J.; Kaufman, Annette R.; Choiniere, Conrad J.

2015-01-01

Background Despite progress in reducing youth smoking, adolescents remain highly susceptible to tobacco use. Of concern is whether youth perceive electronic cigarettes (e-cigarettes) as a preferable alternative to conventional cigarettes. Purpose To describe cigarette harm perception patterns among youth based on the frequency and intensity of cigarette smoking, and examine the relative harm perceptions of conventional versus e-cigarettes, using data from a large, nationally representative sample of U.S. youth. Methods Data from the 2012 National Youth Tobacco Survey (N=24,658) were analyzed in 2013 to identify patterns of cigarette harm perceptions. Multinomial logistic regression was conducted to identify associations between demographic and tobacco use characteristics and cigarette harm perception patterns. Logistic regression was conducted to examine the relationship between cigarette harm perceptions and the perception of e-cigarettes as less harmful than cigarettes for current, ever, and never cigarette smokers. Results The majority of youth (64.2%) perceived the harmfulness of cigarettes as dose-dependent. Approximately one in three students perceived e-cigarettes as less harmful than conventional cigarettes. Regardless of cigarette smoking status, ever users of e-cigarettes and those with “dose-dependent” cigarette harm perceptions consistently were more likely to perceive e-cigarettes as less harmful than conventional cigarettes. Conclusions Many youth perceive tobacco use on a continuum of harm. Youth who perceive gradations in harm—both by frequency and intensity of cigarette use and by type of product—may be particularly susceptible to e-cigarette use. PMID:25044196

Prevalence and Perceptions of Electronic Cigarette Use during Pregnancy.

PubMed

Wagner, Nicholas J; Camerota, Marie; Propper, Cathi

2017-08-01

Objectives The current study is the first to assess pregnant women's perceptions of e-cigarettes and the prevalence of e-cigarette use during pregnancy, using a national sample of pregnant women (N = 445) recruited online. Methods An online survey was used to assess the prevalence and perceptions of e-cigarette use among pregnant women, including perceptions of e-cigarette safety. Results In our sample, 5.62% (n = 25) of women solely used tobacco cigarettes, 6.52% (n = 29) solely used e-cigarettes, 8.54% (n = 38) used both tobacco cigarettes and e-cigarettes, and 79.33% (n = 353) used neither tobacco cigarettes nor e-cigarettes during their current pregnancy. Overall, 64.27% (n = 286) of participants viewed e-cigarettes as being safer than tobacco cigarettes. Having seen advertisements for e-cigarettes increased likelihood of viewing them as safer than tobacco cigarettes (OR [Odds Ratio] = 2.5, p < .01). Conclusions for Practice Taken together, findings from this study suggest that at least as many women use e-cigarettes during pregnancy as tobacco cigarettes, that pregnant women view e-cigarettes as being safer than tobacco cigarettes, and that these views may be influenced by exposure to e-cigarette advertisements.

E-cigarette use, perceptions, and cigarette smoking intentions in a community sample of young adult nondaily cigarette smokers.

PubMed

Brikmanis, Kristin; Petersen, Angela; Doran, Neal

2017-05-01

E-cigarettes have been suggested as a strategy for reducing harm from cigarettes. Although e-cigarettes could be a less-harmful alternative to cigarettes for those trying to quit, there may also be costs that outweigh any benefits of reduction. The purpose of the present study was to prospectively investigate perceptions of e-cigarettes, cigarette smoking intentions, and their associations with e-cigarette use over time. Community participants (N = 348, 57% male) aged 18 to 24 years were recruited for a longitudinal study of tobacco use. Inclusion criteria included nondaily cigarette smoking for ≥ 6 months with no history of daily smoking. Participants reported e-cigarette use over the past 14 days at baseline, and for the past 9 days at 3, 6, and 9 months. Assessments were completed online or via mobile phone. Across the 4 assessments, 22% to 33% of participants reported recent e-cigarette use. Intent to quit smoking cigarettes and intent to maintain smoking were unrelated to e-cigarette frequency. E-cigarette frequency was positively associated with perceiving e-cigarettes as less harmful than cigarettes and more positive e-cigarette expectancies (ps < .05). E-cigarette use was also more frequent among those who smoked cigarettes frequently and who used e-cigarettes to circumvent cigarette bans more often (ps < .05). The combination of these findings suggests that, at least among nondaily smoking young adults, other factors may influence frequency of e-cigarette use more than harm reduction. Findings instead seem consistent with the hypothesis that e-cigarettes are more often used to complement ongoing cigarette smoking. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

E-Cigarette Use, Perceptions, and Cigarette Smoking Intentions in a Community Sample of Young Adult Non-Daily Cigarette Smokers

PubMed Central

Brikmanis, Kristin; Petersen, Angela; Doran, Neal

2017-01-01

E-cigarettes have been suggested as a strategy for reducing harm from cigarettes. While e-cigarettes could be a less-harmful alternative to cigarettes for those trying to quit, there may also be costs that outweigh any benefits of reduction. The purpose of the present study was to prospectively investigate perceptions of e-cigarettes, cigarette smoking intentions and their associations with e-cigarette use over time. Community participants (n = 348, 57% male) aged 18–24 were recruited for a longitudinal study of tobacco use. Inclusion criteria included non-daily cigarette smoking for ≥ 6 months with no history of daily smoking. Participants reported e-cigarette use over the past 14 days at baseline and for the past 9 days at 3, 6, and 9 months. Assessments were completed online or via mobile phone. Across the 4 assessments, 22–33% of participants reported recent e-cigarette use. Intent to quit smoking cigarettes and intent to maintain smoking were unrelated to e-cigarette frequency. E-cigarette frequency was positively associated with perceiving e-cigarettes as less harmful than cigarettes and more positive e-cigarette expectancies (ps < .05). E-cigarette use was also more frequent among those who smoked cigarettes frequently and who used e-cigarettes to circumvent cigarette bans more often (ps < .05). The combination of these findings suggests that, at least among non-daily smoking young adults, other factors may influence frequency of e-cigarette use more than harm reduction. Findings instead seem consistent with the hypothesis that e-cigarettes are more often used to complement ongoing cigarette smoking. PMID:28125242

Behavioral economic substitution between conventional cigarettes and e-cigarettes differs as a function of the frequency of e-cigarette use.

PubMed

Snider, Sarah E; Cummings, K Michael; Bickel, Warren K

2017-08-01

Models measuring the interactions between consumption of conventional cigarettes and electronic cigarettes (e-cigarettes) in the marketplace are becoming vital forecast tools as the popularity of e-cigarettes increases and policy on tobacco products changes. Behavioral economics, which involves the integration of psychology and consumer demand, can be used to measure individuals' purchase behavior under different marketplace conditions. Our goal was to measure hypothetical conventional cigarette and e-cigarette purchasing among smokers with varying e-cigarette use patterns. Daily cigarette smokers were recruited using Amazon Mechanical Turk, an online crowdsourcing tool. Participants were asked about their frequency of e-cigarette use and to complete hypothetical single and cross-commodity purchase tasks. Frequency of e-cigarette use differentially affected how individuals consumed both conventional and e- cigarettes in different hypothetical marketplace conditions. The present study demonstrates four main findings: 1) the demand for conventional cigarettes was the lowest in those with greater frequency of e-cigarette use, 2) the demand for e-cigarettes was the highest in those with greater frequency of e-cigarette use, 3) when both products were available together, daily e-cigarette users purchased more e-cigarettes, but e-cigarettes served as a substitute for cigarettes in all groups regardless of frequency of use, and 4) the demand for conventional cigarette demand was lower in frequent e-cigarette users when e-cigarettes were concurrently available. Together, these data suggest that price and marketplace conditions will impact purchasing behavior of conventional and e-cigarettes users heterogeneously. Therefore, frequency of use patterns should be considered when implementing novel policies and/or marketplace changes. Copyright © 2017 Elsevier B.V. All rights reserved.

Receptivity to e-cigarette marketing, harm perceptions, and e-cigarette use.

PubMed

Pokhrel, Pallav; Fagan, Pebbles; Kehl, Lisa; Herzog, Thaddeus A

2015-01-01

To test whether exposure and receptivity to e-cigarette marketing are associated with recent e-cigarette use among young adults through increased beliefs that e-cigarettes are less harmful than cigarettes. Data were collected from 307 multiethnic 4- and 2-year college students; approximately equal proportions of current, never, and former cigarette smokers [mean age = 23.5 (SD = 5.5); 65% female]. Higher receptivity to e-cigarette marketing was associated with perceptions that e-cigarettes are less harmful than cigarettes, which in turn, were associated with higher recent e-cigarette use. The findings provide preliminary support to the proposition that marketing of e-cigarettes as safer alternatives to cigarettes or cessation aids is associated with increased e-cigarette use among young adults. The findings have implications for development of e-cigarette regulations.

E-cigarette initiation and associated changes in smoking cessation and reduction: the Population Assessment of Tobacco and Health Study, 2013-2015.

PubMed

Berry, Kaitlyn M; Reynolds, Lindsay M; Collins, Jason M; Siegel, Michael B; Fetterman, Jessica L; Hamburg, Naomi M; Bhatnagar, Aruni; Benjamin, Emelia J; Stokes, Andrew

2018-03-24

The role of electronic cigarettes (e-cigarettes) in product transitions has been debated. We used nationally representative data from the Population Assessment of Tobacco and Health Study waves 1 (2013-2014) and 2 (2014-2015) to investigate the associations between e-cigarette initiation and cigarette cessation/reduction in the USA. We limited the sample to current cigarette smokers aged 25+ years who were not current e-cigarette users at wave 1. We modelled 30-day cigarette cessation and substantial reduction in cigarette consumption as a function of e-cigarette initiation between surveys using multivariable logistic regression. Between waves 1 and 2, 6.9% of cigarette smokers who were not current e-cigarette users transitioned to former smokers. After adjusting for covariates, cigarette smokers who initiated e-cigarette use between waves and reported they used e-cigarettes daily at wave 2 had 7.88 (95% CI 4.45 to 13.95) times the odds of 30-day cigarette cessation compared with non-users of e-cigarettes at wave 2. Cigarette smokers who began using e-cigarettes every day and did not achieve cessation had 5.70 (95% CI 3.47 to 9.35) times the odds of reducing their average daily cigarette use by at least 50% between waves 1 and 2 compared with e-cigarette non-users. Daily e-cigarette initiators were more likely to have quit smoking cigarettes or reduced use compared with non-users. However, less frequent e-cigarette use was not associated with cigarette cessation/reduction. These results suggest incorporating frequency of e-cigarette use is important for developing a more thorough understanding of the association between e-cigarette use and cigarette cessation. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Combustible cigarettes cost less to use than e-cigarettes: global evidence and tax policy implications.

PubMed

Liber, Alex C; Drope, Jeffrey M; Stoklosa, Michal

2017-03-01

Some scholars suggest that price differences between combustible cigarettes and e-cigarettes could be effective in moving current combustible smokers to e-cigarettes, which could reduce tobacco-related death and disease. Currently, in most jurisdictions, e-cigarettes are not subject to the same excise taxes as combustible cigarettes, potentially providing the category with a price advantage over combustible cigarettes. This paper tests whether e-cigarettes tax advantage has translated into a price advantage. In a sample of 45 countries, the price of combustible cigarettes, disposable e-cigarettes and rechargeable cigarettes were compared. Comparable units of combustible cigarettes cost less than disposable e-cigarettes in almost every country in the sample. While the e-liquids consumed in rechargeable e-cigarettes might cost less per comparable unit than combustible cigarettes, the initial cost to purchase a rechargeable e-cigarette presents a significant cost barrier to switching from smoking to vaping. Existing prices of e-cigarettes are generally much higher than of combustible cigarettes. If policymakers wish to tax e-cigarettes less than combustibles, forceful policy action-almost certainly through excise taxation-must raise the price of combustible cigarettes beyond the price of using e-cigarettes. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings

PubMed Central

Litt, Mark D; Duffy, Valerie; Oncken, Cheryl

2017-01-01

Introduction The present study examined the influence of flavouring on the smoking and vaping behaviour of cigarette smokers asked to adopt e-cigarettes for a period of 6 weeks. Methods Participants were 88 current male and female smokers with no intention to stop smoking, but who agreed to substitute e-cigarettes for their current cigarettes. On intake, participants were administered tests of taste and smell for e-cigarettes flavoured with tobacco, menthol, cherry and chocolate, and were given a refillable e-cigarette of their preferred flavour or a control flavour. Participants completed daily logs of cigarette and e-cigarette use and were followed each week. Results Analyses over days indicated that, during the 6-week e-cigarette period, cigarette smoking rates dropped from an average of about 16 to about 7 cigarettes/day. e-Cigarette flavour had a significant effect such that the largest drop in cigarette smoking occurred among those assigned menthol e-cigarettes, and the smallest drop in smoking occurred among those assigned chocolate and cherry flavours. e-Cigarette vaping rates also differed significantly by flavour assigned, with the highest vaping rates for tobacco- and cherry-flavoured e-cigarettes, and the lowest rates for those assigned to chocolate. Conclusions The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates and that e-cigarette flavourings can moderate this effect. e-Cigarette vaping rates are also influenced by flavourings. These findings may have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of flavourings in e-cigarettes for harm reduction. PMID:27633766

Contexts of cigarette and e-cigarette use among dual users: a qualitative study.

PubMed

Pokhrel, Pallav; Herzog, Thaddeus A; Muranaka, Nicholas; Regmi, Sakshi; Fagan, Pebbles

2015-09-04

Not much is currently understood regarding the contexts of cigarette and e-cigarette use among dual users. Proper application of e-cigarettes to smoking cessation or tobacco harm reduction would require an understanding of when and why dual users use cigarettes versus e-cigarettes. This study sought to elucidate the contexts of cigarette versus e-cigarette use among dual users. Twelve focus group discussions were conducted with 62 young adult current daily e-cigarette users [63% men; mean age = 25.1 (Standard Deviation = 5.5)]. Almost all participants either concurrently smoked cigarettes or had been recent dual users. Data were analyzed following principles of inductive deduction. Results indicated that dual users' use of cigarettes is influenced by particular activities (e.g., before/after eating), strong craving or need for stimulation (e.g., in response to stress), places/situations (e.g., when cigarette smokers are nearby; outdoors), use of other substances (alcohol, coffee), and unavailability of an e-cigarette when needed. In addition to particular activities and places/situations that are conducive to e-cigarette use, use of e-cigarette when cigarette is not available or where cigarette smoking is not permitted emerged as contexts specific to e-cigarette use. For habitual cigarette smokers wanting to quit tobacco smoking, switching over completely to e-cigarettes may require skills of cognitive-behavioral management. Future research needs to ascertain the characteristics of dual users who use e-cigarettes as cessation aids versus as cigarette alternative when cigarette is unavailable or smoking is not permitted.

The Relationships of Expectancies With E-cigarette Use Among Hospitalized Smokers: A Prospective Longitudinal Study.

PubMed

Hendricks, Peter S; Thorne, Christopher B; Lappan, Sara N; Sweat, Noah W; Cheong, JeeWon; Ramachandran, Rekha; Kohler, Connie L; Bailey, William C; Harrington, Kathleen F

2018-01-05

Expectancies demonstrate cross-sectional associations with e-cigarette use, but the prospective relationships between expectancies and e-cigarette use are unknown. This study examined the longitudinal associations of expectancies with e-cigarette use among hospitalized tobacco cigarette smokers. E-cigarette expectancies (e-cigarette-specific Brief Smoking Consequences Questionnaire-Adult [BSCQ-A]), tobacco cigarette expectancies (tobacco-specific BSCQ-A), and number of days used e-cigarettes in the past 30 days were assessed at baseline hospitalization, 6-months post-hospitalization, and 12-months post-hospitalization among 978 hospitalized tobacco cigarette smokers. Expectancy difference scores (e-cigarette-specific expectancies minus tobacco-specific expectancies) were computed for each of the 10 BSCQ-A scales. Cross-lagged panel models tested the relationships between expectancy difference scores and number of days used e-cigarettes in the past 30 days for each of the 10 BSCQ-A scales. Though some models revealed partial associations between expectancies and e-cigarette use, only one yielded results consistent with hypotheses. Greater e-cigarette use at baseline predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 6 months, which then predicted greater e-cigarette use at 12 months. To a lesser degree greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at baseline predicted greater e-cigarette use at 6 months, which then predicted greater expectancies that e-cigarettes taste pleasant as compared to tobacco cigarettes at 12 months. Expectancies that e-cigarettes provide similar or more pleasant taste sensations as compared to tobacco cigarettes may be both a cause and consequence of e-cigarette use. Focusing on the taste experience may prove most effective in modifying e-cigarette use behavior. The current study offers the first longitudinal examination of expectancies and e-cigarette use. Results suggest expectancies that e-cigarettes provide similar or more pleasant taste sensations relative to tobacco cigarettes are both a cause and consequence of e-cigarette use. Efforts that focus on the e-cigarette taste experience may prove most effective in modifying e-cigarette use behavior. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Assessing the Association Between E-Cigarette Use and Exposure to Social Media in College Students: A Cross-Sectional Study.

PubMed

Sawdey, Michael D; Hancock, Linda; Messner, Marcus; Prom-Wormley, Elizabeth C

2017-12-06

Social media platforms provide an indirect medium for encouraging e-cigarette use between individuals and also serve as a direct marketing tool from e-cigarette brands to potential users. E-cigarette users share information via social media that often contains product details or health-related claims. Determine whether e-cigarette use is associated with exposure to e-cigarettes on social media in college students. Data from a sample of 258 college students was obtained via a clicker-response questionnaire (90% response rate). Demographic, lifetime and current e-cigarette/cigarette use, and e-cigarette exposure via social media (peer posts or advertisements) were examined. Logistic regression was used to assess the relationship between lifetime and current e-cigarette use and viewing peer posts or advertisements on social media while adjusting for cigarette use and self-posting about e-cigarettes. Overall, 46% of participants reported lifetime e-cigarette use, 16% current e-cigarette use, and 7% were current dual users of e-cigarettes and cigarettes. There were positive and significant associations between lifetime e-cigarette use and viewing peer posts (aOR = 3.11; 95% CI = 1.25-7.76) as well as advertisements (aOR = 3.01; 95% CI = 1.19-7.65) on e-cigarettes via social media after adjusting for cigarette use. Current e-cigarette use was only significantly associated with viewing peer posts via social media (aOR = 7.58; 95% CI = 1.66-34.6) after adjusting for cigarette use. Conclusions/Importance: Almost half of college students view peer posts and advertisements on e-cigarettes via social media. This exposure is associated with individual e-cigarette use. Continued efforts to examine online e-cigarette content are needed to help future interventions decrease e-cigarette use.

Estimating cross-price elasticity of e-cigarettes using a simulated demand procedure.

PubMed

Grace, Randolph C; Kivell, Bronwyn M; Laugesen, Murray

2015-05-01

Our goal was to measure the cross-price elasticity of electronic cigarettes (e-cigarettes) and simulated demand for tobacco cigarettes both in the presence and absence of e-cigarette availability. A sample of New Zealand smokers (N = 210) completed a Cigarette Purchase Task to indicate their demand for tobacco at a range of prices. They sampled an e-cigarette and rated it and their own-brand tobacco for favorability, and indicated how many e-cigarettes and regular cigarettes they would purchase at 0.5×, 1×, and 2× the current market price for regular cigarettes, assuming that the price of e-cigarettes remained constant. Cross-price elasticity for e-cigarettes was estimated as 0.16, and was significantly positive, indicating that e-cigarettes were partially substitutable for regular cigarettes. Simulated demand for regular cigarettes at current market prices decreased by 42.8% when e-cigarettes were available, and e-cigarettes were rated 81% as favorably as own-brand tobacco. However when cigarettes cost 2× the current market price, significantly more smokers said they would quit (50.2%) if e-cigarettes were not available than if they were available (30.0%). Results show that e-cigarettes are potentially substitutable for regular cigarettes and their availability will reduce tobacco consumption. However, e-cigarettes may discourage smokers from quitting entirely as cigarette price increases, so policy makers should consider maintaining a constant relative price differential between e-cigarettes and tobacco cigarettes. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

College Students' Perceptions of Risk and Addictiveness of E-Cigarettes and Cigarettes

ERIC Educational Resources Information Center

Cooper, Maria; Loukas, Alexandra; Harrell, Melissa B.; Perry, Cheryl L.

2017-01-01

Background: As conventional cigarette use is declining, electronic cigarette ("e-cigarette") use is rising and is especially high among college students. Few studies examine dual use of e-cigarettes and cigarettes among this population. This study explores the relationship between dual and exclusive e-cigarette / cigarette use and…

Receptivity to E-cigarette Marketing, Harm Perceptions, and E-cigarette Use

PubMed Central

Pokhrel, Pallav; Fagan, Pebbles; Kehl, Lisa; Herzog, Thaddeus A.

2016-01-01

Objective To test whether exposure and receptivity to e-cigarette marketing are associated with recent e-cigarette use among young adults through increased beliefs that e-cigarettes are less harmful than cigarettes. Methods Data were collected from 307 multiethnic 4- and 2-year college students; approximately equal proportions of current, never, and former cigarette smokers [mean age = 23.5 (SD = 5.5); 65% female]. Results Higher receptivity to e-cigarette marketing was associated with perceptions that e-cigarettes are less harmful than cigarettes, which in turn, were associated with higher recent e-cigarette use. Conclusions The findings provide preliminary support to the proposition that marketing of e-cigarettes as safer alternatives to cigarettes or cessation aids is associated with increased e-cigarette use among young adults. The findings have implications for development of e-cigarette regulations. PMID:25290604

E-cigarette Use and Cigarette Smoking Cessation among Texas College Students.

PubMed

Mantey, Dale S; Cooper, Maria R; Loukas, Alexandra; Perry, Cheryl L

2017-11-01

We examined the relationships between e-cigarette use and subsequent cigarette smoking behaviors at 6- and 12-month follow-ups among young adults. Participants were 18-29 year-old current and former cigarette smokers (N = 627) at 24 Texas colleges, participating in a 3-wave study. Multi-level, multivariable logistic regression models, accounting for school clustering, examined the impact of self-reported use of e-cigarettes on cigarette smoking status at 6- and 12-month follow-ups. Two mutually-exclusive groups of e-cigarette users were examined: those that used for cigarette smoking cessation and those that used for reasons other than cessation. Baseline covariates included socio-demographics, past quit attempts, nicotine dependence, cigarettes per day, and other tobacco use. Use of e-cigarettes for cigarette smoking cessation was associated with increased odds of cigarette smoking cessation at 6- and 12-month follow-ups, while using e-cigarettes for other reasons was not, when adjusting for covariates. Use of e-cigarettes for cigarette smoking cessation may reduce cigarette smoking rates in young adult college students. Additional research is needed examining e-cigarettes as a complement to evidence-based cessation resources that are associated with cigarette smoking cessation among young adults.

Symptoms during Adolescents' First Use of Cigarettes and E-Cigarettes: A Pilot Study.

PubMed

Chen, May S; Hall, Marissa G; Parada, Humberto; Peebles, Kathryn; Brodar, Kaitlyn E; Brewer, Noel T

2017-10-20

Symptoms adolescents experience during their first time using a cigarette predict their current use, but little is known regarding the symptoms experienced during first e-cigarette use. We conducted a pilot study to understand the symptoms adolescents experience when they first tried cigarettes and e-cigarettes and the associations between these symptoms and current use. Participants were 41 adolescents in two U.S. cities who had tried cigarettes or e-cigarettes. We asked adolescents to recall the symptoms they experienced during their first cigarette or e-cigarette and categorized symptoms as negative (felt bad, coughing/chest pain, bad taste, upset stomach, dizzy/lightheaded) or positive (felt relaxed, rush/buzz). Adolescents reported fewer negative symptoms for first e-cigarette than first cigarette use (all p < 0.05). Current cigarette smoking was associated with endorsing fewer negative symptoms (OR = 0.49, 95% CI = [0.25, 0.95]) and more positive symptoms (OR = 7.11, 95% CI = [1.47, 34.33]) at first cigarette use. First e-cigarette use symptoms were not associated with current e-cigarette use. Adolescents reported fewer negative symptoms from first e-cigarette than from first cigarette, and e-cigarette symptoms did not influence use as they do for cigarettes. Additional research is needed to confirm these findings in longitudinal studies.

Weight Concerns and Use of Cigarettes and E-Cigarettes among Young Adults.

PubMed

Bennett, Brooke L; Pokhrel, Pallav

2018-05-28

Higher weight concerns have been associated with higher cigarette smoking, particularly among women, partly because smoking is perceived to limit appetite for food. E-cigarettes are increasingly used as an alternative to combustible cigarettes and are widely believed to be less harmful than cigarettes. Currently it is not known whether weight concerns are associated with e-cigarette use among young adults. In this study, we tested the association between weight concerns and cigarette and e-cigarette use and use susceptibility among young adults. Cross-sectional data were collected from college students (N = 470; M age = 20.9; SD = 2.1; 65% women). Results indicated that weight concerns were significantly associated with lifetime and current cigarette smoking status, current cigarette smoking frequency and cigarette use susceptibility (among never smokers), adjusting for demographics variables. Weight concerns were not associated with lifetime or current e-cigarette use status or e-cigarette use susceptibility, adjusting for demographics and cigarette use status. However, higher weight concerns were associated with higher frequency of current e-cigarette use, adjusting for demographic variables and current cigarette smoking frequency. These findings imply that even though weight concerns may not motivate e-cigarette use as strongly as cigarette use, weight concerns may influence higher intensity of e-cigarette use among users.

Risk factors for e-cigarette, conventional cigarette, and dual use in German adolescents: a cohort study.

PubMed

Hanewinkel, Reiner; Isensee, Barbara

2015-05-01

Little is known about risk factors that are associated with e-cigarette use in adolescents. Multilevel mixed-effects regressions were performed to assess the relationship between factors that might be associated with e-cigarette, conventional cigarette and dual use in a cohort of 2693 German adolescents (mean age=12.5 years; SD=0.6). Risk factors were assessed in October 2010 and life time e-cigarette and conventional cigarette use were assessed 26 months later. Use of e-cigarettes as well as use of conventional cigarette and dual use were associated with higher sensation seeking scores, and higher odds of having friends and parents who smoke conventional cigarettes, with conventional cigarette use additionally with male gender, being older, having higher odds of siblings who smoke conventional cigarettes, and less likely for adolescents who attend a Gymnasium, secondary school with a strong emphasis on academic learning. The use of conventional cigarettes at baseline did not predict e-cigarette use at follow-up. Lifetime prevalence of e-cigarette use was 4.7%, of conventional cigarette use 18.4%. A quarter of e-cigarette users (23.8%) never smoked a conventional cigarette. Data indicate that e-cigarette and conventional cigarette use share many but not all risk factors. E-cigarettes could counteract the process of denormalization of smoking. Copyright © 2015 Elsevier Inc. All rights reserved.

Impact of Exposure to Electronic Cigarette Advertising on Susceptibility and Trial of Electronic Cigarettes and Cigarettes in US Young Adults: A Randomized Controlled Trial.

PubMed

Villanti, Andrea C; Rath, Jessica M; Williams, Valerie F; Pearson, Jennifer L; Richardson, Amanda; Abrams, David B; Niaura, Raymond S; Vallone, Donna M

2016-05-01

This study assessed the impact of brief exposure to four electronic cigarette (e-cigarette) print advertisements (ads) on perceptions, intention, and subsequent use of e-cigarettes and cigarettes in US young adults. A randomized controlled trial was conducted in a national sample of young adults from an online panel survey in 2013. Participants were randomized to ad exposure or control. Curiosity, intentions, and perceptions regarding e-cigarettes were assessed post-exposure and e-cigarette and cigarette use at 6-month follow-up. Analyses were conducted in 2014. Approximately 6% of young adults who had never used an e-cigarette at baseline tried an e-cigarette at 6-month follow-up, half of whom were current cigarette smokers at baseline. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette (18.3% exposed vs. 11.3% unexposed, AOR = 1.63, 95% CI = 1.18, 2.26) among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up (3.6% exposed vs. 1.2% unexposed, AOR = 2.85; 95% CI = 1.07, 7.61) among never users of cigarettes and e-cigarettes. Exploratory analyses did not find an association between ad exposure and cigarette trial or past 30-day use among never users, nor cigarette use among smokers over time. Curiosity mediated the relationship between ad exposure and e-cigarette trial among e-cigarette never users. Exposure to e-cigarette ads may enhance curiosity and limited trial of e-cigarettes in never users. Future studies are needed to examine the net effect of curiosity and trial of e-cigarettes on longer-term patterns of tobacco use. This randomized trial provides the first evidence of the effect of e-cigarette advertising on a behavioral outcome in young adults. Compared to the control group, ad exposure was associated with greater curiosity to try an e-cigarette among never e-cigarette users and greater likelihood of e-cigarette trial at follow-up in a small number of never e-cigarette users and greater likelihood of e-cigarette trial at follow-up among never users of cigarettes and e-cigarettes. © The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Cigarette smoking and electronic cigarette vaping patterns as a function of e-cigarette flavourings.

PubMed

Litt, Mark D; Duffy, Valerie; Oncken, Cheryl

2016-11-01

The present study examined the influence of flavouring on the smoking and vaping behaviour of cigarette smokers asked to adopt e-cigarettes for a period of 6 weeks. Participants were 88 current male and female smokers with no intention to stop smoking, but who agreed to substitute e-cigarettes for their current cigarettes. On intake, participants were administered tests of taste and smell for e-cigarettes flavoured with tobacco, menthol, cherry and chocolate, and were given a refillable e-cigarette of their preferred flavour or a control flavour. Participants completed daily logs of cigarette and e-cigarette use and were followed each week. Analyses over days indicated that, during the 6-week e-cigarette period, cigarette smoking rates dropped from an average of about 16 to about 7 cigarettes/day. e-Cigarette flavour had a significant effect such that the largest drop in cigarette smoking occurred among those assigned menthol e-cigarettes, and the smallest drop in smoking occurred among those assigned chocolate and cherry flavours. e-Cigarette vaping rates also differed significantly by flavour assigned, with the highest vaping rates for tobacco- and cherry-flavoured e-cigarettes, and the lowest rates for those assigned to chocolate. The findings suggest that adoption of e-cigarettes in smokers may influence smoking rates and that e-cigarette flavourings can moderate this effect. e-Cigarette vaping rates are also influenced by flavourings. These findings may have implications for the utility of e-cigarettes as a nicotine replacement device and for the regulation of flavourings in e-cigarettes for harm reduction. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

Reasons for Using Electronic Cigarettes and Intentions to Quit Among Electronic Cigarette Users in Malaysia.

PubMed

Wong, Li Ping; Mohamad Shakir, Sharina Mahavera; Alias, Haridah; Aghamohammadi, Nasrin; Hoe, Victor Cw

2016-12-01

The rapidly increasing uptake of e-cigarettes in Malaysia as of late demands a study to identify factors leading to its increased popularity and user intentions to quit smoking e-cigarettes. A convenience sample of e-cigarette smokers visiting e-cigarette retail shops in Selangor and Kuala Lumpur was recruited. The majority of e-cigarette smokers were youth in colleges or universities (39 %), and young professionals and managers (36 %). The main reasons for using e-cigarettes were to help the user quit tobacco cigarettes (88 %), the perception that e-cigarettes are not as intrusive as tobacco cigarettes (85 %) and can be used in public areas (70 %), the perception that e-cigarettes are healthier than tobacco cigarettes (85 %), and its relatively lower cost compared to tobacco cigarettes (65 %). A total of 65.3 % of respondents expressed intentions to quit e-cigarettes. In a multivariate analysis, the respondents who earned monthly income of RM1000 or less were significantly more likely to intend to quit smoking e-cigarettes [OR 1.551; 95 % CI 1.022-2.355; p = 0.015] compared to the respondents who earned a monthly income of more than RM2000. The respondents who disagreed with the statement 'Smoking e-cigs is relatively cheaper compared to tobacco cigarettes' were significantly more likely to intend to quit smoking e-cigarettes [OR 1.548; 95 % CI 1.045-2.293; p = 0.027] compared to respondents who did not agree. e-cigarette preventive interventions should target areas related to the identified main reasons for using e-cigarettes, namely as an aid for quitting tobacco cigarettes, the perception that e-cigarettes are not as intrusive as tobacco cigarettes and can be used in public areas, the idea that e-cigarettes are healthier than tobacco cigarettes, and its relatively lower cost compared to tobacco cigarettes.

Electronic cigarette use among Korean adolescents: a cross-sectional study of market penetration, dual use, and relationship to quit attempts and former smoking.

PubMed

Lee, Sungkyu; Grana, Rachel A; Glantz, Stanton A

2014-06-01

As elsewhere, in South Korea electronic cigarettes (e-cigarettes) are marketed, in part, as a smoking cessation aid. We assessed the prevalence of e-cigarette use among Korean adolescents and the relationship between e-cigarette use and current (past 30-day) smoking, cigarettes/day, attempts to quit conventional cigarettes, and ceasing to use cigarettes. Data from the 2011 Korean Youth Risk Behavior Web-based Survey of 75,643 students aged 13-18 years were analyzed with logistic regression. A total of 9.4% (8.0% ever-dual users who were concurrently using e-cigarettes and smoking conventional cigarettes and 1.4% ever-e-cigarette only users) of Korean adolescents have ever used e-cigarettes and 4.7% were current (past 30-day) e-cigarette users (3.6% dual users and 1.1% e-cigarettes only). After adjusting for demographics, current cigarette smokers were much more likely to use e-cigarettes than were nonsmokers. Among current cigarette smokers, those who smoked more frequently were more likely to be current e-cigarette users. The odds of being an e-cigarette user were 1.58 times (95% confidence interval, 1.39-1.79) higher among students who had made an attempt to quit than for those who had not. It was rare for students no longer using cigarettes to be among current e-cigarette users (odds ratio, .10; confidence interval, .09-.12). Some Korean adolescents may be responding to advertising claims that e-cigarettes are a cessation aid: those who had made an attempt to quit were more likely to use e-cigarettes but less likely to no longer use cigarettes. E-cigarette use was strongly associated with current and heavier cigarette smoking. Copyright © 2014 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Patterns of and reasons for electronic cigarette use in primary care patients.

PubMed

Kalkhoran, Sara; Alvarado, Nicholas; Vijayaraghavan, Maya; Lum, Paula J; Yuan, Patrick; Satterfield, Jason M

2017-10-01

Electronic cigarette (e-cigarette) use is rising in both the general and clinical populations. Little is known about e-cigarette use in primary care, where physicians report discussing e-cigarette use with patients. Identify how and why smokers in primary care use e-cigarettes. Cross-sectional secondary data analysis from a randomized controlled trial of a tablet intervention to deliver the 5As for smoking cessation in primary care. Current smokers aged 18 and older in three primary care clinics in San Francisco, CA (N = 788). Patients reported sociodemographics, cigarette smoking habits, quitting readiness, and ever and current use of e-cigarettes. We also asked reasons they have used or would use e-cigarettes. ICD-9 codes from the medical record determined comorbidities. Fifty-two percent (n = 408) of patients reported ever using an e-cigarette, and 20% (n = 154) reported past-30-day use. Ever e-cigarette use was associated with younger age and negatively associated with being seen at practices at a public safety-net hospital compared to a practice at University-affiliated hospital. The most common reason for having used e-cigarettes among ever e-cigarette users, and for interest in future use of e-cigarettes among never e-cigarette users, was to cut down cigarette use. The mean number of days of e-cigarette use in the past 30 increased with duration of e-cigarette use. Most current e-cigarette users did not know the nicotine content of their e-cigarettes. Over half of smokers in primary care have ever used e-cigarettes, and one-fifth are currently using them. Most reported using e-cigarettes to cut down or quit cigarettes. Primary care providers should be prepared to discuss e-cigarettes with patients. Screening for e-cigarette use may help identify and treat patients interested in changing their cigarette smoking habits.

Perception of e-cigarette harm and its correlation with use among U.S. adolescents.

PubMed

Amrock, Stephen M; Zakhar, Joseph; Zhou, Sherry; Weitzman, Michael

2015-03-01

U.S. adolescents increasingly use e-cigarettes. The perceived harm of e-cigarettes has not been described, nor has the correlation between harm perception and e-cigarette use been assessed. This study examines correlates of e-cigarette harm perception and use of e-cigarettes in a national survey. We used cross-sectional nationally representative data from the 2012 National Youth Tobacco Survey (n = 24,658). Cross-tabulations and multivariate ordered probit and logistic regression models were employed to assess relative harm perception and e-cigarette use. Half of U.S. adolescents had heard of e-cigarettes. Of these, 13.2% (95% confidence interval [CI] = 11.7-14.9) and 4.0% (95% CI = 3.4-4.7) reported ever or currently using e-cigarettes, respectively. Of those aware of e-cigarettes, 34.2% (95% CI = 32.8-35.6) believed e-cigarettes were less harmful than cigarettes. Among those trying e-cigarettes, 71.8% (95% CI = 69.0-74.5) believed e-cigarettes were comparatively less harmful. Females and those ≥ 17 years old were more likely to perceive e-cigarettes as more harmful relative to cigarettes, while on average Whites, users of other tobacco products, and those with family members who used tobacco were more likely to perceive e-cigarettes as comparatively safer. Among cigarette-naive e-cigarette users, use of other tobacco products and perceived harm reduction by e-cigarettes were, respectively, on average associated with 1.6 and 4.1 percentage-point increases in e-cigarette use. Perception of e-cigarettes as less harmful than conventional cigarettes was associated with increased e-cigarette use, including among cigarette-naive e-cigarette users. These findings should prompt further scientific investigation and merit attention from regulators. © The Author 2014. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Dual Use of E-Cigarettes and Traditional Cigarettes Among Adolescents in Taiwan, 2014-2016.

PubMed

Chen, Pei-Ching; Chang, Li-Chuan; Hsu, Chieh; Lee, Yue-Chune

2018-02-02

We investigated the use of electronic cigarettes (e-cigarettes) with traditional cigarettes among adolescents during 2014 to 2016 to identify risk factors for using e-cigarettes only, traditional cigarettes only, or both products. We used cross-sectional data from the Taiwan Global Youth Tobacco Survey, (conducted over a 3-year period by the Health Promotion Administration, Ministry of Health and Welfare, Taiwan), which is representative of tobacco use among adolescents aged 12-18 years. The outcome variable was smoking behavior. Dependent variables included gender, grade, monthly income/allowance, parents' educational level, parents' smoking status, close friends' smoking status, use of other tobacco products, contact with cigarette/e-cigarette advertisements, and access to free cigarettes/e-cigarettes. Multinomial regression identify factors influencing the smoking behaviors of adolescents, as manifested in the use of traditional cigarettes only, e-cigarettes only, e-cigarettes with traditional cigarettes, and nonsmoking. When weighted to the population, the sample included 1723150 adolescents in 2014, 1691568 adolescents in 2015, and 1627216 adolescents in 2016. The rates averaged over three years were as follows: nonsmoking (91.6%), traditional cigarettes only (5.4%), e-cigarettes only (1.5%), and dual usage (1.6%). Among adolescents in Taiwan, the following were risk factors for dual use: male, older, high monthly allowance, smoking parents, smoking friends, use of other tobacco products, contact with cigarette advertisements, and access to free cigarettes. Our results revealed an increase in the number of adolescents using e-cigarettes with traditional cigarettes. We recommend that the government continue smoking cessation programs while maintaining control over advertisements and promotions for tobacco products. This is the first study to examine the dual use of e-cigarettes and traditional cigarettes among adolescents in Taiwan. This study identified the risk factors of using traditional cigarettes only, using e-cigarettes only, and the dual use of e-cigarettes and traditional cigarettes, with nonsmokers used as a reference group. This study examined the relationship between exposure to cigarette promotions and the use of various tobacco products including the dual use of e-cigarettes and traditional cigarettes, both of which have been disregarded in previous studies. © The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

The response of young adult smokers and non-smokers in the United Kingdom to dissuasive cigarettes: An online survey.

PubMed

Moodie, Crawford; Gendall, Philip; Hoek, Janet; MacKintosh, Anne Marie; Best, Catherine; Murray, Susan

2017-11-28

The cigarette stick is an important communications tool as well as the object of consumption. We explored young adults' responses to cigarettes designed to be dissuasive. Data come from a cross-sectional online survey, conducted in September 2015, with 16-24 year old smokers and non-smokers (N=997) in the United Kingdom. Participants were shown images of a standard cigarette (white cigarette paper with imitation cork filter), a standard cigarette displaying the warning 'Smoking kills' on the cigarette paper, and an unattractively coloured cigarette (green cigarette paper and filter). They were asked to rate each of the three cigarettes, shown individually, on eight perception items, and to rate the three cigarettes, shown together, on how likely they would be to try them. Ordering of the cigarettes and questions, with the exception of the question on trial, was randomised. The eight perceptions items were combined to form a composite measure of cigarette perceptions. For smokers and non-smokers, the two dissuasive cigarettes (cigarette with warning, green cigarette) were rated significantly less favourably than the standard cigarette, and less likely to encourage trial. For cigarette perceptions no significant interaction was detected between cigarette style and smoking status or susceptibility to smoke among never smokers. A significant interaction was found for likelihood of trying the cigarettes, with dissuasive cigarettes having a greater impact with smokers than non-smokers. This study suggests that dissuasive cigarettes may help to reduce the desirability of cigarettes. The cigarette stick is the object of tobacco consumption, which is seen every time a cigarette is smoked. It is also an increasingly important promotional tool for tobacco companies. In this study, young adults rated two dissuasive cigarettes (a green coloured cigarette and a cigarette displaying a health warning) more negatively than a standard cigarette, and considered them less likely to encourage product trial. Our findings suggest that it may be possible to reduce the desirability of cigarette sticks by altering their design, e.g., with the addition of a warning or use of an unattractive colour. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes

PubMed Central

ETTER, Jean-François; EISSENBERG, Thomas

2016-01-01

Objective To assess dependence levels in users of e-cigarettes, and compare them with dependence levels in users of nicotine gums and tobacco cigarettes. Design Self-reports from cross-sectional Internet and mail surveys. Comparisons of: a) 766 daily users of nicotine-containing e-cigarettes with 30 daily users of nicotine-free e-cigarettes; b) 911 former smokers who used the e-cigarette daily with 451 former smokers who used the nicotine gum daily (but no e-cigarette); c) 125 daily e-cigarette users who smoked daily (dual users) with two samples of daily smokers who did not use e-cigarettes (2206 enrolled on the Internet and 292 enrolled by mail from the general population of Geneva). We used the Fagerström Test for Nicotine Dependence, the Nicotine Dependence Syndrome Scale, the Cigarette Dependence Scale and versions of these scales adapted for e-cigarettes and nicotine gums. Results Dependence ratings were slightly higher in users of nicotine-containing e-cigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (<=3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers. Conclusions Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive. PMID:25561385

Dependence levels in users of electronic cigarettes, nicotine gums and tobacco cigarettes.

PubMed

Etter, Jean-François; Eissenberg, Thomas

2015-02-01

To assess dependence levels in users of e-cigarettes, and compare them with dependence levels in users of nicotine gums and tobacco cigarettes. Self-reports from cross-sectional Internet and mail surveys. Comparisons of: (a) 766 daily users of nicotine-containing e-cigarettes with 30 daily users of nicotine-free e-cigarettes; (b) 911 former smokers who used the e-cigarette daily with 451 former smokers who used the nicotine gum daily (but no e-cigarette); (c) 125 daily e-cigarette users who smoked daily (dual users) with two samples of daily smokers who did not use e-cigarettes (2206 enrolled on the Internet and 292 enrolled by mail from the general population of Geneva). We used the Fagerström test for nicotine dependence, the nicotine dependence syndrome scale, the cigarette dependence scale and versions of these scales adapted for e-cigarettes and nicotine gums. Dependence ratings were slightly higher in users of nicotine-containing e-cigarettes than in users of nicotine-free e-cigarettes. In former smokers, long-term (>3 months) users of e-cigarettes were less dependent on e-cigarettes than long-term users of the nicotine gum were dependent on the gum. There were few differences in dependence ratings between short-term (≤3 months) users of gums or e-cigarettes. Dependence on e-cigarettes was generally lower in dual users than dependence on tobacco cigarettes in the two other samples of daily smokers. Some e-cigarette users were dependent on nicotine-containing e-cigarettes, but these products were less addictive than tobacco cigarettes. E-cigarettes may be as or less addictive than nicotine gums, which themselves are not very addictive. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Changes in use of cigarettes and non-cigarette alternative products among college students.

PubMed

Loukas, Alexandra; Batanova, Milena; Fernandez, Alejandra; Agarwal, Deepti

2015-10-01

The present study examined change in use of various smoked and smokeless non-cigarette alternative products in a sample of college students, stratified by current, or past 30-day, cigarette smoking status. Participants were 698 students from seven four-year colleges in Texas. Participants completed two waves of online surveys regarding tobacco use, knowledge, and attitudes, with 14 months between each wave. The most prevalent products used by the entire sample at Wave 1 were cigarettes, followed by hookah, cigars/cigarillos/little cigars, and electronic cigarettes (e-cigarettes). At Wave 2, prevalence of e-cigarette use surpassed use of cigars/cigarillos/little cigars. Snus and chew/snuff/dip were relatively uncommon at both waves. Examination of change in use indicated that e-cigarette use increased across time among both current cigarette smokers and non-cigarette smokers. Prevalence of current e-cigarette use doubled across the 14-month period to 25% among current smokers and tripled to 3% among non-cigarette smokers. Hookah use also increased across time, but only among non-cigarette smokers, whereas it decreased among current cigarette smokers. Use of all other non-cigarette alternatives remained unchanged across time. Logistic regression analysis was used to examine the socio-demographic predictors of Wave 2 e-cigarette use, the only product that increased in use among both current cigarette smokers and non-cigarette smokers. Results indicated that Wave 1 current cigarette use and Wave 1 current e-cigarette use, but not gender, age, or race/ethnicity, were significantly associated with Wave 2 e-cigarette use. Findings underscore the need to track changes in the use of non-cigarette alternatives and call for additional research examining the factors contributing to change in use. Copyright © 2015 Elsevier Ltd. All rights reserved.

Patterns of electronic cigarette use and user beliefs about their safety and benefits: an internet survey.

PubMed

Goniewicz, Maciej L; Lingas, Elena O; Hajek, Peter

2013-03-01

As the popularity of electronic cigarettes (e-cigarettes) increases, it is becoming important to find out more about the characteristics of e-cigarette users, why and how they use the product and whether e-cigarettes are used exclusively or in combination with conventional cigarettes. The objective of this study was to investigate patterns and effects of e-cigarette use and user beliefs about e-cigarette safety and benefits. E-cigarette users in Poland were recruited online and asked to participate in a web-based survey. The participants provided information on their smoking history, patterns of e-cigarette use, beliefs and attitudes regarding the product and information on concurrent use of conventional cigarettes. The survey was completed by 179 e-cigarette users. Almost all participants used e-cigarettes daily. E-cigarettes were primarily used to quit smoking or to reduce the harm associated with smoking (both 41%), and were successful in helping the surveyed users to achieve these goals with 66% not smoking conventional cigarettes at all and 25% smoking under five cigarettes a day. Most participants (82%) did not think that e-cigarettes were completely safe, but thought that they were less dangerous than conventional cigarettes. Sixty percent believed that e-cigarettes were addictive, but less so than conventional cigarettes. The participants primarily used e-cigarettes as a stop-smoking aid or as an alternative to conventional cigarettes, and the majority reported that they successfully stopped smoking. More data on e-cigarette safety and its efficacy in harm-reduction and smoking cessation are needed. © 2012 Australasian Professional Society on Alcohol and other Drugs.

The impact of price and tobacco control policies on the demand for electronic nicotine delivery systems

PubMed Central

Huang, Jidong; Tauras, John; Chaloupka, Frank J

2014-01-01

Background While much is known about the demand for conventional cigarettes, little is known about the determinants of demand for electronic nicotine delivery systems (ENDS or e-cigarettes). The goal of this study is to estimate the own and cross-price elasticity of demand for e-cigarettes and to examine the impact of cigarette prices and smoke-free policies on e-cigarette sales. Methods Quarterly e-cigarette prices and sales and conventional cigarette prices from 2009 to 2012 were constructed from commercial retail store scanner data from 52 US markets, for food, drug and mass stores, and from 25 markets, for convenience stores. Fixed-effects models were used to estimate the own and cross-price elasticity of demand for e-cigarettes and associations between e-cigarette sales and cigarette prices and smoke-free policies. Results Estimated own price elasticities for disposable e-cigarettes centred around −1.2, while those for reusable e-cigarettes were approximately −1.9. Disposable e-cigarette sales were higher in markets where reusable e-cigarette prices were higher and where less of the population was covered by a comprehensive smoke-free policy. There were no consistent and statistically significant relationships between cigarette prices and e-cigarette sales. Conclusions E-cigarette sales are very responsive to own price changes. Disposable e-cigarettes appear to be substitutes for reusable e-cigarettes. Policies increasing e-cigarette retail prices, such as limiting rebates, discounts and coupons and imposing a tax on e-cigarettes, could potentially lead to significant reductions in e-cigarette sales. Differential tax policies based on product type could lead to substitution between different types of e-cigarettes. PMID:24935898

Cigarette Cue Attentional Bias in Cocaine-Smoking and Non-Cocaine-Using Cigarette Smokers.

PubMed

Marks, Katherine R; Alcorn, Joseph L; Stoops, William W; Rush, Craig R

2016-09-01

Cigarette smoking in cocaine users is nearly four times higher than the national prevalence and cocaine use increases cigarette smoking. The mechanisms underlying cigarette smoking in cocaine-using individuals need to be identified to promote cigarette and cocaine abstinence. Previous studies have examined the salience of cigarette and cocaine cues separately. The present aim was to determine whether cigarette attentional bias (AB) is higher in cigarettes smokers who smoke cocaine relative to individuals who only smoke cigarettes. Twenty cigarette smokers who smoke cocaine and 20 non-cocaine-using cigarette smokers completed a visual probe task with eye-tracking technology. During this task, the magnitude of cigarette and cocaine AB was assessed through orienting bias, fixation time, and response time. Cocaine users displayed an orienting bias towards cigarette cues. Cocaine users also endorsed a more urgent desire to smoke to relieve negative affect associated with cigarette craving than non-cocaine users (g = 0.6). Neither group displayed a cigarette AB, as measured by fixation time. Cocaine users, but not non-cocaine users, displayed a cocaine AB as measured by orienting bias (g = 2.0) and fixation time (g = 1.2). There were no significant effects for response time data. Cocaine-smoking cigarettes smokers display an initial orienting bias toward cigarette cues, but not sustained cigarette AB. The incentive motivation underlying cigarette smoking also differs. Cocaine smokers report more urgent desire to smoke to relieve negative affect. Identifying differences in motivation to smoke cigarettes may provide new treatment targets for cigarette and cocaine use disorders. These results suggest that cocaine-smoking cigarette smokers display an initial orienting bias towards cigarette cues, but not sustained attention towards cigarette cues, relative to non-cocaine-using smokers. Smoked cocaine users also report a more urgent desire to smoke to relieve negative affect than non-cocaine users. Identifying differences in motivation to smoke cigarettes may provide new treatment targets for both cigarette and cocaine use disorders. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Estimating Demand and Cross-Price Elasticity for Very Low Nicotine Content (VLNC) Cigarettes Using a Simulated Demand Task.

PubMed

Tucker, Megan R; Laugesen, Murray; Grace, Randolph C

2017-03-03

Very Low Nicotine Content (VLNC) cigarettes might be useful as part of a tobacco control strategy, but relatively little is known about their acceptability as substitutes for regular cigarettes. We compared subjective effects and demand for regular cigarettes and Very Low Nicotine Content (VLNC) cigarettes, and estimated cross-price elasticity for VLNC cigarettes, using simulated demand tasks. 40 New Zealand smokers sampled a VLNC cigarette and completed Cigarette Purchase Tasks to indicate their demand for regular cigarettes and VLNC cigarettes at a range of prices, and a cross-price task indicating how many regular cigarettes and VLNC cigarettes they would purchase at 0.5x, 1x, and 2x the current market price for regular cigarettes, assuming the price of VLNC cigarettes remained constant. They also rated the subjective effects of the VLNC cigarette and their usual-brand regular cigarettes. Cross-price elasticity for VLNC cigarettes was estimated as 0.24 and was significantly positive, indicating that VLNC cigarettes are partially substitutable for regular cigarettes. VLNC cigarettes were rated as less satisfying and psychologically rewarding than regular cigarettes, but this was unrelated to demand or substitutability. VLNC cigarettes are potentially substitutable for regular cigarettes. Their availability may reduce tobacco consumption, nicotine intake and addiction; making it easier for smokers to quit. VLNC cigarettes share the behavioural and sensory components of smoking whilst delivering negligible levels of nicotine. Although smokers rated VLNCs as less satisfying than regular cigarettes, smokers said they would increase their consumption of VLNCs as the price of regular cigarettes increased, if VLNCs were available at a lower price. This suggests that VLNCs are partially substitutable for regular cigarettes. VLNCs can be part of an effective tobacco control strategy, by reducing nicotine dependence and improving health and financial outcomes for smokers. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

E-cigarettes: facts, perceptions, and marketing messages.

PubMed

Carr, Ellen R

2014-02-01

Electronic cigarettes (e-cigarettes) are perceived as an alternative to standard tobacco cigarette smoking, primarily because of the e-cigarette industry's marketing messages. However, scientific studies about e-cigarette safety and efficacy remain limited. This column presents some of the issues associated with e-cigarette use, such as potential components of regulation, perceptions that e-cigarettes can help users quit smoking, and free-wheeling marketing strategies that include expanding e-cigarette use to young people. Nurses can be a reliable source of information about e-cigarettes.

[Tobacco and health in the view of univerity students].

PubMed

Silva, Antonia Oliveira; Sousa, Cristina Maria Miranda de; Gaspar, Maria Filomena Mendes; Paredes, Maria Adelaide Silva; Tura, Luiz Fernando Rangel; Jesuíno, Jorge Correia

2008-01-01

Smoking is a serious public health problem. This study aims at understanding how social representation about smoke/tobacco and health are shared by young university students through the impact of figures contained in cigarettes package in heath. This exploratory study was carried with 63 nursing students in Lisboa, Portugal. Data were collected by the technique of free association of words that were submitted to the software Tri-Deux Mots. Students associate "tobacco" like pleasure but also as cancer, disrespect, bad smell, something mean; the health, happiness, joy and self and sickness. Health is represented by hospital but also as something good positive and energetic. "Tobacco/smoking" for the subjects concerned disease as the cancer in addition to causing bad smell and be unpleasant configuring itself as a bad and associated with father.

Cognitive risk factors of electronic and combustible cigarette use in adolescents.

PubMed

Lechner, William V; Murphy, Cara M; Colby, Suzanne M; Janssen, Tim; Rogers, Michelle L; Jackson, Kristina M

2018-07-01

Cognitive susceptibility to cigarette smoking has been demonstrated to predict future cigarette initiation in adolescents. Examining this construct prior to tobacco product initiation may provide useful information on the differential risk of individuals initiating cigarette vs. e-cigarette products. Additionally, examining how susceptibility and tobacco product use relate to perceived harm cognitions will increase understanding of risk predisposition among adolescents. Data were taken from a longitudinal study of middle school students (n = 1023; age = 12.1, 52.2% female, 72.1% white) in the Northeastern U.S. Likelihood of e-cigarette and cigarette ever-use in high school was examined as a function of a validated index of cigarette smoking susceptibility among tobacco naïve students in middle school. Prospective associations between cognitive susceptibility to smoking and subsequent perceived harm of e-cigarettes (assessed in high school), and cross-sectional associations between concurrent tobacco product ever-use status and perceived harm of e-cigarettes were examined. Adolescents classified as susceptible to cigarette smoking in middle school were more likely to initiate use of cigarettes (OR = 2.53) and e-cigarettes (OR = 1.95) as compared to adolescents classified as non-susceptible; cigarette smoking susceptibility did not differentially predict use of one product over the other. Adolescents endorsing e-cigarette use, reported significantly less perceived harm associated with e-cigarettes vs. cigarettes, while those who endorsed cigarette only or dual use did not. Our data indicate that cognitive susceptibility to cigarette smoking may index a broad risk factor for using either cigarettes or e-cigarettes in the future, and is prospectively associated with perceived harm of e-cigarette use. Overall, those who used any tobacco product perceived e-cigarettes as less harmful when compared to abstainers. Individual facets of perceived harm (addiction potential and harm vs. cigarettes) differ between cigarette only users and e-cigarette users and may help to explain the choice to use one product vs. the other. This is the first study to examine prospective associations between cognitive susceptibility to cigarette smoking, predating tobacco use, and subsequent likelihood of cigarette vs. e-cigarette initiation. This study demonstrates that initiation of either product is elevated among youth who are susceptible to smoking; thus susceptibility to smoking may serve as a useful marker of vulnerability to tobacco product use. Furthermore, this study provides novel information on the relationship between tobacco product onset and specific harm perceptions associated with e-cigarettes versus cigarettes among adolescents. Copyright © 2018 Elsevier Ltd. All rights reserved.

Prices and E-Cigarette Demand: Evidence From the European Union.

PubMed

Stoklosa, Michal; Drope, Jeffrey; Chaloupka, Frank J

2016-10-01

Many European Union (EU) Member States have expressed the need for EU legislation to clarify the issue of e-cigarette taxation, but the economic evidence to inform creation of such policies has been lacking. To date, only one study-on the United States only-has examined responsiveness of e-cigarette demand to price changes. We used 2011-2014 pooled time-series data on e-cigarette sales, as well as e-cigarette and cigarette prices for six EU markets (Estonia, Ireland, Latvia, Lithuania, Sweden, and the United Kingdom). We utilized static and dynamic fixed-effects models to estimate the own and cross-price elasticity of demand for e-cigarettes. In a separate model for Sweden, we examined the effects of snus prices on e-cigarette sales. Based on static models, every 10% increase in e-cigarette prices is associated with a drop in e-cigarettes sales of approximately 8.2%, while based on dynamic models, the drop is 2.7% in the short run and 11.5% in the long run. Combustible cigarette prices are positively associated with sales of e-cigarettes. Snus prices are positively associated with sales of e-cigarettes in Sweden. Our results indicate that the sales of e-cigarettes are responsive to price changes, which suggests that excise taxes can help governments to mitigate an increase in e-cigarette use. E-cigarettes and regular cigarettes are substitutes, with higher cigarette prices being associated with increased e-cigarette sales. Making combustible cigarettes more expensive compared to e-cigarettes could be effective in moving current combustible smokers to e-cigarettes, which might have positive health effects. This study is an exploratory analysis of the issues around e-cigarette taxation in Europe. Our results suggest that taxation is a measure that could potentially address the concerns of both opponents and proponents of e-cigarettes: taxes on e-cigarettes could be used to raise prices so as to deter e-cigarette initiation by never users, while concomitant greater tax increases on regular cigarettes could incentivize switching from combustible products to e-cigarettes. The estimates from our models suggest that e-cigarette demand is possibly more responsive to price than cigarette demand. Policymakers who consider implementing excise taxes on e-cigarettes should take this difference in price responsiveness of demand for these two products under consideration. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Association Between Initial Use of e-Cigarettes and Subsequent Cigarette Smoking Among Adolescents and Young Adults: A Systematic Review and Meta-analysis.

PubMed

Soneji, Samir; Barrington-Trimis, Jessica L; Wills, Thomas A; Leventhal, Adam M; Unger, Jennifer B; Gibson, Laura A; Yang, JaeWon; Primack, Brian A; Andrews, Judy A; Miech, Richard A; Spindle, Tory R; Dick, Danielle M; Eissenberg, Thomas; Hornik, Robert C; Dang, Rui; Sargent, James D

2017-08-01

The public health implications of e-cigarettes depend, in part, on whether e-cigarette use affects the risk of cigarette smoking. To perform a systematic review and meta-analysis of longitudinal studies that assessed initial use of e-cigarettes and subsequent cigarette smoking. PubMed, EMBASE, Cochrane Library, Web of Science, the 2016 Society for Research on Nicotine and Tobacco 22nd Annual Meeting abstracts, the 2016 Society of Behavioral Medicine 37th Annual Meeting & Scientific Sessions abstracts, and the 2016 National Institutes of Health Tobacco Regulatory Science Program Conference were searched between February 7 and February 17, 2017. The search included indexed terms and text words to capture concepts associated with e-cigarettes and traditional cigarettes in articles published from database inception to the date of the search. Longitudinal studies reporting odds ratios for cigarette smoking initiation associated with ever use of e-cigarettes or past 30-day cigarette smoking associated with past 30-day e-cigarette use. Searches yielded 6959 unique studies, of which 9 met inclusion criteria (comprising 17 389 adolescents and young adults). Study quality and risk of bias were assessed using the Newcastle-Ottawa Scale and the Risk of Bias in Non-randomized Studies of Interventions tool, respectively. Data and estimates were pooled using random-effects meta-analysis. Among baseline never cigarette smokers, cigarette smoking initiation between baseline and follow-up. Among baseline non-past 30-day cigarette smokers who were past 30-day e-cigarette users, past 30-day cigarette smoking at follow-up. Among 17 389 adolescents and young adults, the ages ranged between 14 and 30 years at baseline, and 56.0% were female. The pooled probabilities of cigarette smoking initiation were 30.4% for baseline ever e-cigarette users and 7.9% for baseline never e-cigarette users. The pooled probabilities of past 30-day cigarette smoking at follow-up were 21.5% for baseline past 30-day e-cigarette users and 4.6% for baseline non-past 30-day e-cigarette users. Adjusting for known demographic, psychosocial, and behavioral risk factors for cigarette smoking, the pooled odds ratio for subsequent cigarette smoking initiation was 3.62 (95% CI, 2.42-5.41) for ever vs never e-cigarette users, and the pooled odds ratio for past 30-day cigarette smoking at follow-up was 4.28 (95% CI, 2.52-7.27) for past 30-day e-cigarette vs non-past 30-day e-cigarette users at baseline. A moderate level of heterogeneity was observed among studies (I2 = 60.1%). e-Cigarette use was associated with greater risk for subsequent cigarette smoking initiation and past 30-day cigarette smoking. Strong e-cigarette regulation could potentially curb use among youth and possibly limit the future population-level burden of cigarette smoking.

‘A good method of quitting smoking’ or ‘just an alternative to smoking’? Comparative evaluations of e-cigarette and traditional cigarette usage by dual users

PubMed Central

Vandrevala, Tushna; Coyle, Adrian; Walker, Victoria; Cabrera Torres, Joshelyn; Ordoña, Izobel; Rahman, Panna

2017-01-01

The development of e-cigarettes was initially hailed as a resource in facilitating a reduction in or cessation of cigarette smoking. Many users of e-cigarettes are ‘dual users’, smoking traditional cigarettes and e-cigarettes. The present qualitative study examines the factors that a group of 20 dual users considered to have been influential in their decisions to use e-cigarettes and their comparative evaluations of e-cigarettes and traditional cigarettes. Health concerns were not found to be sole motivators. Participants pointed to financial and contextual considerations, particularly peer influence on uptake and continued usage of e-cigarettes. E-cigarettes were evaluated as comparable to cigarettes in some ways but not in other important respects such as sensation and satisfaction. Different social evaluations of cigarette and e-cigarette usage were discerned which influenced how participants identified as smokers, ‘vapers’ or neither. Findings are discussed in relation to social representations, identity and implications for continued e-cigarette usage among dual users. PMID:28680694

'A good method of quitting smoking' or 'just an alternative to smoking'? Comparative evaluations of e-cigarette and traditional cigarette usage by dual users.

PubMed

Vandrevala, Tushna; Coyle, Adrian; Walker, Victoria; Cabrera Torres, Joshelyn; Ordoña, Izobel; Rahman, Panna

2017-01-01

The development of e-cigarettes was initially hailed as a resource in facilitating a reduction in or cessation of cigarette smoking. Many users of e-cigarettes are 'dual users', smoking traditional cigarettes and e-cigarettes. The present qualitative study examines the factors that a group of 20 dual users considered to have been influential in their decisions to use e-cigarettes and their comparative evaluations of e-cigarettes and traditional cigarettes. Health concerns were not found to be sole motivators. Participants pointed to financial and contextual considerations, particularly peer influence on uptake and continued usage of e-cigarettes. E-cigarettes were evaluated as comparable to cigarettes in some ways but not in other important respects such as sensation and satisfaction. Different social evaluations of cigarette and e-cigarette usage were discerned which influenced how participants identified as smokers, 'vapers' or neither. Findings are discussed in relation to social representations, identity and implications for continued e-cigarette usage among dual users.

Does e-cigarette use predict cigarette escalation? A longitudinal study of young adult non-daily smokers.

PubMed

Doran, Neal; Brikmanis, Kristin; Petersen, Angela; Delucchi, Kevin; Al-Delaimy, Wael K; Luczak, Susan; Myers, Mark; Strong, David

2017-07-01

Recent studies suggest that e-cigarette use among youth may be associated with increased risk of cigarette initiation. The goal of this study was to test the hypothesis that use of e-cigarettes among young adult non-daily cigarette smokers would be associated with increased cigarette consumption. Participants (n=391; 52% male) were 18-24year-old non-daily cigarette smokers recruited from across California. Cigarette and e-cigarette use were assessed online or via mobile phone every three months for one year between March 2015 and December 2016. Longitudinal negative binomial regression models showed that, adjusted for propensity for baseline e-cigarette use, non-daily smokers who reported more frequent use of e-cigarettes upon study entry reported greater quantity and frequency of cigarette smoking at baseline and greater increases in cigarette quantity over 12months than non-daily cigarette only smokers (ps<0.01). During the 12months of assessment, more consistent consumption of e-cigarettes was associated with greater quantity and frequency of cigarette use (ps<0.01); these effects did not vary over time. Findings suggest that among non-daily smokers, young adults who use e-cigarettes tend to smoke more cigarettes and to do so more frequently. Such individuals may be at greater risk for chronic tobacco use and dependence. Copyright © 2017 Elsevier Inc. All rights reserved.

Characterizing use patterns and perceptions of relative harm in dual users of electronic and tobacco cigarettes

PubMed Central

Rass, Olga; Pacek, Lauren R.; Johnson, Patrick S.; Johnson, Matthew W.

2015-01-01

Awareness and use of electronic cigarettes (e-cigarettes) is increasing. Questions regarding positive (e.g., smoking reduction/cessation) and negative (e.g., delay of cessation) potential public health consequences of e-cigarettes may be informed by studying dual users of e-cigarettes and tobacco cigarettes. A cross-sectional online survey assessed demographics, product use patterns, and beliefs about relative product benefits and harms among dual users (n = 350) in the United States using the website Amazon Mechanical Turk (MTurk). Compared to tobacco cigarettes, e-cigarettes were used less often and were associated with lower dependence. Participants reported a 30% reduction in self-reported tobacco cigarette smoking since beginning to use e-cigarettes. Reported primary reasons for e-cigarette use were harm reduction and smoking cessation. E-cigarette use was reported as more likely in settings with smoking restrictions and when others’ health could be adversely affected. Conversely, participants reported having used tobacco cigarettes more often than e-cigarettes in hedonic situations (e.g., after eating, drinking coffee or alcohol, or having sex), outdoors, or when stressed. Participants were twice as likely to report wanting to quit tobacco cigarettes compared to e-cigarettes in the next year and intended to quit tobacco cigarettes sooner. Tobacco cigarettes were described as more harmful and addictive, but also more enjoyable than e-cigarettes. Participants provided evidence consistent with both positive and negative public health consequences of e-cigarettes, highlighting the need for experimental research, including laboratory studies and clinical trials. Policies should consider potential public health benefits of e-cigarettes, in addition to potential harms. PMID:26389638

E-cigarette Use and Willingness to Smoke in a Sample of Adolescent Nonsmokers

PubMed Central

Wills, Thomas A.; Sargent, James D.; Knight, Rebecca; Pagano, Ian; Gibbons, Frederick X.

2016-01-01

Objective There is little evidence on the consequences of electronic cigarette (e-cigarette) use in adolescence. With a multiethnic sample of nonsmokers, we assessed the relation between e-cigarette use and social-cognitive factors that predict smoking combustible cigarettes (cigarettes). Methods School-based cross-sectional survey of 2,309 high school students (M age 14.7 years). Participants reported on e-cigarette use and cigarette use; on smoking-related cognitions (smoking expectancies, prototypes of smokers) and peer smoker affiliations; and on willingness to smoke cigarettes. Regression analyses conducted for non-cigarette smokers tested the association between e-cigarette use and willingness to smoke cigarettes, controlling for demographics, parenting, academic and social competence, and personality variables. Structural equation modeling (SEM) analyses tested whether the relation between e-cigarette use and willingness was mediated through any of the three smoking-related variables. Results Nonsmokers who had used e-cigarettes (18% of the total sample) showed more willingness to smoke cigarettes compared to those who had never used any tobacco product; the adjusted odds ratio was 2.35 (95% confidence interval 1.73 – 3.19). Additionally, willingness prospectively predicted smoking onset. SEM showed that the relation between e-cigarette use and willingness to smoke was partly mediated through more positive expectancies about smoking but there was also a direct path from e-cigarette use to willingness. Conclusions Among adolescent nonsmokers, e-cigarette use is associated with willingness to smoke, a predictor of future cigarette smoking. The results suggest that use of e-cigarettes by adolescents is not without attitudinal risk for cigarette smoking. These findings have implications for formulation of policy about access to e-cigarettes by adolescents. PMID:26261237

How hearing about harmful chemicals affects smokers' interest in dual use of cigarettes and e-cigarettes.

PubMed

Pepper, Jessica K; Byron, M Justin; Ribisl, Kurt M; Brewer, Noel T

2017-03-01

Substantial harm could result from concurrent cigarette and e-cigarette use (i.e., dual use) were it to undermine smoking cessation. Perceptions of chemical exposure and resulting harms may influence dual use. We conducted a probability-based phone survey of 1164 U.S. adult cigarette smokers in 2014-2015 and analyzed results in 2016. In a between-subjects experiment, smokers heard a hypothetical scenario in which cigarettes and e-cigarettes had the same amount of harmful chemicals or cigarettes had more chemicals than e-cigarettes (10× more, 100× more, or chemicals were present only in cigarettes). Smokers indicated how the scenario would change their interest in dual use and perceived health harms. Few smokers (7%) who heard that the products have the same amount of chemicals were interested in initiating or increasing dual use. However, more smokers were interested when told that cigarettes have 10× more chemicals than e-cigarettes (31%), 100× more chemicals than e-cigarettes (32%), or chemicals were present only in cigarettes (43%) (all p<.001). Individuals told that cigarettes have more chemicals were more likely than those in the "same amount" scenario to perceive that cigarettes would be more harmful than e-cigarettes (79% vs. 41%, OR=5.41, 95% CI=4.08-7.17). These harm perceptions partially explained the relationship between chemical scenario and dual use interest. Smokers associated higher chemical amounts in cigarettes versus e-cigarettes with greater health harms from cigarettes and thus expressed increased interest in dual use. The findings suggest that disclosing amounts of chemicals in cigarette smoke and e-cigarette aerosol could unintentionally encourage dual use. Copyright © 2016 Elsevier Inc. All rights reserved.

Electronic Cigarette Use and Uptake of Cigarette Smoking: A Longitudinal Examination of U.S. College Students

PubMed Central

Spindle, Tory R.; Hiler, Marzena M.; Cooke, Megan; Eissenberg, Thomas; Kendler, Kenneth S.; Dick, Danielle

2016-01-01

Introduction Electronic cigarette (e-cigarette) use prevalence is increasing among U.S. adolescents and adults but recent longitudinal data for college/university students are scarce. Furthermore, the extent that e-cigarette use is associated with the onset of cigarette smoking and the factors that lead to the uptake of e-cigarettes in college students has not been explored. Methods 3,757 participants from a Mid-Atlantic university (women: 66%; White: 45%; Black: 21%; Asian: 19%; Hispanic/Latino: 6%) were surveyed in 2014 and again in 2015. Results Among participants reporting never smoking at time 1, those who had ever tried e-cigarettes or were currently using e-cigarettes (at least one use in past 30 days) were more likely to have ever tried cigarettes by time 2 relative to individuals who had not used e-cigarettes. Ever use of e-cigarettes (but not current use) also increased participants’ likelihood of being current cigarette smokers at time 2. Among initial never users of e-cigarettes or cigarettes, males and ever marijuana users had an increased probability of trying e-cigarettes by time 2. Furthermore, less perseverance (an index of impulsivity) and ever use of other tobacco products increased initial never users’ chances of trying both cigarettes and e-cigarettes by time 2. Conclusions Given that never-smoking participants who had tried e-cigarettes were more likely to initiate cigarette use later, limiting young adults’ access to these products may be beneficial. As the long-term health implications of e-cigarette use become clearer, predictors of e-cigarette use could help identify future populations likely to use and abuse these products. PMID:28038364

Prevalence and Correlates of E-Cigarette Perceptions and Trial Among Early Adolescents in Mexico.

PubMed

Thrasher, James F; Abad-Vivero, Erika N; Barrientos-Gutíerrez, Inti; Pérez-Hernández, Rosaura; Reynales-Shigematsu, Luz Miriam; Mejía, Raúl; Arillo-Santillán, Edna; Hernández-Ávila, Mauricio; Sargent, James D

2016-03-01

Assess the prevalence and correlates of e-cigarette perceptions and trial among adolescents in Mexico, where e-cigarettes are banned. Cross-sectional data were collected in 2015 from a representative sample of middle-school students (n = 10,146). Prevalence of e-cigarette awareness, relative harm, and trial were estimated, adjusting for sampling weights and school-level clustering. Multilevel logistic regression models adjusted for school-level clustering to assess correlates of e-cigarette awareness and trial. Finally, students who had tried only e-cigarettes were compared with students who had tried: (1) conventional cigarettes only; (2) both e-cigarettes and conventional cigarettes (dual triers); and (3) neither cigarette type (never triers). Fifty-one percent of students had heard about e-cigarettes, 19% believed e-cigarettes were less harmful than conventional cigarettes, and 10% had tried them. Independent correlates of e-cigarette awareness and trial included established risk factors for smoking, as well as technophilia (i.e., use of more media technologies) and greater Internet tobacco advertising exposure. Exclusive e-cigarette triers (4%) had significantly higher technophilia, bedroom Internet access, and Internet tobacco advertising exposure compared to conventional cigarette triers (19%) and never triers (71%) but not compared to dual triers (6%), although dual triers had significantly stronger conventional cigarette risk factors. This study suggests that adolescent e-cigarette awareness and use is high in Mexico, in spite of its e-cigarette ban. A significant number of medium-risk youth have tried e-cigarettes only, suggesting that e-cigarettes could lead to more intensive substance use. Strategies to reduce e-cigarette use should consider reducing exposures to Internet marketing. Copyright © 2016 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.

Prevalence and correlates of e-cigarette perceptions and trial among Mexican adolescents

PubMed Central

Thrasher, James F.; Abad-Vivero, Erika N.; Barrientos-Gutíerrez, Inti; Pérez-Hernández, Rosaura; Reynales-Shigematsu, Luz Miriam; Mejía, Raúl; Arillo-Santillán, Edna; Hernández-Ávila, Mauricio; Sargent, James D.

2016-01-01

PURPOSE Assess the prevalence and correlates of e-cigarette perceptions and trial among adolescents in Mexico, where e-cigarettes are banned. METHODS Cross-sectional data were collected in 2015 from a representative sample of middle school students (n=10,146). Prevalence of e-cigarette awareness, relative harm, and trial were estimated, adjusting for sampling weights and school-level clustering. Multilevel logistic regression models adjusted for school-level clustering to assess correlates of e-cigarette awareness and trial. Finally, students who had tried only e-cigarettes were compared with students who had tried: 1) conventional cigarettes only; 2) both e-cigarettes and conventional cigarettes (dual triers); 3) neither cigarette type (never triers). RESULTS 51% of students had heard about e-cigarettes, 19% believed e-cigarettes were less harmful than conventional cigarettes, and 10% had tried them. Independent correlates of e-cigarette awareness and trial included established risk factors for smoking, as well as technophilia (i.e., use of more media technologies) and greater Internet tobacco advertising exposure. Exclusive e-cigarette triers (4%) had significantly higher technophilia, bedroom Internet access, and Internet tobacco advertising exposure compared to conventional cigarette triers (19%) and never triers (71%), but not compared to dual triers (6%), even though dual triers had significantly stronger conventional cigarette risk factors. CONCLUSIONS This study suggests that adolescent e-cigarette awareness and use is high in Mexico, in spite of its e-cigarette ban. A significant number of medium-risk youth have tried e-cigarettes only, suggesting that e-cigarettes could lead to more intensive substance use. Strategies to reduce e-cigarette use should consider reducing exposures to Internet marketing. PMID:26903433

Emergence of electronic cigarette use in US adolescents and the link to traditional cigarette use.

PubMed

Lanza, Stephanie T; Russell, Michael A; Braymiller, Jessica L

2017-04-01

Electronic cigarettes (e-cigarettes) are increasingly used by US adolescents and may be a gateway to traditional cigarette use. We examine rates of both products by age and examine differences in age-varying rates by sex and race/ethnicity. Data are from the 2014 National Youth Tobacco Survey, a national sample of US middle and high school students (n=22.007); students ages 11-19 were included. Past 30-day e-cigarette and traditional cigarette use were examined as a function of age; sex and race/ethnicity were included as moderators. The age-varying association between e-cigarette and traditional cigarette use was also examined. Rates of e-cigarette use increase faster than traditional cigarette use from ages 13-16. Compared to females, males had higher rates of e-cigarette use from ages 14-17.5 and traditional cigarette use from ages 15-18. Between ages 12-14, more Hispanic adolescents used e-cigarettes compared to White or Black adolescents; after age 14 Hispanics and Whites reported similar rates, peaking at twice the rate for Blacks. Hispanic adolescents report greater traditional cigarette use versus Whites between ages 12-13, but lower rates between ages 15-18. E-cigarette use was strongly associated with traditional cigarette use, particularly during early adolescence [OR>40 before age 12]. Young Hispanic adolescents are at elevated risk for use of e-cigarettes and traditional cigarettes during early adolescence. During early adolescence, youth using e-cigarettes are more likely to smoke traditional cigarettes compared to youth not using e-cigarettes. The study of age-varying effects holds promise for advancing understanding of disparities in health risk behaviors. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Relation between Frequency of E-Cigarette Use and Frequency and Intensity of Cigarette Smoking among South Korean Adolescents

PubMed Central

Lee, Jung Ah; Lee, Sungkyu; Cho, Hong-Jun

2017-01-01

Introduction: The prevalence of adolescent electronic cigarette (e-cigarette) use has increased in most countries. This study aims to determine the relation between the frequency of e-cigarette use and the frequency and intensity of cigarette smoking. Additionally, the study evaluates the association between the reasons for e-cigarette use and the frequency of its use. Materials and Methods: Using the 2015 Korean Youth Risk Behavior Web-Based Survey, we included 6655 adolescents with an experience of e-cigarette use who were middle and high school students aged 13–18 years. We compared smoking experience, the frequency and intensity of cigarette smoking, and the relation between the reasons for e-cigarette uses and the frequency of e-cigarette use. Results: The prevalence of e-cigarette ever and current (past 30 days) users were 10.1% and 3.9%, respectively. Of the ever users, approximately 60% used e-cigarettes not within 1 month. On the other hand, 8.1% used e-cigarettes daily. The frequent and intensive cigarette smoking was associated with frequent e-cigarette uses. The percentage of frequent e-cigarette users (≥10 days/month) was 3.5% in adolescents who did not smoke within a month, but 28.7% among daily smokers. Additionally, it was 9.1% in smokers who smoked less than 1 cigarette/month, but 55.1% in smokers who smoked ≥20 cigarettes/day. The most common reason for e-cigarette use was curiosity (22.9%), followed by the belief that they are less harmful than conventional cigarettes (18.9%), the desire to quit smoking (13.1%), and the capacity for indoor use (10.7%). Curiosity was the most common reason among less frequent e-cigarette users; however, the desire to quit smoking and the capacity for indoor use were the most common reasons among more frequent users. Conclusions: Results showed a positive relation between frequency or intensity of conventional cigarette smoking and the frequency of e-cigarette use among Korean adolescents, and frequency of e-cigarette use differed according to the reason for the use of e-cigarettes. PMID:28335449

The Relation between Frequency of E-Cigarette Use and Frequency and Intensity of Cigarette Smoking among South Korean Adolescents.

PubMed

Lee, Jung Ah; Lee, Sungkyu; Cho, Hong-Jun

2017-03-14

The prevalence of adolescent electronic cigarette (e-cigarette) use has increased in most countries. This study aims to determine the relation between the frequency of e-cigarette use and the frequency and intensity of cigarette smoking. Additionally, the study evaluates the association between the reasons for e-cigarette use and the frequency of its use. Using the 2015 Korean Youth Risk Behavior Web-Based Survey, we included 6655 adolescents with an experience of e-cigarette use who were middle and high school students aged 13-18 years. We compared smoking experience, the frequency and intensity of cigarette smoking, and the relation between the reasons for e-cigarette uses and the frequency of e-cigarette use. The prevalence of e-cigarette ever and current (past 30 days) users were 10.1% and 3.9%, respectively. Of the ever users, approximately 60% used e-cigarettes not within 1 month. On the other hand, 8.1% used e-cigarettes daily. The frequent and intensive cigarette smoking was associated with frequent e-cigarette uses. The percentage of frequent e-cigarette users (≥10 days/month) was 3.5% in adolescents who did not smoke within a month, but 28.7% among daily smokers. Additionally, it was 9.1% in smokers who smoked less than 1 cigarette/month, but 55.1% in smokers who smoked ≥20 cigarettes/day. The most common reason for e-cigarette use was curiosity (22.9%), followed by the belief that they are less harmful than conventional cigarettes (18.9%), the desire to quit smoking (13.1%), and the capacity for indoor use (10.7%). Curiosity was the most common reason among less frequent e-cigarette users; however, the desire to quit smoking and the capacity for indoor use were the most common reasons among more frequent users. Results showed a positive relation between frequency or intensity of conventional cigarette smoking and the frequency of e-cigarette use among Korean adolescents, and frequency of e-cigarette use differed according to the reason for the use of e-cigarettes.

Nicotine, Carcinogen, and Toxin Exposure in Long-Term E-Cigarette and Nicotine Replacement Therapy Users: A Cross-sectional Study.

PubMed

Shahab, Lion; Goniewicz, Maciej L; Blount, Benjamin C; Brown, Jamie; McNeill, Ann; Alwis, K Udeni; Feng, June; Wang, Lanqing; West, Robert

2017-03-21

Given the rapid increase in the popularity of e-cigarettes and the paucity of associated longitudinal health-related data, the need to assess the potential risks of long-term use is essential. To compare exposure to nicotine, tobacco-related carcinogens, and toxins among smokers of combustible cigarettes only, former smokers with long-term e-cigarette use only, former smokers with long-term nicotine replacement therapy (NRT) use only, long-term dual users of both combustible cigarettes and e-cigarettes, and long-term users of both combustible cigarettes and NRT. Cross-sectional study. United Kingdom. The following 5 groups were purposively recruited: combustible cigarette-only users, former smokers with long-term (≥6 months) e-cigarette-only or NRT-only use, and long-term dual combustible cigarette-e-cigarette or combustible cigarette-NRT users (n = 36 to 37 per group; total n = 181). Sociodemographic and smoking characteristics were assessed. Participants provided urine and saliva samples and were analyzed for biomarkers of nicotine, tobacco-specific N-nitrosamines (TSNAs), and volatile organic compounds (VOCs). After confounders were controlled for, no clear between-group differences in salivary or urinary biomarkers of nicotine intake were found. The e-cigarette-only and NRT-only users had significantly lower metabolite levels for TSNAs (including the carcinogenic metabolite 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol [NNAL]) and VOCs (including metabolites of the toxins acrolein; acrylamide; acrylonitrile; 1,3-butadiene; and ethylene oxide) than combustible cigarette-only, dual combustible cigarette-e-cigarette, or dual combustible cigarette-NRT users. The e-cigarette-only users had significantly lower NNAL levels than all other groups. Combustible cigarette-only, dual combustible cigarette-NRT, and dual combustible cigarette-e-cigarette users had largely similar levels of TSNA and VOC metabolites. Cross-sectional design with self-selected sample. Former smokers with long-term e-cigarette-only or NRT-only use may obtain roughly similar levels of nicotine compared with smokers of combustible cigarettes only, but results varied. Long-term NRT-only and e-cigarette-only use, but not dual use of NRTs or e-cigarettes with combustible cigarettes, is associated with substantially reduced levels of measured carcinogens and toxins relative to smoking only combustible cigarettes. Cancer Research UK.

E-Cigarettes Use Behavior and Experience of Adults: Qualitative Research Findings to Inform E-Cigarette Use Measure Development

PubMed Central

Davis, Andrew H.; Dohack, Jaime L.; Clark, Pamela I.

2017-01-01

Objectives: To gain a better understanding of electronic cigarette (e-cigarette) use behavior and experience among adult e-cigarette users, with the goal of informing development of future e-cigarette use measures. Methods: Between August and October 2014 six focus groups were conducted in Seattle. Participants (63% male; 60% >35 years old; 60% White): e-cigarette users who used combustible tobacco products either currently or in the past. E-cigarette discussion topics covered: their daily use pattern (eg, frequency), product-related characteristics (eg, nicotine levels), and perceptions about health risks and benefits. Results: Participants’ descriptions of daily use were so varied that no common “unit” of a “session” easily summarized frequency or quantity of typical e-cigarette use. Most users had difficulty in tracking their own use. Participants reported nicotine craving relief when using e-cigarettes, but described e-cigarettes use as less satisfying than combustible cigarettes. Valued characteristics included “ready availability” and the possibility of using indoors. A unique aspect of the e-cigarette use experience is the option of adding flavors and having the ability to exhale “big clouds” of vapor/aerosol. Most perceived e-cigarettes as a better and safer alternative to conventional cigarettes, yet still sought further information about health consequences and safety of e-cigarettes from trusted sources. Conclusions: E-cigarettes users are far from homogeneous in their behavior and motivation for adopting e-cigarettes. A range of use patterns arising from both hedonic and utilitarian factors, along with product characteristics (eg, variable nicotine levels and flavors) extending beyond those of conventional cigarettes, suggest that new, specific e-cigarette use measures must be developed. Implications: The current study provides timely information on adult e-cigarette use behavior, which is a crucial step in measuring this new phenomenon and assessing the risks associated with using e-cigarette products. Our findings reveal that vaping is not a mere replacement for combustible cigarette smoking and that many users of e-cigarettes enjoy product characteristics such as flavors and “clouds” that are unavailable in combustible cigarettes. Therefore, commonly available cigarette smoking measures are not well suited to measurement of e-cigarette use behavior, and indication that new measures need to be developed to accurately track e-cigarette use. PMID:27613944

Associations of attitudes towards electronic cigarettes with advertisement exposure and social determinants: a cross sectional study.

PubMed

Reinhold, Benjamin; Fischbein, Rebecca; Bhamidipalli, Surya Sruthi; Bryant, Jennifer; Kenne, Deric R

2017-01-01

The exposure of young adults to electronic cigarette (e-cigarette) advertisements has risen rapidly. E-cigarette ads have been shown to increase short term perceived acceptability of using e-cigarettes in places where traditional cigarettes are banned. We set out to investigate if advertising exposure was related to perceptions of harm, addictiveness, and acceptability of use of e-cigarettes in places where traditional cigarettes are banned. Using a cross-sectional design, 6037 students at a large Midwestern university between the ages of 18-24 were surveyed about e-cigarette use and smoking status. Bivariate analyses were performed associating perception of harm, addictiveness, and acceptability of e-cigarette use in places where smoking is banned with demographic and other background factors, and e-cigarette advertising exposure through different media channels. Logistic regression analyses were used to explore the relationship of these factors on perceptions of harm, addictiveness and acceptability of e-cigarette use in places where smoking is banned. More than a quarter (27.4%) of respondents had used an e-cigarette, greater than half (53.2%) had seen an advertisement on TV and 42.0% had seen an advertisement on the Internet. Logistic regressions revealed that being white, male, an e-cigarette user, a smoker, having a mother who smoked, and Internet advertisement exposure were associated with lower perceived harm of e-cigarettes. The same factors, plus having seen advertisements on TV, were associated with increased likelihood of perceiving e-cigarette use in bars, stores, at work and in a dorm as acceptable. Perceiving use of e-cigarettes as acceptable in classrooms was also associated with the aforementioned factors and also included race. Only being male and an e-cigarette user were associated with lower perceived addictiveness of e-cigarettes. E-cigarette use is increasing in adolescents and young adults, as is exposure to e-cigarette advertising. Independent of nicotine use and demographics factors, e-cigarette advertising is associated with increased beliefs in acceptability of e-cigarette use in places where cigarettes are banned. E-cigarette advertisements may be responsible for normalizing e-cigarette use. Exposure to internet e-cigarette advertisements was associated with lower perceived harm; this may be due to the false health claims often made in internet advertisements.

Trends in characteristics and multi-product use among adolescents who use electronic cigarettes, United States 2011-2015

PubMed Central

Chaffee, Benjamin W.; Couch, Elizabeth T.; Gansky, Stuart A.

2017-01-01

Objectives Evaluate trends from 2011–2015 in electronic cigarette (e-cigarette) use among U.S. adolescents, grades 6–12, including prevalence and associations with past month use of cigarettes and other tobacco products, cigarette smoking intensity, quit attempts, and quit contemplation. Methods Five consecutive waves from the National Youth Tobacco Survey (N = 101,011) were used to estimate the grade- and race/ethnicity-standardized prevalence of past month use of e-cigarettes and nine non e-cigarette tobacco products. We assessed linear trends by year and compared outcomes (e.g., tobacco use, smoking intensity) by e-cigarette past month use. Results Past month e-cigarette use rose sharply from 2011–2015. In all years and both sexes, e-cigarette past month use and ever use were positively associated with use of cigarettes and other tobacco products, with past month e-cigarette use reaching 52% in 2015 among individuals who used ≥1 non e-cigarette tobacco product in the past month. Meanwhile, from 2011–2015, the population of adolescent past month e-cigarette users increasingly encompassed adolescents who were not past month users of other products (females: 19.0% to 41.7%; males: 11.1% to 36.7%) or had never used other products (females: 7.1% to 13.5%; males: 6.7% to 15.0%). Among male (but not female) past month cigarette users, there was a statistically significant positive association between past month e-cigarette use and daily cigarette smoking but not in all individual years. Past month e-cigarette use among past month cigarette smokers was not associated with cigarette quit attempts or quit contemplation, with no temporal trend. Conclusion Adolescent past month e-cigarette use is associated with past month use of other tobacco but not with cigarette quit attempts or quit contemplation among cigarette users. Over five years, the average characteristics of U.S. adolescents who use e-cigarettes have shifted, increasingly including more adolescents who do not use non e-cigarette tobacco products. PMID:28475634

E-cigarette price sensitivity among middle- and high-school students: evidence from monitoring the future.

PubMed

Pesko, Michael F; Huang, Jidong; Johnston, Lloyd D; Chaloupka, Frank J

2018-05-01

We estimated associations between e-cigarette prices (both disposable and refill) and e-cigarette use among middle and high-school students in the United States. We also estimated associations between cigarette prices and e-cigarette use. We used regression models to estimate the associations between e-cigarette and cigarette prices and e-cigarette use. In our regression models, we exploited changes in e-cigarette and cigarette prices across four periods of time and across 50 markets. We report the associations as price elasticities. In our primary model, we controlled for socio-demographic characteristics, cigarette prices, tobacco control policies, market fixed effects and year-quarter fixed effects. United States of America. A total of 24 370 middle- and high-school students participating in the Monitoring the Future Survey in years 2014 and 2015. Self-reported e-cigarette use over the last 30 days. Average quarterly cigarette prices, e-cigarette disposable prices and e-cigarette refill prices were constructed from Nielsen retail data (inclusive of excise taxes) for 50 US markets. In a model with market fixed effects, we estimated that a 10% increase in e-cigarette disposable prices is associated with a reduction in the number of days vaping among e-cigarette users by approximately 9.7% [95% confidence interval (CI) = -17.7 to 1.8%; P = 0.02] and is associated with a reduction in the number of days vaping by the full sample by approximately 17.9% (95% CI = -31.5 to -4.2%; P = 0.01). Refill e-cigarette prices were not statistically significant predictors of vaping. Cigarette prices were not associated significantly with e-cigarette use regardless of the e-cigarette price used. However, in a model without market fixed effects, cigarette prices were a statistically significant positive predictor of total e-cigarette use. Higher e-cigarette disposable prices appear to be associated with reduced e-cigarette use among adolescents in the US. © 2017 Society for the Study of Addiction.

A Randomized Trial of the Effect of Youth Appealing E-Cigarette Advertising on Susceptibility to Use E-Cigarettes Among Youth.

PubMed

Padon, Alisa A; Lochbuehler, Kirsten; Maloney, Erin K; Cappella, Joseph N

2017-07-05

Very little is known about how e-cigarette marketing is being perceived by youth, and the potential effect it will have on youth vaping and smoking behaviors. This limits the ability to identify youth-focused marketing efforts and to design effective policies for the regulation of e-cigarette marketing content and placement. A sample of 417 nonsmoking youth (mean age = 15, SD = 1.3) were randomly assigned to either view four e-cigarette ads with low youth appeal, four e-cigarette ads with high youth appeal or four control ads. After exposure, participants completed covert and overt measurements of e-cigarette and tobacco cigarette attitudes and susceptibility to use. Youth in an e-cigarette ad condition were more likely to select an e-cigarette item in a product choice task compared to control, and had more positive e-cigarette beliefs. Contrary to hypotheses, youth in the low youth appeal condition reported greater susceptibility to trying e-cigarettes and tobacco cigarettes compared to control. Exposure to any e-cigarette advertising may play a role in teens' decision to initiate e-cigarette and tobacco cigarette use. As the Food and Drug Administration now has regulatory authority over the marketing of e-cigarettes, regulations on e-cigarette advertising are suggested. Teens are increasingly being exposed to e-cigarette advertising, and many places are considering e-cigarette regulations, yet we know very little about how e-cigarette advertisements might influence youth tobacco use. This study utilized a novel dataset of e-cigarette ads coded for youth appeal and presented them to a sample of 417 nonsmoking teens in a randomized controlled design to test the effect of features on youth susceptibility to initiating e-cigarette and tobacco cigarette use. The findings inform evidence-based recommendations for regulating the marketing of e-cigarettes. © The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.