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FDAs new plan to reduce the nicotine in cigarettes to sub-addictive levels could be a game-changer

August 22, 2017 - 9:23am

On 28 July 2017, US Food and Drug Administration (FDA) Chief Scott Gottlieb, MD, announced a bold new plan to limit the nicotine allowed in manufactured cigarettes.1 Gottlieb, a Trump appointee revealing C Everett Koop-like potential, pointed out that cigarettes remain the leading preventable cause of death in the USA, killing nearly half a million Americans every year.2 But of course it is the nicotine in cigarettes—kept above some crucial level and potency—that keeps people smoking and ultimately leads to disease, death and the suffering of families. Gottlieb did not specify a level below which nicotine would have to be lowered, but he did say it would have to render cigarettes ‘minimally or non-addictive’.

Gottlieb’s announcement caused a panic on Wall Street, where cigarette stocks took a plunge not seen for decades. Altria’s market value was briefly down nearly 20%, and other cigarette makers suffered significant losses....

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Die Another Day, James Bond's smoking over six decades

August 22, 2017 - 9:23am

We aimed to examine smoking-related content in all 24 James Bond movies in the Eon Productions series from 1962 to 2015. There were favourable downward trends for any smoking by James Bond (p=0.015 for trend), and for tobacco-related spy-gadgetry (p=0.009). Around 20% of Bond's 60 sexual partners smoked in each decade, and most recently in 2012. There were regular mentions of smoking risks to health (starting from 1967) and product placement of branded packs was present in two movies. Overall, the persisting smoking content remains problematic from a public health perspective, especially given the popularity of this movie series.

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Worldwide news and comment

August 22, 2017 - 9:23am

In July 2017, the tobacco industry faced a fresh exposé of the many ways in which it has sought to undermine global and national tobacco control policies. Reuters published a two-part series based on thousands of leaked internal documents. The first report demonstrated the many ways in which the tobacco industry has systematically undermined the WHO Framework Convention on Tobacco Control (FCTC). The second report included several documents from Philip Morris International (PMI) India which laid out the explicit tactics used by the company to flout and undermine India’s tobacco control laws.

All articles written by Marita Hefler unless otherwise attributed. Ideas and items for News Analysis should be sent to: marita.hefler@menzies.edu.au

The Reuters reports were published in the wake of a Guardian series called Tobacco: a deadly business. The series focused on inequality and tobacco use, as well as the activities of the tobacco industry, including its legal...

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Systematic review of health and behavioural outcomes of smoking cessation interventions in prisons

August 22, 2017 - 9:23am
Objective

We conducted a systematic review to examine the impact of smoking cessation interventions, including smoking bans, on prisoners and prison staff.

Data sources

We systematically searched health and criminal justice databases for relevant studies. Search strings were used to combine terms related to smoking cessation interventions with terms related to incarceration. We used forward and backward snowballing to capture additional studies.

Study selection

Studies were included if: they were published between 1 January 1994 and 23 May 2016; the population was incarcerated adults and/or prison staff; they had a quantitative component; they were published in English; and they reported outcomes of a smoking cessation programme/ban with regard to reported change in smoking behaviour and/or behavioural outcomes.

Data extraction

Studies were reviewed for methodological rigour using the Effective Public Health Practice Project's Quality Assessment Tool for Quantitative Studies. Data were independently reviewed for methodological quality by 1 author and a research assistant.

Data synthesis

Cessation programmes, including free nicotine replacement therapy and/or behavioural counselling can significantly increase the likelihood of quitting in prison and increase abstinence postrelease. Indoor bans have little impact on prisoner smoking behaviour. Prisoners who experience a complete smoking ban typically resume smoking shortly after release from prison. Bans may result in adverse behavioural outcomes, but these are generally minimal and short-lived.

Conclusions

While there is limited evidence to inform tobacco control policies in custodial settings, outcomes of this review suggest that cessation programmes/bans can be an effective mechanism to interrupt prisoner smoking behaviour when properly enforced.

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Chemometric and trace element profiling methodologies for authenticating, crossmatching and constraining the provenance of illicit tobacco products

August 22, 2017 - 9:23am
Background

Illicit tobacco products have a disproportionately negative effect on public health. Counterfeits and cheap whites as well as legal brands smuggled from countries not adopting track and trace technologies will require novel forensic tools to aid the disruption of their supply chains.

Methods

Data sets of trace element concentrations in tobacco were obtained using X-ray fluorescence spectrometry on samples of legal and illicit products mainly from Europe. Authentic and counterfeit products were discriminated by identifying outliers from data sets of legal products using Mahalanobis distance and graphical profiling methods. Identical and closely similar counterfeits were picked out using Euclidean distance, and counterfeit provenance was addressed using chemometric methods to identify geographical affinities.

Results

Taking Marlboro as an exemplar, the major brands are shown to be remarkably consistent in composition, in marked contrast to counterfeits bearing the same brand name. Analysis of 35 illicit products seized in the European Union (EU) indicates that 18 are indistinguishable or closely similar to Marlboro legally sold in the EU, while 17 are sufficiently different to be deemed counterfeit, among them being 2 counterfeits so closely similar that their tobaccos are likely to come from the same source. The tobacco in the large majority of counterfeits in this data set appears to originate in Asia.

Conclusions

Multivariate and graphical analysis of trace elements in tobacco can effectively authenticate brands, crossmatch illicit products across jurisdictions and may identify their geographical sources.

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Evaluating South Africa's tobacco control policy using a synthetic control method

August 22, 2017 - 9:23am
Background

South Africa has since 1994 consistently increased the excise tax on cigarettes to maintain a total tax burden of 50% (1997–2003) and 52% (after 2004) of the average retail selling price. Between 1994 and 2004, the real (inflation-adjusted) excise tax increased by 249%, and the average real retail price of cigarettes increased by 110%. In addition, advertising and smoking bans were implemented in 2001. These measures, which we collectively refer to as tax-led, coincided with a 46% decrease in per capita consumption of cigarettes. No evaluation of South Africa's tobacco control policies has created a counterfactual of what would have happened if the tax-led measures had not occurred.

Objective

(1) To create a credible counterfactual of what would have happened to per capita cigarette consumption if the tax-led measures had not happened. (2) To use this counterfactual to estimate their impact on cigarette consumption in South Africa.

Method

We use a synthetic control method to create a synthetic South Africa, as a weighted average of countries (the ‘donor pool’) that are similar to South Africa, but that did not engage in large-scale tobacco control measures between 1990 and 2004.

Results

Per capita cigarette consumption would not have continued declining in the absence of the tax-led measures that began in 1994. By 2004, per capita cigarette consumption was 36% lower than it would have been in the absence of the tax-led measures. These results, which we mostly attribute to tax increases, are robust to different specifications of the ‘donor pool’.

Conclusions

Significant public health dividends can be obtained by consistently increasing the real tax on cigarettes.

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Levels and trends in cigarette contraband in Canada

August 22, 2017 - 9:23am
Background

There is overwhelming evidence that increases in tobacco taxes reduce tobacco use, save lives and increase government tax revenue. High taxes, however, create an incentive to devise ways to avoid or evade tobacco taxes through contraband tobacco. The associated consequences are significant and call for an accurate measurement of contraband's magnitude. However, its illegal nature makes the levels and trends in contraband intrinsically difficult to measure accurately.

Objective

To examine levels and trends in cigarette contraband in Canada.

Methods

We employed 2 approaches: first, we contrasted estimates of tax-paid cigarettes sales with consumption estimates based on survey data; second, we used data from several individual-level surveys that examined smokers' purchasing and use behaviours. We placed a particular emphasis on the provinces of Québec and Ontario because existing research suggests that cigarette contraband levels are far higher than in any other province.

Results

The estimates presented show a clear upward trend from the early 2000s in cigarette contraband in Québec and Ontario followed by, on the whole, a decreasing trend from about 2007 to 2009. None of the data presented provide support to the narrative that cigarette contraband has been increasing in recent years. Of note are Québec estimates which suggest relatively low levels of cigarette contraband since 2010, at levels no higher than in the early 2000s.

Conclusions

The data presented suggest that policies to tackle cigarette contraband introduced from the mid-2000s to late 2000s, at both federal and provincial levels, may have dampened the demand for contraband cigarettes.

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Impact of self-reported lifetime depression or anxiety on effectiveness of mass distribution of nicotine patches

August 22, 2017 - 9:23am
Background

Large-scale public health initiatives providing free nicotine replacement therapy have been shown to increase smoking cessation rates; however, their effectiveness among the highly prevalent population of smokers with depression and anxiety disorders has not been explored. The aim of this study was to investigate the influence of lifetime history of depression or anxiety on smoking cessation success following the free distribution of nicotine patches.

Method

In the context of a randomised controlled trial, a secondary analysis was conducted on 1000 adult regular smokers randomised to be mailed a 5-week supply of nicotine patches or to a no intervention control group. Participants were divided into subgroups based on the presence of self-reported lifetime diagnosis of depression and anxiety.

Results

Irrespective of self-reported lifetime history of depression or anxiety, odds of self-reported cessation at 6 months were significantly greater among groups receiving nicotine patches compared to no intervention control (no history of depression or anxiety: OR 2.20; 95% CI 1.05 to 4.63; history of depression or anxiety present: OR 3.90; 95% CI 1.28 to 11.88). Among nicotine patch recipients only, quit outcomes did not differ between those with and without self-reported lifetime depression or anxiety in models unadjusted and adjusted for differences in demographic and smoking characteristics.

Conclusions

The mass distribution of free nicotine patches (without behavioural support) is effective among smokers with or without lifetime history of depression or anxiety alike, providing further support for the adoption of similar initiatives as a means of promoting tobacco cessation on a population level.

Trial registration number

NCT01429129, Post-results.

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E-cigarette use is differentially related to smoking onset among lower risk adolescents

August 22, 2017 - 9:23am
Objective

E-cigarette use has been linked to onset of cigarette smoking among adolescents, but some commentators have suggested that this simply reflects high-risk adolescents being more likely to use e-cigarettes and to smoke. We tested whether the effect of e-cigarette use for smoking onset differs for youth who are lower versus higher on propensity to smoke.

Methods

School-based survey with a longitudinal sample of 1136 students (9th–11th graders, mean age 14.7 years) in Hawaii, initially surveyed in 2013 (T1) and followed up 1 year later (T2). We assessed e-cigarette use, propensity to smoke based on 3 psychosocial factors known to predict smoking (rebelliousness, parental support and willingness to smoke), and cigarette smoking status. Analyses based on T1 never-smokers tested the relation of T1 e-cigarette use to T2 smoking status for participants lower versus higher on T1 propensity to smoke.

Results

The relation between T1 e-cigarette use and T2 smoking onset was stronger among participants with lower levels of rebelliousness and willingness and higher levels of parental support. A multiple logistic regression analysis with T2 smoking as the criterion tested the cross-product of T1 e-cigarette use and T1 smoking propensity score; the interaction (OR=0.88, p=0.01) indicated a significantly larger effect for smoking onset among lower risk youth.

Conclusions

The results indicate e-cigarette use is a risk factor for smoking onset, not just a marker of high risk for smoking. This study provides evidence that e-cigarettes are recruiting lower risk adolescents to smoking, which has public health implications.

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Factors that influence attitude and enforcement of the smoke-free law in Turkey: a survey of hospitality venue owners and employees

August 22, 2017 - 9:23am
Introduction

In 2009, Turkey extended the smoke-free legislation to hospitality venues. Compliance, however, remains low in some hospitality venues. We identified characteristics associated with knowledge of health effects that can be prevented by the smoke-free law, the attitude towards and enforcement of the law.

Methods

In 2014, we conducted 400 interviews with hospitality venue owners and employees in 7 cities in Turkey. The venues were identified based on a random sampling strategy in a previous phase of the study.

Results

Over one-third (37.3%) of hospitality owners and employees had adequate knowledge of the health effects from secondhand smoke (SHS), 71.3% had a positive attitude towards the law and 19.5% had personally enforced the law. Participants who worked 70 hours or more per week were more likely to have a positive attitude towards the law. Older individuals, women, participants working in bars/nightclubs, venue owners receiving fines for non-compliance and current smokers were less likely to have a positive attitude towards the law. Participants working in traditional coffee houses, former smokers, and participants with a high school education or greater were more likely to enforce the law. Smokers who quit or reduced smoking because of the law were more likely to enforce the law compared with those who were not influenced by the law.

Conclusions

Although the attitude towards the law was positive, interventions are needed to increase knowledge on the health effects of SHS and facilitate enforcement of the law, particularly among subgroups less likely to have a positive attitude and enforce the law.

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When smokers quit: exposure to nicotine and carcinogens persists from thirdhand smoke pollution

August 22, 2017 - 9:23am
Background

Over a 6-month period, we examined tobacco smoke pollutants (also known as thirdhand smoke, THS) that remained in the homes of former smokers and the exposure to these pollutants.

Methods

90 smokers completed study measures at baseline (BL). Measures were repeated among verified quitters 1 week (W1), 1 month (M1), 3 months (M3) and 6 months (M6) following cessation. Measures were analysed for THS pollutants on household surfaces, fingers and in dust (ie, nicotine, tobacco-specific nitrosamines) and for urinary markers of exposure (ie, cotinine, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL)).

Results

We observed significant short-term reduction of nicotine on surfaces (BL: 22.2 μg/m2, W1: 10.8 μg/m2) and on fingers of non-smoking residents (BL: 29.1 ng/wipe, W1: 9.1 ng/wipe) without further significant changes. Concentrations of nicotine and nicotine-derived nitrosamine ketone (NNK) in dust did not change and remained near BL levels after cessation. Dust nicotine and NNK loadings significantly increased immediately following cessation (nicotine BL: 5.0 μg/m2, W1: 9.3 μg/m2; NNK BL: 11.6 ng/m2, W1: 36.3 ng/m2) before returning to and remaining at near BL levels. Cotinine and NNAL showed significant initial declines (cotinine BL: 4.6 ng/mL, W1: 1.3 ng/mL; NNAL BL: 10.0 pg/mL, W1: 4.2 pg/mL) without further significant changes.

Conclusions

Homes of smokers remained polluted with THS for up to 6 months after cessation. Residents continued to be exposed to THS toxicants that accumulated in settled house dust and on surfaces before smoking cessation. Further research is needed to better understand the consequences of continued THS exposure after cessation and the efforts necessary to remove THS.

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Impact of the Spanish smoking legislations in the adoption of smoke-free rules at home: a longitudinal study in Barcelona (Spain)

August 22, 2017 - 9:23am
Objective

To assess the impact of two Spanish smoking legislations in the adoption of voluntary smoke-free-homes rules in Spain.

Methods

This is a longitudinal study, before and after the implementation of two national smoking bans (in 2005 and 2010), in a representative sample (n=1245) of non-institutionalised adults (≥16 years) from Barcelona (Spain) surveyed in 2004–2005 and followed up in 2013–2014. The final sample analysed was 736 individuals (400 women and 336 men). We defined smoking rules in the houses as complete (when smoking was not allowed in the household), partial (when smoking was allowed in some places inside the house) or absent (when smoking was allowed everywhere). We calculated relative changes in the prevalence of smoking rules in homes before and after 2 national smoking legislations by means of prevalence ratios (PRs) and their 95% CIs.

Results

The households with voluntary smoke-free rules (complete or partial) relatively increased 31% after Spanish smoking bans (from 55.6% to 72.6%, p<0.001). The houses with complete rules relatively increased 57% (from 23.9% to 37.6%, p<0.001) whereas the houses with partial rules increased 11% (from 31.7% to 35.0%, p=0.148). The increase of any type of rules (complete and partial) was statistically significantly independent of sex (PR between 1.29 and 1.33), age (PR between 1.24 and 1.33), educational level (PR between 1.19 and 1.47) and minimum age in house (PR between 1.12 and 1.40). However, this increase was statistically and significantly higher only among never smokers (PR=1.46) at baseline.

Conclusions

The implementation of the smoke-free regulations in public and work places in Spain was associated with an increasing of voluntary adoption of smoke-free rules in homes. According to our data, the Spanish smoking bans did not shift the tobacco consumption from public and work places to private places (homes).

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Qualitative exploration of young adult RYO smokers&#039; practices

August 22, 2017 - 9:23am
Background

Although roll-your-own (RYO) tobacco often elicits negative connotations of a lower class product, uptake and use by young adult smokers has grown because RYO is more cost-effective than tailor-made (TM) cigarettes. We explored the practices and beliefs young adults develop to distance themselves from unattractive stereotypes of RYO smokers.

Methods

We conducted 20 in-depth interviews with New Zealand young adult RYO users aged between 18 and 30 years, and used thematic analysis to interpret the transcripts.

Results

We identified three themes: establishing the superiority of RYO tobacco; creating and enacting usage rituals, and ritual disruption. Participants regarded RYO tobacco as more natural and better-tasting; they used it to control their tobacco use and facilitate interactions with others. Many described rolling rituals where they used specific artefacts and microbehaviours to construct cigarettes they saw as personal and artisanal. Several, though not all, disliked unattractively coloured papers as these disrupted the value their rituals created.

Conclusions

Young adults imbue RYO tobacco with positive attributes, many of which centre on rolling rituals or draw on widely held misperceptions of RYO tobacco as less harmful. Excise tax increases could counter perceptions of RYO as more cost-effective while mandating that dissuasively coloured paper could disrupt reduced-harm connotations. However, evidence that erroneous harm beliefs are widespread and entrenched may justify restricting or eliminating the key artefact—the product itself.

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Effect of cigarette prices on smoking initiation and cessation in China: a duration analysis

August 22, 2017 - 9:23am
Background

China is the world's largest producer and consumer of cigarettes. The status of tobacco as both a contributor to China's economy and a liability for the health of its population may complicate the use of taxes for addressing smoking in the country. Understanding how cigarette prices affect transitions in smoking behaviour in China can increase understanding of how China's high smoking rates can be influenced by tax policy.

Methods

In order to estimate the effect of cigarette prices on smoking initiation and cessation in China, we construct pseudo-longitudinal samples for duration analysis using data from the Global Adult Tobacco Survey China 2010. We use the historical variation in prices representative of 4 China regions over a 20-year period to identify the average price effect on the hazards of initiation and cessation while controlling for unobserved fixed and time-varying region characteristics.

Findings

We find that initiation rates fall in response to higher prices (with a price elasticity of initiation estimated at –0.95 for men and –1.07 overall).

Conclusions

The effect of prices on smoking in China is likely to occur through averting initiation over time. At the population level, cessation behaviour may be less responsive to price increases as the wide range of cigarette prices in China may provide relatively high opportunity for switching to lower priced brands.

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Vaping on Instagram: cloud chasing, hand checks and product placement

August 22, 2017 - 9:23am
Introduction

This study documented images posted on Instagram of electronic cigarettes (e-cigarette) and vaping (activity associated with e-cigarette use). Although e-cigarettes have been studied on Twitter, few studies have focused on Instagram, despite having 500 million users. Instagram's emphasis on images warranted investigation of e-cigarettes, as past tobacco industry strategies demonstrated that images could be used to mislead in advertisements, or normalise tobacco-related behaviours. Findings should prove informative to tobacco control policies in the future.

Methods

3 months of publicly available data were collected from Instagram, including images and associated metadata (n=2208). Themes of images were classified as (1) activity, for example, a person blowing vapour; (2) product, for example, a personal photo of an e-cigarette device; (3) advertisement; (4) text, for example, ‘meme’ or image containing mostly text and (5) other. User endorsement (likes) of each type of image was recorded. Caption text was analysed to explore different trends in vaping and e-cigarette-related text.

Results

Analyses found that advertisement-themed images were most common (29%), followed by product (28%), and activity (18%). Likes were more likely to accompany activity and product-themed images compared with advertisement or text-themed images (p<0.01). Vaping-related text greatly outnumbered e-cigarette-related text in the image captions.

Conclusions

Instagram affords its users the ability to post images of e-cigarette-related behaviours and gives advertisers the opportunity to display their product. Future research should incorporate novel data streams to improve public health surveillance, survey development and educational campaigns.

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Tobacco retail outlet restrictions: health and cost impacts from multistate life-table modelling in a national population

August 22, 2017 - 9:23am
Background

Since there is some evidence that the density and distribution of tobacco retail outlets may influence smoking behaviours, we aimed to estimate the impacts of 4 tobacco outlet reduction interventions in a country with a smoke-free goal: New Zealand (NZ).

Methods

A multistate life-table model of 16 tobacco-related diseases, using national data by sex, age and ethnicity, was used to estimate quality-adjusted life years (QALYs) gained and net costs over the remainder of the 2011 NZ population's lifetime. The outlet reduction interventions assumed that increased travel costs can be operationalised as equivalent to price increases in tobacco.

Results

All 4 modelled interventions led to reductions of >89% of current tobacco outlets after the 10-year phase-in process. The most effective intervention limited sales to half of liquor stores (and nowhere else) at 129 000 QALYs gained over the lifetime of the population (95% UI: 74 100 to 212 000, undiscounted). The per capita QALY gains were up to 5 times greater for Māori (indigenous population) compared to non-Māori. All interventions were cost-saving to the health system, with the largest saving for the liquor store only intervention: US$1.23 billion (95% UI: $0.70 to $2.00 billion, undiscounted).

Conclusions

These tobacco outlet reductions reduced smoking prevalence, achieved health gains and saved health system costs. Effects would be larger if outlet reductions have additional spill-over effects (eg, smoking denormalisation). While these interventions were not as effective as tobacco tax increases (using the same model), these and other strategies could be combined to maximise health gain and to maximise cost-savings to the health system.

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Effects of hookah smoking on indoor air quality in homes

August 22, 2017 - 9:23am
Introduction

Hookahs (water pipes) are rapidly increasing in popularity worldwide. Evidence suggests that although perceived as safer than cigarette smoke, hookah smoke may be as, or even more, dangerous as cigarette smoke.

Methods

Air samples from 33 homes—11 where only hookah-smoking occurred, 12 with only cigarettes and 10 with no smoking—were collected to analyse concentrations of particulate matter (PM2.5), black carbon, elemental and organic carbon and carbon monoxide (CO). Air quality was assessed in rooms where smoking occurred and in an adjacent room.

Results

Hookah and cigarette smoking impaired home air quality. The rooms in which hookahs were smoked showed the highest concentrations for all pollutants. CO was significantly greater in the rooms where hookahs were smoked than in the cigarette-smoking rooms and the non-smoking households (p<0.05). In addition, CO levels in the rooms adjacent to where hookah was smoked were 2.5-fold to 4-fold greater than those in the smoking and non-smoking rooms of the cigarette homes (p<0.05). PM2.5 levels were also elevated in hookah homes compared to cigarette and non-smoking homes, although not significantly different.

Conclusions

This study, the first of its kind, demonstrates potentially hazardous levels of home air pollution in rooms where hookahs are being smoked as well as in adjacent rooms. These levels were greater than those in cigarette smoking homes, raising concerns about potential negative health effects on all individuals living in homes where hookahs are smoked.

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Public understanding of cigarette smoke constituents: three US surveys

August 22, 2017 - 9:23am
Introduction

The Tobacco Control Act requires public disclosure of information about toxic constituents in cigarette smoke. To inform these efforts, we studied public understanding of cigarette smoke constituents.

Methods

We conducted phone surveys with national probability samples of adolescents (n=1125) and adults (n=5014) and an internet survey with a convenience sample of adults (n=4137), all in the USA. We assessed understanding of cigarette smoke constituents in general and of 24 specific constituents.

Results

Respondents commonly and incorrectly believed that harmful chemicals in cigarette smoke mostly originate in additives introduced by cigarette manufacturers (43–72%). Almost all participants had heard that nicotine is in cigarette smoke, and many had also heard about carbon monoxide, ammonia, arsenic and formaldehyde. Less than one-quarter had heard of most other listed constituents being in cigarette smoke. Constituents most likely to discourage respondents from wanting to smoke were ammonia, arsenic, formaldehyde, hydrogen cyanide, lead and uranium. Respondents more often reported being discouraged by constituents that they had heard are in cigarette smoke (all p<0.05). Constituents with names that started with a number or ended in ‘ene’ or ‘ine’ were less likely to discourage people from wanting to smoke (all p<0.05).

Discussion

Many people were unaware that burning the cigarette is the primary source of toxic constituents in cigarette smoke. Constituents that may most discourage cigarette smoking have familiar names, like arsenic and formaldehyde and do not start with a number or end in ene/ine. Our findings may help campaign designers develop constituent messages that discourage smoking.

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Cigarette prices and community price comparisons in US military retail stores

August 22, 2017 - 9:23am
Background

Tobacco pricing impacts use, yet military retailers sell discounted cigarettes. No systematic research has examined how military retail stores use internal community comparisons to set prices. We analysed data obtained through a Freedom of Information Act request on community price comparisons used by military retail to set cigarette prices.

Methods

Data on cigarette prices were obtained directly from military retailers (exchanges) from January 2013 to March 2014. Complete pricing data were obtained from exchanges on 114 military installations.

Results

The average price for a pack of Marlboro cigarettes in military exchanges was US$5.51, which was similar to the average lowest community price (US$5.45; mean difference=–0.06; p=0.104) and almost a US$1.00 lower than the average highest price (US$6.44). Military retail prices were 2.1%, 6.2% and 13.7% higher than the lowest, average and highest community comparisons, respectively, and 18.2% of exchange prices violated pricing instructions. There was a negative correlation (r=–0.21, p=0.02) between the number of community stores surveyed and exchange cigarette prices.

Conclusions

There was no significant difference between prices for cigarettes on military installations and the lowest average community comparison, and in some locations, the prices violated Department of Defense (DoD) policy. US Marine Corps exchanges had the lowest prices, which is of concern given that the Marines also have the highest rates of tobacco use in the DoD. Given the relationship between tobacco product prices and demand, a common minimum (or floor) shelf price for tobacco products should be set for all exchanges and discount coupon redemptions should be prohibited.

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Cigarette stick as valuable communicative real estate: a content analysis of cigarettes from 14 low-income and middle-income countries

August 22, 2017 - 9:23am
Background

The current cigarette market is heavily focused on low-income and middle-income countries. Branding of tobacco products is key to establishing and maintaining a customer base. Greater restrictions on marketing and advertising of tobacco products create an incentive for companies to focus more on branding via the product itself. We consider how tobacco sticks are used for communicative purposes in 14 low-income and middle-income countries with extensive tobacco markets.

Methods

In 2013, we collected and coded 3232 cigarette and kretek packs that were purchased from vendors in diverse neighbourhoods in 44 cities across the 14 low-income and middle-income countries with the greatest number of smokers. A single stick from each pack was assessed for branding, decorative and communicative elements using a common coding framework. Stick communication variables included brand name, brand image/logo, brand descriptor, colour and design carried through from pack, ‘capsule cigarette’ symbol, and embellishment of filter end.

Results

Communication and branding on the stick is essentially ubiquitous (99.75%); 97% of sticks include explicit branding (brand name or logo present). Colour is commonly carried through from the pack (95%), and some sticks (13%) include decorative elements matching the pack. Decorative elements can be found anywhere on the stick, including the filter tip (8%), and ‘convertible’ cigarettes include a symbol to show where to push.

Conclusions

Cigarette sticks are clearly valuable ‘real estate’ that tobacco companies are using for communicative purposes. Across all countries and brands, the stick communicates branding via text, colour and imagery.

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