Wonkyong Beth Lee

The effects of smoking norms and attitudes on quitting intentions in Malaysia, Thailand and four Western nations: A cross-cultural comparison

This research investigated the influence of smoking attitudes and norms on quitting intentions in two predominantly collectivistic countries (Malaysia and Thailand) and four predominantly individualistic Western countries (Canada, USA, UK and Australia). Data from the International Tobacco Control Project (N = 13,062) revealed that higher odds of intending to quit were associated with negative personal attitudes in Thailand and the Western countries, but not in Malaysia; with norms against smoking from significant others in Malaysia and the Western countries, but not in Thailand; and with societal norms against smoking in all countries. Our findings indicate that normative factors are important determinants of intentions, but they play a different role in different cultural and/or tobacco control contexts. Interventions may be more effective if they are designed with these different patterns of social influence in mind.

Levels and correlates of awareness of tobacco promotional activities among adult smokers in Malaysia and Thailand: Findings from the International Tobacco Control Southeast Asia (ITC-SEA) Survey

Aim: To examine the impact of tobacco advertising policy on adult smokers’ awareness of tobacco promotion in two developing countries—Malaysia and Thailand. Methods: Data from 2004 Malaysian and 2000 Thai adult smokers who participated in the baseline wave of the International Tobacco Control Southeast Asia survey (ITC-SEA). Respondents were asked in a face-to-face interview conducted between January and March 2005 to indicate their levels of awareness of tobacco advertising and promotional activities in the last six months. Results: Unprompted awareness of any tobacco marketing activities was very low in Thailand (20%) but significantly higher in Malaysia (53%; OR = 5.6, 95% CI: 3.5 to 8.9, p<0.001). When prompted about specific locations, Thai adult smokers reported very low recall of tobacco advertising where it was banned, being highest around point of sale, particularly street vendors (7.5%). In contrast, Malaysian adult smokers reported significantly higher levels of awareness of tobacco advertising in all locations (range = 17.7% noticing in disco lounges to 59.3% on posters) including where they are notionally banned (for example, billboards). Conclusions: These findings demonstrate that comprehensive tobacco advertising legislation when well implemented can lead to dramatic decline in awareness of tobacco promotion, thus supporting strong implementation of Article 13 of the Framework Convention on Tobacco Control.

Association of Sociodemographic Factors, Smoking-Related Beliefs, and Smoking Restrictions With Intention to Quit Smoking in Korean Adults: Findings From the ITC Korea Survey

Background Few studies have reported the factors associated with intention to quit smoking among Korean adult smokers. This study aimed to examine sociodemographic characteristics, smoking-related beliefs, and smoking-restriction variables associated with intention to quit smoking among Korean adult smokers. Methods We used data from the International Tobacco Control Korea Survey, which was conducted from November through December 2005 by using random-digit dialing and computer-assisted telephone interviewing of male and female smokers aged 19 years or older in 16 metropolitan areas and provinces of Korea. We performed univariate analysis and multiple logistic regression analysis to identify predictors of intention to quit. Results A total of 995 respondents were included in the final analysis. Of those, 74.9% (n = 745) intended to quit smoking. In univariate analyses, smokers with an intention to quit were younger, smoked fewer cigarettes per day, had a higher annual income, were more educated, were more likely to have a religious affiliation, drank less alcohol per week, were less likely to have self-exempting beliefs, and were more likely to have self-efficacy beliefs regarding quitting, to believe that smoking had damaged their health, and to report that smoking was never allowed anywhere in their home. In multiple logistic regression analysis, higher education level, having a religious affiliation, and a higher self-efficacy regarding quitting were significantly associated with intention to quit. Conclusions Sociodemographic factors, smoking-related beliefs, and smoking restrictions at home were associated with intention to quit smoking among Korean adults.

Comparing the Experience of Regret and Its Predictors Among Smokers in Four Asian Countries: Findings From the ITC Surveys in Thailand, South Korea, Malaysia, and China

Introduction: Nearly all smokers in high-income Western countries report that they regret smoking (Fong, G. T., Hammond, D., Laux, F. L., Zanna, M. P., Cummings, M. K., Borland, R., & Ross, H. [2004]. The near-universal experience of regret among smokers in four countries: Findings from the International Tobacco Control Policy Evaluation Survey. Nicotine and Tobacco Research, 6, S341–S351. doi:10.1080/14622200412331320743), but no research to date has examined the prevalence of regret among smokers in non-Western, low- and middle-income countries. Methods: Data were from the International Tobacco Control (ITC) Surveys of smokers in 4 Asian countries (China, Malaysia, South Korea, and Thailand); N = 9,738. Regret was measured with the statement: “If you had to do it over again, you would not have started smoking.” Results: Prevalence of regret in 3 countries (South Korea = 87%, Malaysia = 77%, and China = 74%) was lower than that found by Fong et al. in the United States, Australia, Canada, and the United Kingdom (89%–90%); but was higher in Thailand (93%). These significant country differences in regret corresponded with differences in tobacco control and norms regarding smoking. The predictors of regret in the Asian countries were very similar to those in the 4 Western countries: Regret was more likely to be experienced by smokers who smoked fewer cigarettes per day, perceived greater benefits of quitting and higher financial costs of smoking, had more prior quit attempts, worried that smoking would damage their health, and felt that their loved ones and society disapproved of smoking. Regret was also positively associated with intentions to quit (r = 0.23, p < .001). Conclusions: Across the Asian countries and high-income Western countries, the prevalence of regret varies, but the factors predicting regret are quite consistent. Regret may be an important indicator of tobacco control and is related to factors associated with future quitting.

Malaysian and Thai smokers' beliefs about the harmfulness of ‘light’ and menthol cigarettes

Objective This study explored the extent to which Malaysian and Thai smokers believe “light” and menthol cigarettes are less harmful than “regular” cigarettes and the correlates of these beliefs. Methods The study used data from wave 1 of the International Tobacco Control Southeast Asia Survey. 2006 adult smokers (95.3% male) from Malaysia and 2000 adult smokers (94.5% male) from Thailand were interviewed face to face in 2005. Results 29% of Malaysian respondents reported currently smoking light cigarettes and 14% menthols, with 19% agreeing that lights are less harmful and 16% agreeing that menthols are less harmful. 38% of Thai respondents reported currently smoking light cigarettes and 19% menthols, with 46% agreeing that lights are less harmful and 35% agreeing that menthols are less harmful. Malaysian smokers reporting current use of light or menthol cigarettes were more likely to believe that they are less harmful. Reported use of lights did not relate to beliefs for Thai respondents. The belief that light and/or menthol cigarettes are less harmful was strongly related to the belief that they have smoother smoke. Conclusions The experience of smoother smoke is likely to produce some level of belief in reduced harm, regardless of how brands are labelled and whether or not Federal Trade Commission FTC/International Organisation for Standardisation tar, nicotine and carbon monoxide yield figures are used.

Cigarette advertising in the Republic of Korea: a case illustration of The One

Korea is regarded as the worlds eighth largest cigarette market, which reflects a sizeable population of the country and roughly 40% of Korean men being smokers.1 2 Moreover, Korea has been identified as one of the lowest (machine-measured) tar delivery markets in the world. According to internal corporate documentation from Philip Morris, Korean smokers prefer lower (machine-measured) tar and nicotine products that are complemented with promotional appeals relating to luxury.3 The primary marketing communication channels utilised by tobacco firms in Korea appear to be the print media (ie, business and fashion magazines with a predominantly male readership, given legislation, the National Health Promotion Act, which stipulates that cigarette advertisements cannot be directed overtly towards women), retail merchandising (eg, ‘power-wall’ and sales-counter signage in convenience stores) and packaging.1 The Korean tobacco industry is dominated by four firms: Korean Tomorrow and Global (KT&G), Philip Morris International, Japan Tobacco International and British American Tobacco. KT&G has nearly a 70% market share, while Philip Morris International, Japan Tobacco International and British American Tobacco have a collective market share of approximately 30%.4 In this paper, we provide a semiotic analysis of packaging and promotions for KT&Gs The One, which is a brand with a relatively low machine-measured tar delivery. Semiotics refers to the theory of signs, and offers an interpretive approach to the study of signs and produced meanings.5–7 As will be seen in this paper, The One packaging makes use of ‘white space’ to convey prestige, purity and healthiness consequently, it is argued that the use of white is generally ill-advised for plain packaging prototypes. We present several examples to show that important obligations of the WHOs Framework Convention on Tobacco Control (WHO FCTC) have …

Exporting an Inherently Harmful Product: The Marketing of Virginia Slims Cigarettes in the United States, Japan, and Korea

Abstract Ethical issues surrounding the marketing and trade of controversial products such as tobacco require a better understanding. Virginia Slims, an exclusively women’s cigarette brand first launched in 1968 in the USA, was introduced during the mid 1980s to major Asian markets, such as Japan and Korea, dominated by male smokers. By reviewing internal corporate documents, made public from litigation, we examine the marketing strategies used by Philip Morris as they entered new markets such as Japan and Korea and consider the extent that the company attempted to appeal to women in markets where comparatively few women were smokers. The case study of Virginia Slims reveals that the classification of “vulnerable” consumers is variable depending on culture, tobacco firms display responsive efforts and strategies when operating within a “mature” market, and cultural values played a role in informing Philip Morris’ strategic decision to embrace an adaptive marketing approach, particularly when entering the Korean market. Finally, moral questions are raised with tobacco being identified as a priority product for export and international trade agreements being used by corporations, governments, or trade partners in efforts to undermine domestic public health policies.

Social Marketing in Malaysia: Cognitive, Affective, and Normative Mediators of the TAK NAK Antismoking Advertising Campaign

Antismoking mass media campaigns are known to be effective as part of comprehensive tobacco control programs in high-income countries, but such campaigns are relatively new in low- and middle-income countries and there is a need for strong evaluation studies from these regions. This study examines Malaysias first national antismoking campaign, TAK NAK. The data are from the International Tobacco Control Malaysia Survey, which is an ongoing cohort survey of a nationally representative sample of adult smokers (18 years and older; N = 2,006). The outcome variable was quit intentions of adult smokers, and the authors assessed the extent to which quit intentions may have been strengthened by exposure to the antismoking campaign. The authors also tested whether the impact of the campaign on quit intentions was related to cognitive mechanisms (increasing thoughts about the harm of smoking), affective mechanisms (increasing fear from the campaign), and perceived social norms (increasing perceived social disapproval about smoking). Mediational regression analyses revealed that thoughts about the harm of smoking, fear arousal, and social norms against smoking mediated the relation between TAK NAK impact and quit intentions. Effective campaigns should prompt smokers to engage in both cognitive and affective processes and encourage consideration of social norms about smoking in their society.

Who is the target? Package health warnings and the role of market segmentation

Guidelines for implementation of Article 11 of the WHO Framework Convention on Tobacco Control recognise that ‘it is important to assess the impact of packaging and labelling measures on the target populations,’ yet how target populations may be identified is largely unspecified.1 We have previously characterised that early tobacco control efforts are often implemented in a given jurisdiction with a mass market approach, where the total population is treated in its entirety and largely undivided, but market segmentation should be adopted over time.2 Indeed, marketing strategists normally recognise the human diversity of consumers they are attempting to influence and a segmentation strategy involves the identification of well-defined consumer subgroups who share certain common characteristics to facilitate marketing communication that is more efficient, customised and personally relevant. When people find a message personally relevant, they are more likely to pay attention and process the message more thoroughly.3 The target market heavily affects communication decisions regarding where it will be said, what will be said, how it will be said, when it will be said and who will say it.4 Concerning where it will be said, decisions must be made about the medium of communication (eg, magazines) or the message channel of the traditional communication process.5 The cigarette package may also be regarded as a medium of communication for tobacco control efforts, with the cigarette brand serving to inform which health warnings and messages are most relevant based on the target consumer. A health warning that is more directly aimed towards women is more …

Lamborghini brand sharing and cigarette advertising

Licensing and brand sharing arrangements, where a fee or royalty is paid for use of a name, is a common strategic consideration to provide a newly introduced product or service with an immediate and proven brand identity (table 1).1 Serving as such an example, Korean Tomorrow and Global (KT&G), which is South Korea’s leading tobacco firm, launched a new cigarette brand, Tonino Lamborghini, on 18 April 2012, where the branding resembles the legendary Italian luxury sports car maker (figure 1A,B).2 3 According to The Moodie Report , it took 1 year of negotiation to reach a brand licensing agreement and 3 years to develop the cigarette product.4 The cigarette brand was initially offered in two variants, L8 (predominantly black package) and L6 (predominantly yellow package), with reported tar deliveries of 8.0 mg and 6.0 mg, respectively. Compared with KT&G’s other product offerings, Tonino Lamborghini cigarettes have considerably higher reported tar deliveries and such product characteristics contribute to the brand’s masculine, powerful and assertive image.4–8 Tonino Lamborghini now offers additional brand variants, including ‘Ice Volt’ (figure 2), which is mentholated and has promotional claims that the product possesses ‘the thrilling taste of powerful cooling freshness,’ and ‘Ice Tornado,’ which is described as having a strong, fresh and cool flavour and …