Gary A. Giovino

The conceptual framework of the International Tobacco Control (ITC) Policy Evaluation Project

This paper describes the conceptual model that underlies the International Tobacco Control Policy Evaluation Project (ITC Project), whose mission is to measure the psychosocial and behavioural impact of key policies of the Framework Convention on Tobacco Control (FCTC) among adult smokers, and in some countries, among adult non-smokers and among youth. The evaluation framework utilises multiple country controls, a longitudinal design, and a pre-specified, theory-driven conceptual model to test hypotheses about the anticipated effects of specific policies. The ITC Project consists of parallel prospective cohort surveys of representative samples of adult smokers currently in nine countries (inhabited by over 45% of the world’s smokers), with other countries being added in the future. Collectively, the ITC Surveys constitute the first-ever international cohort study of tobacco use. The conceptual model of the ITC Project draws on the psychosocial and health communication literature and assumes that tobacco control policies influence tobacco related behaviours through a causal chain of psychological events, with some variables more closely related to the policy itself (policy-specific variables) and other variables that are more downstream from the policy, which have been identified by health behaviour and social psychological theories as being important causal precursors of behaviour (psychosocial mediators). We discuss the objectives of the ITC Project and its potential for building the evidence base for the FCTC.

Effects of Anti-Smoking Advertising on Youth Smoking: A Review

This paper reviews empirical studies, encompassing community trials and field experiments, and evaluates government-funded anti-smoking campaigns, ecologic studies of population impact of anti-smoking advertising, and qualitative studies that have examined the effects of anti-smoking advertising on teenagers. We conclude that anti-smoking advertising appears to have more reliable positive effects on those in pre-adolescence or early adolescence by preventing commencement of smoking. It is unclear whether this is due to developmental differences, or is a reflection of smoking experience, or a combination of the two. In addition, it is evident that social group interactions, through family, peer and cultural contexts, can play an important role in reinforcing, denying, or neutralizing potential effects of anti-smoking advertising. Although there is some research to suggest that advertising genres that graphically depict the health effects of smoking, emphasize social norms against smoking, and portray the tobacco industry as manipulative can positively influence teenagers, these findings are far from consistent. Finally, the effects of anti-smoking advertising on youth smoking can be enhanced by the use of other tobacco control strategies, and may be dampened by tobacco advertising and marketing. Overall, the findings of this review indicate that there is no single recipe for anti-smoking advertising that leads to reductions in youth smoking. Anti-smoking advertising can influence youth smoking, but whether it does in the context of individual anti-smoking campaigns needs to be the subject of careful evaluation.

State Tobacco Control Spending and Youth Smoking

OBJECTIVEnWe examined the relationship between state-level tobacco control expenditures and youth smoking prevalence and cigarette consumption.nnnMETHODSnWe estimated a 2-part model of cigarette demand using data from the 1991 through 2000 nationally representative surveys of 8th-, 10th-, and 12th-grade students as part of the Monitoring the Future project.nnnRESULTSnWe found that real per capita expenditures on tobacco control had a negative and significant impact on youth smoking prevalence and on the average number of cigarettes smoked by smokers.nnnCONCLUSIONSnHad states represented by the Monitoring the Future sample and the District of Columbia spent the minimum amount of money recommended by the Centers for Disease Control and Prevention, the prevalence of smoking among youths would have been between 3.3% and 13.5% lower than the rate we observed over this period.

Tobacco Industry Marketing at Point of Purchase After the 1998 MSA Billboard Advertising Ban

Point-of-purchase marketing has become increasingly important for the tobacco industry in the United States.1 In the wake of the 1998 master settlement agreement (MSA) that required tobacco advertising on billboards across the country to end on April 24, 1999, the point-of-purchase environment is likely to assume even greater importance in the industrys marketing efforts. n nOne goal of the billboard advertising ban (as well as other MSA advertising and promotion restrictions) was to reduce youth exposure to cigarette advertising. However, previous research suggests that the tobacco industry is able to compensate for an inability to advertise in one medium by transferring advertising dollars to other marketing activities.2–6 Accordingly, there is concern that the MSA billboard advertising ban may merely shift tobacco advertising funding to other efforts, such as point-of-purchase marketing. In this study, we used data from a unique national sample of retailers to explore changes in the point-of-purchase environment after implementation of the billboard tobacco advertising ban.

An assessment of the effect of data collection setting on the prevalence of health risk behaviors among adolescents

PURPOSEnTo examine the effect of data collection setting on the prevalence of priority health risk behaviors among adolescents.nnnMETHODSnAnalyses were conducted using data from two national probability surveys of adolescents, the 1993 national school-based Youth Risk Behavior Survey (YRBS) and the 1992 household-based National Health Interview Survey (NHIS/YRBS). Forty-two items were worded identically on both surveys.nnnRESULTSnThirty-nine of the 42 identically worded items (93%) showed that the YRBS produced estimates indicating higher risk than the NHIS. Twenty-four of these comparisons yielded statistically significant differences. The prevalence estimates affected most were those for behaviors that are either illegal or socially stigmatized.nnnCONCLUSIONSnSchool-based surveys produce higher prevalence estimates for adolescent health risk behaviors than do household-based surveys. Each has advantages and disadvantages, and both can play a role in assessing these behaviors.

Mentholated cigarettes and smoking cessation: findings from COMMIT

Objective: To examine the association between the use of menthol cigarettes and smoking cessation, amount smoked, and time to first cigarette in the morning. Background: The majority of African American smokers smoke mentholated cigarettes. Some evidence suggests that African Americans may be more nicotine dependent than whites. One theory is that menthol in cigarettes is responsible for enhancing the dependence producing capacity of cigarettes; however, few studies have prospectively examined the association between menthol use and indicators of nicotine dependence. Methods: Baseline smokers from the Community Intervention Trial for Smoking Cessation (COMMIT) completed a telephone tobacco use survey in 1988 and were re-interviewed in 1993. Use of mentholated cigarettes was assessed by self report at baseline. Indicators of dependence examined were six month cessation in 1993, amount smoked among continuing smokers in 1993, and time to first cigarette in the morning in 1988. Multivariate regression techniques were used to assess the association of baseline menthol use with these outcomes while controlling for other factors related to dependence. Results: Overall, 24% of the sample smoked a mentholated brand in 1988. No consistent associations were observed for menthol use and indicators of dependence in both overall and race specific analyses. Factors significantly associated with increased menthol use were female sex, age 25–34 years, African American and Asian race/ethnicity, greater education, greater than 60 minutes to the first cigarette in the morning, two or more past quit attempts, and use of premium brand cigarettes. Canadian respondents and those who smoked 15–24 cigarettes per day had lower rates of menthol use. Use of mentholated cigarettes was not associated with quitting, amount smoked, or time to first cigarette in the morning. Conclusion: Future work is needed to clarify the physiological and sociocultural mechanisms involved in mentholated cigarette smoking.

Other substance use among high school students who use tobacco

PURPOSEnTo examine relationships between tobacco use and use of other substances among U.S. high school students, by gender and racial/ethnic subgroups.nnnMETHODSnData about tobacco and other substance use were analyzed from the 1995 national Youth Risk Behavior Survey implemented by the Centers for Disease Control and Prevention.nnnRESULTSnCompared to nonsmokers, current smokers were significantly more likely to report use of all other substances we examined, including lifetime use of cocaine, inhalants, other illegal substances, and multiple substances and current alcohol use, episodic heavy drinking, marijuana use, and cocaine use. A strong dose-dependent relationship between current cigarette smoking and other substance use was identified. Among smokeless tobacco users, a strong dose-dependent relationship was found for all examined substances with the exception of lifetime and current cocaine use. Finally, a pattern of risk emerged suggesting that the likelihood of other substance use increases as students move from no tobacco use to smokeless tobacco use only, to cigarette smoking only, and to use of both smokeless tobacco and cigarettes.nnnCONCLUSIONSnPrograms designed to prevent tobacco or other substance use should consider that such use often occurs concomitantly.

Reducing tobacco harm: Research challenges and issues

The emergence of potential reduced-exposure tobacco and cigarette-like products and the reduction of smoking as a treatment approach, have recently been forcing the debate and discussion about the science that is necessary to inform policies, regulation, and programs. To deal effectively with the issues evolving around tobacco harm reduction, a comprehensive and strategic research agenda must be forged, and a multi-disciplinary, collaborative approach must be taken. The goal of this article is to describe research challenges and issues related to tobacco exposure and harm reduction. Scientists from multiple disciplines and individuals from government agencies, nonprofit organizations, and tobacco control advocacy groups as well as the pharmaceutical and tobacco industries attended a two-day meeting that focused on addressing the current knowledge regarding tobacco harm reduction, identifying gaps in knowledge, and recommending research directions. Workgroups, comprising a subset of attendees, met after the conference to synthesize, discuss, and prioritize the important research frontiers. The resulting document provides guidance for scientists, grant funding agencies, industry and policy makers by identifying areas in which to invest research effort and funds to develop a science base to ensure the future health of this nation and world.

Tobacco Institute lobbying at the state and local levels of government in the 1990s

Objective: To describe variation in Tobacco Institute (TI) lobbying expenditures across states and test whether these expenditures vary in relationship to measures of tobacco control activity at the state level. Independent variable: Data for this study came from the TIs State Activities Division (SAD) annual budgets for the years 1991-97, excluding 1993. These data include budgetary information pertaining to state and local lobbying activity and special projects reported by state. Dependent variables: The following measures of state tobacco control activity during the period 1991 to 1997 were considered: (1) American Stop Smoking Intervention Study (ASSIST) funding; (2) voter initiatives to raise cigarette taxes; (3) cigarette excise tax level; (4) workplace smoking restrictions; (5) the intensification of smoke-free air laws covering private worksites, government worksites, and restaurants; (6) the intensification of strength of sales to minors laws; (7) the intensification of strength of laws that punish minors for possessing, purchasing, and/or using cigarettes; (8) state status as a major grower of tobacco; (9) partisan control of state government, 1996; and (10) an overall composite index reflecting a states strength of tobacco control, combining cigarette prices with workplace and home smoking bans. Results: The overall annual budget for the TI declined steadily during the 1990s, from

Methods to assess potential reduced exposure products

47.7 million in 1991 to