Simon Chapman

Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence.

OBJECTIVES We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence. METHODS We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws. RESULTS Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence. CONCLUSIONS Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.

The impact of smoke-free workplaces on declining cigarette consumption in Australia and the United States.

OBJECTIVES This study estimates the contribution of smoke-free workplaces to the recent national declines in cigarette consumption in Australia and the United States. METHODS Nineteen studies of the impact of smoke-free workplaces on workday cigarette consumption were reviewed. The number and cost of cigarettes forgone were calculated and extrapolated to a scenario in which all indoor work areas were smoke-free. RESULTS Of the 19 studies, 18 reported declines in daily smoking rates, and 17 reported declines in smoking prevalence. Smoke-free workplaces are currently responsible for an annual reduction of some 602 million cigarettes, or 1.8% of all cigarettes that might otherwise be consumed, in Australia, and an annual reduction of 9.7 billion cigarettes (2%) in the United States. Approximately 22.3% of the 2.7 billion decrease in cigarette consumption in Australia between 1988 and 1995 can be attributed to smoke-free workplaces, as can 12.7% of the 76.5 billion decrease in the United States between 1988 and 1994. CONCLUSIONS If workplaces were universally smoke-free, the number of cigarettes forgone annually would increase to 1.14 billion (3.4%) in Australia and 20.9 billion (4.1%) in the United States.

Markers of the denormalisation of smoking and the tobacco industry

Background: In nations with histories of declining smoking prevalence and comprehensive tobacco control policies, smoking-positive cultures have been severely eroded. Smoking, smokers and the tobacco industry are today routinely depicted in everyday discourse and media representations in a variety of overwhelmingly negative ways. Several authors have invoked Erving Goffman’s notions of stigmatisation to describe the process and impact of this radical transformation, which importantly includes motivating smoking cessation. Efforts to describe nations’ progress toward comprehensive tobacco control have hitherto taken little account of the role of cultural change to the meaning of smoking and the many ways in which it has become denormalised. Methods: This paper identifies a diversity of generally undocumented yet pervasive markers of the “spoiled identity” of smoking, smokers and the tobacco industry, illustrated with examples from Australia, a nation with advanced tobacco control. Results: We caution about some important negative consequences arising from the stigmatisation of smokers. Conclusions: We recommend that schemes rating the comprehensiveness of national tobacco control should be supplemented by documentation of markers of this denormalisation.

The Global Research Neglect of Unassisted Smoking Cessation: Causes and Consequences

Simon Chapman and Ross MacKenzie review the evidence and argue that health promotion messages should emphasize that the most successful method used by most ex-smokers is unassisted cessation.

Self-exempting beliefs about smoking and health: differences between smokers and ex-smokers.

OBJECTIVES The purpose of the present study was to examine the role of self-exempting or cognitive dissonance-reducing beliefs about smoking and health. Such beliefs may hold important implications for the content and targeting of health promotion campaigns. METHODS A survey of smokers and ex-smokers was conducted in western Sydney, Australia. Six hypotheses were tested. RESULTS The principal findings were (1) that 27.9% of smokers and 42.1% of ex-smokers agreed that smokers were more likely than non-smokers to get five smoking-related diseases; (2) that for 11 of 14 beliefs tested, more smokers than ex-smokers agreed to a statistically significant degree; (3) that the median number of such beliefs agreed to by smokers was five, compared with three for ex-smokers; (4) that for only 5 of 14 beliefs was agreement expressed by more precontemplative smokers than smokers contemplating or taking action to quit; (5) that more than one in four smokers, despite agreeing that smokers are more likely than non-smokers to get five diseases, nonetheless maintain a set of self-exempting beliefs. CONCLUSIONS Fewer smokers than ex-smokers accept that smoking causes disease, and smokers also maintain more self-exempting beliefs. Becoming an ex-smoker appears to involve shedding such beliefs in addition to accepting information about the diseases caused by smoking.

Effects of workplace smoking bans on cigarette consumption.

A sample of staff working in the Australian Public Service (n = 2113) were surveyed two to four weeks before a mandated total ban on workplace smoking was introduced, and again five to six months later. Among the 391 smokers on whom complete data were available, the workplace smoking bans were associated with reduced rates of smoking, particularly among heavier smokers where the reduction in consumption was over 25 percent.

Is "YouTube" telling or selling you something? Tobacco content on the YouTube video-sharing website

With advertising bans eroding direct tobacco advertising and promotional opportunities, tobacco companies are embracing more covert means of keeping their products in the minds of current and potential consumers. Compared with the breadth of published research on “above-the-line” tobacco advertising, research examining “below-the-line”1 indirect forms of tobacco promotion is in its infancy. Promotions at dance parties,2 themed nights in hip clubs,3 bars and music festivals,4 and disguising market research as sampling promotions5 are examples of identified strategies. Just as tobacco company marketers have infiltrated youth-friendly venues, it is conceivable that they also have a presence on youth-friendly websites. While the world wide web (WWW) is being used extensively to sell cigarettes,6 its largely unregulated status holds much potential as a vehicle for both promoting smoking and particular brands of tobacco products, and for promoting antismoking discourse. The WWW is no longer a vehicle to simply retrieve information and purchase goods, it is now a fully interactive and participatory platform.7 Coined in 2004 as Web 2.0, the WWW is increasingly being driven by consumer-generated content.8 It is both timely and critical to examine tobacco marketing in the Web 2.0 era. We are particularly interested in websites that appeal to youth and young adults, the same target population for tobacco companies. Internet use by young people is part of their everyday life; in 2006, more than half of youth and young adult Australians (aged 15–24 years) used the internet on a daily basis.9 The website YouTube (www.youtube.com) is an ideal example of a youth-friendly website that embodies the Web 2.0 principles of participation. It has the potential to be a fruitful place for tobacco marketers to turn their efforts. ### What is YouTube? YouTube was founded in February 2005, as a “consumer media company for people to …

Australia’s 1996 gun law reforms: faster falls in firearm deaths, firearm suicides, and a decade without mass shootings

Background: After a 1996 firearm massacre in Tasmania in which 35 people died, Australian governments united to remove semi-automatic and pump-action shotguns and rifles from civilian possession, as a key component of gun law reforms. Objective: To determine whether Australia’s 1996 major gun law reforms were associated with changes in rates of mass firearm homicides, total firearm deaths, firearm homicides and firearm suicides, and whether there were any apparent method substitution effects for total homicides and suicides. Design: Observational study using official statistics. Negative binomial regression analysis of changes in firearm death rates and comparison of trends in pre–post gun law reform firearm-related mass killings. Setting: Australia, 1979–2003. Main outcome measures: Changes in trends of total firearm death rates, mass fatal shooting incidents, rates of firearm homicide, suicide and unintentional firearm deaths, and of total homicides and suicides per 100 000 population. Results: In the 18 years before the gun law reforms, there were 13 mass shootings in Australia, and none in the 10.5 years afterwards. Declines in firearm-related deaths before the law reforms accelerated after the reforms for total firearm deaths (p = 0.04), firearm suicides (p = 0.007) and firearm homicides (p = 0.15), but not for the smallest category of unintentional firearm deaths, which increased. No evidence of substitution effect for suicides or homicides was observed. The rates per 100 000 of total firearm deaths, firearm homicides and firearm suicides all at least doubled their existing rates of decline after the revised gun laws. Conclusions: Australia’s 1996 gun law reforms were followed by more than a decade free of fatal mass shootings, and accelerated declines in firearm deaths, particularly suicides. Total homicide rates followed the same pattern. Removing large numbers of rapid-firing firearms from civilians may be an effective way of reducing mass shootings, firearm homicides and firearm suicides.

Tobacco industry efforts at discrediting scientific knowledge of environmental tobacco smoke: a review of internal industry documents

STUDY OBJECTIVE Using tobacco industry internal documents to investigate the use of tobacco industry consulting scientists to discredit scientific knowledge of environmental tobacco smoke (ETS). DESIGN Basic and advanced searches were performed on the Philip Morris, Tobacco Institute, R J Reynolds, Brown and Williamson, Lorillard, and the Council for Tobacco Research document web sites, with a concentration on the years 1985–1995. Guildford depository files located on the Canadian Council on Tobacco Control website were also searched. The documents were found in searches undertaken between 1 March and 30 June 2000. MAIN RESULTS The industry built up networks of scientists sympathetic to its position that ETS is an insignificant health risk. Industry lawyers had a large role in determining what science would be pursued. The industry funded independent organisations to produce research that appeared separate from the industry and would boost its credibility. Industry organised symposiums were used to publish non-peer reviewed research. Unfavourable research conducted or proposed by industry scientists was prevented from becoming public. CONCLUSIONS Industry documents illustrate a deliberate strategy to use scientific consultants to discredit the science on ETS.

Tobacco in the news: an analysis of newspaper coverage of tobacco issues in Australia, 2001

Objective: To assess the extent and nature of newspaper coverage of tobacco related issues in Australia in 2001. Design: Content analysis of newspaper articles. Subjects: All articles (n=1188) at least seven lines long and containing at least one paragraph focused on tobacco in all major Australian national and State capital city newspapers (n=12) in 2001. Main outcome measures: Number of articles, month of publication, State in which newspaper published, prominence of article, type of article, article theme, and slant of article relative to tobacco control objectives. Results: The number of tobacco articles varied considerably in different months over the course of the year, from a low of 51 in December to a peak of 180 in May. The most frequent theme was secondhand smoke issues (30% of articles), with the second most dominant theme related to education, prevention, and cessation programmes and services (20%). Events that were covered were predominantly positive for tobacco control: 62% of articles were related to events that were positive, compared with 21% that were negative for tobacco control objectives. Excluding news articles, the opinions expressed by the authors of articles were also mainly positive (61%) rather than negative (22%) for tobacco control objectives. The amount of coverage of and population exposure to tobacco focused articles showed considerable variation across different Australian States, with Victoria having the highest frequency and rate of articles and the most media impressions per capita throughout 2001. Conclusions: Coverage of events and opinions related to tobacco in Australian newspapers in 2001 was generally positive for tobacco control objectives. Given that over 2 million individuals (out of a population of 19 million) were potentially exposed to tobacco related newspaper articles per day in Australia, this represents good news for tobacco control advocates. The variation in news coverage in different States and at different times in the year, however, illustrates how a combination of local events and advocacy efforts may at times combine to make tobacco more newsworthy. Understanding which tobacco issues are most likely to be covered and the nature of the coverage about them provides valuable feedback for tobacco control advocates and is a useful gauge of actual events as well as the tobacco related agendas promoted by the press.