To calculate cigarette affordability for a number of countries using different techniques and data, to investigate trends since 1990 and to assess the appropriateness of different measures of affordability.
Two existing measures were specified. Relative income price (RIP) uses per capita gross domestic product (GDP) as the measure of income, while "minutes of labour" is based on a Union Bank of Switzerland (UBS) survey of earnings.
RIP (1990–2006) is calculated for 32 high-income and 45 low-income and middle-income countries. The "minutes of labour" measure is calculated for 29 high-income and 23 low-income and middle-income countries.
In high-income countries cigarettes are significantly more affordable than in low-income and middle-income countries, but have become less affordable since 1990. Among low-income and middle-income countries, cigarettes have become more affordable since 1990 and at an increasingly rapid rate since 2000. In 33 of 34 countries where cigarette affordability decreased since 1990, the real price increased. In 20 of 37 countries where cigarettes became more affordable, real price decreased.
When measuring affordability in low-income and middle-income countries, a broad income measure, such as per capita GDP, is most appropriate. For high-income countries, the choice of income measure is not important.
In international comparisons, cigarette prices should not only be viewed in monetary terms but also in terms of their affordability. Fast-growing countries face greater tobacco control challenges since rising incomes increase the affordability of cigarettes. The fact that cigarettes have become increasingly affordable in a majority of low-income and middle-income countries is a major tobacco control failure.
To examine the role of tobacco use in prison and possible influences of the prison environment on smoking among inmates in the context of developing inmate smoking cessation programmes.
Qualitative study based on seven focus groups with prisoners and ex-prisoners.
A maximum security prison in rural New South Wales (NSW), Australia, and a community justice restorative centre and accommodation service for ex-prisoners in Sydney, NSW, Australia.
40 participants (28 men and 12 women) comprising nine prisoners (including four Indigenous inmates) and 31 ex-prisoners.
Prisoners reported that tobacco serves as a de facto currency in correctional settings and can be exchanged for goods, used to pay debts and for gambling. Smoking helps manage the stressful situations such as transfers, court appearances and prison visits. Inmate smoking cessation programmes need to address the enmeshment of tobacco in prison life, improve availability of pharmacotherapies (for example, nicotine patches, bupropion) and the quitline (a free telephone helpline providing information on stopping smoking), provide non-smoking cells and areas within prisons, encourage physical activity for inmates and maintain monitoring of smoking cessation status after release.
Tobacco is integrally bound up in the prison "culture". Our findings are relevant to inform prison health authorities concerned with improving the health of prisoners, and for support organisations attempting to facilitate smoking cessation both in prison and after release. Smoking cessation programmes in prisons should be tailored to the unique stresses of the prison environment. Programmes need to acknowledge the difficulties of quitting smoking in prison arising from the stresses posed by this setting.
In Australia, smoking prevalence has declined in men since the 1950s and in women since the 1980s. Future smoking prevalence in Australia is predicted from estimates of previous and current age-specific and sex-specific cessation rates and smoking uptake in young people derived from national survey data on the prevalence of smoking between 1980 and 2007.
A dynamic forecasting model was used to estimate future smoking prevalence in the Australian population based on a continuation of these current trends in smoking uptake and cessation.
The results suggest that Australia’s smoking prevalence will continue to fall while current rates of initiation and cessation are maintained. But a continuation of current smoking cessation and initiation patterns will see around 14% of adults still smoking in 2020.
Smoking cessation rates will need to double for Australian smoking prevalence to reach a policy target of 10% by 2020.
Although the use of a geographical information systems (GIS) approach is usually applied to epidemiological disease outbreaks and environmental exposure mapping, it has significant potential as a tobacco control research tool in monitoring point-of-purchase (POP) tobacco advertising.
An ecological study design approach was applied so as to primarily evaluate and interpret the spatial density and intensity of POP and tobacco industry advertisements within <300 m to high schools in Greece with the application of GIS methodology combining mapping, photographing and global positioning data.
The GIS approach identified 133 POP and 44 billboards within 300 m of the school gates of Heraklion schools. On average 13 POP (range 4–21) and 4.4 billboards (range 1–9) were located per school, and all had at least 1 POP within 20 m of the school gate. On average (SD) 9 (6) tobacco advertisements per POP (range 0–25) were noted, and 80% of them were below child height. The GIS protocol identified that kiosks, that were excepted from the Greek ban on tobacco advertising, in comparison to other POP, were found not only to be closer and visible from the school gates (44.1% vs 10.8%, p<0.001) but were also found to have more external advertisements (8 (5) vs 5 (3), p<0.001).
This study demonstrates the effectiveness of a GIS system in monitoring tobacco industry advertising on a large population-based scale and implies its use as a standardised method for monitoring tobacco industry strategies and tobacco control efforts.
To estimate the risk of dying from all causes and from specified smoking-related diseases in people who were ex-smokers at two consecutive examinations, compared with never smokers and with people who were ex-smokers at the first examination but who had resumed smoking at the following examination.
A prospective cohort study.
Three counties in Norway.
A total of 23 560 men and 25 122 women, aged 20–49, screened for cardiovascular disease risk factors in the mid 1970s, rescreened after 3–13 years and followed throughout 2005 participated in this study.
Absolute mortality and relative risks adjusted for confounding variables, of dying from all causes, cardiovascular disease, ischaemic heart disease, stroke, lung cancer and other smoking-related cancer.
With sustained never smokers as reference, the sustained ex-smokers had adjusted relative risk (95% CI), of dying from any cause, for men 0.97 (0.80 to 1.18), for women 0.98 (0.65 to 1.48). Corresponding risk for ex-smokers who resumed smoking was for men 1.59 (1.32 to 1.91), for women 1.40 (1.08 to 1.81). For the specified smoking-related diseases, the risk in sustained ex-smokers was not significantly different from the risk in sustained never-smokers, except for lung cancer in men. For ex-smokers who resumed smoking, the corresponding risk was on the whole significantly higher.
A more valid and favourable picture of ex-smokers’ risk will be obtained if exposure is being based upon people with two consecutive examinations, years apart. The study confirms clearly the large health benefit of quitting smoking for good.
African countries are a major potential market for the tobacco industry, and the smoking epidemic is at various stages of evolution across the continent. Ghana is an African country with a low prevalence of smoking despite an active tobacco industry presence for over 50 years. This study explores potential reasons for this apparent lack of industry success.
To explore the history of tobacco industry activity in Ghana and to identify potential reasons for the current low prevalence of smoking.
A search was made of tobacco industry archives and other local sources to obtain data relevant to marketing and consumption of tobacco in Ghana.
British American Tobacco, and latterly the International Tobacco Company and its successor the Meridian Tobacco Company, have been manufacturing cigarettes in Ghana since 1954. After an initial sales boom in the two decades after independence in 1957, the sustained further increases in consumption typical of the tobacco epidemic in most countries did not occur. Possible key reasons include the taking of tobacco companies into state ownership and a lack of foreign exchange to fund tobacco leaf importation in the 1970s, both of which may have inhibited growth at a key stage of development, and the introduction of an advertising ban in 1982. BAT ceased manufacturing cigarettes in Ghana in 2006.
The tobacco industry has been active in Ghana for over 50 years but with variable success. The combination of an early advertising ban and periods of unfavourable economic conditions, which may have restricted industry growth, are likely to have contributed to the sustained low levels of tobacco consumption in Ghana to date.
The international trend towards comprehensive bans on tobacco advertising has seen the tobacco industry become increasingly innovative in its approach to marketing. Further fuelling this innovation is the rapid evolution and accessibility of web-based technology. The internet, as a relatively unregulated marketing environment, provides many opportunities for tobacco companies to pursue their promotional ambitions.
In this paper, "open source marketing" is considered as a vehicle that has been appropriated by the tobacco industry, through a case study of efforts to design the packaging for the Camel Signature Blends range of cigarettes. Four sources are used to explore this case study including a marketing literature search, a web-based content search via the Google search engine, interviews with advertising trade informants and an analysis of the Camel brand website.
RJ Reynolds (RJR) has proven to be particularly innovative in designing cigarette packaging. RJR engaged with thousands of consumers through their Camel brand website to design four new cigarette flavours and packages. While the Camel Signature Blends packaging designs were subsequently modified for the retail market due to problems arising with their cartoon-like imagery, important lessons arise on how the internet blurs the line between marketing and market research.
Open source marketing has the potential to exploit advertising ban loopholes and stretch legal definitions in order to generate positive word of mouth about tobacco products. There are also lessons in the open source marketing movement for more effective tobacco control measures including interactive social marketing campaigns and requiring plain packaging of tobacco products.
To assess the influence of point-of-sale (POS) cigarette displays on unplanned purchases.
Intercept interviews were conducted with customers observed purchasing cigarettes from retail outlets featuring POS cigarette displays. Measures included intention to purchase cigarettes prior to entering the store, unprompted and prompted salience of POS tobacco displays, urge to buy cigarettes as a result of seeing the POS display, brand switching and support for a ban on POS cigarette displays.
In total, 206 daily smokers aged 18–76 years (90 male, 116 female) were interviewed. Unplanned cigarette purchases were made by 22% of participants. POS displays influenced nearly four times as many unplanned purchases as planned purchases (47% vs 12%, p<0.01). Brand switching was reported among 5% of participants, half of whom were influenced by POS displays. Four times as many smokers were supportive of a ban on POS tobacco displays than unsupportive (49% vs 12%), and 28% agreed that such a ban would make it easier to quit.
POS tobacco displays act as a form of advertising even in the absence of advertising materials. They stimulate unplanned cigarette purchases, play an important role in brand selection and tempt smokers trying to quit. This justifies removing POS tobacco displays from line of sight—something that very few smokers in our sample would object to.
China currently does not have comprehensive laws or regulations on tobacco advertising and promotion, although it ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) in October 2005 and promised to ban all tobacco advertising by January 2011. Much effort is needed to monitor the current situation of tobacco advertising and promotion in China.
This study aims to examine levels of awareness of tobacco advertising and promotion among smokers in China as compared to other countries with different levels of restrictions.
One developing country (Thailand) and two developed countries (Australia and the USA) were selected for comparison. All four countries are part of the International Tobacco Control (ITC) Policy Evaluation Survey project. Between 2005 and 2006, parallel ITC surveys were conducted among adult smokers (at least smoked weekly) in China (n = 4763), Thailand (n = 2000), Australia (n = 1767) and the USA (n = 1780). Unprompted and prompted recall of noticing tobacco advertising and promotion were measured.
Chinese respondents reported noticing tobacco advertisements in a range of channels and venues, with highest exposure levels on television (34.5%), billboards (33.4%) and in stores (29.2%). A quarter of respondents noticed tobacco sponsorships, and a high level of awareness of promotion was reported. Cross-country comparison reveals that overall reported awareness was significantly higher in China than in Thailand (particularly) and Australia, but lower than in the USA.
There is a big gap between China and the better-performing countries such as Thailand and Australia regarding tobacco promotion restrictions. China needs to do more, including enhanced policy and more robust enforcement.
In March 2006, Australia introduced graphic pictorial warnings on cigarette packets. For the first time, packs include the Quitline number.
To measure the combined effect of graphic cigarette pack warnings and printing the Quitline number on packs on calls to the Australian Quitline service.
Calls to the Australian Quitline were monitored over 4 years, 2 years before and after the new packets were introduced.
There were twice as many calls to the Quitline in 2006 (the year of introduction), as there were in each of the preceding 2 years. The observed increase in calls exceeds that explained by the accompanying television advertising alone. While call volume tapered back in 2007, it remained at a level higher than before the introduction of new packets. No change was observed in the proportion of first time callers.
Introducing graphic cigarette packet warnings and the Quitline number on cigarette packets boosts demand for Quitline services, with likely flow on effects to cessation.
Thailand is internationally renowned for its stringent tobacco control measures. In Thailand, a regulation banning smoking in air-conditioned hotel lobbies was issued in late 2006, causing substantial apprehension within the hospitality industry. A survey of tourists’ attitudes toward the ban was conducted.
A cross-sectional survey of 5550 travellers staying in various hotels in Bangkok, Surat Thani, Phuket, Krabi and Songkhla provinces, October 2005 to December 2006. Travellers aged 15 years or older with a check-in duration of at least one day and willing to complete the questionnaire were requested by hotel staff to fill in the 5-minute questionnaire at check-in or later at their convenience.
Secondhand cigarette smoke was recognised as harmful to health by 89.7% of respondents. 47.8% of travellers were aware of the Thai regulation banning smoking in air-conditioned restaurants. 80.9% of the respondents agreed with the ban, particularly female non-smokers. 38.6% of survey respondents indicated that they would be more likely to visit Thailand again because of the regulation, 53.4% that the regulation would not affect their decision and 7.9% that they would be less likely to visit Thailand again.
Banning smoking in air-conditioned hotel lobbies in Thailand is widely supported by tourists. Enforcement of the regulation is more likely to attract tourists than dissuade them from holidaying in Thailand.
The tobacco industry has organised research institutions to generate misleading data on indoor air quality, including second-hand smoke exposure and health effects.
To describe tobacco industry involvement in the organisation and financial support of an air quality research laboratory in El Salvador.
Tobacco industry documents on the internet were systematically searched from August 2007 to February 2008 for air quality studies undertaken in El Salvador, and laboratory personnel were interviewed.
Philip Morris sought to establish a network of air quality laboratories throughout Latin America. In El Salvador, in 1997, through Tabacalera de El Salvador (a subsidiary of Philip Morris) and the Salvadoran Foundation for Economic Development (FUSADES), the industry organised an air quality research laboratory. FUSADES was part of the industry’s Latin American Scientific Network, which consisted of doctors hired as consultants who would send air samples from their research to FUSADES. Philip Morris Scientific Affairs personnel hired LabStat, a Canadian-based laboratory, to provide technical assistance to FUSADES (train and assist the laboratory in air quality measurements). In addition, the Washington-based HMS Group successfully implemented a plan to upgrade the laboratory and obtain international certifications. HMS Group also assisted in searching for sustainable funding for FUSADES, including seeking funds from international aid for Hurricane Mitch.
Air quality studies that have used the FUSADES laboratory should be carefully interpreted, given the support that this laboratory received from Philip Morris.
To determine whether adolescents living in parental homes where smoking is banned are more likely to move into smoke-free living quarters when they leave home.
We analysed data on 693 youths from a 4-year, three-wave prospective study of a representative sample of Massachusetts adolescents (aged 12–17). All youths resided in independent living quarters at follow-up. The primary outcome was presence of a smoking ban in the living quarters at follow-up. The primary predictor was presence of a household smoking ban in the parental home, assessed 2 years before the outcome. Generalised linear mixed effects models examined the effect of a parental household smoking ban on the odds of moving into smoke-free living quarters at follow-up overall and stratified by smoking status at follow-up.
Youths leaving home had much higher odds of moving to smoke-free living quarters if their parental household had had a smoking ban (odds ratio (OR) = 12.70, 95% CI, 6.19 to 26.04). Other independent predictors included moving into a school or college residence (OR = 3.88, 95% CI 1.87 to 8.05), and not living with smokers at follow-up (OR = 3.91, 95% CI 1.93 to 7.92).
A household smoking ban in the parental home appears to lead youths to prefer smoke-free living quarters once they leave home.