Throughout the Eastern Mediterranean region (EMR), tobacco is used primarily in two forms: cigarette smoking and waterpipe (called narghile (nar-GIL-eh) in Syria) smoking.
To explore whether narghile smokers are different from cigarette smokers in how their smoking habits are embedded in their everyday lives.
One-to-one interviews with 16 adult narghile smokers and 16 adult cigarette smokers about their feelings, experiences and beliefs regarding their initiation, use patterns, and attempts to quit.
Narghile smokers found that narghile was a pleasurable social experience embedded in cultural rituals. By contrast, cigarette smokers saw their cigarette smoking as a mundane, oppressive, personal addiction. Narghile smokers generally started in their 20s and found that smoking narghile fostered a sense of togetherness and cultural identity, while cigarette smokers started in their early teens, males having started to becoming a "real man". Unlike cigarette smokers who felt stigmatised, narghile smokers generally felt that smoking narghile was socially accepted. Cigarette smokers believed that cigarettes were harmful to their health and harmful to those around them, but narghile smokers believed smoking narghile was relatively harmless to themselves or to others. Unlike cigarette smokers who used cigarettes to manage stress, narghile smokers used narghile for entertainment, leisure, and escape. However, frequent narghile smokers confessed that they felt addicted in much the same way as cigarette smokers. Cigarette smokers and narghile smokers viewed quitting as a matter of will and conviction. Most cigarette smokers had tried to quit. Very few narghile smokers had ever tried to quit, and most were not interested in quitting. Disturbingly, some cigarette smokers had tried to quit cigarettes by switching to smoking narghile, but later relapsed to smoking cigarettes.
This exploratory study suggests that Syrian narghile smokers are different from Syrian cigarette smokers in their perceptions and beliefs about their smoking, and in their smoking patterns and lived experiences with tobacco. Our findings indicate that further in-depth research is need in the EMR to understand both modes of smoking to develop effective mode-specific prevention and cessation approaches. This study also raises concerns about a possible pattern where cigarette smokers are using narghile as a method for quitting cigarettes, and then relapsing.
To determine the percentage of gamblers who smoke while gambling at three of Nevada’s major gambling destinations, Las Vegas, Reno/Sparks and Lake Tahoe.
Teams of two people counted the number of smokers and total number of gamblers at various Nevada casinos. The total number of gamblers observed smoking was then multiplied by three to determine the total number of smokers. This methodology for determining the number of smokers in a room was established by Repace and Lowry in 1980.
We observed a total of 14 052 gamblers at the three sites, of which a total of 947 were smoking. We estimated the percentage of smokers at three gaming tourist centres in Nevada (Las Vegas, Reno/Sparks and Lake Tahoe). The percentage of smokers at Las Vegas (20.3% (95% CI 0.9)) and Reno/Sparks (21.5% (95% CI 1.2%)) did not significantly differ from the US population percentage of smokers (20.9% (95% CI 0.6%)) (p>0.05). However, at Lake Tahoe the percentage of smokers (16.4% (95% CI 1.8%)) was significantly lower than the published US population smoker percentage (p<0.0001). Mean percentage of smokers by location did not significantly differ (p = 0.43)
The results of this study suggest that the percentage of gamblers who smoke was less than or not different from the overall US percentage of a population who smoke. These findings provide additional evidence to refute the exemption to smoking bans for casinos based upon the supposition that a greater percentage of casino customers are smokers than the general population and therefore a smoking ban for casinos may result in an economic hardship.
Little is known about what youth think about restricting smoking in their homes or in cars. The present study characterises the frequency of youth being exposed to smoking in their homes and cars, and the beliefs that youth have about restricting people from smoking around youth in those locations.
Data from the 2004 Youth Smoking Survey (YSS) were used to examine youth exposure to smoking and beliefs about smoking in the home and car among 29 243 Canadian youth in grades 5–9. Logistic regression models were conducted to examine if being exposed to smoking at home or in the car were associated with the beliefs youth have about either smoking around children at home or smoking around children in cars.
In 2004, 23.1% of youth in grades 5–9 were exposed to smoking in their home on a daily or almost daily basis, 26.3% were exposed to smoking while travelling in a car at least once in the previous week. The majority of youth reported that they do not think smoking should be allowed around children at home (90.6%) or in cars (90.2%). Males were more likely than females to report that smoking should not be allowed around children at home (OR 1.38) or in cars (OR 1.39). Youth living in a house where someone smokes inside daily were more likely to report that smoking should not be allowed around children at home (OR 1.20) or in cars (OR 1.21). Youth living in a house where the rules do not prevent people from smoking inside were also more likely to report that smoking should not be allowed around children at home (OR 2.07) or in cars (OR 1.76). Youth who have ridden in a car with someone who was smoking cigarettes in the past 7 days were more likely to report that smoking should not be allowed around children in cars (OR 1.73).
It is common for Canadian youth to be exposed to SHS in their homes or while in cars on a frequent basis even though the vast majority of youth do not think smoking should be allowed around children in those locations. This new evidence suggests that programs and policies designed to prevent individuals from smoking around youth in these locations should be a public health priority.
Cigarette companies spend more of their marketing dollars in stores than in any other venue. In 2005, they spent 88% of a total of $13.1 billion to advertise and promote product sales in stores.
The purposes of this study were to identify how the amount and types of cigarette advertising and sales promotions have changed in stores in California between 2002 and 2005, and to assess neighbourhood influences on cigarette marketing in stores.
Four observational assessments of cigarette advertising were conducted in approximately 600 California stores that sold cigarettes from 2002 to 2005. Trained observers collected data on the amount and type of cigarette advertising, including signs, product shelving and displays and functional items, and presence of sales promotions on these items. Longitudinal analyses were performed to estimate trends over time and identify correlates of change in the amount and type of tobacco advertising.
The mean number of cigarette advertisements per store increased over time from 22.7 to 24.9. The percentage of stores with at least one advert for a sales promotion increased from 68% to 80%. The amount of advertising and proportion of stores with sales promotions increased more rapidly in stores situated in neighbourhoods with a higher proportion of African–Americans.
The results indicate increasing use of stores to market and promote cigarette sales. Further, these increases are disproportionately accelerating in neighbourhoods with more African–Americans. Legislative strategies should be pursued to control the marketing of tobacco products and promotional strategies used to reduce prices in stores.
Nasal use of snuff is the predominant form of tobacco use among black South African women. This study examines the association between snuff use and chronic bronchitis (CB) among black South African women.
The study investigated a nationally representative sample of 4464 black South African women >=25 years old who participated in the 1998 South African Demographic and Health Survey. Data on participants’ tobacco use patterns, medical history and other relevant factors were obtained through an interviewer-administered questionnaire. Peak expiratory flow rates (PEFR) were also measured. Data analysis included 2 statistics, Student t tests and multiple logistic regression analysis.
CB, defined as reporting a productive cough for >=3 months/year for at least 2 successive years.
The prevalence of current snuff use was 16.1% (n = 719). Compared to non-users of snuff, snuff users were not only more likely to present with a history of tuberculosis (TB) (23.3% vs 15.9%; p = 0.06), but they were also more likely to present with CB (5.3% vs 2.8%; p<0.01) and a lower PEFR (275 litres/min vs 293 litres/min; p<0.01). Significant determinants of CB included snuff use >8 times/day (odds ratio (OR) 2.86, 95% CI 1.17 to 7.02), a history of TB (OR 7.23, 95% CI 4.02 to 13.03), current smoking (OR 2.84, 95% CI 1.60 to 5.04) and exposure to smoky cooking fuels (OR 1.98, 95% CI 1.32 to 2.96).
These data suggest that snuff use, in the form predominantly used in South Africa, increases the risk of CB. This challenges the idea that snuff may be a much less harmful alternative to smoking in South Africa.
The price of cigarettes to consumers in Mexico, and Latin America in general, remains low in comparison with other regions of the world. In Mexico, taxes represented 59% of the total price of cigarettes in 2006, compared to 75% or more in many high-income countries. The feasibility of raising taxes on cigarettes in Mexico—to both discourage consumption and increase revenues—is an important policy question.
Using household survey data, we undertake a pooled cross-sectional analysis of the demand for cigarettes in Mexico. We use a two-part model to estimate the price elasticity of cigarettes. This model controls for the selection effect that arises from the fact that the impact of price on the decision to smoke or not is estimated using all households in the dataset.
The results indicate that price is a significant factor in household decisions concerning smoking and the number of cigarettes smoked. Holding other factors constant, our simulations show that a 10% increase in the cigarette tax in Mexico—calculated as a percentage of the price—yields a 12.4% increase in the price to the consumer, a 6.4% decrease in consumption of cigarettes and a 15.7% increase in the revenue yielded by the tax.
In Mexico, there are strong arguments for increasing cigarette taxes. Revenue raised could be used to further prevent tobacco consumption and to finance current funding shortages for the treatment of diseases related to smoking.
Argentina has one of the highest cigarette smoking rates among both men and women in the Americas and no legislated restrictions on tobacco industry advertising. The tobacco industry has traditionally expanded markets by targeting adolescents and young adults. The objective of this study was to determine whether and how the tobacco industry promotes cigarettes to adolescents in Argentina.
We conducted a systematic search of tobacco industry documents available through the internet dated between 1995 and 2004 using standard search terms to identify marketing strategies in Argentina. A selected review of the four leading newspapers and nine magazines with reported high readership among adolescents was completed. The selected print media were searched for tobacco images and these were classified as advertisements if associated with a commercial product or as a story if not.
The tobacco industry used market segmentation as a strategy to target Argentinean consumers. British American Tobacco (BAT) undertook a young adult psychographic study and classified them as "progressives", "Jurassics" or "conservatives" and "crudos" or "spoiled brats". BAT marketed Lucky Strike to the "progressives" using Hollywood movies as a vehicle. The tobacco industry also targeted their national brands to the conservatives and linked these brands with "nationalistic values" in advertising campaigns. Philip Morris promoted Marlboro by sponsoring activities directed at young people and they launched the 10 cigarettes packet as a starter vehicle.
The tobacco industry used psychographic segmentation of the population and developed advertising strategies focused on youth. Tobacco control researchers and advocates must be able to address these strategies in counter-marketing interventions.
To explore young adult smokers’ construction of meaning and identity in accounts of cigarette brands and cigarette package design, and the processes by which positive associations with a brand may be reinforced and sustained.
Qualitative in-depth interviews with 21 smokers aged 18–23 in Norway, where advertising for tobacco has been banned since 1975.
Cigarette brand and cigarette package design appear as an integrated part of young smokers’ constructions of smoker identities, enabling the communication of personal characteristics, social identity and positions in hierarchies of status.
Through branding and package design tobacco companies appear to be able to promote their products in a country where advertising is banned, by means of similar principles that make advertising effective: by creating preferences, differentiation and identification.
To ascertain whether a new indoor smoking ban law in North Carolina correctional facilities was successfully implemented and whether the indoor air quality has improved as a result.
Before the law came into effect, we tested the air quality of 22 dormitory and common areas within six North Carolina prisons using standard protocols for testing particulate matter. We measured particulate matter 2.5 µm in diameter (PM2.5) using state of the art TSI SidePak monitors. After the law went into effect, the same locations within each prison were tested again. Written inmate surveys were also conducted at two prisons, one with partial smoking ban (indoors only) and one with a total smoking ban (indoors and outdoors).
The findings indicate that, on average, levels of respirable suspended particulates (RSPs), an accepted marker for secondhand smoke (SHS) levels, decreased 77% in these prisons after the law took effect compared to levels obtained before ban implementation. Several areas were tobacco-free before the implementation of this ban. In those areas no significant decreases in RSPs were noted.
Laws banning tobacco use in correctional facilities can significantly reduce indoor SHS exposure among inmates, visitors and staff and potentially lead to reduced use. To date, 24 US states have enacted 100% smoke-free correctional facility polices for all indoor areas even though inmates and staff have much higher tobacco use prevalence rates than the general population. With an estimated nine million people incarcerated worldwide, prison smoking bans could have a substantial impact in terms of health outcomes and long-term costs if they can effectively reduce exposure to secondhand smoke.
Smokeless tobacco is an efficient delivery vehicle for nicotine and can contain significant amounts of carcinogens. However, few studies have examined factors that might moderate levels of nicotine or carcinogen exposure.
To determine the effect of duration of smokeless tobacco use on the uptake of nicotine and a tobacco-specific carcinogen, 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanone (NNK).
Questionnaires on use of smokeless tobacco were administered, and urine samples from 212 smokeless tobacco users were analysed for biomarkers of uptake of nicotine and NNK. The biomarkers were cotinine and total 4-(methylnitrosamino)-1-(3-pyridyl)-1-butanol (NNAL). Male smokeless tobacco users were recruited for studies designed to investigate methods of reducing smokeless tobacco use. The questionnaire and biomarker data were obtained at baseline, prior to reduction.
Levels of cotinine (p<0.001) and total NNAL (p<0.001) were significantly correlated with duration (in years) of use of smokeless tobacco products. Median cotinine and total NNAL were 2.4 and 2.1 times higher, respectively, in the >=21 years of use than in the 0–5 years of use category.
Smokeless tobacco users adjust their intensity of use with experience in order to increase their nicotine dose, resulting in a corresponding increase in exposure to NNK, a powerful carcinogen. These results indicate the importance of educating smokeless tobacco users about the effects of prolonged use of these products.