In an Industry Watch piece featured in this same issue, Sebayang and colleagues (see page
All articles written by David Simpson unless otherwise attributed. Ideas and items for News Analysis should be sent to: David.Simpson@ctsu.ox.ac.uk
Since early March, when a ban on tobacco advertising, promotion and sponsorship took effect, health advocates have had their hands full monitoring what looks all too like tobacco companies and their agents trying to ignore, delay compliance with, or just get round the ban. Under the new regulations, no advertising of any sort is permitted anywhere, including in or outside shops or other points of sale, where cigarette packs alone may be displayed, and then only in places where consumers cannot take them directly themselves.
Even before the ban took effect, cigarette companies appeared to be jostling for advantage. In January, for example, a large glittering camel sculpture in a glass case suddenly appeared in the middle...]]>
Indonesia is the world's fifth largest cigarette market in the world but for decades, transnational tobacco companies (TTCs) have had limited success infiltrating this market, due to their inability to compete in the kretek market. Kreteks are clove/tobacco cigarettes that most Indonesians smoke.
To determine how Phillip Morris International (PMI) and British American Tobacco (BAT) have now successfully achieved a substantial market presence in Indonesia.
We analyzed previously secret, tobacco industry documents, corporate reports on Indonesia operations, the Tobacco Trade press, Indonesia media, and "The Roadmap."
Internal, corporate documents from BAT and PMI demonstrate that they had known for decades that kreteks are highly carcinogenic. Despite that knowledge, BAT and PMI now own and heavily market these products, as well as new more westernised versions of kreteks. BAT and PMI used their successful basic strategy of keeping cigarettes affordable by maintaining the social responsibility of smoking and opposing smoke-free workplace laws but in the 21st century, they added the acquisition of and westernisation of domestic kretek manufacturers as an additional strategy. These acquisitions allowed them to assert influences on health policy in Indonesia and to grow their business under current government policy embodied in the 2007-2020 Roadmap of Tobacco Products Industry and Excise Policy which calls for increased cigarette production by 12% over the next 15 years.
PMI and Bat have successfully entered and are expanding their share in the Indonesia cigarette market. Despite the obvious and pervasive influence of the tobacco industry on policy decisions, the Indonesian government should ratify the FCTC and implement effective legislation to reduce tobacco consumption and exposure to tobacco smoke and revise the Roadmap to protect future generations of Indonesians.
This study sought to increase government, civil society and media attention to the tobacco–poverty connection in Bangladesh, particularly as it relates to bidi-dependent livelihoods.
This study consisted of a literature review that examined the socioeconomic impacts of tobacco farming, the working conditions of tobacco workers and the impact of tobacco on consumers, and a primary research study among bidi workers and users. The research included in-depth and semistructured interviews and focus group discussions among bidi workers and a closed-ended quantitative survey among bidi users.
Most bidi worker families earn about $6.40 per 7-day work week, leaving them below the poverty line. The majority of bidi workers are women and children, classified as unpaid assistants, who toil long hours in toxic environments. Bidi users are primarily low-income earners who spend up to 10% of their daily income on bidis; the average proportion of income spent on bidis decreased as income increased. If bidi expenditures were reduced and spent instead on food or local transportation, many higher value jobs could be created. This could also mean better health and nutrition for those currently engaged in bidi work.
The results of this study illustrate the linkages between tobacco and poverty. Tobacco control is not simply about health and the environment, but also about the living conditions of the poorest of the poor. If we are to improve the lives of the poor, we must address the root causes of poverty, which include the production and use of tobacco.
To examine the longitudinal relationship between exposure and receptivity to tobacco advertisements and progression towards tobacco use among adolescents in India.
A 2-year longitudinal group-randomised trial, Mobilizing Youth for Tobacco Related Initiatives (MYTRI), was undertaken from 2004 to 2006 in 32 schools in Delhi and Chennai. Among the control schools (n=16), mixed-effects regression models were used to assess the objectives.
Students who were non-susceptible, never users of tobacco (n=2782) at baseline (2004) in the control schools of Project MYTRI, who progressed academically and were followed up at endline (2006).
Progression towards tobacco use (on tobacco uptake continuum).
Bivariate results suggest that exposure to tobacco advertisements at baseline was associated in a dose-dependent manner with progression at endline. Students exposed at more than four places were 1.5 times (95% CI 1.12 to 1.94; p<0.05) more likely to progress towards tobacco use at endline versus those not exposed. Among boys, those exposed at more than four places were 1.7 times more likely to progress (95% CI 1.14 to 2.62; p<0.05). These significant results disappeared in multivariate analysis, when other psychosocial risk factors for tobacco use were controlled. In both bivariate and multivariate analyses, the risk of progression at endline was more than two times higher (95% CI 1.28 to 4.32; p<0.05) among boys who were highly receptive versus non-receptive boys. The same relationship did not hold among girls.
High receptivity to tobacco advertising predicts future progression to tobacco use among boys in India. Suggestive evidence exists of a causal relationship between tobacco marketing and adolescent tobacco use.
Secondhand smoke (SHS) represents a major preventable cause of morbidity for communities, especially for children, who are more susceptible than adults to the adverse effects of passive smoking. SHS contains several carcinogens, including benzene.
To investigate the role of household characteristics and the smoking behaviours of cohabitants in predicting SHS-derived benzene exposure levels.
In this cross-sectional study, 122 children (aged 5–11 years old) were selected from a school in rural Italy. Characteristics of their home environment and the smoking habits of the children's cohabitants were obtained via questionnaire, and urinary unmodified benzene (u-UB) and cotinine (a specific nicotine metabolite) levels were determined from spot urine samples.
Significant differences between SHS-exposed and SHS-unexposed children were found with respect to u-UB levels (median values 359.50 and 92.50 ng/litre, respectively; p<0.001). The excretion of u-UB increased significantly in parallel to increased SHS exposure as follows: unexposed to SHS (median value 92.50 ng/litre)<cohabitant(s) smoker(s) not smoking inside the home (282.00 ng/litre)<cohabitant(s) smoking inside the home only when children are out (314.50 ng/litre)<cohabitant(s) smoking inside the home even when children are in (596.00 ng/litre). The difference between groups was significant (p=0.019).
Although smoke-free legislation has transformed the smoking behaviours of some, domestic environments remain an important source of SHS exposure for children. This fact holds true even in the case of parents and other cohabitants who believe they are fully protecting children by smoking only outdoors or at home only when the children are not present. These findings should be included in Italian community-level health promotion interventions for discouraging tobacco use.
The funding statement in this article should have read:
Funding Cancer Research UK; UK Centre for Tobacco Control Studies fund two of the authors (GH and AF).
]]>The following competing interest statement should have been included with this article:
Competing interests The authors alone are responsible for the views expressed in this publication and they do not necessarily represent the decisions or the policies of the World Health Organization.
]]>The author list for this article should read Richard A Daynard, Rangita de Silva de Alwis and Mark Gottlieb.
Rangita de Silva de Alwis. Senior Consultant for International Programs at the Public Health Advocacy Institute at Northeastern University School of Law and Senior Adviser for International Programs at the Wellesley Centers for Women at Wellesley College. Mark Gottlieb. Executive Director of the Public Health Advocacy Institute at Northeastern University School of Law.
]]>Home smoking bans significantly reduce the likelihood of secondhand smoke exposure among children and non-smoking adults. The purpose of this study was to examine national trends in (1) the adoption of home smoking bans, (2) discrepancies in parental smoking ban reports and (3) household and parental correlates of home smoking bans among households with underage children from 1995 to 2007.
The authors used data from the 1995–1996, 1998–1999, 2001–2002, 2003 and 2006–2007 Tobacco Use Supplement of the US Current Population Survey to estimate prevalence rates and logistic regression models of parental smoking ban reports by survey period.
Overall, the prevalence of a complete home smoking bans increased from 58.1% to 83.8% (p<0.01), while discrepancies in parental reports decreased from 12.5% to 4.6% (p<0.01) from 1995 to 2007. Households with single parent, low income, one or two current smokers, parents with less than a college education or without infants were consistently less likely to report a home smoking ban over this period (p<0.05).
Despite general improvements in the adoption of home smoking bans and a reduction on parental discrepancies, disparities in the level of protection from secondhand smoke have persisted over time. Children living in households with single parents, low income, current smoker parents, less educated parents or without infants are less likely to be protected by a home smoking ban. These groups are in need of interventions promoting the adoption of home smoking bans to reduce disparities in tobacco-related diseases.
Changes in cigarette design to meet mandated fire safety standards may have unintended effects on smoker responses by diminishing the consumer's perceptions of product acceptability, smoking and increasing fire-risk behaviours. To address these concerns, population-level data are needed from a jurisdiction where reduced ignition propensity (RIP) cigarettes have been introduced.
A cohort of adult smokers was recruited in Massachusetts, USA using a random-digit-dialled telephone survey. The cohort was contacted prior to, and 8 months following, the state-mandated introduction of RIP cigarettes on 1 January 2008. Changes in self-reported subjective cigarette characteristics, smoking topography, fire-risk behaviours, fire events and quitting intentions were assessed.
A total of 620 Massachusetts smokers completed the baseline survey conducted prior to implementation of the law, and 353 (57%) completed the follow-up survey conducted after implementation. No significant changes were found in self-reported fire-risk behaviour or quitting intentions. In addition, smokers were less likely to report smoking greater than 20 cigarettes per day and inhaling deeply into the chest after the law.
The introduction of RIP cigarettes in Massachusetts yielded little change, and no adverse effect, on self-reported smoker response, among a sample of mostly Caucasian smokers.
To assess the determinants of smoking behaviour and to estimate the impact of tobacco consumption on the consumption of other commodities by Cambodian households.
To assess the determinants of smoking in Cambodia, the authors used a logistic regression model that estimated the probability of an individual smoking, given a set of socioeconomic and demographic characteristics. A Seemingly Unrelated Regression method was used to assess the impact of tobacco consumption on the consumption of other commodities. The nationally representative 2004 Cambodia Socio-Economic Survey, collected by the National Institute of Statistics of the Ministry of Planning in Cambodia, was used for the analysis.
Smoking in Cambodia is influenced by a variety of factors such as gender, marital status, age, ethnicity, literacy, health status and perceptions about the health consequences of tobacco use. The authors found that spending on tobacco crowds out expenditures on education and clothing at the national level and expenditures on food for low- and middle-income households.
The first analysis of the study showed that increased education is associated with lower daily smoking, and the second analysis revealed that expenditures on tobacco crowds out expenditures on education. Combining these two results points to a vicious circle where low education means higher likelihood of smoking, which in turn results in lower spending on education. Such budget allocation clearly has negative intergenerational consequences.
To examine whether genetic testing for smoking-related diseases benefits smoking cessation.
PubMed, EMBASE, ERIC, PsycINFO, PsychArticles, CiNAHL and socINDEX databases, the search engine Google Scholar, and key-author and reference list searches.
Randomised controlled smoking cessation interventions using genetic testing for smoking-related diseases.
Consistent with the Cochrane guidelines, two reviewers completed the review process (initial n=139) in three phases, title selection (n=56), abstract selection (n=28) and whole paper selection (n=9). From these nine studies, each reviewer extracted information about outcome measures and statistical and methodological quality.
Relevant data were abstracted from included papers and were subsequently subjected to meta-analysis.
Interest in genetic testing was relatively high with 60-80% of smokers reporting to be interested. The authors observed positive short-term effects on risk perception, motivation to quit smoking and smoking cessation, but these effects fade at longer follow-ups. Importantly, the authors did not find any evidence of adverse effect of testing negative on the risk-predisposing gene.
This systematic review does not provide solid evidence for the proposed beneficial effects of genetic testing for smoking-related diseases on smoking cessation, but does suggest the presence of an immediate motivational effect, such that genetic testing resulted in higher risk perception and more motivation to quit smoking.
To describe the determinants of self-initiated smoking cessation of duration of at least 6 months as identified in longitudinal population-based studies of adolescent and young adult smokers.
A systematic search of the PubMed and EMBASE databases using smoking, tobacco, cessation, quit and stop as keywords was performed. Limits included articles related to humans, in English, published between January 1984 and August 2010, and study population aged 10–29 years. A total of 4502 titles and 871 abstracts were reviewed independently by 2 and 3 reviewers, respectively. Nine articles were retained for data abstraction. Data on study location, timeframe, duration of follow-up, number of data collection points, sample size, age/grade of participants, number of quitters, smoking status at baseline, definition of cessation, covariates and analytic method were abstracted from each article. The number of studies that reported a statistically significant association between each determinant investigated and cessation were tabulated, from among all studies that assessed the determinant.
Despite heterogeneity in methods across studies, five factors robustly predicted quitting across studies in which the factor was investigated: not having friends who smoke, not having intentions to smoke in the future, resisting peer pressure to smoke, being older at first use of cigarette and having negative beliefs about smoking.
The literature on longitudinal predictors of cessation in adolescent and young adult smokers is not well developed. Cessation interventions for this population will remain less than optimally effective until there is a solid evidence base on which to develop interventions.
Recently, a company has been promoting a wide range of smoking accessories called ‘Smokerhood’ that seems to be trying to create an ‘ideal smoker’ identity, a light and environmentally aware smoker. The name Smokerhood itself suggests the foundations of such an identity by conveying a sense...]]>
Dissolvable tobacco products manufactured by RJ Reynolds and purchased in (A) Portland, Oregon, USA, and (B) Taipei, Taiwan.
Nearly identical dissolvable tobacco products were introduced into Taiwanese markets under the brand name Revo in 2010 (
According to former RJR CEO Susan Ivey, Camel Dissolvables ‘offer adult consumers the most discrete and convenient way to enjoy tobacco today’. Ivey has also...]]>
PT HM Sampoerna Tbk, one of the largest Indonesian tobacco companies, now owned by Philip Morris International, is known for its longstanding creativity in advertising, promotion and marketing....]]>
The Smoke-free Illinois Act was implemented in January 2008, one month after the beginning of a national recession. In December 2010, the Illinois legislature proposed new legislation that would provide an exemption for casinos from the act until neighbouring states also implement smoke-free casino policies. Lobbyists and gaming commission representatives argued that Illinois casinos were losing patrons to casinos in neighbouring states that allow smoking. This study examined the influence of the act on casino admissions in Illinois and neighbouring states in light of the economy.
A multilevel model was developed to examine monthly casino admissions from January 2007 to December 2008.
There was no difference in changes in admissions across the four states over time after accounting for the economic downturn.
The Smoke-Free Illinois Act did not have a detectable effect on Illinois casino admissions.
Waterpipe tobacco package labelling typically indicates "0.0% tar" and "0.05% or 0.5% nicotine".
To determine the extent to which nicotine labeling is related to nicotine delivery.
110 waterpipe smokers engaged in a 45-minute waterpipe smoking session. Puff topography and plasma nicotine were measured. Three waterpipe tobacco brands were used: Nakhla (0.5% nicotine), Starbuzz (0.05% nicotine), and Al Fakher (0.05% nicotine). Data were analyzed by one-way ANOVA.
Topography did not differ across brands. Peak plasma nicotine varied significantly across brands. Al Fakher had the highest nicotine delivery (11.4 ng/ml) followed by Nakhla (9.8 ng/ml) and Starbuzz (5.8 ng/ml).
Nicotine labelling on waterpipe tobacco products does not reflect delivery; smoking a brand with a "0.05% nicotine" label led to greater plasma nicotine levels than smoking a brand with a "0.5% nicotine" label. Waterpipe tobacco products should be labelled in a manner that does not mislead consumers.
We used the International Tobacco Control Survey (the ITC survey) data to examine trends in cigarette prices in China after the 2009 tax adjustment. The ITC survey is a prospective survey of tobacco use. Its overall objective is to measure the effects of key tobacco control policies. In China, the first three waves of the ITC survey were conducted in six cities: Beijing, Shenyang, Shanghai, Changsha, Guangzhou and Yinchuan....]]>
When smokers are informed that ingredients such as cocoa, coffee, peppermint, sugars and other sweeteners are added to most manufactured cigarettes
The current voluntary agreement for the disclosure of the ingredients of cigarettes,