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Guided by the extended parallel process model (EPPM) and reactance theory, this study examined the relationship between efficacy beliefs, reactance, and adult smokers' responses to pictorial health warning labels (HWL) on cigarette packaging, including whether efficacy beliefs or reactance modify the relationship between HWL responses and subsequent smoking cessation behavior. Four waves of data were analyzed from prospective cohorts of smokers in Australia and Canada (n=7,120 observations) over a period of time after implementation of more prominent, pictorial HWLs. Three types of HWL responses were studied: psychological threat responses (i.e., thinking about risks from smoking), forgoing cigarettes due to HWLs, and avoiding HWLs. The results from Generalized Estimating Equation models indicated that stronger efficacy beliefs and lower trait reactance were significantly associated with greater psychological threat responses to HWLs. Similar results were found for models predicting forgoing behavior, although response efficacy was inversely associated with it. Only response efficacy was significantly associated with avoiding HWLs, showing a positive relationship. Higher self-efficacy and stronger responses to HWLs, no matter the type, were associated with attempting to quit in the follow-up period; reactance was unassociated. No statistically significant interactions were found. These results suggest that stronger efficacy beliefs and lower trait reactance are associated with some stronger responses to fear-arousing HWL responses; however, these HWL responses appear no less likely to lead to cessation attempts among smokers with different levels of self-efficacy to quit, of response efficacy beliefs, or of trait reactance against attempts to control their behavior.

This study uses longitudinal data from the International Tobacco Control Southeast Asia (ITC-SEA Thailand) survey to explore patterns and predictors of successful quitting among Thai adult smokers as a function of time quit. A cohort of a representative sample of 2000 smokers was surveyed four times from 2005 to 2009. A sample of 1533 individuals provided data for at least one of the reported analyses. Over the four years of follow-up, 97% made attempts to quit. Outcomes were successful quitting/relapse: (a) quit attempts of at least one month (short-term relapse, 43%) (57% remaining quit); (b) surviving at least six months (medium-term) (31%); (c) relapse between one and six months (45%); (d) having continuously quit between Waves 3 and 4 (sustained abstinence) (14%); and (e) relapse from six months on (44%) compared to those who continuously quit between Waves 3 and 4 (56%). Predictors for early relapse (<1 month) differ from longer-term relapse. Age was associated with reduced relapse over all three periods, and was much stronger for longer periods of abstinence. Cigarette consumption predicted relapse for short and medium terms. Self-assessed addiction was predictive of early relapse, but reversed to predict abstinence beyond six months. Previous quit history of more than one week was predictive of early abstinence, but became unrelated subsequently. Self-efficacy was strongly predictive of abstinence in the first month but was associated with relapse thereafter. Some determinants of relapse change with time quit, but this may be in somewhat different to patterns found in the West.

INTRODUCTION: In this study, we aimed to examine, in Thailand, the impact on smokers' reported awareness of and their cognitive and behavioral reactions following the change from text-only to pictorial warnings printed on cigarette packs. We also sought to explore differences by type of cigarette smoked (roll-your-own [RYO] vs. factory-made [FM] cigarettes). METHODS: Data came from the International Tobacco Control Southeast Asia Survey, conducted in Thailand and Malaysia, where a representative sample of 2,000 adult smokers from each country were recruited and followed up. We analyzed data from one wave before (Wave 1) and two waves after the implementation of the new pictorial warnings (two sets introduced at Waves 2 and 3, respectively) in Thailand, with Malaysia, having text-only warnings, serving as a control. RESULTS: Following the warning label change in Thailand, smokers' reported awareness and their cognitive and behavioral reactions increased markedly, with the cognitive and behavioral effects sustained at the next follow-up. By contrast, no significant change was observed in Malaysia over the same period. Compared to smokers who smoke any FM cigarettes, smokers of only RYO cigarettes reported a lower salience but greater cognitive reactions to the new pictorial warnings. CONCLUSIONS: The new Thai pictorial health warning labels have led to a greater impact than the text-only warning labels, and refreshing the pictorial images may have helped sustain effects. This finding provides strong support for introducing pictorial warning labels in low- and middle-income countries, where the benefits may be even greater, given the lower literacy rates and generally lower levels of readily available health information on the risks of smoking.

OBJECTIVE: To determine the prevalence, correlates and changes in secondhand smoke (SHS) exposure over the period after comprehensive smoke-free policy implementation in two Latin American countries. METHODS: Data were analysed from population-based representative samples of adult smokers and recent quitters from the 2008 and 2010 waves of the International Tobacco Control Policy Evaluation Survey in Mexico (n = 1766 and 1840, respectively) and Uruguay (n = 1379 and 1411, respectively). Prevalence of SHS exposure was estimated for regulated venues, and generalized estimating equations were used to determine correlates of SHS exposure. RESULTS: Workplace SHS exposure in the last month was similar within and across countries (range: Mexico 20-25%; Uruguay 14-29%). At the most recent restaurant visit, SHS exposure was lower where comprehensive smoke-free policies were implemented (range: Uruguay 6-9%; Mexico City 5-7%) compared with Mexican cities with weaker policies, where exposure remained higher but decreased over time (32-17%). At the most recent bar visit, SHS exposure was common (range: Uruguay 8-36%; Mexico City 23-31%), although highest in jurisdictions with weaker policies (range in other Mexican cities: 74-86%). In Uruguay, males were more likely than females to be exposed to SHS across venues, as were younger compared with older smokers in Mexico. CONCLUSIONS: Comprehensive smoke-free policies are more effective than weaker policies, although compliance in Mexico and Uruguay is not as high as desired.

Background: Although on the decline, smoking-related fires remain a leading cause of fire death in the United States and United Kingdom and account for over 10% of fire-related deaths worldwide. This has prompted lawmakers to enact legislation requiring manufacturers to implement reduced ignition propensity (RIP) safety standards for cigarettes. The current research evaluates how implementation of RIP safety standards in different countries influenced smokers' perceptions of cigarette self-extinguishment, frequency of extinguishment, and the impact on consumer smoking behaviors, including cigarettes smoked per day and planning to quit. Methods. Participants for this research come from Waves 3 through 8 of the International Tobacco Control (ITC) Four Country Survey conducted longitudinally from 2004 through 2011 in the United States, United Kingdom, Australia, and Canada. Results: Perceptions of cigarette self-extinguishment and frequency of extinguishment increased concurrently with an increase in the prevalence of RIP safety standards for cigarettes. Presence of RIP safety standards was also associated with a greater intention to quit smoking, but was not associated with the number of cigarettes smoked per day. Intention to quit was higher among those who were more likely to report that their cigarettes self-extinguish sometimes and often, but we found no evidence of an interaction between frequency of extinguishment and RIP safety standards on quit intentions. Conclusions: Overall, because these standards largely do not influence consumer smoking behavior, RIP implementation may significantly reduce the number of cigarette-related fires and the associated death and damages. Further research should assess how implementation of RIP safety standards has influenced smoking-related fire incidence, deaths, and other costs associated with smoking-related fires.

Background: We examined the impact of cigarette pack warning labels on interest in quitting and subsequent quit attempts among adult smokers in Malaysia and Thailand. Methods. Two overlapping cohorts of adults who reported smoking factory- made cigarettes from Malaysia and Thailand were interviewed face-to-face (3189 were surveyed at baseline and 1781 re-contacted at Wave 2; 2361 current smokers were surveyed at Wave 2 and 1586 re-contacted at Wave 3). In Thailand at baseline, large text only warnings were assessed, while at Wave 2 new large graphic warnings were assessed. In Malaysia, during both waves small text only warnings were in effect. Reactions were used to predict interest in quitting, and to predict making quit attempts over the following inter-wave interval. Results: Multivariate predictors of "interest in quitting" were comparable across countries, but predictors of quit attempts varied. In both countries, cognitive reactions to warnings (adjusted ORs; 1.57 & 1.69 for Malaysia at wave 1 and wave 2 respectively and 1.29 & 1.19 for Thailand at wave 1 and wave 2 respectively), forgoing a cigarette (except Wave 2 in Malaysia) (adjusted ORs; 1.77 for Malaysia at wave 1 and 1.54 & 2.32 for Thailand at wave 1 and wave 2 respectively), and baseline knowledge (except wave 2 in both countries) (adjusted ORs; 1.71 & 1.51 for Malaysia and Thailand respectively) were positively associated with interest in quitting at that wave. In Thailand only, "cognitive reactions to warnings" (adjusted ORs; 1.12 & 1.23 at wave 1 and wave 2 respectively), "forgoing a cigarette" (adjusted OR = 1.55 at wave 2 only) and "an interest in quitting" (adjusted ORs; 1.61 & 2.85 at wave 1 and wave 2 respectively) were positively associated with quit attempts over the following inter-wave interval. Salience was negatively associated with subsequent quit attempts in both Malaysia and T

BACKGROUND: Prior studies have demonstrated that time perspective-the propensity to consider short-versus long-term consequences of one's actions-is a potentially important predictor of health-related behaviors, including smoking. However, most prior studies have been conducted within single high-income countries. The aim of this study was to examine whether time perspective was associated with the likelihood of being a smoker or non-smoker across five countries that vary in smoking behavior and strength of tobacco control policies. METHODS: The data were from the International Tobacco Control (ITC) Surveys in five countries with large probability samples of both smokers (N=10,341) and non-smokers (N=4,955): Scotland, France, Germany, China, and Malaysia. The surveys were conducted between 2005-2008. Survey respondents indicated their smoking status (smoker vs. non-smoker) and time perspective (future oriented vs. not future-oriented) and provided demographic information. RESULTS: Across all five countries, non-smokers were significantly more likely to be future-oriented (66%) than were smokers (57%), χ(2)(1, N = 15,244) = 120.64, p < .001. This bivariate relationship between time perspective and smoking status held in a multivariate analysis. After controlling for country, age, sex, income, education, and ethnicity (language in France), those who were future-oriented had 36% greater odds of being a non-smoker than a smoker (95% CI: 1.22 to 1.51, p<.001). CONCLUSION: These findings establish time perspective as an important predictor of smoking status across multiple countries and suggest the potential value of incorporating material to enhance future orientation in smoking cessation interventions.