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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]

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]

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]

Objective: This study assessed whether dramatic funding reductions to the Florida Tobacco Control Program (FOP) influenced trends in recall of the Florida "truth" anti-smoking media campaign, anti-industry attitudes and non-smoking intentions among Florida teens. Methods: We used an interrupted time series technique to test for differences in the rates of change in Florida "truth" recall, anti-industry beliefs and non-smoking intentions before and after the FTCP budget cuts using the Florida Anti-tobacco Media Evaluation (FAME) survey, a repeated cross-sectional telephone survey of Florida teens. Results: Recall of the Florida "truth" anti-smoking campaign, anti-industry attitudes, and non-smoking intentions increased dramatically between April 1998 and May 1999. Florida "truth" recall declined after FTCP budget cuts in June 1999. Anti-industry beliefs and nonsmoking intentions plateaued or began to decline after the budget cuts. The launch of the national "truth" campaign in February 2000 may have offset otherwise deleterious effects of the budget cuts on anti-industry beliefs, but not smoking intentions. Conclusion: Reductions in tobacco control funding have immediate effects on programme exposure and cognitive precursors to smoking initiation. There is a critical need to maintain and enhance funding for state tobacco control programmes to continue nationwide progress in preventing youth from initiating cigarette smoking. [ABSTRACT FROM AUTHOR]

A dynamic oligopoly model of the cigarette industry is developed to study the effects of anti-smoking policies on the market structure of the U.S. cigarette industry. Firms are modeled as competing in price and advertising in a dynamic game. Two commonly used anti-smoking policies – advertising restrictions and tobacco tax increases – are evaluated using calibrated parameters. The simulation results show that in the long run both advertising restrictions and tax increases can successfully reduce the smoking rate. However, advertising restrictions reduce the smoking rate mainly in an indirect way through their impact on the concentration of the market, while tax increases reduce the smoking rate directly and have little effect on the concentration of the market. In addition, in the short run, advertising restrictions have a much smaller effect on reducing the smoking rate than tax increases. [ABSTRACT FROM AUTHOR]

Objectives: To examine the phenomenon of non-smokers spontaneously taking action to seek help for smokers; to provide profiles of non-smoking helpers by language and ethnic groups. Selling A large, statewide tobacco quitline (California Smokers Helpline) in operation since 1992 in California, providing free cessation services in English, Spanish, Mandarin, Cantonese, Korean, and Vietnamese. Subjects: Callers between August 1992 and September 2005 who identified themselves as either white, black, Hispanic, American Indian, or Asian (n = 349 110). A subset of these were "proxies": callers seeking help for someone else. For more detailed analysis, n = 2143 non-smoking proxies calling from October 2004 through September 2005. Main outcome measures: Proportions of proxies among all callers in each of seven language/ethnic groups; demographics of proxies; and proxies' relationships to smokers on whose behalf they called. Results: Over 22 000 non-smoking proxies called. Proportions differed dramatically across language/ ethnic groups, from mean (±95% confidence interval) 2.7 (0.3)% among English-speaking American Indians through 9.3 (0.3)% among English-speaking Hispanics to 35.3 (0.7)% among Asian-speaking Asians. Beyond the differences in proportion, however, remarkable similarities emerged across all groups. Proxies were primarily women (79.2 (1.7)%), living in the same household as the smokers (65.0 (2.1)%), and having either explicit or implicit understandings with the smokers that calling on their behalf was acceptable (90.0 (1.3)%). Conclusions: The willingness of non-smokers to seek help for smokers holds promise for tobacco cessation and may help address ethnic and language disparities. Non-smoking women in smokers' households may be the first group to target. [ABSTRACT FROM AUTHOR]

How, if at all, do public policies influence the opinions of ordi-nary citizens? Using the longitudinal variation in the passage of state smok-ing bans in restaurants, I consider how policies influence views toward target populations, educate the public about what is good/bad, safe/danger-ous, right/wrong, and so forth, and affect support for future policy inter-ventions. I find that people view smokers with more antipathy and believe that secondhand smoke is more harmful post-enactment of smoking bans. Length of exposure matters for support of future policy interventions: peo-ple exposed to smoking bans for long periods of time are more supportive of additional smoking restrictions in public places. The theoretical frame-work offered here can be used to evaluate how other policies, particularly those that are tangible to a majority of citizens, influence public opinion. [ABSTRACT FROM AUTHOR]

Understanding the mechanisms that construct and maintain the taken-for-granted, “common sense” understandings of everyday life is an essential prerequisite for reconfiguring conditions in more progressive directions. Highlighting particular moments, when these processes can be made visible, and drawing appropriate insights from such interrogations is useful not only for illuminating the fundamental malleability of “common sense” (itself a crucial element of change), but also for providing suggestive strategies and tactics for effectuating change. Here the construction and reconstruction of the “common sense” around tobacco is offered as an instructive case. [ABSTRACT FROM AUTHOR]

This study examines the ethical dimensions of public health communication, with a focus on antismoking public service announcements (PSAs). The content analysis of 826 television ads from the U.S. Centers for Disease Control and Prevention's (CDC) Media Campaign Resource Center is an empirical testing of Baker and Martinson's (2001) TARES Test that directly examines persuasive messages for truthfulness, authenticity, respect, equity, and social responsibility. In general, the antismoking ads score highly on ethicality. There are significant relationships between ethicality and message attributes (thematic frame, emotion appeal, source, and target audience). Ads that portrayed smoking as damaging to health and socially unacceptable score lower in ethicality than ads that focus on tobacco industry manipulation, addiction, dangers of secondhand smoke, and cessation. Emotion appeals of anger and sadness are associated with higher ethicality than shame and humor appeals. Ads targeting teen/youth audiences score lower on ethicality than ads targeting adult and general audiences. There are significant differences in ethicality based on source; ads produced by the CDC rate higher in ethicality than other sources. Theoretical implications and practical recommendations are discussed. [ABSTRACT FROM AUTHOR]

The authors comment on the use of Nazi rhetoric in attacking tobacco control advocacy. A 1967 article by Tiderock Corp. president compared non-smokers and tobacco control measures to German chancellor Adolf Hitler and the Nazi regulations. The industry defeated efforts to pass laws requiring non-smoking sections by popular vote in 1978 and 1980 in the U.S. The authors argue that the use of health fascism rhetoric can be considered as part of an institutionalised practice to discredit tobacco control activities.

Increased awareness of the dangers of cigarettes has failed to prevent millions of Americans from continuing to smoke. Thus, policy makers should consider viable options to reduce the harmful effects of smoking. Among the proposed options is increasing public awareness of the relative health risk of smokeless tobacco in comparison with cigarettes. Compelling scientific evidence indicates that smokeless tobacco is considerably less harmful than cigarettes. Therefore, innovative approaches to nicotine replacement, such as smokeless tobacco, may provide an effective means of reducing the overall harm associated with smoking and ultimately may reduce smoking prevalence in the United States. The underlying principle of harm reduction is that a product that has adverse health consequences is promoted as a substitute for one that has more severe adverse health consequences. As a result, the authors review the relevant literature and put forth a research agenda to advance this notion of tobacco harm reduction. The policy debate would be enhanced by evidence of the constructs and relationships outlined in the proposed model. Specifically, the authors discuss five particular areas of needed research. [ABSTRACT FROM AUTHOR]

This study developed inoculation-driven antismoking interventions aimed at changing attitudes, norms and intentions about smoking to influence smoking behavior in adolescents. This study explored the efficacy of 2 intervention approaches designed to help adolescents to refrain from smoking initiation. Participants were junior high students (6th, 7th, and 8th grade) from schools in the Northeast. Two kinds of experimental workshops and a control group were designed as stimulus material in a repeated measure nonequivalent group experimental design. The 2 intervention workshops developed included: analysis + analysis (where participants discussed and analyzed cigarette and antismoking ads) and analysis + production (where participants discussed, analyzed, and then created their own antismoking ads). The analysis + production workshop was generally more successful than the analysis + analysis workshop and control group in changing participants' behavioral intention to smoke and attitude toward smoking but not subjective norms over time. Implications and directions for future research are discussed. [ABSTRACT FROM AUTHOR]

The objectives of this study included the following: obtaining qualitative information on tobacco use among Cambodian Americans, identifying cultural factors that influence tobacco use and acquiring information for the development of effective smoking prevention and cessation strategies. Data were collected by using demographic and behavioral questionnaires and focus group interviews. A total of 14 focus group interviews that covered cultural practices associated with smoking were administered. Statistical analyses included univariate frequency distributions and cross-tabulations. The subjects in = 119) were Cambodian American volunteers who participated in social services programs offered by a community service organization. All subjects were 18 years of age or older and resided in the city of Long Beach. The principal outcomes measured were cigarette smoking and tobacco use. Other variables included reasons for smoking, traditional uses of tobacco, stress factors related to smoking and the perceived health effects of smoking. Predisposing, reinforcing and enabling factors associated with tobacco-use behaviors included peer group influences, smoking adopted as a coping method, tobacco Used for medicinal purposes and smoking practiced within cultural traditions. The frequency of smoking was four times higher among males than among females. Smokers (n = 29) in comparison with non-smokers (n = 90) tended to be men (79% versus 33%), not married (68% versus 49%) and unemployed (79% versus 54%), and had attained somewhat lower levels of education. The role of cultural factors needs to be considered when designing appropriate smoking cessation strategies for Cambodian Americans. [ABSTRACT FROM AUTHOR]

Aims To describe and compare the extent of exposure among youth and adults to antitobacco advertising funded by tobacco control agencies, and to smoking-related advertising from tobacco and pharmaceutical companies. Design Archival records of television advertising exposures from Nielsen Media Research for the largest 75 media markets in the United States from 1999 to 2003. Measurements Mean monthly advertising exposures for households with televisions and adolescents aged 12–17 years for: state tobacco control programs; the national American Legacy Foundation (Legacy) program; tobacco company advertising for youth smoking prevention, parent advertising and corporate image; pharmaceutical company advertising for nicotine replacement therapy and Zyban®; and other miscellaneous tobacco-related advertising. Findings Combined tobacco company youth/parent advertising exposures matched those for combined State/Legacy campaigns (4.56 advertisements/month versus 4.97 advertisements/month among households; 3.05 advertisements/month versus 3.38 advertisements/month among adolescents). Tobacco company corporate image advertising averaged 3.25 advertisements/month among households and 0.73 advertisements/month among adolescents. Tobacco company advertising exceeded public health-sponsored advertising by a factor of 1.57–1, and among youth by 1.11–1. Pharmaceutical companies were the largest sponsor of tobacco-related advertising for households (10.37 advertisements/month) and provided significant exposure among adolescents (2.61 advertisements/month). Conclusions This is the first study to demonstrate systematically that public health-sponsored antitobacco campaigns in the United States are matched or exceeded by tobacco company advertising, as well as pharmaceutical cessation product advertising. Research is needed to determine whether such advertising may dilute or undermine the established benefits of tobacco control-sponsored campaigns. [ABSTRACT FROM AUTHOR]

Objectives. In early 2000, the American Legacy Foundation launched the national "truth" campaign, the first national antismoking campaign to discourage tobacco use among youths. We studied the impact of the campaign on national smoking rates among US youths (students in grades 8, 10, and 12). Methods. We used data from the Monitoring the Future survey in a pre/post quasi-experimental design to relate trends in youth smoking prevalence to varied doses of the "truth" campaign in a national sample of approximately 50000 students in grades 8, 10, and 12, surveyed each spring from 1997 through 2002. Results. Findings indicate that the campaign accounted for a significant portion of the recent decline in youth smoking prevalence. We found that smoking prevalence among all students declined from 25.3% to 18.0% between 1999 and 2002 and that the campaign accounted for approximately 22% of this decline. Conclusions. This study showed that the campaign was associated with substantial declines in youth smoking and has accelerated recent declines in youth smoking prevalence. (Am J Public Health. 2005;95:425-431.). [ABSTRACT FROM AUTHOR]

Background: The Framework Convention on Tobacco Control includes tobacco advertising restrictions that are strongly opposed by the tobacco industry. Marketing strategies used by transnational tobacco companies to open the Japanese market in the absence of such restrictions are described. Methods: Analysis of internal company documents. Findings: Between 1982 and 1987 transnational tobacco companies influenced the Japanese government through the US Trade Representative to open distribution networks and eliminate advertising restrictions. US cigarette exports to Japan increased 10-fold between 1985 and 1996. Television advertising was central to opening the market by protecting a popular image (despite a small actual market share) to attract existing smokers, combined with hero-centred advertisements to attract new smokers. Philip Morris's campaigns featured Hollywood movie personalities popular with young men, including James Coburn, Pierce Brosnan, Roger Moore, and Charlie Sheen. Event sponsorships allowed television access despite restrictions. When reinstatement of television restrictions was threatened in the late 1980s, Philip Morris more than doubled its television advertising budget and increased sponsorship of televised events. By adopting voluntary advertising standards, transnational companies delayed a television advertising ban for over a decade. Conclusions: Television image advertising was important to establish a market, and it has been enhanced using Hollywood personalities. Television advertising bans are essential measures to prevent industry penetration of new markets, and are less effective without concurrent limits on sponsorship and promotion. Comprehensive advertising restrictions, as included in the Framework Convention for Tobacco Control, are vital for countries where transnational tobacco companies have yet to penetrate the market. [ABSTRACT FROM AUTHOR]

Objective: To help close the gap between health promotion research and practice by using systems thinking. Methods: We reviewed 3 national US tobacco control initiatives and a project (ISIS) that had introduced systems thinking to tobacco control, speculating on ways in which systems thinking may add value to health promotion dissemination and implementation in general. Results: The diversity of disciplines involved in tobacco control have created disconnection in the field; systems thinking is necessary to increase the impact of strategies. Conclusion: Systems thinking has potential to improve synthesis, translation, and dissemination of research findings in other health promotion initiatives. [ABSTRACT FROM AUTHOR]

Background: Minnesota was the first state in the USA to implement a large state funded tobacco control programma (in 1985). Despite evidence of effectiveness, it was dismantled in 1993. Objective: To describe and analyze how and why these events transpired and identify lessons for tobacco control advocates facing similar challenges in the 21st century. Design: Case study based on previously secret tobacco industry documents, news reports, research reports, official documents, and interviews with health advocates and state government officials. Results: Unable to defeat funding for this campaign in 1985, the tobacco industry organized groups which eliminated it later. Despite the programma's documented effectiveness, it was dismantled based on claims of fiscal crisis. These claims were not true; the real debate was what to do with the state's surplus. Health advocates failed to challenge the claim of fiscal crisis or mobilize public support for the programma. Conclusions: Simply quoting evidence that a tobacco control programma is effective does not ensure its continuing survival. Claims of fiscal crisis are an effective cover for tobacco industry efforts to dismantle successful programmes, particularly if health advocates accept these claims and fail to mobilize political pressure to defend the programma. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To identify, from policy makers' perspectives, strategies that enhance tobacco control advocates' effectiveness in the regulatory arena. DESIGN: Key informant interview component of a comparative case study of regulatory agencies in the USA. SUBJECTS: Policy makers involved in the development of four regulatory tobacco control policies (three state and one federal). METHODS: Interviews of policy makers, field notes, and deliberation minutes were coded inductively. RESULTS: Policy makers considered both written commentary and public testimony when developing tobacco control regulations. They triaged written commentary based upon whether the document was from a peer reviewed journal, a summary of research evidence, or from a source considered credible. They coped with in-person testimony by avoiding being diverted from the scientific evidence, and by assessing the presenters' credibility. Policy makers suggested that tobacco control advocates should: present science in a format that is well organised and easily absorbed; engage scientific experts to participate in the regulatory process; and lobby to support the tobacco control efforts of the regulatory agency. CONCLUSIONS: There is an important role for tobacco control advocates in the policy development process in regulatory agencies. [ABSTRACT FROM AUTHOR]

Examines the twenty-two-year history of cigarette advertising on television in the United States. Messages conveyed by cigarette commercials; Use of competitive campaigns to increase product sales; Emergence of antismoking public service announcements; Impact of the television ban on the shift to other advertisement media.

In the absence of the antismoking campaign, adult per capita cigarette consumption in 1987 would have been an estimated 79-89 percent higher than the level actually experienced. The smoking prevalence of all birth cohorts of men and women born during this century is well below that which would have been expected in the absence of the campaign. As a consequence, in 1985 an estimated 56 million Americans were smokers; without the campaign, an estimated 91 million would have been smokers. As a result of campaign-induced decisions not to smoke, between 1964 and 1985 an estimated 789,200 Americans avoided or postponed smoking-related deaths and gained an average of 21 additional years of life expectancy each; collectively this represents more than 16 million person-years of additional life. The greatest health benefit lies in the future, however, as younger individuals reach the ages at which smoking claims its greatest toll, and as middle-aged former smokers realize relative reductions in smoking mortality risks as a result of long-term abstinence from smoking. For example, campaign-induced decisions not to smoke made prior to 1986 will result in the postponement or avoidance of an estimated 2.1 million smoking-related deaths between 1986 and the year 2000. [ABSTRACT FROM AUTHOR]

Three methodologic issues (definitions of smoking. period of follow-up, composition of study group) were assessed in 426 persons five years after participation in a stop smoking program of a prepaid medical plan. When smoking was defined by measurement interval or by type or amount of tobacco smoked, smoking rates varied only slightly. Little information was gained by extending the follow-up period beyond the first year. However, study group composition (as defined by attendance at program sessions) had a pronounced effect on smoking rates, Those who attended fewer sessions were more likely to smoke during the follow-up period. (Am J Public Health 1985; 75:634-638.) [ABSTRACT FROM AUTHOR]

The article evaluates the impact of a targeted anti-smoking media campaign. The target group for the campaign was women cigarette smokers with young children. It has been found that smoking rates have remained relatively stable among younger adult women whereas smoking rates have declined steadily for males and older females. A post-test only control group design has been utilized in the article. A mix of professionally produced broadcast and print materials encouraging smokers to telephone the Cancer Information Service (CIS), a toll-free hot-line service of the National Cancer Institute and its CIS-affiliated offices located throughout the U.S., for information on quitting has been utilized in the campaign. Anti-smoking campaign was successful in increasing the number of smokers calling CIS for information on quitting.

The article comments on the unprecedented policy on youth-oriented tobacco marketing implemented by the U.S. Food and Drug Administration. In the U.S., tobacco taxes were raised by voters. They also allocated revenues to anti-smoking media campaigns. There are 40 states that have filed legal actions against the tobacco industry for health hazards. In the cities, public smoking are mostly prohibited. Despite increasing citizen concerns, tobacco companies found ways to earn more profits. Children's smoking has risen annually since the early 1990s. The U.S. Congress is torn between the amount of taxes remitted by tobacco companies and caring for the public's health.

The article focuses on the modification of health education in high school in the U.S. The modification in health education is intended to eliminate the number of cigarette smokers in high school. The modification process can be done through an anti-smoking program that is included in the traditional science curriculum. The anti-smoking program will assess the attitude modification under the following categories: health, peer pressure, and social image as related to smoking. The study reveals that attitudes of students are modifiable in the desired direction although there are small changes. The study indicates gender differences which suggests that there are greater number of male smokers compared to female.