Impact of tobacco tax reforms on tobacco prices and tobacco use in Australia

OBJECTIVE: To document the impact of changes to tobacco taxes on the range and price of tobacco sold during the period when the National Tobacco Campaign (NTC) was run.

DATA SOURCES: Information about brand availability, pack size, and price was extracted from Australian Retail Tobacconist. A retail observational survey was undertaken to monitor actual retail prices. Data on cigarette prices, brands, packet configurations, and outlets from which they were purchased were obtained from the benchmark and three follow up population telephone surveys conducted to evaluate the NTC.

METHOD: Data from the three sources were compared to see the extent to which the impact of tax changes had been offset by greater retail discounting and a more concerted effort by consumers to purchase cheaper products.

RESULTS: Smokers were unable to cushion themselves from the sharp price increases that occurred during the third phase of the NTC. Both average recommended retail prices of manufactured cigarettes and average actual cigarette prices paid by smokers increased by 25% in real prices.

CONCLUSION: The fall in smoking prevalence over the first two phases of the NTC was substantially greater than would be expected due to tax changes alone. The fall in smoking consumption over the first two phases was slightly less than would be expected and in the third considerably higher than would be expected.

Review of prevalence data in, and evaluation of methods for cross cultural adaptation of, UK surveys on tobacco and alcohol in ethnic minority groups

Objective To assess the adequacy of cross cultural adaptations of survey questions on self reported tobacco and alcohol consumption in the United Kingdom.

Design Assessment of consistency of data between studies identified through literature review. Studies evaluated with 12 guidelines developed from the research literature on achieving cross cultural comparability.

Results The literature review identified 18 key studies, five of them on national samples. Survey instruments were obtained for 15 of these. The comparison of prevalence data in national surveys showed some important discrepancies, greater for tobacco than for alcohol. For example, prevalence of cigarette smoking in Bangladeshi women was 6% in a national survey in 1994 and 1% in a national survey in 1999; in Chinese men it was 31% in a survey in 1993-4 and 17% in one in 1999; in African-Caribbean men it was 29% in a 1992 survey and 42% in one in 1993-4. The most guidelines met by any study was three, although one study partly met a fourth. Two studies met no guidelines. Only four studies consulted with ethnic minority communities in developing the questionnaire, none checked each language version with all others, and two stated the questionnaire had not been validated.

Conclusions Surveys have not followed best practice in relation to measurement of risk factors in cross cultural settings. There is inconsistency in the prevalence data on smoking provided by different major national UK studies. Users of such data should be aware of their limitations. Research is needed to help achieve linguistic equivalence of survey questions in cross cultural research.

Smoking and drinking behaviours : the role of Reinforcement Sensitivity Theory

This thesis examines the predictions of Jeffrey Gray's Reinforcement Sensitivity Theory in the development of smoking and hazardous drinking behaviours in young women. Impulsivity was found to significantly predict alcohol use and young women who smoked and drank at hazardous levels were significantly more impulsive than hazardous drinkers.

Sustainable funding of health initiatives in Wonju, Republic of Korea via a tobacco consumption tax

Wonju is the first municipality in the Republic of Korea to fund the Healthy City project through municipal revenues from the local tobacco consumption tax. We investigated the process of the local tobacco consumption tax being approved as the main source of financing for the local Healthy City project. We also examined the sustainability and sufficiency of the funding by looking at the pricing policies instituted for cigarettes, smoking prevalence, cigarette consumption and revenues from local tobacco consumption as well as the budgetary allocations among programs in the city. The strong initiative of the mayor of Wonju was one of the factors that enabled the earmarking of the local tobacco consumption tax for the Healthy City Wonju project. He consulted academic counselors and persuaded the municipal government and the City Council to approve the bill. Despite the increasing price of cigarettes in Korea, adequate funding can be sustained to cover the short-term and mid-term programs in Wonju for at least 5 years of the mayor's term, because the smoking rate is persistently high. Analyzing the effects of strong leadership on the part of local authorities and the balance between revenues from the tobacco tax and the prevalence of smoking in the face of anti-smoking policies would be helpful for other countries and communities interested in developing sustainable Healthy Cities projects.

Re-testing the link between youth receptivity to tobacco promotion and their susceptibility to smoke

The Index of Receptivity to Tobacco Industry Promotion (IRTIP) is a model that is used by hundreds of articles. The causal claim based on findings from this model is even more pervasive, and has resulted in much of the modern post 1998 tobacco legislation that is still enforced. This thesis tested the link between adolescent receptivity to tobacco industry promotion and susceptibility to smoking. Pierce et al. (1998) reported that they had found a positive and causal association between receptivity and susceptibility by using IRTIP. They claimed that receptivity to tobacco industry promotion was the only significant causal factor affecting adolescent susceptibility to smoking. Exposure to peer and parental smoking was not found to be a significant effect. A review of the literature found that many sections of IRTIP differ from accepted marketing theory on how cigarette advertising and promotions affect adolescent adoption of cigarette smoking. The proxy measures used in IRTIP were shown to diverge from those previously used for measuring the constructs of Attention, Intention, Desire and Action (AIDA) in marketing communications. IRTIP also differs from previous theory by including measures that attempt to quantify the effect of tobacco premiums into a model that was designed to measure the effects of advertising.

Extreme response bias in measuring susceptibility to smoking.

Pierce, Choi, Gilpin, Farkas, and Berry (1998) were the first to claim that they could provide causal evidence that tobacco industry advertising and promotion caused adolescent smoking. This claim continues to significantly influence the theory and conceptualization of how youth react to tobacco marketing. The Pierce et al. (1998) methodology has been used by many researchers to establish the influence of tobacco marketing on adolescent smoking (Goldberg, 2003; NCI, 2006; Sargent, Dalton, & Beach, 2000). Pierce et al. (1998) selected respondents for only the second of their two survey longitudinal study because they chose the extreme-negative response. This choice could be the result of the tendency of some significant number of sample members exhibiting extreme-response bias. The results from an analysis of several questions from the original data used by Pierce et al. (1998) has suggested that there is a significant extreme-response style pattern in the Pierce et al. data. This unaccounted for bias in the responses of their sample was due to the procedure used by Pierce et al. (1998) in the selection of their respondents. The Pierce et al. (1998) sample selection procedure requires more research before the causal link can be claimed.

The influence of parents, siblings and peers on pre- and early-teen smoking : a multilevel model

Introduction and Aims. Despite considerable success in tobacco control, many teenagers in Australia and other industrialised countries still smoke tobacco. There is mixed evidence on the relative influence of proximal social networks (parents/siblings/peers) on pre- and early-teen smoking, and no research has examined how these influences compare after accounting for school- and community-level effects.The aim of this study was to compare the relative influences of parents, siblings and peers, after accounting for school- and community-level variation in smoking.

Design and Methods. A cross-sectional fixed and random effects model of smoking prevalence was used, with individuals (n = 7314) nested within schools (n = 231) nested within communities (n = 30). Grade 6 and 8 students (modal ages 11 and 13 years) completed an on-line survey. Key variables included parent/sibling/peer use. Controls included alcohol involvement, sensation seeking, pro-social beliefs, laws/norms about substance use and school commitment.

Results.There was significant variation in smoking at both the school and community levels, supporting the need for a multilevel model. Individual-level predictors accounted for much of the variance at higher levels. The strongest effects were for number of friends who smoke, sibling smoking and alcohol involvement. Smaller significant effects were found for parent smoking. At the community level, socioeconomic disadvantage was significant, but community-level variance in pro-social and drug-related laws/norms was not related to smoking.

Discussion and Conclusions. Cross-level interactions were generally non-significant. Early teenage smoking was best explained by sibling and peer smoking, and individual risks largely accounted for the substantial variation observed across schools and communities. In terms of future tobacco control, findings point to the utility of targeting families in disadvantaged communities.[Kelly AB, O'Flaherty M, Connor JP, Homel R, Toumbourou JW, Patton GC, Williams J. The influence of parents, siblings and peers on pre- and early-teen smoking: A multilevel model.

Association of adolescent symptoms of depression and anxiety with daily smoking and nicotine dependence in young adulthood : findings from a 10-year longitudinal study

Aims To examine the association of adolescent depression and anxiety symptoms with daily smoking and nicotine dependence in young adulthood.

Design A prospective cohort study of adolescent and young adult health (n = 1943). Teen assessments occurred at 6-monthly intervals, with two follow-up assessments in young adulthood (wave 7, 1998; wave 8, 2001–03).

Setting Victoria, Australia.

Participants Students who participated at least once during the first six (adolescent) waves of the cohort study.

Measurements Adolescent depression and anxiety symptomswere assessed using the Revised Clinical Interview Schedule (CIS-R).Young adult tobacco usewas defined as: daily use (6 or 7 days perweek) and dependent use (>4 on the Fagerstrom Test for Nicotine Dependence).

Findings Among adolescent ‘less than daily’ smokers, those with high levels of depression and anxiety symptoms had an increased risk of reporting nicotine dependence in young adulthood [odds ratio (OR) 3.3, 95% confidence interval (CI) 1.2–9.1] compared to young adults who had low levels of adolescent depression and anxiety symptoms, after adjusting for potential confounding factors. Similarly, in the adjusted model (OR 1.9, 95% CI 1.0–3.4), among adolescent ‘daily’ smokers, those with high levels of depression and anxiety symptoms had an almost two-fold increase in the odds of reporting nicotine dependence in young adulthood compared to young adults with low levels of adolescent depression and anxiety symptoms.

Conclusions Adolescent smokerswith depression and anxiety symptoms are at increased risk for nicotine dependence into young adulthood. They warrant vigilance from primary care providers in relation to tobacco use well into adulthood.

Association between dependent smoking and a polymorphism in the tyrosine hydroxylase gene in a prospective population-based study of adolescent health

This study reports pilot data on an association between tobacco dependence and a five-allele tetranucleotide repeat polymorphism in the first intron of the tyrosine hydroxylase (TH) gene. One hundred and twenty-six Australian adolescents who had participated in the Health in Transition Study (1993–1997), and who showed patterns of either dependent or nondependent smoking across four waves of data collection, consented to participation in the pilot study. The smoking status of those recruited was confirmed using a telephone-administered drug use questionnaire during 2000. Tobacco dependence was defined as smoking more than 6 days per week and more than 10 cigarettes per day during wave 5 (year 2000) and at lfeast one prior wave (n = 58). A second, more stringent phenotype included smoking within an hour of waking (n = 37). The control group comprised adolescents who had used tobacco but had remained low-level social smokers across each wave of data (n = 56). DNA was collected using a mouthwash procedure. Using the more strictly defined tobacco dependence phenotype, and after adjusting for sex, a significant protective association was found between the K4 allele and tobacco dependence (OR 0.27, 95% confidence interval [CI] 0.09, 0.82). No association was found using the liberal criteria of tobacco dependence (OR 0.51, 95% confidence interval [CI] 0.23, 1.2). These preliminary results replicate a previous association between tobacco use and the K4 allele of the TH gene (Lerman et al., 1997). The potential significance of including time to first cigarette in definitions of tobacco dependence and the possible role that these TH variants might play in tobacco dependence are discussed.

Smokers and ex-smokers reaction to anti-smoking advertising : a mixed methods approach

Anti-smoking advertising is a central component of modern public health policy. Nevertheless, some smokers have reported that viewing anti-smoking advertising provokes intense nicotine craving. Anti-smoking advertising frequently features images of cigarettes and of individuals smoking. However, research indicates that images of tobacco paraphernalia may induce cravings in individuals addicted to nicotine. The effects of the presence of smoking cues in anti-smoking advertising were considered in the present study. Smokers and ex-smokers (N=63) were randomly assigned to view an anti-smoking advertisement or to complete a control task. Urge to smoke was measured pre- and post-test. Qualitative responses to anti-smoking advertising were also elicited from all participants in the intervention groups. According to both qualitative and quantitative data analyses viewing anti-smoking advertising, even with images of smoking related paraphernalia, led to decreases in craving amongst smokers. Ex-smokers experienced no change in quantitatively measured craving after viewing anti-smoking advertising. These findings are inconsistent with findings from studies using neutral or positive smoking cues. Qualitative data shows that no smokers or ex-smokers who viewed anti-smoking advertising reported an increase in tobacco craving as a result of viewing the campaign. Implications of these findings for future research and anti-smoking campaigns are discussed.

STin2 VNTR polymorphism is associated with comorbid tobacco use and mood disorders.

There is a significant comorbidity between mood disorders and tobacco use disorder (TUD), which may be related to both genetic and environmental factors. Gene variants of the 5-HT transporter, such as STin2 VNTR (a variable number of tandem repeats in the functional serotonin transporter intron 2) may be associated with mood disorders and TUD.

N-acetylcysteine for therapy-resistant tobacco use disorder: a pilot study

Introduction N-Acetylcysteine (NAC) may have efficacy in treating tobacco use disorder (TUD) by reducing craving and smoking reward. This study examines whether treatment with NAC may have a clinical efficacy in the treatment of TUD. Methods A 12-week double blind randomized controlled trial was conducted to compare the clinical efficacy of NAC 3 g/day versus placebo. We recruited 34 outpatients with therapy resistant TUD concurrently treated with smoking-focused group behavioral therapy. Participants had assessments of daily cigarette use (primary outcome), exhaled carbon monoxide (COEXH) (secondary outcome), and quit rates as defined by COEXH<6 ppm. Depression was measured with the Hamilton Depression Rating Scale (HDRS). Data were analyzed using conventional and modified intention-to-treat endpoint analyses. Results NAC treatment significantly reduced the daily number of cigarettes used (Δ mean±SD = -10.9 ± 7.9 in the NAC-treated versus -3.2 ± 6.1 in the placebo group) and COEXH (Δ mean± SD = -10.4 ± 8.6 ppm in the NAC-treated versus -1.5 ± 4.5 ppm in the placebo group); 47.1% of those treated with NAC versus 21.4% of placebo-treated patients were able to quit smoking as defined by COEXH<6 ppm. NAC treatment significantly reduced the HDRS score in patients with tobacco use disorder. Conclusions These data show that treatment with NAC may have a clinical efficacy in TUD. NAC combined with appropriate psychotherapy appears to be an efficient treatment option for TUD.

Does tobacco-control mass media campaign exposure prevent relapse among recent quitters?

OBJECTIVE: To determine whether greater mass media campaign exposure may assist recent quitters to avoid relapse. METHOD: Using date of data collection and postcode, media market estimates of televised tobacco-control advertising exposure measured by gross ratings points (GRPs) were merged with a replenished cohort study of 443 Australians who had quit in the past year. Participants' demographic and smoking characteristics prior to quitting, and advertising exposure in the period after quitting, were used to predict relapse 1 year later. RESULTS: In multivariate analysis, each increase in exposure of 100 GRPs (i.e., 1 anti-smoking advertisement) in the three-month period after the baseline quit was associated with a 5% increase in the odds of not smoking at follow-up (OR = 1.05, 95% CI 1.02-1.07, p < 0.001). This relationship was linear and unmodified by length of time quit prior to the baseline interview. At the mean value of 1081 GRPs in the 3 months after the baseline-quit interview, the predicted probability of being quit at follow-up was 52%, whereas it was 41% for the minimum (0) and 74% for the maximum (3,541) GRPs. CONCLUSION: Greater exposure to tobacco-control mass media campaigns may reduce the likelihood of relapse among recent quitters.

The acute effects of exercise on cigarette cravings, withdrawal symptoms, affect, and smoking behaviour: systematic review update and meta-analysis

RATIONALE: Smoking cessation is associated with cigarette cravings and tobacco withdrawal symptoms (TWS), and exercise appears to ameliorate many of these negative effects. A number of studies have examined the relationships between exercise, cigarette cravings, and TWS. OBJECTIVES: The objectives of this study were (a) to review and update the literature examining the effects of short bouts of exercise on cigarette cravings, TWS, affect, and smoking behaviour and (b) to conduct meta-analyses of the effect of exercise on cigarette cravings. METHODS: A systematic review of all studies published between January 2006 and June 2011 was conducted. RESULTS: Fifteen new studies were identified, 12 of which found a positive effect of exercise on cigarette cravings. The magnitude of statistically significant effect sizes for 'desire to smoke' and 'strength of desire to smoke' ranged from 0.4 to 1.98 in favour of exercise compared to passive control conditions, and peaked either during or soon after treatment. Effects were found up to 30 min post-exercise. Cigarette cravings were reduced following exercise with a wide range of intensities from isometric exercise and yoga to activity as high as 80-85 % heart rate reserve. Meta-analyses revealed weighted mean differences of -1.90 and -2.41 in 'desire to smoke' and 'strength of desire to smoke' outcomes, respectively. Measures of TWS and negative affect were reduced following light-moderate intensity exercise, but increased during vigorous exercise. CONCLUSIONS: Exercise can have a positive effect on cigarette cravings and TWS. However, the most effective exercise intensity to reduce cravings and the underlying mechanisms associated with this effect remain unclear.

Design and conduct of a pragmatic randomized controlled trial to enhance smoking-cessation outcomes with exercise: The Fit2Quit study

Background: Most smokers want to stop smoking and many try to quit. However abstinence rates are low and most smokers do not manage to abstain for even a week. Relapse to smoking can be related to the occurrence of tobacco withdrawal symptoms (e.g., sleep disturbance, irritability, and craving) and weight gain. If regular exercise mitigates these effects it could have potential as an aid to smoking cessation. The aim of the Fit2Quit study is to determine the effects of a home and community-based exercise intervention on smoking abstinence at six months when used as an adjunct to usual care (telephone smoking-cessation counseling and nicotine replacement therapy; NRT). Methods/design: A prospective parallel two-arm randomized controlled trial. Participants (n = 1400, 700 per arm) will be randomized to a structured home and community-based exercise program plus usual care (behavioral counseling and NRT) or to usual-care alone. It is targeted that at least 25% of the sample will be of Mori ethnicity (New Zealand indigenous). Outcomes to be measured using intention-to-treat analysis include: seven-day point prevalence of smoking abstinence verified by salivary cotinine (primary outcome); 6 months continuous abstinence; body mass index (BMI); cardio-respiratory fitness; physical activity levels; and cost effectiveness. Discussion: The Fit2Quit study is an example of a large, pragmatic randomized controlled trial in a community setting. Specific components of the exercise intervention are outlined in detail. Trial registration: Australian New Zealand Clinical Trials Registry ACTRN12609000637246.