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The public health white paper for England Choosing Health: Making Healthy Choices Easier (Department of Health (DH) 2004) was published last November. The RCN welcomed the white paper, which signalled [...]

In 2005, the European Union (EU) commissioned a study as part of an EU-wide antismoking campaign. The study was conducted by a consortium of EU companies. Our research reanalyzes the EU data, based on interviews with over 25,000 consumers in 25 countries. This paper focuses on Eastern EU countries and addresses the potential effects of source misattribution. We built a conceptual model linking comprehension of and attitude toward the campaign with outcome measures: responsible thinking toward smoking and intention to quit. Our analysis suggests that source attribution plays a moderating role in the relationship between message comprehension and the two outcome variables. [ABSTRACT FROM AUTHOR]

The article focuses on the request of the World Health Organization (WHO) for preemptive ban on smokeless tobacco. A group of experts meeting under the auspices of the organization has called for a ban to prevent the new public health epidemic from a new form of tobacco use. The group declared that smokeless tobacco is being promoted cynically across the globe despite of its known harmful health consequences. WHO working paper studies indicated that beyond any reasonable doubt, smokeless tobacco is a serious health hazard for it caused cancer of the oral cavity and of nicotine addiction. Finally, some measures are recommended by the WHO experts like the prohibition of promotion in the mass media and health warnings on all smokeless tobacco products.

Although most research on the effect of tobacco warnings has been focused on attitude changes following the presentation of tobacco warnings, this paper takes a somewhat new perspective by investigating cognitive processing of tobacco warnings by adolescents of different ages (i.e., 14-, 16-, and 18-year-olds). More specifically, this paper investigates the way adolescents encode different textual elements presented in tobacco warnings. By means of a standard psycholinguist paradigm (i.e., sentence evaluation paradigm), we evaluated tobacco warnings differing along three variables: (1) severity, (2) time consequence and (3) target (health vs. others). Our main result demonstrated noticeable differences between the age groups and between smoking experiences in the cognitive processing of tobacco warnings. Our experimental paradigm represents an important step in identifying the mechanisms through which certain types of written warnings are cognitively processed, which in turn may well set a critical base for understanding decision makers' responses to risky behaviors such as smoking and for constructing adequate health warnings. [ABSTRACT FROM AUTHOR]

The paper compares the response of the South African Government to HIV and AIDS with the government's policy development concerning the use of tobacco. The high burden of disease from HIV and AIDS in South Africa and the morbidity and mortality from the use of tobacco are outlined. Using the framework of the Ottawa Charter for Health Promotion, the paper reviews and critiques the Government's different stance to building public policy, creating supportive environments, engaging community participation, developing personal skills and re-orienting the health services, for HIV/AIDS and tobacco. The result of these policy choices is described. The lack of adequate implementation of the key elements of the Ottawa Charter has resulted in high morbidity and mortality due to the spread of HIV infection in South Africa. This has also influenced the resurgence of tuberculosis, and the accompanying MDR and XDR TB epidemics. The high prevalence of HIV infection has also meant that the health system is unable to cope with the large numbers of patients requiring anti-retroviral treatment, and the early morbidity and mortality of young economically active people has had devastating social consequences, resulting in the large numbers of orphans. In contrast, South Africa is a signatory to the World Health Organizations' Framework Convention on Tobacco Control, and has successfully implemented many of the policies. [ABSTRACT FROM AUTHOR]

This paper starts from the premise that, particularly in industrialized countries, the consumption decisions made by individuals and households are a major source of environmental strain. Several international organizations and national governments have addressed this issue, but, thus far, their efforts have had minimal effect. This paper examines the conditions necessary for the implementation of policy able to effectively reduce the environmental impact of household consumption. It draws from the experience of American tobacco control, a relatively rare example of a public effort that succeeded in reducing the negative consequences of an entitled consumer behaviour. An extensive review of the tobacco control literature informs the conclusion that three fundamental changes brought about conditions conducive to a widespread reduction in smoking, namely, information about its negative effects became common knowledge and was widely believed as true; cigarettes became a target for taxes that raised the price of smoking while placing a penalty on a behaviour increasingly seen as ‘bad’; the public sentiment regarding smoking shifted, deglamourizing the behaviour. The paper further suggests that these changes, which were the result of a concerted public effort, have a similar potential in reducing environmentally unsustainable consumption. A closer tying of consumption to the issue of climate change is suggested as a primary facilitating strategy. [ABSTRACT FROM AUTHOR]

Purpose — Previous studies have indicated that antismoking advertising potentially prevents or reduces smoking among teenagers. However, not all message themes of antismoking advertising have proved effective. This study aims to explore the effects of different message themes on teenagers' intention to smoke. Attitude towards the advertisement and attitude towards the act (smoking) are proposed as mediating variables between the message theme and smoking intentions. The paper also aims to examine effect of three themes, namely health effects, mental effects and social effects on smoking/not smoking. Design/methodology/approach — The data consist of 325 Finnish high school students aged between 13 and 16. The hypotheses are tested using LISREL 8. Findings — The paper finds that only the attitudes towards advertisements displaying social effects are significantly ,elated with attitudes towards smoking. The attitudes towards the advertisements portraying the themes of health effects and mental effects are not significantly related with attitudes towards smoking and thus are not effective in influencing the respondents' attitudes towards smoking and smoking intentions. Research limitations/implications — Data were, gathered only in one European country (Finland). Future studies should examine whether teenagers in other European countries differ in the way they are affected by different message themes. Practical implications — Teenagers are susceptible to messages that are related to social approval of not smoking or disapproval of smoking, thus social appeals should be used in antismoking advertising targeted at them. Originality/value — This study focuses on exploring how message themes used in antismoking advertising affect smoking intentions among teenagers in the European context and specifically in Finland. [ABSTRACT FROM AUTHOR]

This paper tests the hypothesis that education improves health and increases life expectancy. The analysis of smoking histories shows that after 1950, when information about the dangers of tobacco started to diffuse, the prevalence of smoking declined earlier and most dramatically for college graduates. I construct panels based on smoking histories in an attempt to isolate the causal effect of smoking from the influence of time-invariant unobservable characteristics. The results suggest that, at least among women, college education has a negative effect on smoking prevalence and that more educated individuals responded faster to the diffusion of information on the dangers of smoking. [ABSTRACT FROM AUTHOR]

Objectives: Epidemiological surveys make it clear that youth smoking contributes to bath current and future tobacco industry revenue: over 80% of adult smokers reportedly began smoking before age 18. This paper estimates annual and lifetime revenue from youth smoking, and highlights the association between declines in youth smoking and declines in tobacco industry revenue. Main outcome measures: This paper reports the amount of tobacco industry revenue generated by youth smoking at two points in time (1997 and 2002), and describes the distribution of youth generated tobacco income among the major tobacco companies. The authors project the amount of tobacco industry revenue that will be generated by members of two cohorts (the high school senior classes of 1997 and 2002) over the course of their lifetimes. Results: In 1997, youth consumed 890 million cigarette packs, generating $737 million in annual industry revenue. By 2002, consumption dropped to 541 million packs and revenue increased to nearly $1.2 billion. Fifty eight per cent of youth generated revenue goes to Philip Morris USA, 18% to Lorillard, and 12% to RJ Reynolds. The authors project that, over the course of their lives, the 1997 high school senior class will smoke 12.4 billion pecks of cigarettes, generating $27.3 billion in revenue. The 2002 high school senior class is projected to smoke 10.4 billion packs, generating $22.9 billion in revenue over the course of their lives. Conclusions: Cigarette price increases from 1997 to 2002 have resulted in greater revenue for the tobacco industry, despite declines in youth smoking prevalence. However, in the absence of further cigarette price increases, declines in youth smoking are projected to lead ultimately to a loss of approximately $4 billion in future tobacco industry revenue from a single high school cohort. [ABSTRACT FROM AUTHOR]

The Eighth Annual Meeting of the Society for Research on Nicotine and Tobacco (SRNT) was held in Savannah, Georgia, on 21-23 February 2002. This meeting was the largest to date, with more than 600 registered attendees, five outstanding plenary speakers, 10 symposia, six oral paper sessions, and four filled-to-capacity poster sessions. The meeting content represented three major areas of SRNT's emphasis: Preclinical, Epidemiology/Public Health and Clinical research; thus the meeting was an outstanding opportunity to share with, and learn from, colleagues engaged in the full spectrum of nicotine and tobacco research. Additional events included pre- and post-meeting symposia, a career development question-and-answer workshop, a global network interest meeting, and a variety of awards. SRNT also remembered and honored the lives and work of two outstanding colleagues who were lost to the society over the past year: Dr. Chris Silagy and Dr. John Slade. Highly significant and innovative research continues in the field of nicotine and tobacco, and this innovation and significance was readily apparent in the science presented at the eighth annual meeting. [ABSTRACT FROM AUTHOR]

This paper examines the causal effect of smoking on body weight in Italy. We take advantage of the discontinuity in smoking habits introduced by the Italian smoking ban in 2005. Our estimates indicate that the ban reduced smoking intensity by half a cigarette per day and smoking participation rate by 2 percentage points. We estimate a significant effect on body weight of about 1 kg. Heterogeneous effects are also found, highlighting a smaller impact on men, employees and overweight and obese people. Most of the weight variations are attributed to quitting smoking, whereas reductions in cigarette consumption are not significant. [ABSTRACT FROM AUTHOR]

Introduction: There is growing concern about population disparities in tobacco-related morbidity and mortality. This paper introduces the reach ratio as a complementary measure to reach for monitoring whether quitline interventions are reaching high risk groups of smokers proportionate to their prevalence in the population. Methods: Data on smokers were collected at intake by 7 Canadian provincial quitlines from 2007 to 2009 and grouped to identify 4 high risk subgroups: males, young adults, heavy smokers, and those with low education. Provincial data are from the Canadian Tobacco Use Monitoring Survey. Reach ratios (ReRas), defined as the proportion of quitline callers from a subgroup divided by the proportion of the smoking population in the subgroup, and 95% confidence intervals were calculated for the subgroups. A ReRa of 1.0 indicates proportionate representation. Results: ReRas for male smokers and young adults are consistently less than 1.0 across all provinces, indicating that a lower proportion of these high-risk smokers were receiving evidence-based smoking cessation treatment from quitlines. Those with high levels of tobacco addiction and less than high school education have ReRas greater than 1.0, indicating that a greater proportion of these smokers were receiving cessation treatments. Conclusion: ReRas complement other measures of reach and provide a standardized estimate of the extent to which subgroups of interest are benefiting from available cessation interventions. This information can help quitline operators, funders, and policymakers determine the need for promotional strategies targeted to high risk subgroups, and allocate resources to meet program and policy objectives. [ABSTRACT FROM PUBLISHER]

In this paper, we explore one mechanism that may underlie the negative relationship between social capital and smoking: whether social capital strengthens the effect of anti-smoking regulations. We use data on smoking behaviors collected immediately before and after the implementation of smoking bans in public places in Germany in order to determine whether the impact of these bans on smoking prevalence and intensity is greater among individuals richer in social capital. We find that smoking bans reduce both smoking prevalence and intensity mainly among men and that individual social capital strengthens the effect of the bans. [ABSTRACT FROM AUTHOR]

ABSTRACT Antismoking campaigns have traditionally ignored the differences between social and regular smokers. This paper reports the results of three studies: interviews with 17 college students describing themselves as social smokers, a survey verifying the interview results with a larger sample of undergraduates, and an experimental test of advertising appeals based on the survey results. In the interviews, social smokers differentiated themselves from regular smokers and described smoking mostly in situations where drinking and smoking goes hand in hand. They did not feel vulnerable to the long-term consequences of smoking. The survey confirmed differences between the behaviors, motivations, and perceived vulnerability of social and regular smokers. The experimental study found that both social and regular smokers were persuaded by an advertisement describing the risk of cancer, but social smokers expressed the lowest vulnerability to this risk. A message strategy describing the risk of addiction was particularly effective in capturing the attention of social smokers. Copyright © 2012 John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]

Effective mass media campaigns are hard to come by. A delicate blend of art and science is required to ensure content is technically accurate as well as being creatively engaging for the target audience. However, the most expensive component of a media campaign is not its development but its placement at levels that allow smokers to see, engage and respond to its content. This paper uses two examples to illustrate the process of adapting existing effective material to maximise the expenditure of precious resources on the placement of material. [ABSTRACT FROM AUTHOR]

Purpose - Whereas much previous research focuses on the ways consumers strive to gain social approval, consumption that may result in social disapproval must be considered. In order to do so, the purpose of this paper is to explore consumers' self-concepts within a risky consumption context, namely smoking. Self-concept discrepancies and the resulting emotions and coping strategies are identified. Design/methodology/approach - A qualitative methodology based on 30 focus groups conducted across ten European countries is employed. Findings - Findings demonstrate self-concept discrepancies between both the actual self and ought/ideal guiding end states, as well as between the "I" and social selves. Such discrepancies generate negative emotions and result in emotion-focused coping strategies. In addition, the accuracy of smokers' social self-concepts with reference to the actual perceptions of non-smokers is discussed. Practical implications - Important implications for the design of effective anti-smoking advertising are discussed, based on the findings. It is suggested that counter advertising should encourage dialogue between smokers and non-smokers and that message themes should centre on building the self-efficacy of smokers. Originality/value - The reason why the social context should be an integral part of consumer self-concept research is highlighted. Moreover, the importance of moving beyond merely understanding the existence of self-discrepancies, to focus on the emotions that are generated by these discrepancies and the consequent coping strategies employed to resolve them is identified. As such, the potential contributions that may arise by recognising the intersection between two bodies of literature that are often treated separately, namely, consumer coping and the self-concept, are highlighted. [ABSTRACT FROM AUTHOR]

In 2001 and 2002, the Korean government dramatically increased cigarette taxes, anti-smoking advertisements, and smoking prohibitions as part of an anti-smoking campaign. This paper examines the impacts of these policy changes by modeling quit success and smoking intentions pre- and post-policy and attributing model differences to anti-smoking policies. Model results provide evidence that national anti-smoking policies increased both quitting success and intention to quit. However, the impacts of these policies are uneven throughout Korean society. Females and those who exercise for health maintenance experienced higher quit success. Heavy smokers and high frequency alcohol drinkers stated they are less likely to quit smoking post-policy. One impact of national anti-smoking policies is reduced provincial differences among Koreans in both quit success and intention to quit. Future anti-smoking policies should address the different needs of these groups. ( JEL D12, I19) [ABSTRACT FROM AUTHOR]

With the rising popularity of smoking among young people causing social concern, cigarette consumption has been the subject of growing interest among academics, health professionals and public policymakers. The paper examines the effect of antismoking information on teenagers' attitudes and intention towards smoking. Data are collected from a sample of teenagers via an experimental approach based on a school antismoking intervention programme. The longitudinal research design reveals the relatively short-term effect of the intervention studied, supporting previous research findings about the role of emotion in decisions teenagers make about smoking. Implications and challenges are discussed for designing antismoking school interventions. [ABSTRACT FROM AUTHOR]

Title. Tobacco smoking habits among nursing students and the influence of family and peer smoking behaviour. Aim. This paper is a report of a study assessing tobacco smoking habits among nursing students and how these are influenced by family members and peers. Background. Tobacco smoking among nursing students is a serious problem because of the public role model of these future healthcare professionals. Methods. The smoking attitude of nursing students attending the 3 year full-time course at the University of Milan in the academic years 2006–2007 and 2007–2008 was investigated. A total of 820 students filled in the self-administered questionnaire and 812 valid questionnaires were returned. The response rate was 87%. Results. Forty-four percent of the 812 students were tobacco smokers and 7% former smokers. Among the smoking students 75% had at least one smoking parent, 47% had at least one smoking brother or sister and 87% saw smoking friends. Conclusion. There is an urgent need to implement effective anti-smoking measures among nursing students. Decreasing the number of smokers among healthcare professionals would discourage people from smoking and would increase the credibility of anti-smoking campaigns. [ABSTRACT FROM AUTHOR]

The United Kingdom has recently enacted smoking bans in public places such as restaurants and pubs. Public health advocates argue that bans are necessary because non-smokers need protection from second-hand smoke. Advocates also claim that bans do not exert harm on owners because of a vast empirical literature showing that restaurants and bars in the United States never suffer harm following bans. This paper examines whether these claims are true by developing a model within the Coasian framework whereby owners of businesses have incentives to deal with smoking disputes between smokers and non-smokers. Our model demonstrates that it is incorrect to argue that smoking bans are necessary because the private market has no method of attempting to solve smoking problems. It also predicts that bans exert different effects on different businesses: some will be unaffected while others will experience losses or gains. Our literature review reveals that predictions of differential effects are consistent with the empirical evidence. [ABSTRACT FROM AUTHOR]

During the last 20 years, anti-smoking campaigns have been developed in Australia in an effort to reduce the prevalence of smoking. Existing research indicates that these campaigns have provoked an increase in the negative attitudes towards smoking, and messages encouraging people to quit have reached increasing numbers of men and women. While existing research shows that anti-smoking campaigns are 'effective' at reducing rates of smoking, there is a distinct lack of research that theorizes about why anti-smoking campaigns are 'effective'. In this paper, Foucauldian discourse analysis is employed to examine a recent series of television anti-smoking campaigns in New South Wales Australia, and to explore the knowledges and techniques used to construct and disseminate an anti-smoking message. The aim of this paper is to use a number of examples from this series of anti-smoking campaigns to show that the medical knowledge, imagery, and Language dominantly used, Legitimates and confirms the 'expert' status of medicine in regard to smoking conduct, and normalizes health conduct according to the medical dichotomy of healthy/non-smoking individuals and unhealthy/smoking individuals. I argue that the anti-smoking discourse disseminated in these campaigns is underpinned by some of the key features of neo-liberalism, and passively coerces individuals into making 'healthy' choices. The paper concludes by problematizing both the universal applicability of these anti-smoking campaigns, and the notion of self-governance, specifically in relation to young people' who smoke. [ABSTRACT FROM AUTHOR]

Objective. This paper examines overall and gender- and racial/ethnic-specific relationships between exposure to state-sponsored anti-tobacco televised advertising and smoking-related outcomes among US middle and high school students using five years of cross-sectional nationally representative data. Design. Nationally representative 8th, 10th, and 12th grade student sample data for 1999-2003 were merged with commercial ratings data on mean potential audience exposure to network and cable television anti-tobacco advertising across the 74 largest US designated market areas, resulting in a final sample size for analysis of 122,340. Associations between state-sponsored anti-tobacco televised advertising exposure and youth smoking-related beliefs and behaviours were modelled while controlling for relevant individual and environmental factors as well as other televised tobacco-related advertising. Results. Higher potential for exposure to state anti-tobacco advertising within the previous four months was generally associated with decreasing odds of current smoking across groups. In addition, such exposure was related, to varying degrees, with decreased perceptions that most/all friends smoked, stronger five-year intentions not to smoke, and increased perceived harm of smoking. These relationships appeared possibly to be weaker for Asian students. Conclusions. The results from these analyses indicate that state anti-tobacco advertising significantly relates to beneficial outcomes - especially regarding current smoking behaviour - among US youth as a whole. [ABSTRACT FROM AUTHOR]

This paper explores adolescent preferences for the setting, timing, delivery format, provider and key elements of tobacco control programmes. The need for programme sensitivity towards urban/rural, gender and ethnic subgroups is also discussed. Schools were purpo- sively selected from the Southern Cape-Karoo Region, South Africa. Twelve prevention and nine cessation focus group discussions were conducted with Grade 6-8 students and Grade 8-9 smokers and ex-smokers, respectively. Adolescents reported similar preferences for prevention and cessation programmes. Although they were unaware of smoking prevention or cessation programmes, they reported a willingness to participate in such programmes. Programmes should include school-based activities that are supported by out-of-school activities held over weekends and holidays. Non-judgemental and empathetic teachers and peers, as well as ex-smokers were preferred as programme providers. School-based participatory delivery formats should be supported by community- based mass media approaches. Programmes can be jointly presented to boys and girls of diverse ethnic backgrounds with some gender- sensitive sessions. Programme participation and sustainability would be enhanced if it were exciting, fun filled and integrated into their daily lives. School-based programmes must be embedded within comprehensive approaches that involve community- and policy-level interventions. [ABSTRACT FROM AUTHOR]

The purpose was 2-fold: first to analyse how compliance with the minimum-age law of 18 for the purchase of tobacco has changed over time, second to determine what factors affect the possibility for adolescents to buy cigarettes. Three series (1996, 1999 and 2002) of test purchases of tobacco were conducted in three regions of Sweden. Altogether, 36 test purchasers carried out 1867 test purchases. In 1996, 93% of all attempted purchases resulted in the purchase of cigarettes. The corresponding figures for 1999 were 80% and for 2002 63%. The results indicate significant regional differences in the test purchasers' opportunities to buy cigarettes. This paper demonstrates that compliance with the minimum-age law has had an effect on the ease with which adolescents purchase cigarettes, and further that such purchase has become more difficult. The study also indicates great potential for local efforts to induce more retailers to comply with the law. [ABSTRACT FROM AUTHOR]

It is increasingly argued that the effectiveness of health promotion interventions should be measured to inform policy and practice. The randomized controlled trial (RCT) continues to be regarded as the 'gold standard' of health services research but health promotion practitioners have raised concerns about the RCT's appropriateness for evaluating their work. A preferred model is currently the pragmatic trial, measuring effectiveness under 'routine' conditions, incorporating a process evaluation to examine context, implementation and receipt. This model was chosen by A Stop Smoking in Schools Trial (ASSIST) to evaluate an intervention in which influential Year 8 students (12-13 years old) were trained to encourage non-smoking behaviour through informal conversations with their peers. Outcome data show that the intervention was effective in reducing smoking levels in intervention schools compared with control schools. In this paper we describe the extensive process evaluation embedded within the trial and, rather than focusing on resultant data, we consider the potential for such detailed examination of process to affect the intervention's delivery, receipt and outcome evaluation. We describe how some acknowledged challenges were addressed within ASSIST, which have relevance for future similar trials: Hawthorne effects, overlapping roles within the team and distinguishing between the intervention and its evaluation. [ABSTRACT FROM AUTHOR]

The UK Department of Health required that by April 2001, all NHS bodies would have implemented a smoking policy. It has been suggested that the best demonstration a hospital can make of its commitment to health is to ban smoking on its premises. This paper reports on an evaluation of the effectiveness of a non-smoking policy in a newly opened NHS psychiatric hospital. Questionnaires were sent to all 156 nursing staff in a psychiatric hospital to assess the effectiveness of the policy in terms of staff smoking behaviour, attitudes to the restriction and compliance with the policy. Of the 156 questionnaires distributed, 92 (58%) were returned; smokers, former smokers and those who have never smoked were quite evenly represented at 34.78%, 34.78% and 30.43%, respectively. Of eight critical success factors for the policy, only one, staff not smoking in Trust public areas, had been achieved. A non-smoking policy was generally accepted as necessary by nursing staff working in a mental health setting. Staff felt that the policy was not effective in motivating smoking nurses to stop and that insufficient support was given to these nurses. The study highlights the importance of introducing staff support systems as an integral part of smoking policies and the role of counterintuitive behaviour in the effectiveness of smoking policy introduction in healthcare settings. [ABSTRACT FROM AUTHOR]

Utilizing published ratings of state-level antismoking laws, this paper addresses the merits of limits to smoking in public places and restrictions on youth access to tobacco. Consistent with the literature, we find that clean indoor-air laws reduce demand. However, by failing to address supply considerations, the literature to date presents a biased reaction of consumption to anti- smoking laws. Indeed, we find that clean indoor-air laws also intensify competition, which suggests that producers mitigate demand reductions by lowering price. Nonetheless, restrictions to youth access, as well as enforcement and penalty efforts, have little impact on cigarette consumption across states. [ABSTRACT FROM AUTHOR]

Despite more than 30 years of public health programs to reduce tobacco use, smoking is still the leading preventable cause of death in the United States. In response to this continuing epidemic, voters in California (1988), Massachusetts (1992), Arizona (1994), and Oregon (19%) approved ballot initiatives that established state- wide tobacco control programs funded by cigarette excise tax revenues. Evaluating these innovative public health interventions is important, both to improve existing programs and to guide other states in developing and implementing similar interventions. In this paper we describe the methods being used to evaluate the statewide anti-tobacco campaigns in California and Massachusetts, and review the findings of process and outcome evaluations of both programs. Our review suggests that both programs have had a substantial impact on the public `s health by reducing cigarette consumption and stimulating the development of policies to reduce environmental tobacco smoke exposure. However, it does not appear that either program has reduced smoking initiation among adolescents. Our evaluation suggests three problems in pm gram implementation that future anti-tobacco campaigns must avoid in order to produce long-term, sustained effects: (1) the gradual erosion of program funding by the state legislatures and governors; (2) the lack of a consistent, supportive constituency within state government and (3) inconsistency in campaign themes, messages, and programs. We conclude by offering recommendations to correct these problems so that state- wide cigarette-tax -funded anti-tobacco campaigns can realize their potential to become one of the most effective public health interventions available. [ABSTRACT FROM AUTHOR]

Abstract: The tobacco industry has lobbied successfully to obtain the support of the United States government for opening Asian Markets to American tobacco products. This paper comments on two issues arising from these efforts: the development of an atmosphere of invasion and resistance to invasion in Asia; and the change in the image of the United States in Asian nations from that of a leader in health to that of an exporter of death. The threat of sanctions and the effects of the open market and United States tobacco company advertising in Japan, Taiwan, and South Korea are noted. Parallels are drawn between the opium wars a century and a half ago in China and the current threat of trade sanctions. Reacting to American policy, an Asia-Pacific Association for Control of Tobacco has been formed and linked with the US Coalition Against Smoking. (Am J Public Health 1990;80:659-662.) [ABSTRACT FROM AUTHOR]

This paper is a review of published reports, in English, of educational programs designed to change smoking behavior. Attempts to change the smoking behavior of young people have included anti-smoking campaigns, youth-to-youth programs, and a variety of message themes and teaching methods. Instruction has been presented both by teachers who were committed or persuasive and by teachers who were neutral or presented both sides of the issue. Didactic teaching, group discussion, individual study, peer instruction, and mass media have been employed. Health effects of smoking, both short- and long-term effects, have been emphasized. Most methods used with youth have shown little success. Studies of other methods have produced contradictory results. Educational programs for adults have included large scale anti-smoking campaigns, smoking cessation clinics, and a variety of more specific withdrawal methods. These methods have included individual counseling, emotional role playing, aversive conditioning, desensitization, and specific techniques to reduce the likelihood that smoking will occur in situations previously associated with smoking. Some of these techniques have produced poor results while studies of other methods have shown inconsistent results. The two methods showing the most promise are individual counseling and smoking withdrawal clinics. [ABSTRACT FROM AUTHOR]

Objectives. Question 1 raised the Massachusetts state tobacco tax to fund tobacco education programs. This paper examines the process of qualifying and passing Question 1. Methods. Information was gathered from internal memoranda, meeting minutes, newspaper articles, internal documents, letters, newsletters, news and press releases, and personal interviews. Data about campaign contributions were obtained from the Massachusetts Office of Campaign and Political Finance. Results. Three factors help explain why Question 1 passed: (1) the policy environment was favorable because of the social unacceptability of smoking; (2) the activists assembled a large coalition of supporters; and (3) the activists countered industry claims that the new tax would hurt small business and lower-income smokers and would be wasted by the legislature. The ballot initiative passed despite the industry's $7 million campaign to defeat it. Conclusions. The apparent influence of the tobacco industry on the legislature was the driving force behind the decision of public health activists to qualify Question 1. Moving policy-making out of the legislature into the public arena widened the scope of conflict and enabled public health activists to win. [ABSTRACT FROM AUTHOR]

Florida's "truth" counter-marketing campaign was one of the most successful anti-smoking campaigns of all time thanks to its edgy industry attacking messages, use of Florida teens in all phases of the campaign, and noteworthy reduction in teen smoking rates. The purpose of this paper is to examine some of the unique facets of the campaign and uncover some previously unpublished findings related to campaign effectiveness. The importance of campaign inclusiveness, use of mass media, brand name recognition, and a resonating big idea are examined. Lessons and implications for future anti-smoking campaigns are discussed. [ABSTRACT FROM AUTHOR]

Public health policy often involves implementing cost-efficient, large-scale interventions. When mandating or forbidding a specific behaviour is not permissible, public health professionals may draw on behaviour change interventions to achieve socially beneficial policy objectives. Interventions can have two main effects: (i) a direct effect on people initially targeted by the intervention; and (ii) an indirect effect mediated by social influence and by the observation of other people's behaviour. However, people's attitudes and beliefs can differ markedly throughout the population, with the result that these two effects can interact to produce unexpected, unhelpful and counterintuitive consequences. Public health professionals need to understand this interaction better. This paper illustrates the key principles of this interaction by examining two important areas of public health policy: tobacco smoking and vaccination. The example of antismoking campaigns shows when and how public health professionals can amplify the effects of a behaviour change intervention by taking advantage of the indirect pathway. The example of vaccination campaigns illustrates how underlying incentive structures, particularly anticoordination incentives, can interfere with the indirect effect of an intervention and stall efforts to scale up its implementation. Recommendations are presented on how public health professionals can maximize the total effect of behaviour change interventions in heterogeneous populations based on these concepts and examples. Les politiques de sante publique impliquent souvent I'organisation de campagnes rentables a grande echelle. Lorsqu'il est impossible d'imposer ou d'interdire certains comportements, les professionnels de la sante publique ont parfois recours a des actions induisant un changement de comportement afin d'atteindre des objectifs benefiques pour la societe. Ces actions sont susceptibles d'entrainer deux effets: (i) un effet direct sur les personnes initialement visees par la campagne; et (ii) un effet indirect provoque par la pression sociale et l'observation du comportement d'autres personnes. Neanmoins, les attitudes et croyances peuvent considerablement varier au sein de la population; ainsi, ces deux effets peuvent interagir et avoir des consequences imprevues, inefficaces et contre-intuitives. Les professionnels de la sante publique ont besoin de mieux comprendre cette interaction. Le present document en illustre donc les principes majeurs en examinant deux domaines cles des politiques de sante publique: le tabagisme et la vaccination. Lexemple des campagnes antitabac montre quand et comment les acteurs de la sante publique peuvent accentuer l'impact d'une action destinee a faire evoluer les comportements en optant pour l'approche indirecte. L'exemple des campagnes de vaccination met en lumiere la maniere dont les structures d'incitation sous-jacentes, en particulier celles favorisant l'anticoordination, peuvent interferer avec l'effet indirect d'une action et aneantir les efforts deployes pour la mettre en reuvre. Plusieurs recommandations sont formulees afin d'aider les professionnels de la sante publique a amplifier l'effet global des actions de changement comportemental au sein d'une population heterogene, en s'appuyant sur ces concepts et exemples. La politica de salud publica suele incluir la aplicacion de intervenciones rentables y a gran escala. Cuando no es posible imponer o prohibir un comportamiento especifico, los profesionales de la salud publica pueden recurrir a intervenciones de cambio de comportamiento para lograr objetivos politicos que sean favorables para la sociedad. Es posible que las intervenciones generen dos efectos principales: i) un efecto directo sobre las personas a las que en principio se dirige la intervention; y ii) un efecto indirecto mediado por la influencia social y por la observation del comportamiento de otras personas. Sin embargo, las actitudes y creencias de las personas pueden ser muy diferentes en toda la poblacion, por lo que estos dos efectos pueden interactuar y producir consecuencias inesperadas, poco utiles y contraproducentes. Los profesionales de la salud publica deben comprender mejor esta interaccion. Este documento explica los principios clave de esta interaccion al analizar dos areas importantes de la politica de salud publica: el tabaquismo y la vacunacion. El ejemplo de las campanas antitabaco muestra cuando y como los profesionales de la salud publica pueden aumentar los efectos de una intervention de cambio de comportamiento si se aprovecha el procedimiento indirecto. El ejemplo de las campanas de vacunacion explica como las estructuras subyacentes de incentivos, en particular los incentivos de descoordinacion, pueden interferir con el efecto indirecto de una intervention y detener los esfuerzos para ampliar su aplicacion. A partir de estos conceptos y ejemplos, se formulan recomendaciones sobre como los profesionales de la salud publica pueden maximizar el efecto total de las intervenciones de cambio de comportamiento en poblaciones heterogeneas., Introduction Public health policy objectives often conflict with local culture. (1-3) Thus, to avoid a backlash when trying to change people's behaviour, policy-makers may often resist policies that forbid or [...]

Objectives. This paper reexamines the work of Meier and Licari in a previous issue of the Journal. Methods. The impact of excise taxes on cigarette consumption and sales was measured via standard regression analysis. Results. The 1983 federal tax increase is shown to have an anomalous effect on the regression results. When those data are excluded, there is no significant difference between state and federal tax increases. Further investigation suggests that firms raised cigarette prices substantially in the years surrounding the 1983 federal tax increase, which accounts for the relatively large decrease in consumption during this period. Conclusions. Federal excise taxes per se do not appear to be more effective than state excise taxes in terms of reducing cigarette consumption. The reaction of cigarette firms to government policies appears to be an important determinant of the success of antismoking initiatives. [ABSTRACT FROM AUTHOR]