Christopher M. Anderson

Mandated lowering of toxicants in cigarette smoke: a description of the World Health Organization TobReg proposal

Preventing initiation of tobacco product use, promoting cessation of tobacco use, and protecting the public from exposure to second hand smoke are recognised by the World Health organization (WHO) Framework Convention on Tobacco Control (FCTC) and by the WHO Study Group on Tobacco Product Regulation (TobReg) as the most effective approaches to reducing tobacco related morbidity and mortality. However, the FCTC also recognises the need for tobacco product regulation in articles 9 and 10 of the treaty. In order to inform that process TobReg has developed a series of reports that begin to provide a scientific foundation for tobacco product regulation.1–6 This paper summarises a proposal, and the considerations that led to it, developed by a joint International Agency for Research on Cancer (IARC) and WHO working group, and approved by TobReg, which presents performance standards for cigarettes and a strategy to use them to mandate a reduction in the toxicant yields for cigarette smoke. The most common measurements used historically to categorise cigarette smoke have been machine measured tar, nicotine and carbon monoxide (TNCO) yields per cigarette based on the US Federal Trade Commission (FTC)/International Standards Organization (ISO) testing regimen. There is a current scientific consensus that these per cigarette yields do not provide valid estimates of human exposure or of relative human exposure when smoking different brands of cigarettes.1 7–9 Communication of these measures to smokers as estimates of their exposure or risk creates harm by misleading smokers to believe that differences in exposures and risk are likely to occur with switching to cigarette brands with different machine-measured yields. This ongoing harm precludes continued acceptance of current regulatory strategies based on per cigarette machine measured TNCO levels and necessitates development of new regulatory approaches. Machine smoking regimens other than the FTC/ISO regimen …

Tobacco quitlines: looking back and looking ahead

Telephone based tobacco cessation services, or quitlines, have become central components of many comprehensive tobacco control programmes. This paper provides an overview of their history, noting milestones in the growth of quitlines. Key factors in their worldwide adoption were solid evidence from clinical trials with large community samples and strong backing from public health officials. Quitlines are now available throughout most of North America, Europe, Australia and in many other locations around the world. The paper also offers several recommendations for future directions in quitline practice and research. Benchmarks should be established for key areas of quitline implementation, such as accessibility, quality and cost efficiency. Advances in pharmacotherapy, telephony and web based applications should be investigated for opportunities to expand service offerings. Research and development are needed to determine how best to serve a diverse clientele in the most cost effective manner. Funding should be expanded and diversified to enable quitlines to serve much larger numbers of users. Healthcare providers should be targeted for quitline promotion, to engage them in a broad effort to increase the number of patients receiving cessation messages from clinicians. The goal of quitline promotion should expand to include an increase in unaided quit attempts in the population. Early research findings were quickly adopted in quitline practice, and future research to answer questions that have arisen through the implementation of quitlines will probably also find quick adoption.

Perception of foreign cigarettes and their advertising in China: a study of college students from 12 universities

OBJECTIVE To examine how deeply foreign cigarette advertising had penetrated the Chinese market when a new ban on cigarette advertising was enacted in February 1995. DESIGN A survey using self-completion questionnaires administered in college classrooms from November 1994 to March 1995. SETTINGS Eight universities and four medical schools in three Chinese cities: Beijing, Wenzhou, and Hangzhou. SUBJECTS 1896 college students who agreed to complete a written questionnaire. The mean age was 21.2 years; 39.5% of respondents were female. RESULTS Four of the top eight cigarette brands most familiar to the respondents were foreign: Marlboro, 555, Kent, and Hilton. Advertisements for the foreign brands were much more likely to be seen than those for the domestic brands; those for Marlboro were reported most often (29.7%), followed by 555 (21.8%) and Kent (18.1%). Among smokers, Marlboro was the most preferred foreign brand, by 44.2%. The preference for Marlboro was also correlated with smokers having seen its advertisements. Most respondents, 71.8%, believed that cigarette advertising should be banned. CONCLUSIONS The previous restrictions on cigarette advertising in China failed to prevent a large portion of the population from seeing and understanding the advertisements. Before the 1995 advertising ban took effect, strict limitations on imports of foreign cigarettes notwithstanding, certain highly advertised brands such as Marlboro achieved wide recognition and even consumer preference. Stricter restrictions are suggested as previous ones have failed to achieve their intended effects.

Reaching Young Adult Smokers Through Quitlines

This study compared state quitline data (1992-2006) with population survey data to assess use by young adults aged 18 to 24 years. Young adult daily smokers used the service in proportion to their numbers in the state. Young adults responded to mass media quitline promotion, even promotion that did not target them. Women, ethnic minorities, and persons with low income and lower education levels were well represented among young adult quitline callers. Quitlines are a viable means of intervening with this priority population.

A National Asian-Language Smokers’ Quitline — United States, 2012–2014

Introduction Until recently, in-language telephone quitline services for smokers who speak Asian languages were available only in California. In 2012, the Centers for Disease Control and Prevention (CDC) funded the national Asian Smokers’ Quitline (ASQ) to expand this service to all states. The objective of this study was to examine characteristics of ASQ callers, how they heard about the quitline, and their use of the service. Methods Characteristics of callers from August 2012 through July 2014 were examined by using descriptive statistics. We examined demographics, cigarette smoking status, time to first cigarette, how callers heard about the quitline, and service use (receipt of counseling and medication) by using ASQ intake and administrative data. We analyzed these data by language and state. Results In 2 years, 5,771 callers from 48 states completed intake; 31% were Chinese (Cantonese or Mandarin), 38% were Korean, and 31% were Vietnamese. More than 95% of all callers who used tobacco were current daily cigarette smokers at intake. About 87% of ASQ callers were male, 57% were aged 45 to 64 years, 48% were uninsured, and educational attainment varied. Most callers (54%) were referred by newspapers or magazines. Nearly all eligible callers (99%) received nicotine patches. About 85% of smokers enrolled in counseling; counseled smokers completed an average of 4 sessions. Conclusion ASQ reached Chinese, Korean, and Vietnamese speakers nationwide. Callers were referred by the promotional avenues employed by ASQ, and most received services (medication, counseling, or both). State quitlines and local organizations should consider transferring callers and promoting ASQ to increase access to cessation services.

The Break Up: Evaluation of an Anti-Smoking Educational Campaign for Lesbians, Gays, and Bisexuals in Los Angeles County

Lesbian, gay, and bisexual (LGB) adults in the United States have a higher prevalence of smoking than their heterosexual counterparts. In 2013, the Los Angeles County Department of Public Health launched a social marketing and outreach campaign called Break Up to reduce the prevalence of smoking in LGB communities. Break Up was evaluated using cross-sectional, street-intercept surveys before and near the end of campaign. Surveys measured demographics, campaign awareness, and self-reported smoking-related outcomes. Bivariate statistics and logistic regression models were used to identify whether campaign awareness was associated with smoking-related outcomes. Calls by LGB persons to a smokers’ helpline were also measured. Among those interviewed at endline, 32.7% reported Break Up awareness. Awareness was associated with thinking of quitting smoking and ever taking steps to quit but not with smoking cessation (defined as not smoking in the past 30 days among those who had smoked in the past 6 months). There was a 0.7% increase in the percentage of weekly calls by LGB persons to the helpline in the year after the campaign. Break Up reached about a third of its intended audience. The campaign was associated with smoking cessation precursors and may have led to an increase in helpline utilization, but there is no evidence it affected quit attempts. This study adds to the limited literature on tobacco programs for LGB persons and, as far as we know, is one of the first to evaluate tobacco-free social marketing in this important yet understudied population.