Article

Public Support for Family Smoking Prevention and Tobacco Control Act Point-of-Sale Provisions: Results of a National Study

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Abstract

We assessed public and smoker support for enacted and potential point-of-sale (POS) tobacco-control policies under the Family Smoking Prevention and Tobacco Control Act. We surveyed a US nationally representative sample of 17 507 respondents (6595 smokers) in January through February 2013, and used linear regression to calculate weighted point estimates and identify factors associated with support for POS policies among adults and smokers. Overall, nonsmokers were more supportive than were smokers. Regardless of smoking status, African Americans, Hispanics, women, and those of older ages were more supportive than White, male, and younger respondents, respectively. Policy support varied by provision. More than 80% of respondents supported minors' access restrictions and more than 45% supported graphic warnings. Support was lowest for plain packaging (23%), black-and-white advertising (26%), and a ban on menthol cigarettes (36%). Public support for marketing and POS provisions is low relative to other areas of tobacco control. Tobacco-control advocates and the Food and Drug Administration should build on existing levels of public support to promote and maintain evidence-based, but controversial, policy changes in the retail environment. (Am J Public Health. Published online ahead of print August 13, 2015: e1-e8. doi:10.2105/AJPH.2015.302751).

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... 9 Moreover, studies assessing policy attitudes can illuminate potential messages for media campaigns designed to increase public support for and compliance with regulation. 10,11 Before implementation of a new law, media campaigns can inform individuals of the upcoming law and its rationale; after implementation, media campaigns can also increase support and compliance, typically by emphasizing the law's benefits and thanking individuals for helping with successful implementation. 12 Research suggests that high compliance exists in jurisdictions where media campaigns have been aired. ...
... 21,22 Smokers, who likely place greater importance on tobacco than non-smokers, may therefore react more negatively to potential tobacco control policies. 21 Indeed, previous research has found that smokers are less supportive of tobacco control policies than non-smokers, 10,23,24 and while data are limited, smokers may react more negatively to tobacco control efforts, such as cigarette pack warnings. 21 Previous research has examined attitudes toward e-cigarette regulation, finding a moderate to high proportion of favorable attitudes for different e-cigarette regulations, depending on the type of regulation, participant characteristics, and setting (eg, geographic location). ...
... We also found that smokers with higher quit intentions and more negative beliefs about smokers had more favorable attitudes toward FDA regulations, a finding that is consistent with previous research. 10 It is possible that smokers who would like to quit smoking cigarettes support regulations of other tobacco products as an additional measure to aid quit attempts. We cannot, however, determine the temporality of this association. ...
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Objective: To examine how smokers perceive FDA oversight of e-cigarettes, hookah, and cigars. Methods: Current US smokers (N = 1,520) participating in a randomized clinical trial of pictorial cigarette pack warnings completed a survey that included questions about attitudes toward new FDA regulations covering newly deemed tobacco products (ie, regulation of e-cigarettes, nicotine gels or liquids used in e-cigarettes, hookah, and cigars). Results: Between 47% and 56% of current smokers viewed these new FDA regulations favorably and between 17% - 24% opposed them. Favorable attitudes toward the regulations were more common among smokers with higher quit intentions (adjusted odds ratio (aOR): 1.17, 95% CI: 1.02, 1.33) and more negative beliefs about smokers (aOR: 1.18, 95% CI: 1.05, 1.33). Participants with higher education, higher income, and previous exposure to e-cigarette advertisements had higher odds of expressing positive attitudes toward the new FDA regulations (p < .05). Conclusions: Almost half of current smokers viewed FDA regulation of newly deemed tobacco products favorably. Local and state policy-makers and tobacco control advocates can build on this support to enact and strengthen tobacco control provisions for e-cigarettes, cigars, and hookah.
... Past research has identified individual level factors associated with attitudes towards tobacco prevention and control. Across several studies, women (compared to men), non-White individuals (compared to White individuals), non-Hispanic individuals (compared to Hispanic individuals), and older individuals have been found to be more supportive of some tobacco control policies [17][18][19][20][21]. There have been more mixed findings about educational attainment; in some studies, lower educational attainment has been positively associated with supportive policy attitudes [18,21] although other studies have found no association [17], or contrary findings [20,22]. ...
... Across several studies, women (compared to men), non-White individuals (compared to White individuals), non-Hispanic individuals (compared to Hispanic individuals), and older individuals have been found to be more supportive of some tobacco control policies [17][18][19][20][21]. There have been more mixed findings about educational attainment; in some studies, lower educational attainment has been positively associated with supportive policy attitudes [18,21] although other studies have found no association [17], or contrary findings [20,22]. Smoking behavior has been consistently associated with policy attitudes such that nonsmokers tend to hold more favorable attitudes towards tobacco control policies than smokers [17][18][19][20][21]23]. ...
... There have been more mixed findings about educational attainment; in some studies, lower educational attainment has been positively associated with supportive policy attitudes [18,21] although other studies have found no association [17], or contrary findings [20,22]. Smoking behavior has been consistently associated with policy attitudes such that nonsmokers tend to hold more favorable attitudes towards tobacco control policies than smokers [17][18][19][20][21]23]. With respect to beliefs, political ideology may impact attitudes, such that favorable attitudes towards tobacco control decreased as individuals showed more conservative political views and had less knowledge of tobacco's health impacts. ...
Article
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Favorable attitudes towards tobacco control policies can facilitate their implementation and success. We examined attitudes toward four potential U.S. Federal tobacco regulations (banning menthol from cigarettes, reducing nicotine levels in cigarettes, banning candy and fruit flavored electronic cigarettes, and banning candy and fruit flavored little cigars and cigarillos) and associations with individual and state variables. A nationally representative phone survey of 4337 adults assessed attitudes toward potential policies. Weighted logistic regression was used to assess relationships between attitudes and demographic factors, smoking behavior, beliefs about the government (knowledge, trust, and credibility), exposure to tobacco control campaigns, and state variables from the US Centers for Disease Control and Prevention (CDC) State Tobacco Activities Tracking and Evaluation (STATE) System. Most respondents supported three out of four policies. Respondents that were female, non-white, Latino, living below the poverty line, had less than high school education, were of older age, did not smoke, had higher trust in government, and were exposed to national tobacco control campaigns had higher odds of expressing favorable attitudes toward potential new tobacco regulations than did their counterparts. No state-level effects were found. While differences in attitudes were observed by individual demographic characteristics, behaviors, and beliefs, a majority of participants supported most of the potential new tobacco regulations surveyed.
... The extent of favorable attitudes toward warnings that we observed are consistent with, if not higher than, attitudes for other tobacco control policies. For instance, Rose et al. examined national attitudes for enacted and potential point-of-sale tobacco control policies and found moderate to poor levels of support (less than 50%) for a variety of point-of-sale policies, such as advertising restrictions, product bans, and promotion restrictions [39]. Thus, compared to other tobacco control policies that have been proposed or implemented, our study demonstrates strong support. ...
... Thus, compared to other tobacco control policies that have been proposed or implemented, our study demonstrates strong support. The findings about smokers (i.e., 61% of smokers showing favorable attitudes toward a warning label of 75% size) is particularly important given that it is substantially higher than levels of favorable attitudes found among smokers for a variety of other tobacco control policies [39], and smokers are usually more opposed to tobacco control policies than non-smokers [39][40][41]. ...
... Thus, compared to other tobacco control policies that have been proposed or implemented, our study demonstrates strong support. The findings about smokers (i.e., 61% of smokers showing favorable attitudes toward a warning label of 75% size) is particularly important given that it is substantially higher than levels of favorable attitudes found among smokers for a variety of other tobacco control policies [39], and smokers are usually more opposed to tobacco control policies than non-smokers [39][40][41]. ...
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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.
... Por ejemplo, se ha reportado que la adopción de políticas para la generación de espacios libres de humo en Nueva Zelanda y Escocia llevó luego a un aumento en el apoyo de la sociedad civil a estas mismas (8,9) políticas . Sin embargo, la presencia o ausencia de este apoyo ciudadano podría potencialmente facilitar o dificultar la aplicación de estas medidas en un (10,11) país . ...
... La presencia o ausencia de apoyo ciudadano podría potencialmente facilitar o dificultar la implementación (10,11) de políticas para el control del tabaco en Paraguay . El presente trabajo tenía como objetivo determinar la presencia o no de dicho apoyo, y los resultados muestran que todas las políticas para el control del tabaco presentadas en la encuesta recibieron el apoyo de la mayoría de los participantes. ...
Article
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Introducción: El impacto negativo del tabaquismo en Paraguay demanda la adopción de todas las medidas disponibles para disminuir dicho impacto. La presencia o ausencia de apoyo ciudadano podría influenciar la implementación de estas medidas. Objetivo: Determinar la presencia de apoyo ciudadano a políticas para el control del tabaco. Materiales y métodos: Estudio observacional descriptivo de corte transversal, mediante una encuesta en línea en la que se evaluó, a través de una escala tipo Likert de 1 al 5 (muy en desacuerdo, en desacuerdo, neutral, de acuerdo, muy de acuerdo), la presencia de apoyo ciudadano a 13 políticas para el control del tabaco. Resultados: Participaron del estudio 502 adultos con (5 años de residencia en el país, el 67,73% mujeres, el 87,65% universitarios, y el 63,75% no fumadores. Las medidas para el control del tabaco que recibieron mayor apoyo son prohibir fumar en el transporte público (98,01%) y en los edificios públicos (93,63%), prohibir la venta de tabaco a menores de 18 años (96,81%) y multar a aquellos que lo hagan (96,22%), y aumentar los impuestos al tabaco para pagar por los costos a la salud debidos al mismo (94,02%) o para disminuir su prevalencia (90,64%). Las medidas que recibieron menor apoyo fueron prohibir la publicidad de tabaco (56,97%) y prohibir el exhibir tabaco (51%) en los lugares de venta. Conclusiones: Las 13 políticas para el control del tabaco evaluadas en el presente trabajo recibieron el apoyo mayoritario de los participantes. Se sugiere implementar y hacer cumplir estas medidas.
... Por ejemplo, se ha reportado que la adopción de políticas para la generación de espacios libres de humo en Nueva Zelanda y Escocia llevó luego a un aumento en el apoyo de la sociedad civil a estas mismas (8,9) políticas . Sin embargo, la presencia o ausencia de este apoyo ciudadano podría potencialmente facilitar o dificultar la aplicación de estas medidas en un (10,11) país . ...
... La presencia o ausencia de apoyo ciudadano podría potencialmente facilitar o dificultar la implementación (10,11) de políticas para el control del tabaco en Paraguay . El presente trabajo tenía como objetivo determinar la presencia o no de dicho apoyo, y los resultados muestran que todas las políticas para el control del tabaco presentadas en la encuesta recibieron el apoyo de la mayoría de los participantes. ...
Article
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Introduction: In Paraguay, tobacco smoking negative impact demands the adoption of all available measures to reduce that impact. The presence or not of public support could potentially influence the adoption of these measures. Objective: To determine the presence of public support to tobacco control policies. Methodology: The present was a cross-sectional descriptive study that used an online survey to assess public support to 13 tobacco control policies using a Likert-type scale from 1 to 5 (strongly agree, agree, neutral, disagree, strongly disagree). Results: There were 502 participants, 67.73% of whom were women, 87.65% had completed studies at a tertiary level, and 63,75% were non-smokers. Measures that received the most support were banning smoking from public transport (98,01%) and from public buildings (93,63%), banning tobacco sales to people under the age of 18 (96,81%), and issuing a fine to those who do it (96,22%), and raising tobacco taxes either to support for the health care expenditure attributable to smoking (94,02%) or to reduce the prevalence of smoking (90,64%). Measures that received the least support were banning tobacco advertisement in points of sale (56,97%) and banning tobacco display on points of sale (51%). Conclusion: All 13 tobacco control policies assessed in the present study received the majority of support from all participants. We recommend the adoption and enforcement of these measures
... Strategies that limit the number, type, location, and density of outlets also have good evidence in support of their effectiveness at reducing exposure to tobacco marketing and smoking rates (8, 35). Policies that restrict or remove tobacco product displays in retail outlets (eg, display bans) have resulted in reductions among consumers in noticing or recalling displays (36,37) and making impulse purchases (37) but no short-term change in tobacco use prevalence among adults or adolescents (36), although mathematical models suggest that these policies would reduce tobacco use over time (38). Multiple online resources provide lists of policy options together with summaries of and citations to evidence in support of their impact (Table). ...
... Data on political will include data on attitudes, beliefs, and vested interest among community members and key political decision makers in POS marketing relative to other priorities (eg, maintaining a business-friendly climate) and toward POS marketing policy solutions. Information on public support for policies can be gathered through public opinion polls or focus groups and interviews (38,39). Resources for conducting public opinion surveys, such as those provided by CounterTobacco.org, ...
Article
In 2015, the tobacco industry spent $8.24 billion to market tobacco products in convenience stores, supermarkets, pharmacies, and other retail or point-of-sale settings. Community tobacco control partnerships have numerous evidence-based policies (eg, tobacco retailer licensing and compliance, tobacco-free-school buffer zones, eliminating price discounts) to counter point-of-sale tobacco marketing. However, deciding which point-of-sale policies to implement - and when and in what order to implement them - is challenging. The objective of this article was to describe tools and other resources that local-level tobacco use prevention and control leaders can use to assemble the data they need to formulate point-of-sale tobacco policies that fit the needs of their communities, have potential for public health impact, and are feasible in the local policy environment. We were guided by Kingdon's theory of policy change, which contends that windows of policy opportunity open when 3 streams align: a clear problem, a solution to the problem, and the political will to work for change. Community partnerships can draw on 7 data "springs" to activate Kingdon's streams: 1) epidemiologic and surveillance data, 2) macro retail environment data, 3) micro retail environment data, 4) the current policy context, 5) local legal feasibility of policy options, 6) the potential for public health impact, and 7) political will.
... Despite the mounting evidence supporting the effectiveness of pictorial warnings, nearly 100 countries covering 42% of the world's population-including the US-do not yet have pictorial warnings on cigarette packs (Canadian Cancer Society, 2016). Estimates of public support for pictorial warnings from nationally representative studies in the US range from 45% (Rose et al., 2015) to 74% (Kamyab et al., 2015). Importantly, non-smokers are consistently more supportive of pictorial warnings (and other tobacco control policies) than smokers (Diepeveen et al., 2013;Kamyab et al., 2015;Rose et al., 2015). ...
... Estimates of public support for pictorial warnings from nationally representative studies in the US range from 45% (Rose et al., 2015) to 74% (Kamyab et al., 2015). Importantly, non-smokers are consistently more supportive of pictorial warnings (and other tobacco control policies) than smokers (Diepeveen et al., 2013;Kamyab et al., 2015;Rose et al., 2015). ...
Article
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Background: Understanding factors that influence public support for "nudging" policies, like pictorial cigarette pack warnings, may offer insight about how to increase such support. We sought to examine factors that influence smokers' support for requiring pictorial warnings on cigarette packs. Methods: In 2014 and 2015, we randomly assigned 2149 adult US smokers to receive either pictorial warnings or text-only warnings on their cigarette packs for 4 weeks. The outcome examined in the current study was support for a policy requiring pictorial warnings on cigarette packs in the US. Results: Support for pictorial warnings was high at baseline (mean: 3.2 out of 4). Exposure to pictorial warnings increased policy support at week 4 (β = .05, p = .03). This effect was explained by increases in perceived message effectiveness (p < .001) and reported conversations about policy support (p < .001). Message reactance (i.e., an oppositional reaction to the warning) partially diminished the impact of pictorial warnings on policy support (p < .001). Conclusions: Exposing people to a new policy through implementation could increase public support for that policy by increasing perceived effectiveness and by prompting conversations about the policy. Reactance may partially weaken the effect of policy exposure on public support.
... existing second-hand smoke policies among smokers and desire to protect youth from tobacco use observed in other studies. 30,50,51 In contrast, about one-quarter of current e-cigarette users supported a ban on flavored e-cigarette sales, and approximately one-third supported efforts to prohibit e-cigarette use indoors or in bars. Although only 3.2% of the adult population currently use e-cigarettes, 9 many may use flavored e-cigarettes 20 or use e-cigarette in indoor public place or bars 52,53 which could reflect points of resistance to policy support. ...
Article
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Background The wide availability of flavored e-cigarettes and broad use of e-cigarettes in public places may contribute to the rapidly increasing rates of use among youth and young adults in the U.S. However, policies at the federal, state and local levels can address these factors. Objective Assess public support for 5 e-cigarette-related policies and evaluate response patterns by demographics, tobacco use, e-cigarette harm perceptions, geographic region, and strength of state-level clean indoor air policies. Methods Data were collected Oct-Dec 2018 from a nationally representative online panel of U.S. adults (n = 3211). We measured support for 5 policies: (1) a ban on the sale flavored e-cigarettes; (2) requiring tobacco products, like e-cigarettes, be kept out of view in stores where adolescents shop; and prohibiting e-cigarette use in (3) all public places; (4) restaurants; and (5) bars. Weighted, adjusted logistic regressions modeled variation in policy support. Results A majority of respondents (63.3%) supported a flavor ban, with no differences in support by smoking status. Most respondents supported keeping tobacco products out of view (78.0%) and prohibiting e-cigarette use in indoor public places (82.9%), restaurants (86.5%), and bars (76.1%). In the adjusted models, current e-cigarette users had significantly lower odds of policy support compared to never users. We observed no differences in support by geographic region or strength of state-level clean indoor air policies. Conclusion Results suggest high levels of public support to regulate e-cigarette flavors, marketing, and use in public places. Targeted messaging may be needed to increase support among current e-cigarette users.
... This ban aims to limit appeal and attractiveness of such cigarettes, particularly to young people, and could constitute an important opportunity to promote cessation among MFC smokers 3 . To date, most studies of menthol cigarette smokers have been conducted in the United States [4][5][6][7][8][9][10] , with little research available on European smokers 11 . The International Tobacco Control (ITC) Project conducted in eight European countries offers an opportunity to study the characteristics and behaviours of MFC smokers 12 . ...
Article
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INTRODUCTION: This study characterises smoking and cessationrelated behaviours among menthol and other flavoured cigarette users in Europe prior to the implementation of the European Tobacco Products Directive (TPD) ban on the sale of flavoured cigarettes. METHODS: An analysis of cross-sectional data from the 2016 EUREST-PLUS ITC Europe Surveys was conducted among a sample of 10760 adult smokers from eight European Union Member States. Respondents were classified as menthol, other flavoured, unflavoured, or no usual flavour cigarette users and compared on smoking and cessation behaviours and characteristics. Data were analysed in SPSS Complex Samples Package using bivariate and multivariate regression analyses adjusted for sociodemographic characteristics, dependence, and country. RESULTS: In bivariate analyses, cigarette flavour was significantly associated with all outcomes (p<0.001). After adjusting for sociodemographic characteristics, these associations attenuated but remained significant and in the same direction for dependence, self-efficacy, plans to quit, past quit attempts, and ever e-cigarette use. In fully adjusted models, compared to smokers of non-flavoured cigarettes, menthol smokers were less likely to smoke daily (AOR=0.47, 95% CI: 0.32–0.71), smoke within 30 min of waking (0.52,0.43–0.64), consider themselves addicted (0.74,0.59–0.94), and more likely to have ever used e-cigarettes (1.26,1.00–1.57); other flavoured cigarette smokers were less likely to smoke daily (0.33,0.15–0.77), and have higher self-efficacy (1.82,1.20–2.77); no usual flavour smokers were less likely to smoke daily (0.34,0.22–0.51), smoke within 30 min of waking (0.66,0.55–0.80), consider themselves addicted (0.65,0.52–0.78), have ever made a quit attempt (0.69,0.58– 0.84), have ever used e-cigarettes (0.66,0.54–0.82), and had higher self-efficacy (1.46,1.19–1.80). CONCLUSIONS: Smokers of different cigarette flavours in Europe differ on smoking and cessation characteristics. The lower dependence of menthol cigarette smokers could lead to greater success rates if quit attempts are made, however cross-country differences in smoking behaviours and quitting intentions could lead to the TPD ban on cigarette flavours having differential impact if not accompanied by additional measures, such as smoking cessation support.
... The study also shows that almost half of all smokers support the ban on additives, including one-quarter of menthol smokers and half of other flavoured cigarette smokers. This is a positive finding, also in comparison with a 2016 US survey that showed a low support of 17% for a ban on menthol cigarettes among US smokers 14 . The majority of MFC smokers tend to be supportive of other tobacco control measures, including smoking bans in restaurants, bars, and pubs, but not on plain packaging, which shows that there still exists a need for better public communication in arguing for certain areas of tobacco control legislation. ...
Article
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Introduction: Little research exists on the sociodemographic characteristics of menthol and flavoured cigarette (MFC) smokers in Europe. This study assessed the proportion of MFC smokers in Europe, their sociodemographic characteristics, and their attitudes towards tobacco control measures. Methods: Cross-sectional data were collected in 2016 among 10760 adult current smokers from 8 European countries (ITC Europe Project and EUREST-PLUS). Smokers of menthol, other flavoured, unflavoured tobacco, or no usual brand were compared on sociodemographic characteristics, attitudes towards a range of tobacco control measures (e.g. ban on flavouring), and on intentions regarding their smoking behaviour following the ban on flavoured tobacco. Data were analysed in SPSS Complex Samples Package using univariate analyses. Results: Among the respondents, 7.4% smoked menthol cigarettes and 2.9% other flavoured tobacco, but large differences existed between countries (e.g. 0.4% smokers smoked menthol cigarettes in Spain vs 12.4% in England). Compared to other groups, menthol cigarette smokers were younger, more likely to be female, better educated, had higher household income, and smoked fewer cigarettes (all p<0.001). A quarter of menthol smokers supported a ban on additives, compared with almost half of all other smokers (p<0.001). In case of a ban on flavourings, around a fifth of all MFC smokers intended to switch to another brand, and a third to reduce the amount they smoked or to quit smoking, but there was no consistent pattern across MFC smokers among the countries. Conclusions: The ban on flavourings introduced by the EU Tobacco Products Directive (extended to 2020 for menthols) will affect one in ten smokers in the countries surveyed, which provides an opportunity for targeting these groups with cessation programmes. However, smokers of menthol and flavoured cigarettes in the different European countries are a heterogeneous group and may need different approaches.
... Our results provide additional evidence that lower or no intention to quit led to higher attrition of a follow-up survey. Findings from follow-up surveys such as those on the change of smoking behaviors and attitudes may not be representative of all smoking respondents and may inflate the public support towards tobacco control policies [40][41][42]. Population-based cohort studies need to adjust the results by weighting for these factors appropriately. ...
Article
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Background: Monetary incentive is often used to increase response rate in smokers' survey, but such effect of prepaid and promised incentives in a follow-up survey is unknown. We compared the effect of different incentive schemes on the consent and retention rates in a follow-up survey of adult cigarette smokers. Methods: This was a randomized controlled trial (RCT) in Hong Kong, China. Smokers who completed a non-incentivized baseline telephone smoking survey were invited to a 3-month follow-up, with randomization into (1) the control group (no incentive), (2) a promised HK$100 (US$12.8) incentive upon completion, (3) a promised HK$200 (US$25.6) incentive upon completion, or (4) a prepaid HK$100 incentive plus another promised HK$100 incentive ("mixed incentive"). Crude risk ratios from log-binomial regression models were used to assess if the 3 incentive schemes predicted higher rates of consent at baseline or retention at 3-month than no incentive. Results: In total, 1246 smokers were enrolled. The overall consent and retention rates were 37.1 and 23.0%, respectively. Both rates generally increased with the incentive amount and offer of prepaid incentive. The mixed incentive scheme marginally increased the retention rate versus no incentive (26.8% vs 20.3%; risk ratio (RR) = 1.32; 95% CI: 1.00-1.76; P = 0.053), but not the consent rate (RR = 1.13; 95% CI: 0.93-1.38; P = 0.22). Among the consented participants, approximately 50% in the mixed incentive group received the mailed prepaid incentive, who achieved a higher retention rate than the group without incentives (82.8% vs 56.1%; RR = 1.48; 95% CI: 1.21-1.80; P < 0.01). Conclusion: The mixed incentive scheme combining the prepaid and promised incentive was effective to increase the follow-up retention rate by 48%. We recommend this mixed incentive scheme to increase the follow-up retention rate. More efficient methods of delivering the incentive are needed to maximize its effects. Trial registration: U.S. Clinical Trials registry (clinicaltrials.gov, retrospectively registered, reference number: NCT03297866 ).
... On average, girls also supported more policies than boys. Such a difference between the sexes was consistent with the results of previous research in adults [20,21]. Although age was not associated with the number of policies supported, support for most of the policies decreased with age, which may reflect the urge for free choice in older adolescents. ...
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Public support is crucial for advancing tobacco control policies. We investigated adolescent support for such policies, and its association with potential factors of social denormalization (SD) beliefs of smoking, tobacco industry denormalization (TID) beliefs (negative perceptions of the industry), and harm perceptions of smoking. In a cross-sectional survey in Hong Kong, 13,964 secondary school students (mean age 15.0 years, 51.3% boys) reported their support (yes/no) for each of 14 tobacco control policies (e.g., further increase tobacco tax). Tobacco-related beliefs and perceptions, and smoking status were also measured. Support for the 14 tobacco control policies ranged from 17.6% to 54.1%. In current non-smokers, SD beliefs, TID beliefs, and harm perceptions were all associated with support for all tobacco control policies. In current smokers, the study factors were each associated with support for two to three policies. To conclude, support for tobacco control policies was weak to moderate in Hong Kong adolescents. SD beliefs, TID beliefs, and harm perceptions of smoking were associated with policy support in current non-smokers. In current smokers, the corresponding associations were less consistent or weaker.
... The study also shows that almost half of all smokers support the ban on additives, including one-quarter of menthol smokers and half of other flavoured cigarette smokers. This is a positive finding, also in comparison with a 2016 US survey that showed a low support of 17% for a ban on menthol cigarettes among US smokers 14 . The majority of MFC smokers tend to be supportive of other tobacco control measures, including smoking bans in restaurants, bars, and pubs, but not on plain packaging, which shows that there still exists a need for better public communication in arguing for certain areas of tobacco control legislation. ...
Article
Full-text available
Introduction: Little research exists on the sociodemographic characteristics of menthol and flavoured cigarette (MFC) smokers in Europe. This study assessed the proportion of MFC smokers in Europe, their sociodemographic characteristics, and their attitudes towards tobacco control measures. Methods: Cross-sectional data were collected in 2016 among 10760 adult current smokers from 8 European countries (ITC Europe Project and EUREST-PLUS). Smokers of menthol, other flavoured, unflavoured tobacco, or no usual brand were compared on sociodemographic characteristics, attitudes towards a range of tobacco control measures (e.g. ban on flavouring), and on intentions regarding their smoking behaviour following the ban on flavoured tobacco. Data were analysed in SPSS Complex Samples Package using univariate analyses. Results: Among the respondents, 7.4% smoked menthol cigarettes and 2.9% other flavoured tobacco, but large differences existed between countries (e.g. 0.4% smokers smoked menthol cigarettes in Spain vs 12.4% in England). Compared to other groups, menthol cigarette smokers were younger, more likely to be female, better educated, had higher household income, and smoked fewer cigarettes (all p<0.001). A quarter of menthol smokers supported a ban on additives, compared with almost half of all other smokers (p<0.001). In case of a ban on flavourings, around a fifth of all MFC smokers intended to switch to another brand, and a third to reduce the amount they smoked or to quit smoking, but there was no consistent pattern across MFC smokers among the countries. Conclusions: The ban on flavourings introduced by the EU Tobacco Products Directive (extended to 2020 for menthols) will affect one in ten smokers in the countries surveyed, which provides an opportunity for targeting these groups with cessation programmes. However, smokers of menthol and flavoured cigarettes in the different European countries are a heterogeneous group and may need different approaches.
... Knowledge Networks 2015) GfK provides those in non-Internet households with a computer and internet access. The GfK panel is increasingly used in public health research (Rose, Emery et al. 2015) and provides the unique opportunity to test how exposure to narrative communication strategies about SMI affect attitudes among a national sample of adult participants. The experiment was fielded over a 13-day period from March 21-April 2, 2016. ...
Article
In the ongoing national policy debate about how to best address serious mental illness (SMI), a major controversy among mental health advocates is whether drawing public attention to an apparent link betweenSMI and violence, shown to elevate stigma, is the optimal strategy for increasing public support for investing inmental health services or whether nonstigmatizing messages can be equally effective.We conducted a randomized experiment to examine this question. Participants in a nationally representative online panel (N= 1,326) were randomized to a control arm or to read one of three brief narratives about SMI emphasizing violence, systemic barriers to treatment, or successful treatment and recovery. Narratives, or stories about individuals, are a common communication strategy used by policy makers, advocates, and the news media. Study results showed that narratives emphasizing violence or barriers to treatment were equally effective in increasing the public's willingness to pay additional taxes to improve the mental health system (55 percent and 52 percent, vs. 42 percent in the control arm). Only the narrative emphasizing the link between SMI and violence increased stigma. For mental health advocates dedicated to improving the public mental health system, these findings offer an alternative to stigmatizingmessages linking mental illness and violence.
... Terry and Zhang (2016) would seem to concur; their study of smoking policy effectiveness found that policy enforcement was significantly more effective for reducing smoking rates than simply policy provision. Rose et al. (2015) had similarly low findings of public support for smoking and tobacco control point of sale informational provisions with widespread support only enjoyed with provisions related to restricted access to smoking products by minors. ...
... Point of sale display bans achieved high compliance and public support in Ireland and Norway [26], and in Thailand, an evaluation of its 2005 ban found high support among smokers [16]. A study of public support of marketing and point of sale bans in the United States found low support [27], and an evaluation of a point of sale ban is currently underway in the United Kingdom [28]. Prior research has found that airports are not necessarily subject to in-country or local smoke-free legislation [2], thus a concerted effort among smoke-free advocates and policy makers may be required to implement a TAPS ban. ...
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Tobacco advertising, promotion, and sponsorship (TAPS) bans are effective and are increasingly being implemented in a number of venues and countries, yet the state of TAPS in airports and their effect on airport smoking behavior is unknown. The objective of this study was to evaluate the presence of TAPS in airports across Europe and the US, and to begin to examine the relationship between TAPS and smoking behaviors in airports. We used a cross-sectional study design to observe 21 airports in Europe (11) and the US (10). Data collectors observed points of sale for tobacco products, types of products sold, advertisements and promotions, and branding or logos that appeared in the airport. Tobacco products were sold in 95% of all airports, with significantly more sales in Europe than the US. Advertisements appeared mostly in post-security areas; however, airports with advertisements in pre-security areas had significantly more smokers observed outdoors than airports without advertisements in pre-security areas. Tobacco branding appeared in designated smoking rooms as well as on non-tobacco products in duty free shops. TAPS are widespread in airports in Europe and the US and might be associated with outdoor smoking, though further research is needed to better understand any relationship between the two. This study adds to a growing body of research on tobacco control in air transit and related issues. As smoke-free policies advance, they should include comprehensive TAPS bans that extend to airport facilities.
... The exception was relatively high levels of support among retailers for graphic warning labels on cigarette packs (59 %) and graphic warnings on advertisements in stores (43 %). Overall, the level of support among retailers for most of the provisions more closely resembled the level of support we found in a similar study among the general public (smokers and nonsmokers) than among smokers who had significantly lower support for every provision compared with non-smokers [31]. ...
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Background: The objectives of this study were to document retailer opinions about tobacco control policy at the point of sale (POS) and link these opinions with store level compliance with sales and marketing provisions of the Tobacco Control Act. Methods: This study conducted interviews of 252 tobacco retailers in three counties in North Carolina and linked their opinions with in-person observational audit data of their stores' compliance with POS policies. We conducted analyses examining retailer factors associated with noncompliance using Generalized Estimating Equations (GEE) controlling for individual, store, neighborhood, and county factors. Results: Over 90 % of retailers support minors' access provisions and a large minority (over 40 %) support graphic warnings and promotion bans. Low levels of support were found for a potential ban on menthol cigarettes (17 %). Store noncompliance with tobacco control policies was associated with both more reported retailer barriers to compliance and less support for POS policies. Awareness of and source of information about tobacco control regulations were not associated with compliance when accounting for neighborhood and county characteristics. Conclusions: Retailers expressed some support for a wide range of POS policies. Advocates and government agencies tasked with enforcement can work with retailers as stakeholders to enhance support, mitigate barriers, and promote compliance with tobacco control efforts at the point of sale.
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Introduction To examine population-level characteristics of support for – versus neutrality or opposition toward – cigarette pack warnings that use text and images to portray the negative health effects of smoking. Methods We used nationally representative cross-sectional data of U.S. adults age 18 and older from the 2020 Health Information National Trends Survey (n=3865). Frequencies and weighted proportions were calculated for neutrality toward, opposition to, and support for pictorial warnings across sociodemographics and other predictors. Weighted, multivariable logistic regression examined predictors of being neutral or opposed versus supportive of pictorial warnings. Results In 2020, an estimated 69.9% of U.S. adults supported pictorial warnings, 9.1% opposed, and 20.9% neither supported nor opposed them. In fully adjusted models, current smokers had almost twice the odds of being neutral or opposed to pictorial warnings as never smokers (OR=1.99, CI 1.12,3.52). Adults 75 years and older (vs. 18-34) (OR=0.55, CI 0.33,0.94) and those with children under 18 in their household (vs. no children) (OR=0.67, CI 0.46,0.98) were less likely to be neutral or opposed. Conclusions In advance of the Food and Drug Administration’s implementation of pictorial warnings on cigarette packages, nearly 70% of American adults support this policy. Disseminating information about the effectiveness of pictorial warnings may further strengthen support among current smokers who are less supportive than never smokers. Furthermore, framing messages around the benefits of pictorial warnings for protecting youth may increase public support. Implications While public support for pictorial warnings on cigarette packages is high in the U.S., it may increase further after policy implementation and be strengthened by utilizing information campaigns that convey the evidence that pictorial warnings are an effective public health strategy
Article
The Family Smoking Prevention and Tobacco Control Act granted the U.S. Food and Drug Administration authority to regulate tobacco advertising and promotion, including at the retail level, and preserved state, tribal, and local tobacco advertising and promotion authorities. Public health experts have proposed prohibiting point-of-sale tobacco advertisements and product displays, among other tobacco advertising restrictions. We examined the prevalence and correlates of public support, opposition, and neutrality toward proposed tobacco product placement and advertising restrictions at point-of-sale and on social media utilizing the National Cancer Institute's 2020 Health Information National Trends Survey (HINTS) (N = 3865), a cross-sectional, probability-based postal survey of U.S. addresses conducted from Feb 24, 2020 to June 15, 2020 (Bethesda, MD). Frequencies and unadjusted, weighted proportions were calculated for support, neutrality, and opposition toward the three policies under study, and weighted, adjusted multivariable logistic regression was employed to examine predictors of neutrality and opposition. Tests of significance were conducted at the p < 0.05 level. Sixty-two percent of U.S. adults supported a policy prohibiting tobacco product advertising on social media; 55% supported a policy restricting the location of tobacco product advertising at point-of-sale; and nearly 50% supported a policy to keep tobacco products out of view at the checkout counter. Neutrality and opposition varied by sociodemographic characteristics including age, sex, education, rurality, and presence of children in the household. Understanding public opinion toward tobacco product placement and advertising restrictions may inform policy planning and implementation.
Article
Objectives The US Food and Drug Administration (FDA) and local jurisdictions have different authorities to regulate menthol cigarettes, and a growing number of localities and the FDA are considering these policy options. The objective of this study was to update previous research on public support for a menthol ban, including examining differences in support by demographic factors, geographic region, and smoking status. Methods We assessed policy support among a cross-sectional sample of 2871 adults aged 18-64 from a nationally representative online panel. We calculated weighted estimates of support by demographic factors, political ideology, region (Northeast, Midwest, South, West), and smoking status (never, former, current nonmenthol, current menthol). We used weighted adjusted logistic regression analysis to examine correlates of support for a menthol ban. Results Overall, 56.4% (95% CI, 54.4%-58.3%) of participants supported a government policy to ban menthol cigarette sales. Support was significantly higher among women than among men (62.5% vs 50.1%; P < .001); among Hispanic/Latino (69.3%), non-Hispanic African American (60.5%), and non-Hispanic other (65.8%) people than among non-Hispanic White people (50.4%; P < .001); and among never (64.8%) and former (47.0%) smokers than among current nonmenthol cigarette smokers (30.1%; P < .001). A significant proportion (28.5%; P < .001) of current menthol cigarette smokers supported a ban. After controlling for other factors, geographic region was not significantly associated with support for a ban. Conclusions Efforts are needed to further increase support for a ban among current menthol cigarette smokers. These findings can be used to assist policy makers and communities in efforts to ban menthol cigarettes in their jurisdictions.
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Introduction : Utilisant une technique de scénarios, cette étude a exploré et cartographié les positions des Français de manière détaillée concernant les politiques de contrôle du tabac, de l’alcool et des jeux de hasard et d’argent. Méthode : Un échantillon de 344 adultes (dont des professionnels de santé et des juristes a jugé de l’acceptabilité des politiques de contrôle présentées dans 54 vignettes. Chacune d’entre elles vise une politique de contrôle relative à une consommation potentiellement addictive (tabac, alcool ou jeu d’argent), comprenant des mesures de prévention, de réglementation et des sanctions. Résultats : Grâce à l’analyse typologique, huit positions qualitativement différentes ont été trouvées. Elles se présentent sur un continuum allant du rejet total de toute politique de contrôle ou de réglementation faible, à une forte réglementation et des sanctions sévères. Ces huit positions sont : jamais acceptable (9 %), réglementation faible ou modérée (5 %), réglementation modérée associée à une forte prévention (11 %), réglementation modérée ou forte (11 %), réglementation forte associée à une forte prévention (23 %), sanctions modérées (9 %), sanctions sévères (9 %) et toujours favorable (9 %). Certains participants (14 %) ont été qualifiés d’« indécis ». Ces positions ont été associées avec les caractéristiques sociodémographiques des participants, leurs opinions politiques et leurs habitudes de consommation de produits potentiellement addictifs. Conclusion : Cette étude confirme que ces pratiques, fumer, boire de l’alcool et jouer de l’argent, ne sont plus considérées comme privées mais sont bien perçues comme des problèmes publics. Elles sont envisagées comme relevant de choix de société, ayant des incidences sur l’ordre social. Une majorité de participants est d’accord avec la politique de contrôle française actuelle. Le type préféré de politique de contrôle varie en fonction du produit considéré et selon le comportement de consommation du répondant (ex : plus le répondant est consommateur de produit addictif, moins il est favorable à une politique de contrôle fort). L’analyse des résultats donne à voir une convergence de traitement de ces consommations. Tous les participants sont favorables à la prévention, quel que soit le produit considéré. En général, les participants ont légitimé des mesures de réglementation forte, et plus particulièrement pour les JHA, ainsi qu’une politique de sanctions sévères pour l’alcool.
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Background: Public authorities resort to various control policies in order to curb the prevalence of unhealthy behaviors. As these policies can only succeed to the extent that people agree with them, this study mapped French people's positions regarding restrictive control policies in general. Method: A sample of 344 adults (among them health professionals and lawyers) were presented with 54 vignettes depicting a control policy. Each vignette contained four pieces of information: the type of addictive behavior targeted (smoking, drinking, or gambling), the nature of preventive measures (e.g., information campaigns), the degree of regulative measures (e.g., prohibition to minors), and the severity of sanctions. Results: Through cluster analysis, eight qualitatively different positions were found: Never acceptable (9%), Weak or moderate regulation (5%), Moderate regulation associated with strong prevention (11%), Strong or moderate regulation (11%), Strong regulation in association with strong prevention (23%), Moderate sanctions in association with strong prevention and moderate regulation (9%), Severe sanctions (9%), and Always acceptable (9%). Some participants (14%) expressed no opinion at all. Conclusion: French people's positions regarding control policies were extremely diverse. Regarding tobacco, however, one type of policy would likely be supported by a majority of people: Moderate regulation associated with at least a moderate level of prevention and low-level sanctions. Regarding alcohol, an acceptable position would be: Moderate regulation associated with at least a moderate level of prevention and high-level sanctions. Regarding gambling, an acceptable position would be: Strong regulation associated with at least a moderate level of prevention and low-level sanctions.
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Despite declines in overall cigarette smoking in the United States, menthol cigarette smoking prevalence has increased among young adults (18-25 years) and remains constant among older adults (26 years and older). Disparities in menthol cigarette use exist, with higher prevalence among younger adult smokers and among racial/ethnic minority populations. Menthol in cigarettes has been shown to play a role in increasing smoking initiation and making it more difficult to quit smoking. Little research focuses on perceptions of the addictive potential and health consequences of menthol cigarette use. This analysis uses data from a national panel of U.S. adults ( n = 1,303) surveyed in 2016. Participants were asked to what extent they agreed with various statements regarding menthol use among demographic and tobacco use subgroups. These data reveal disparities in perceptions of the impact of menthol use, with Black, non-Hispanic, and Hispanic adults and adults with lower income and less education misperceiving the health effects and addiction potential of menthol in cigarettes. Determining how and to what extent population subgroups understand the effect of menthol cigarette use can inform public education strategies and, in turn, policy efforts to ban or restrict menthol cigarette availability.
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The research aimed to investigate the associations between problem gambling and risky behaviors and the demographic, psychosocial, psychological factors related to these behaviors in adolescence. According to the findings of the data (N = 784, 14-19 ages) gambling problem severity and frequency of alcohol use (r = .39, p <.001), frequency of smoking (r = .44, p <.001) and GPA (r = -.38 p <.001) were found to be associated. Problem gambling and all types of risky behaviors were found to be more common among males compared to the girls. The results demonstrated that enjoyment/excitement, socialization, avoidance and monetary motives were associated with problem gambling. In addition, the South Oaks Gambling Screen - Revised for Adolescents (SOGS-RA) was adapted to the Turkish culture in the current study. The psychometric properties of the Turkish version of the SOGS-RA were found to be satisfactory. The results indicated that SOGS-RA is a valid and reliable measurement tool to estimate gambling problem severity of high school students in Turkey. Keywords: Problem Gambling, Risky Behaviors, Adolescence, Gambling Participation, Motivation
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p class="Pa7"> Objective: To examine the relationship between menthol perceptions and support for a national menthol ban. Design: Descriptive cross-sectional study. Participants: Data were collected from a nationally representative probability-based panel of adults aged ≥18 years during June 21, 2016 through July 18, 2016. A total of 1,303 respondents, including an oversample of 300 African Americans, completed the survey. Main Outcome Measures: Weighted logistic regression models examined the relationship between menthol perceptions, specifically related to health and addiction, and the outcome measure: support for a menthol ban, by menthol smoking status. All models controlled for age, sex, education level, and race/ethnicity. Results: The association between reporting accurate menthol health perceptions dif­fered by menthol preference. Among non-menthol smokers, there was no association between accurate menthol health percep­tions and support of a menthol ban while more accurate menthol perceptions of ad­diction were associated with greater support of a menthol ban (aOR=2.83, CI=1.19- 6.72). Among menthol smokers, more accurate health-related menthol percep­tions were associated with increased odds of supporting a menthol ban (aOR=3.90, CI=1.02-14.79) while more accurate men­thol addiction perceptions were not. Conclusions: Fewer current menthol smok­ers support a menthol ban than current non-menthol smokers given its effect on their preferred product. Given the large proportions of smokers who have misper­ceptions of the health consequences and addictive properties of menthol, there is a moral imperative to inform those who use these products. Findings suggest the need for tailored messaging strategies targeted to reach menthol smokers who will be most impacted by a ban, but also have the most to gain from such a policy change. Ethn Dis. 2018;28(3):177-186; doi:10.18865/ ed.28.3.177.</p
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Background Awareness and use of electronic cigarettes has rapidly grown in the USA recently, in step with increased product marketing. Using responses to a population survey of US adults, we analysed demographic patterns of exposure to, searching for and sharing of e-cigarette-related information across media platforms. Methods An online survey of 17 522 US adults was conducted in 2013. The nationally representative sample was drawn from GfK Group's KnowledgePanel plus off-panel recruitment. Fixed effects logit models were applied to analyse relationships between exposure to, searching for and sharing of e-cigarette-related information and demographic characteristics, e-cigarette and tobacco use, and media behaviours. Results High levels of awareness about e-cigarettes were indicated (86% aware; 47% heard through media channels). Exposure to e-cigarette-related information was associated with tobacco use, age, gender, more education, social media use and time spent online. Although relatively small proportions of the sample had searched for (∼5%) or shared (∼2%) e-cigarette information, our analyses indicated demographic patterns to those behaviours. Gender, high income and using social media were associated with searching for e-cigarette information; lesbian, gay and bisexual and less education were associated with sharing. Current tobacco use, age, being Hispanic and time spent online were associated with both searching and sharing. Conclusions US adults are widely exposed to e-cigarette marketing through the media; such marketing may differentially target specific demographic groups. Further research should longitudinally examine how exposure to, searching for and sharing of e-cigarette information relate to subsequent use of e-cigarettes and/or combustible tobacco.
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To determine whether smokers smoking from packs required under Australia's plain packaging law had different smoking beliefs and quitting thoughts, compared with those still smoking from branded packs. Cross-sectional survey during the roll-out phase of the law, analysed by timing of survey. Australian state of Victoria, November 2012. 536 cigarette smokers with a usual brand, of whom 72.3% were smoking from a plain pack and 27.7% were smoking from a branded pack. Perceived quality and satisfaction of cigarettes compared with 1 year ago, frequency of thoughts of smoking harm, perceived exaggeration of harms, frequency of thoughts of quitting, quitting priority in life, intention to quit, approval of large graphic health warnings and plain packaging. Compared with branded pack smokers, those smoking from plain packs perceived their cigarettes to be lower in quality (adjusted OR (AdjOR)=1.66, p=0.045), tended to perceive their cigarettes as less satisfying than a year ago (AdjOR=1.70, p=0.052), were more likely to have thought about quitting at least once a day in the past week (AdjOR=1.81, p=0.013) and to rate quitting as a higher priority in their lives (F=13.11, df=1, p<0.001). Plain pack smokers were more likely to support the policy than branded pack smokers (AdjOR=1.51, p=0.049). Branded and plain pack smokers did not differ on measures of less immediate smoking intentions, frequency of thoughts about harms or perceived exaggeration of harms. Appeal outcomes, but not other outcomes, were sensitive to the extent of roll-out, with responses from branded pack smokers approaching those of plain pack smokers, once 80% of survey respondents were smoking from plain packs 1-2 weeks before the December implementation date. The early indication is that plain packaging is associated with lower smoking appeal, more support for the policy and more urgency to quit among adult smokers.
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A burgeoning literature suggests that self-interest has little influence on policy preferences. In sharp contrast are the findings discussed in this paper: we show that self-interest plays a decisive role in shaping attitudes toward smoking restrictions and cigarette taxes. Data from two random samples of California adults collected by the Field Institute in April 1987 and February 1984 indicate that nonsmokers are far more enthusiastic about tightening smoking restrictions and increasing cigarette taxes than smokers, particularly heavy smokers. We conclude by discussing several explanations for the apparent discrepancy between these results and the pattern of null findings characteristic of the self-interest literature.
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California's Smoke-Free Workplace Act--CA Labor Code Sec. 6404.5(a)--was extended to bars in 1998. This article analyzes changes in normative beliefs and behaviors related to bar smoking in the decade following the adoption of the Act. In a series of studies evaluating the smoke-free workplace law in bars, researchers conducted extensive observations and interviews with bar staff and patrons, health officials, and law enforcement personnel in three California counties. Smoking outside became a normal pause in the social environment and created a new type of bar socializing for outside smokers. Although some bar owners and staff reported initially resenting the responsibility to uphold the law, once norms regarding cigarettes and smoking began changing, bar workers experienced less conflict in upholding the law. Non-smoking behavior within bars also became the normative behavior for bar patrons. California's Smoke-Free Workplace Act has both reflected and encouraged normative beliefs and behaviors related to smoking in bars. The findings indicate that such shifts are possible even in contexts where smoking behaviors and attitudes supporting smoking were deeply entrenched. Recommendations include attending to the synergistic effect of education and policy in effective tobacco control programs.
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Objectives: We assessed support for a ban by the Food and Drug Administration on menthol in cigarettes and behavioral intentions among menthol smokers in the event of such a ban. Methods: We surveyed 2649 never, former, and current smokers and used ordinal logistic regression to calculate weighted point estimates and predictors of support for a menthol ban among the adult population and menthol smokers only. For menthol smokers, we also calculated weighted point estimates and predictors of behavioral intentions. Results: Overall, 28.2% of adults opposed, 20.0% supported, and 51.9% lacked a strong opinion about a menthol ban. Support was highest among Hispanics (36.4%), African Americans (29.0%), never smokers (26.8%), and respondents with less than a high school education (28.8%). Nearly 40% of menthol smokers said they would quit if menthol cigarettes were no longer available, 12.5% would switch to a nonmenthol brand, and 25.2% would both switch and try to quit. Conclusions: Support for a menthol ban is strongest among populations with the highest prevalence of menthol cigarette use. A menthol ban might motivate many menthol smokers to quit.
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This study proposed and tested a model of consumer online buying behavior. The model posits that consumer online buying behavior is affected by demographics, channel knowledge, perceived channel utilities, and shopping orientations. Data were collected by a research company using an online survey of 999 U.S. Internet users, and were cross-validated with other similar national surveys before being used to test the model. Findings of the study indicated that education, convenience orientation, experience orientation, channel knowledge, perceived distribution utility, and perceived accessibility are robust predictors of online buying status (frequent online buyer, occasional online buyer, or non-online buyer) of Internet users. Implications of the findings and directions for future research were discussed.
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On June 22, 2009, the US FDA was granted the authority to regulate tobacco products through the Family Smoking Prevention and Tobacco Control Act (FSPTCA). The intent is to improve public health through regulations on tobacco product marketing and tobacco products themselves. This manuscript reports baseline data on smokers' attitudes and beliefs on specific issues relevant to the FSPTCA. Between November 2009 and January 2010, a telephone survey among a nationally representative sample of n = 678 smokers in the US was performed as part of the International Tobacco Control (ITC) United States Survey. Participants answered a battery of questions on their attitudes and beliefs about aspects of the FSPTCA. Most smokers were unaware of the new FDA tobacco regulations. Smokers indicated support for banning cigarette promotion and nearly a quarter supported requiring tobacco companies to sell cigarettes in plain packaging. Seventy two percent of smokers supported reducing nicotine levels to make cigarettes less addictive if nicotine was made easily available in non-cigarette form. Most smokers were limited in their understanding of efforts to regulate tobacco products in general. Smokers were supportive of efforts to better inform the public about health risks, restrict advertising, and make tobacco products less addictive.
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Menthol is a cigarette flavoring that makes smoking more appealing to smokers. The US Food and Drug Administration (FDA) has regulatory authority to ban mentholated cigarettes to reduce youth uptake and encourage adult cessation. Survey findings indicate that more than half of all Americans (56.1%) and of Blacks alone (68.0% in one sample and 75.8% in another) support banning menthol. Endorsement of a ban-especially by Blacks, who have the highest rates of menthol cigarette use-would support FDA action to ban menthol to protect the public's health.
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The World Health Organization Framework Convention on Tobacco Control (FCTC) has little to say about the regulation of tobacco retailing, with most research and policy debate having been restricted to confining sales to adults and removing advertising displays, including packs. Tobacco retailing is largely unregulated, reflecting the historical regulatory trivialisation of tobacco products, now demonstrably anachronistic with the advent of near global support for the FCTC. This situation contrasts markedly with the regulation of pharmaceuticals, and many other goods and services subject to a wide variety of restrictions. This review proposes that the international tobacco control community should open up debate on retail regulation to examine the suitability of principles long accepted in pharmaceutical regulation. These include: restrictions on the number and location of tobacco retail outlets, the banning of tobacco retail displays, floor (minimum) price controls, restricting the amount of tobacco smokers could purchase over a given time and loss of retail licensure following breaches of any of the conditions of license. It proposes that retail licenses should be heavily restricted and tradable, becoming valuable commercial assets, where the threat of loss or revocation would act as an incentive for strict adherence to the measures proposed.
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The longitudinal ITC Scotland/U.K. survey was used to investigate adult smokers' support for smoke-free legislation and whether this support was associated with higher quit intentions at follow-up, either directly or indirectly, via the mediation of perceived social unacceptability of smoking. Structural equation modeling was employed to compare differences between the two samples (507 adult smokers from Scotland and 507 from the rest of the United Kingdom) across two waves (February/March 2006 and March 2007). During these two waves, a smoking ban was introduced in Scotland but not the rest of the United Kingdom. For smokers in both samples, support for smoke-free legislation at baseline significantly heightened perceived unacceptability of smoking, although perceptions of unacceptability were somewhat stronger in Scotland than the rest of the United Kingdom postban. Unlike the rest of the United Kingdom, support for a ban at baseline among smokers in Scotland was associated with higher quit intentions at follow-up. For both samples, quit intentions were significantly associated with heightened perceived unacceptability at follow-up. The overall variance explained in quit intentions was greater in Scotland than in the rest of the United Kingdom but not significantly so. Support for smoke-free legislation at baseline significantly increased support at follow-up for both samples. However, this did not independently increase quit intentions among smokers from both Scotland and the rest of the United Kingdom. The findings suggest that normative influences are one of the mechanisms through which comprehensive smoke-free legislation influences quit intentions.
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Little research has been conducted to determine the psychosocial and behavioral impacts of smoke-free policies in middle-income countries. Cross-sectional data were analyzed from the 2006 waves of the International Tobacco Control Policy Evaluation. Survey comparing adult smokers in Mexico (n = 1,080), where smoke-free legislation at that time was weak, and Uruguay (n = 1,002), where comprehensive smoke-free legislation was implemented. Analyses aimed to determine whether exposure to smoke-free policies and perceived antismoking social norms were associated with smokers' receiving cues about the bothersome nature of secondhand smoke (SHS), with smokers' reactance against such cues, and with smokers' level of support for smoke-free policies in different venues. In bivariate analyses, Uruguayan smokers were more likely than Mexican smokers to experience verbal anti-SHS cues, lower reactance against anti-SHS cues, stronger antismoking societal norms, and stronger support for 100% smoke-free policies in enclosed workplaces, restaurants, and bars. In multivariate models for both countries, the strength of voluntary smoke-free policies at home was independently associated with support for smoke-free policies across all venues queried, except for in bars among Uruguayans. Perceived strength of familial antismoking norms was consistently associated with all indicators of the social acceptability of smoking in Uruguay but only with the frequency of receiving anti-SHS verbal cues in Mexico. These results are generally consistent with previous research indicating that comprehensive smoke-free policies are likely to increase the social unacceptability of smoking and that resistance against such policies is likely to diminish once such policies are in place.
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This study was undertaken to explore smoking patterns and attitudes that influence smoking cessation and relapse among African Americans. Baseline data from eight Community Intervention Trial for Smoking Cessation (COMMIT) sites were analyzed. Compared with Whites, African Americans who smoke less than 25 cigarettes per day were 1.6 times more likely to smoke within 10 minutes of awakening (a behavioral indicator of nicotine dependence), adjusting for education, age, and gender (OR = 1.2 for heavier smokers). African Americans reported a stronger desire to quit smoking and reported serious quit attempts in the past year. African Americans favored tobacco restrictions (they were 1.8 times more likely than Whites to view smoking as a serious community problem, 1.7 times more likely to favor restrictions on cigarette vending machines, and 2.1 times more likely to prohibit smoking in their car). African Americans were lighter/moderate, menthol smokers. African Americans find smoking socially unacceptable and are strongly motivated to quit, but their "wake-up" smoking may indicate high nicotine dependence, making abstinence difficult even for lighter smokers.
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To prevent smoking and exposure to environmental tobacco smoke, California has implemented anti-tobacco policies, including laws restricting youth access to tobacco, and smoking bans in workplaces, schools, restaurants and bars. Although studies have examined adults' attitudes toward anti-tobacco policies, little is known about adolescents' awareness of and support for these policies. This study examined attitudes toward anti-tobacco policies in a sample of 6887 10th grade California adolescents. Awareness of anti-tobacco policies was highest among current smokers and lowest among susceptible never-smokers. Support for anti-tobacco policies was highest among non-susceptible never-smokers and lowest among current smokers. Policy awareness and support were significantly associated with psychosocial tobacco-related variables (e.g. perceived consequences of smoking, friends' smoking, perceived access to cigarettes, prevalence estimates of smoking among peers, cigarette offers and cigarette refusal self-efficacy). Policy awareness and support were associated with the probability of performing advocacy actions against tobacco use. Although these results cannot prove a causal association, they suggest that adolescents' attitudes toward anti-tobacco policies may play a role in their decisions about smoking. Tobacco control and education programs should include information about existing anti-tobacco policies, and should educate youth about the importance and benefits of anti-tobacco policies.
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Using data from a 1996 random-digit-dialing computer-assisted telephone survey of Ontario adults, 424 smokers and 1,340 nonsmokers were compared regarding knowledge about the health effects of tobacco use, attitudes toward restrictions on smoking and other tobacco control measures, and predictions of compliance with more restrictions. The response rate was 65%. Smokers were less knowledgeable than nonsmokers. Smokers were also less likely to support bans on smoking in specific locations, but majorities of both groups supported some restriction in most settings. Smokers were more likely than nonsmokers to predict that most smokers would comply with more restrictions, and more than three quarters indicated that they, themselves, would comply. Sizable proportions of both groups, especially smokers, failed to appreciate the effectiveness of taxation in reducing smoking. Support for other control measures also differed by smoking status. Both knowledge and smoking status were independently associated with support for more restrictions and other tobacco control policy measures.
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Comprehensive tobacco control policies for US colleges and universities have been proposed by several groups in order to counter the rising use of tobacco by students enrolled in these institutions. Student opinion of these policies is not known, and concern about student opposition is one barrier that deters administrators from adopting the policies. This study measured student support for recommended college tobacco control policies. Mailed survey of US college students (2001 Harvard School of Public Health College Alcohol Study). 119 nationally representative, four-year colleges and universities in the USA. 10,904 randomly selected undergraduate students enrolled at participating schools. Students' opinion of 7 proposed tobacco control policies. A majority of students supported each policy. Over three quarters of students favoured smoke-free policies for all college buildings, residences, and dining areas, while 71% supported prohibiting tobacco advertising and sponsorship of campus social events, 59% favoured prohibiting tobacco sales on campus, and 51% supported smoke-free campus bars. All policies had more support among non-smokers than smokers (p < 0.001). Among smokers, support for policies was inversely related to intention to quit and intensity of tobacco consumption. Because college students' tobacco consumption is low, a majority of smokers favoured banning smoking in college buildings and dining areas and prohibiting tobacco marketing on campus. Student support for proposed campus tobacco control policies is strong, even among smokers, and broadly based across demographic subgroups. These findings should provide reassurance to college administrators who are considering adopting these policies.
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The role of the US federal government in developing tobacco control through a cooperative, interactive program with state and local private and public organizations has been underestimated. This article investigates how the government initiated and sustained a program of "capacity building" through the scientific authority of the National Cancer Institute, beginning in the 1980s. There are several major questions to be answered: (1) How did this program manage to be adopted and sustained despite the well-documented hindrances to effective tobacco control policy at the federal level? (2) How did a tobacco control policy program become incorporated into the scientific research agenda of the National Cancer Institute? (3) How have science, social factors, and government at various levels interacted in this capacity-building program? The study emphasizes how the US federal government, blocked by a tobacco-friendly Congress from enacting effective tobacco control legislation, utilized its scientific research role and, with the cooperation of other levels of government and large, private antitobacco organizations, established an ongoing policy effort.
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While tobacco taxes and smoke-free air regulations have significantly decreased tobacco use, tobacco-related illness accounts for hundreds of thousands of annual deaths. Experts are considering additional strategies to further reduce tobacco consumption. We investigated smokers' (n=2118) and non-smokers' (n=2210) opinions on existing and theoretical strategies, including tax and retailer-based strategies in New York City, across three cross-sectional surveys. Compared with smokers, non-smokers were significantly more likely (p<0.05) to favour all tobacco control strategies. Overall, 25% of smokers surveyed favoured increasing taxes on cigarettes, climbing to 60% if taxes were used to fund healthcare programmes. Among non-smokers, 72% favoured raising taxes, increasing to 83% if taxes were used to fund healthcare programmes. 54% of non-smoking New Yorkers favoured limiting the number of tobacco retail licences, as did 30% of smokers. The most popular retail-based strategies were raising the minimum age to purchase cigarettes from 18 to 21, with 60% of smokers and 69% of non-smokers in favour, and prohibiting retailers near schools from selling tobacco, with 51% of smokers and 69% of non-smokers in favour. Keeping tobacco products out of customers' view, prohibiting tobacco companies from paying retailers to display or advertise tobacco products and prohibiting price promotions were favoured by more than half of non-smokers surveyed, and almost half of smokers. While the support level varied between smokers and non-smokers, price and retail-based tobacco control strategies were consistently supported by the public, providing useful information for jurisdictions examining emerging tobacco control strategies.
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Scholars have offered two primary explanations for the influence that neighboring states have on policy diffusion: state officials learn by observing the outcomes of policies and states seek an economic advantage over other states. Both models contend that decision making occurs laterally as state officials learn from or react to the policy decisions of other elites; the public has a minor role. I offer an additional explanation, the social contagion model, which suggests that state residents react to neighboring policies by changing their aggregate opinions on that policy. If state opinion becomes supportive, state officials respond by enacting similar policies in the home state or risk being ousted from office. Using both individual and aggregate data on antismoking legislation, I find empirical support for the social contagion model. The results reorient theories of policy diffusion to the public and, consequently, open up new avenues for future research.
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This article investigates which socio-economic and ideological factors make individuals support the normative principles of the welfare state. Two principal theoretical perspectives, relating to self-interest and the political ideology, respectively, have been proposed in the literature as causal explanations. However, as most studies utilize solely cross-sectional data, causal interpretations of which factors make people express support for the welfare state have so far been hard to sustain. This article, using panel data from the Canadian ‘Equality, Security, and Community’ survey and an extended random-effect model, exploits the longitudinal nature of the data and econometric methods to provide a more accurate analysis of the extent to which self-interest and political ideology actually determine support for welfare state principles. The empirical analysis indicates that both self-interest and political ideology variables to some extent are significant predictors of support for welfare state principles. In addition, the article discusses several avenues for future research.
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The expertise of medical and science professionals is needed in public policy debates in the U.S. and around the world. As societies mature, questions in public policy become increasingly complex and should be informed by science. However, too often public agendas are advanced without the benefit of science and those trained in how to interpret it. Similarly, those trained in the sciences often do not have requisite knowledge, training or an interest in politics and policymaking. Yet, it is clear that optimal policy results in those cases when scientists and policy elites work together in meaningful partnerships. Because the worlds of science and politics—their cultures, assumptions, and methods—are largely separate and different, cooperation between these two cultures is difficult. The authors of this paper hope that their work interpreting one major issue of scientific importance as it has wound its way through public policy processes will be instructive to those in science who are enlisted to bring scientific discovery to public policy making (Fritschler and Rudder 2007). The 60-year political struggle to move the issue of tobacco control from the agenda of a small group of medical researchers to the public agenda offers insights about public policymaking that are transferable to other issues which rest on science.
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This article considers the impact of public opinion on public policy, asking: (1) how much impact it has; (2) how much the impact increases as the salience of issues increases; (3) to what extent the impact of public opinion may be negated by interest groups, social movement organizations, political parties, and elites; (4) whether responsiveness of governments to public opinion has changed over time; and (5) the extent to which our conclusions can be generalized. The source of data is publications published in major journals and included in major literature reviews, systematically coded to record the impact of public opinion on policy. The major findings include: the impact of public opinion is substantial; salience enhances the impact of public opinion; the impact of opinion remains strong even when the activities of political organizations and elites are taken into account; responsiveness appears not to have changed significantly over time; and the extent to which the conclusions can be generalized is limited. Gaps in our knowledge made apparent by the review are addressed in proposals for an agenda for future research.
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This article examines the adequacy of the “rules of thumb” conventional cutoff criteria and several new alternatives for various fit indexes used to evaluate model fit in practice. Using a 2‐index presentation strategy, which includes using the maximum likelihood (ML)‐based standardized root mean squared residual (SRMR) and supplementing it with either Tucker‐Lewis Index (TLI), Bollen's (1989) Fit Index (BL89), Relative Noncentrality Index (RNI), Comparative Fit Index (CFI), Gamma Hat, McDonald's Centrality Index (Mc), or root mean squared error of approximation (RMSEA), various combinations of cutoff values from selected ranges of cutoff criteria for the ML‐based SRMR and a given supplemental fit index were used to calculate rejection rates for various types of true‐population and misspecified models; that is, models with misspecified factor covariance(s) and models with misspecified factor loading(s). The results suggest that, for the ML method, a cutoff value close to .95 for TLI, BL89, CFI, RNI, and Gamma Hat; a cutoff value close to .90 for Mc; a cutoff value close to .08 for SRMR; and a cutoff value close to .06 for RMSEA are needed before we can conclude that there is a relatively good fit between the hypothesized model and the observed data. Furthermore, the 2‐index presentation strategy is required to reject reasonable proportions of various types of true‐population and misspecified models. Finally, using the proposed cutoff criteria, the ML‐based TLI, Mc, and RMSEA tend to overreject true‐population models at small sample size and thus are less preferable when sample size is small.
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  The US Food and Drug Administration must consider whether to ban the use of menthol in cigarettes. This study examines how current smokers might respond to such a ban on menthol cigarettes.   Convenience sample of adolescent and adult smokers recruited from an online survey panel.   United States, 2010.   A total of 471 adolescent and adult current cigarette smokers.   Respondents were asked a series of questions about how they might react if menthol cigarettes were banned. In addition, participants completed a simulation purchase task to estimate the demand for menthol and non-menthol cigarettes across a range of prices.   Overall, 36.1% of respondents said they always (18.9%) or usually (17.2%) smoked menthol cigarettes. When asked how they might respond to a ban on menthol cigarettes, 35% of current menthol smokers said they would stop smoking, and 25% said they would 'find a way to buy a menthol brand'. Those who reported they might quit tended to have greater current intentions to quit [odds ratio (OR) = 4.47], while those who reported that they might seek illicit menthol cigarettes were far less likely to report current intentions to quit (OR = 0.06). Estimates for demand elasticity for preferred cigarette type were similar for menthol (α = 0.0051) and non-menthol (α = 0.0049) smokers. Demand elasticity and peak consumption were related to usual cigarette type and cigarettes smoked per day, but did not appear to differ by race, gender or age.   Preliminary evidence suggests that a significant minority of smokers of menthol cigarettes in the United States would try to stop smoking altogether if such cigarettes were banned.
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Knowledge of current public opinion is important as the Food and Drug Administration (FDA) applies the best scientific evidence available to tobacco product regulation. Based on a nationally representative survey of the US adult population, we report 43% support for banning of cigarettes, 65% for reducing nicotine, and 77% for reducing nicotine if such an action could cause fewer children to become addicted to cigarettes. The FDA should consider protecting children by removing all but non-addictive cigarettes from the marketplace.
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This paper examines the links between attitudes towards cigarette smoking and the social environments of communities involved in the U.S. National Cancer Institute's Community Intervention Trial for Smoking Cessation (COMMIT). Our objective is to identify sources of social-geographic variation in smoking attitudes and norms which can hinder or enhance public health efforts to reduce tobacco use. The analysis had two stages: (1) place (measured as region and community) was identified as an important main effect accounting for individual variation in smoking attitudes independent of smoking status and personal characteristics; (2) case studies of COMMIT sites in North Carolina, Iowa, Washington, New Jersey and New Mexico were conducted to reveal features of the local milieux which could account for variations in smoking attitudes. Some of the place characteristics that we suggest are linked to local attitudes include economic reliance on the tobacco industry, libertarian political orientations, socio-economic conditions, legislative context and ethnic composition. Given the effects of regional and community attributes on individual attitudes towards smoking, we conclude that public health efforts to control smoking should continue to be targeted beyond individual smokers to the broader social environment.
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To develop more effective smoking cessation interventions for the 70% of African American smokers who smoke menthol cigarettes, it is important to understand smokers' reasons for choosing menthols verses nonmenthols. This study conducted a focus group of African American smokers about their attitudes and beliefs about menthol cigarettes. These attitudes and beliefs, along with others from the literature, were included in a survey of 720 African American smokers in Los Angeles County, California. Five common factors emerged-Medicinal Effects, Image, Less Harmful, Tradition, and Taste/Sensation. Menthol smokers had significantly higher scores on the Taste/Sensation, Medicinal Effects, and Less Harmful scales than nonmenthol smokers did. Men were significantly more likely than women to endorse Medicinal Effects, Image, and Tradition, whereas women were significantly more likely to endorse Taste/Sensation. Education was inversely associated with endorsement of Medicinal Effects, Image, Less Harmful, and Tradition. Respondents aged 40 years or older had significantly higher scores on Medicinal Effects, Image, and Less Harmful, compared with younger respondents. Smoking cessation interventions for African American menthol smokers should address commonly held myths that menthols have medicinal effects and are less harmful than nonmenthols, especially among smokers who are older, male, and/or have low levels of education. The new measures presented in this article could be useful for tailoring cessation interventions to individual smokers' attitudes and beliefs about menthol cigarettes.
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With a court challenge to the Family Smoking Prevention and Tobacco Control Act, the stage is set for the struggle between those who believe that protecting the public health warrants stringent limits on commercial expression and those who warn that any chink in the armor of First Amendment protection threatens U.S. democracy. Ronald Bayer and Matthew Kelly discuss the ethical questions.
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To examine smoker support for tobacco tax and for increased dedicated tobacco taxes, along with associations forany such support. The New Zealand (NZ) arm of the International Tobacco Control Policy Evaluation Survey utilizes the NZ Health Survey (a national sample). From this sample, we surveyed adult smokers (N = 1,376). Most smokers considered that the current level of tobacco tax is "too high" (68%), but a majority (59%) would support an increase in tobacco tax if the extra revenue was used to promote healthy lifestyles and support quitting. There was majority support for a dedicated tobacco tax increase among all sociodemographic groups of smokers (including Māori, Pacific, and Asian smokers). In the fully adjusted multivariate model, significant associations with support for a dedicated tax increase included higher deprivation level (adjusted odds ratio [AOR] = 1.15) and suffering one form of financial stress (AOR = 1.81, 95% CI = 1.18-2.78). Other significant associations with support included concern about the smoking impacts on health and quality of life (AOR = 1.41), expressing support for tobacco control regulation (AOR = 1.83), and strength of intention to quit (AOR = 1.30). A majority of smokers from all sociodemographic groups supported an increase in tobacco tax if it was dedicated to quitting support and health promotion. The higher support among smokers with stronger intentions to quit is consistent with other evidence that smokers value tobacco control regulation such as high taxes to help them achieve their long-term quitting goals.
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We examined whether support for tobacco control policies varies by demographic group, including nativity status (i.e., immigrant versus US born). We analyzed 1995 to 2002 data from the Current Population Survey Tobacco Use Supplement (n=543,951). The outcome was a summary attitudinal measure assessing support of smoking bans in 4 of 6 venues. US-born respondents, smokers, male respondents, Native Americans, Whites, and those who were unmarried, of lower socioeconomic status, and whose workplaces and homes were not smoke free were less likely to support smoking bans. Immigrants exhibited stronger support for banning smoking in every venue, with a generation-specific gradient in which support eroded with increasing assimilation to the United States. Levels of support were more than twice as high among immigrants as among US-born respondents (odds ratio [OR]=2.16; 95% confidence interval [CI]=2.08, 2.23). Naturalized citizens displayed higher support than US-born citizens, which may be relevant for mobilization of the electorate. Differences in population composition and contexts (e.g., smoke-free workplaces) only partially accounted for immigrants' stronger level of support. Immigrants and their children may be valuable tobacco control allies given their supportive attitudes toward smoke-free policies.
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Numerous studies report that self-interest has a non significant influence upon various political and social attitudes. In contrast, a recent article by Green and Gerken (1989) reports a California study showing that cigarette smokers are significantly more opposed than nonsmokers to public smoking restrictions and tobacco sales tax increases. The present article replicates and extends this analysis with data from two different states—Illinois (in 1984, N =458)—and North Carolina (in 1985, N =488)—and using analysis techniques that differ from and expand upon the California study. Despite these methodological differ ences, self-interest is again shown to have a significant influence on opinions concerning public smoking restrictions and taxation, as well as on several additional issues relating to smoking and tobacco.
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ON JUNE 17, 1998, the US Senate voted to end consideration of comprehensive antitobacco legislation.1 The $516 billion bill was built on a blueprint developed nearly 1 year earlier in a settlement between the tobacco industry and 40 state attorneys general.The Senate bill would have increased cigarette taxes by $1.10 per pack over several years, penalized the tobacco industry if youth smoking rates did not drop significantly, and given the Food and Drug Administration complete authority to regulate nicotine as a drug. The bill would also have included new regulations on the sale, manufacturing, labeling, and marketing of tobacco products, particularly to children. In addition, the legislation would have devoted a large share of the monies raised to health-related activities, including medical research, antismoking campaigns, and prevention research.1
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We explored the relationship between public opinion and Kentucky state legislators' views on increasing the cigarette excise tax to curb smoking, local option to pass stricter youth access to tobacco laws, and smoking restrictions in public places. The relationship of gender, education, political party affiliation, tobacco use, and tobacco allotment ownership to public and legislators' opinions was examined using logistic regression. Data from the random, statewide University of Kentucky Public Opinion Poll (n = 628 Kentucky adults) and a Delphi study of Kentucky legislators (n = 116 members of the Kentucky General Assembly) were used in this study. Controlling for the demographic differences in gender, age, ethnicity, education, and tobacco allotment ownership between the public opinion and legislator samples, legislators were far less likely than the public to support workplace or restaurant smoking restrictions. Participants with a college education were twice as likely to favor cigarette tax hikes and four to five times more likely to favor workplace and restaurant smoking restrictions than were those without a college degree. Tobacco allotment owners and tobacco users were less likely to support raising cigarette taxes and local option to curb teen tobacco use compared to nonowners and nonusers. Findings of this study suggest that Kentucky legislators are not keeping up with public opinion about tobacco control, particularly in regard to smoking restrictions in workplaces and restaurants. Health professional organizations can play a role by educating both their membership and lawmakers about public support for tobacco control policy.
Article
The authors examined trends and predictors of public support for smoke-free restaurants in Massachusetts. Since 1992, the Massachusetts Behavioral Risk Factor Surveillance System has asked survey respondents about their attitudes toward smoking in restaurants. Analyses using data from 1992 to 1999 characterized changes over time in support for smoke-free restaurants and the role of demographic and smoking-related factors in predicting support. During 1992 to 1999, the rate of support for smoke-free restaurants increased from 37.5% to 59.8%, with similar increases among current, former, and never smokers. After adjustment for smoking status, support was associated with socioeconomic characteristics, race/ethnicity, and household smoking rules. Among current smokers, lighter smokers and those who were trying to quit were more likely to endorse smoke-free restaurants. There has been a substantial increase in support for smoke-free restaurants among both smokers and nonsmokers in Massachusetts.
Article
We examine the heterogeneity among current and former smokers categorized by 'stage of change' with respect to their perceptions about tobacco and tobacco control. Current and former smokers (n = 846) from a general population sample of adults in Ontario, Canada, were subdivided according to the stages of change categories (precontemplation, contemplation, preparation, action, maintenance, and termination) and compared on measures of knowledge, attitudes, and support. Multivariate analyses were conducted adjusting for sociodemographic covariates. Adjusted overall increases across the six stages were observed for seven of eight knowledge items and for all attitude and support items. Among current smokers, adjusted increases across the three stages were detected for a majority of items. However, statistically significant differences from one stage to the next, across all three current smoker stages, were detected only for one item. Among former smokers, adjusted increases across the three stages were observed for a minority of items. The stages of change classification was useful for differentiating subgroups of current smokers with regard to knowledge, attitudes, and support for tobacco control measures.
Article
The decade long California Tobacco Control Program is unique to the nation in its duration, emphasis, and level of funding. Programme emphasis is on changing social norms about smoking as a means to discourage smoking and thus reduce the harmful health effects of tobacco to the population. Data from the 1992-93, 1995-96, and 1998-99 Tobacco Use Supplements to the national Current Population Survey (n > 175 000 each period) were used to examine changes in norms regarding where smoking should "not be allowed at all" in both California and in the rest of the USA. Venues queried were restaurants, hospitals, work areas, bars, indoor sports venues, and indoor shopping malls. There were substantial increases in the percentages of the adult population (18+ years) stating that smoking should not be allowed in the venues queried in California by 1998-99 compared to 1992-93; only modest increases were observed in the rest of the USA. In fact, for most venues, the percentages for the rest of the USA were lower in 1998-99 than in California in 1992-93. Further, the percentage increase over this period in respondents stating that smoking should not be allowed in four or more of the six venues was 30% in California and 23% in the rest of the USA. The most dramatic percentage increase in California occurred among current smokers (93%). A strong, comprehensive tobacco control programme such as California's can influence population norms, including those of smokers, with respect to where smoking should not be allowed.
Article
This study examined African Americans' opinions regarding cigarette excise taxes and other tobacco control issues. A stratified cluster sample of US congressional districts represented by African Americans was selected. African Americans from 10 districts were interviewed. Forty-seven percent of respondents stated that taxes on tobacco products should be increased, whereas about 30% believed that they should be reduced. Almost 75% disagreed that raising taxes on tobacco products is unfair to African Americans, and 57.9% reported that they would not be opposed to increasing taxes on cigarettes even if low-income smokers would be hit the hardest. The present results indicate substantial support for cigarette excise taxes among African Americans.