tag:theconversation.com,2011:/fr/topics/antismoking-8205/articlesAntismoking – The Conversation2022-03-10T20:23:18Ztag:theconversation.com,2011:article/1777752022-03-10T20:23:18Z2022-03-10T20:23:18ZSmoking and pregnancy: financial incentives can double abstinence rates<figure><img src="https://images.theconversation.com/files/448084/original/file-20220223-19-jm8yii.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">file muv wc</span> </figcaption></figure><p>The adverse effects of maternal smoking during pregnancy are well known. Pregnant women who smoke are at higher risk of miscarriage, fetal death, prematurity and <a href="https://pubmed.ncbi.nlm.nih.gov/28403455/">low birth weight</a>. Smoking during pregnancy also affects the health of the child, as it increases the risk of asthma, <a href="https://pubmed.ncbi.nlm.nih.gov/20679592/">psychiatric disorders</a>, and <a href="https://pubmed.ncbi.nlm.nih.gov/18278059/">obesity</a>.</p>
<p>Even if pregnant women are aware of the health risks, they may continue to smoke. Nicotine replacement therapies, such as patches, appear to be <a href="https://www.cairn.info/traite-d-addictologie--9782257206503-page-882.htm">less effective for pregnant women</a> than in the general smoking population. Other support methods, such as counselling by specialists or cognitive-behavioral therapy, <a href="https://www.cairn.info/traite-d-addictologie--9782257206503.htm">do not work well for pregnant smokers</a>. Thus, <a href="https://www.santepubliquefrance.fr/determinants-de-sante/alcool/documents/enquetes-etudes/barometre-sante-2017.-alcool-et-tabac.-consommation-d-alcool-et-de-tabac-pendant-la-grossesse">25% pregnant women smoked at least occasionally</a> (and 22% were daily smokers) in France in 2017.</p>
<p>This long-standing trend is too high given the health risks for the newborns and the mothers. It is therefore necessary to explore other therapeutic avenues to help pregnant smokers quit. Economic theory indicates that a financial reward can lead to a change in health behavior.</p>
<h2>Why would providing financial rewards change a health behavior?</h2>
<p>Although smoking is above all an addiction, smoking cessation, like any other decision, is the result of a trade-off between the costs such as the loss of the satisfaction derived from smoking and efforts required to stop, and the benefits such as the money saved from not buying cigarettes and the perception of health improvement due to smoking cessation. </p>
<p>Providing financial rewards to quitters could compensate for their efforts and loss of satisfaction derived from smoking. The financial rewards would affect the trade-off such that <a href="https://econpapers.repec.org/bookchap/eeeheachp/1-29.htm">the benefits of quitting would outweigh the costs</a>.</p>
<p>Would it then be effective to offer a financial reward to help pregnant women quit smoking? To find out, we set up a randomized trial involving 460 pregnant women in 18 maternity wards in France. Our study, <a href="https://www.bmj.com/content/375/bmj-2021-065217.long">published in the <em>British Medical Journal</em></a>, aimed to test the effectiveness of conditional financial incentives for smoking cessation in pregnant smokers.</p>
<p>The participants, all in their first trimester of pregnancy, were randomly assigned, into two groups of equal size: a financial incentives group receiving financial incentives conditional on abstinence and a control group that did not. Monthly face-to-face visits were planned that included routine medical and smoking cessation counselling up to the end of the pregnancy. At each visit, the pregnant women met with health care professionals specifically trained for smoking cessation skills.</p>
<p>The participants’ smoking abstinence was assessed by self-report of smoking, and by a test measuring carbon monoxide level in the expired air, a standard measure of smoke exposure. At each visit, participants of the financial incentives group received vouchers whose amount depended on their current abstinence, and on their past abstinence. The more times they were abstinent, the larger was the amount of financial rewards. The maximum amount that could be earned in the study was 520 euros. Each 20 € voucher could be redeemed in many shops (including groceries, childcare equipment, etc.) but they could not be used to purchase tobacco or alcohol.</p>
<p>The financial incentives schedule was specifically designed to encourage continuous abstinence throughout pregnancy, as only continuous abstinence might have a major impact on the newborn’s health.</p>
<h2>Financial incentives doubled the number of pregant women who stopped smoking</h2>
<p>Financial incentives conditional on abstinence helped women quit smoking throughout their pregnancy and improved some major birth characteristics. With no financial incentives, 7.42% of the participants quit smoking throughout their pregnancy. Among those who benefited from financial incentives, this rate reached 16.45%. Hence, financial incentives were associated with doubling continuous smoking abstinence rate. The figure below shows that smoking abstinence was also systematically higher at each medical visit in the group that received financial incentives.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=300&fit=crop&dpr=1 600w, https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=300&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=300&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=377&fit=crop&dpr=1 754w, https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=377&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/448085/original/file-20220223-23-c0mmm9.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=377&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption"></span>
<span class="attribution"><a class="source" href="https://www.bmj.com/content/375/bmj-2021-065217">BJM</a>, <span class="license">Author provided</span></span>
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</figure>
<p>These results translate into better health outcomes for the newborns. Newborns were less likely to have a low birth weight, a known predictor of perinatal and infant adverse health events. Poor neonatal outcomes (transfer to neonatal unit, convulsion, malformation, and deaths) decreased by 5.3 percentage points between newborns of participants who were in the financial incentives group compared to those in the control group. The intervention had no effect on prematurity.</p>
<h2>Benefits long after pregnancy</h2>
<p>Would public health authorities implement financial incentives into the health care routine of pregnant smokers? Our results show that providing financial incentives conditional on abstinence is effective in increasing smoking cessation rate throughout the pregnancy and improve birth characteristics. But the evaluation of the impact of this measure should not be limited to this period of life. <a href="https://www.aeaweb.org/articles?id=10.1257/000282802762024520">Healthier newborns</a> may also become <a href="https://pubmed.ncbi.nlm.nih.gov/15721050/">healthier children</a> then <a href="https://www.rand.org/pubs/working_papers/WR860.html">adults</a>.</p>
<p>Before choosing to implement such an unusual policy, public decision-makers may ask themselves how it would be perceived by the general population. We had precisely evaluated its acceptability before carrying out our study, by surveying a representative sample of the French population. More than 50% of respondents were in favor of this type of policy. As other studies from other countries have shown that acceptability of financial incentives increases when proof of effectiveness is provided, we are confident that this policy could be widely accepted in France.</p><img src="https://counter.theconversation.com/content/177775/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Les auteurs ne travaillent pas, ne conseillent pas, ne possèdent pas de parts, ne reçoivent pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'ont déclaré aucune autre affiliation que leur organisme de recherche.</span></em></p>How can we help pregnant women quit smoking, for their health and that of their unborn child, when substitutes and other methods seem less effective during this period?Léontine Goldzahl, Professeur Associé, EDHEC Business SchoolFlorence Jusot, Professeure en Sciences Economiques, Université Paris Dauphine – PSLIvan Berlin, MCU-PH, Hôpital Pitié-Salpêtrière (AP-HP) – Département de pharmacologie, Sorbonne Université, Faculté de médecine – CESP-INSERM 1018, Sorbonne UniversitéNoémi Berlin, Chargée de recherche CNRS, laboratoire EconomiX, Université Paris Nanterre – Université Paris LumièresLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1028742018-09-23T15:30:35Z2018-09-23T15:30:35ZBig Tobacco’s opposition to plain packaging is plain spin<figure><img src="https://images.theconversation.com/files/236989/original/file-20180918-158228-1vivgt9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">An Ottawa high school student looks at plain cigarette packaging examples on World No Tobacco Day in May 2016. Tobacco companies are railing against Ottawa's plans for plain cigarette packaging in Canada. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Sean Kilpatrick</span></span></figcaption></figure><p>No matter how you look at it, a standardized cigarette pack is ugly. The colours are unappealing, the font bland and the large graphic health warnings gruesome. That’s why standardized packaging is such an <a href="https://tobaccocontrol.bmj.com/content/24/Suppl_2">effective public health policy</a> — and why tobacco companies hate it. </p>
<p>The Canadian government is currently drafting regulations on standardized tobacco packaging as required by the new <a href="https://www.canada.ca/en/health-canada/services/health-concerns/tobacco/legislation/federal-laws/tobacco-act.html">Tobacco and Vaping Products Act</a> passed in May 2018. Tobacco companies are trying to weaken the regulations through lobbying and public relations campaigns. </p>
<p>Our research finds that these efforts are based on the <a href="https://doi.org/10.1016/j.healthpol.2018.08.001">same arguments and selective sources</a> of information that the industry has used in other countries that have proposed similar measures, including Australia, the U.K. and the Netherlands.</p>
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<a href="https://theconversation.com/australias-plain-tobacco-packaging-law-at-the-wto-14043">Australia's plain tobacco packaging law at the WTO</a>
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<p>We reviewed tobacco industry campaigns from around the world and found they all used the same key messages: That no evidence exists to support claims for the effectiveness of plain packaging; that such legislation contributes to a “slippery slope” of regulation that would accelerate the encroachment of the “nanny state” into citizens’ lives; that standardized packaging represents a threat to intellectual property rights and would increase the illicit trade in tobacco products. </p>
<p>To support these messages, public relations documents refer exclusively to studies funded by the tobacco industry or from groups with links to the tobacco industry.</p>
<h2>Misleading messages</h2>
<p>In Canada, JTI-MacDonald, the country’s third-largest tobacco company, launched the <a href="https://www.bothsidesoftheargument.ca/sides-plain-cigarette-packaging-debate/">Both Sides of the Argument</a> campaign, which claims to presents the “facts” against standardized packaging using websites, posters, advertisements, as well as Twitter and Facebook accounts. </p>
<p>Campaign materials argue that no credible evidence has emerged from Australia to support the effectiveness of standardized packaging, and repeat the same misleading messages used to challenge legislation in Australia and the U.K.</p>
<p>The campaign quotes research from consulting firms paid for by tobacco companies, which do not describe their methods in detail or subject them to peer review. </p>
<p>Knowing they have little public credibility, tobacco companies rely on “arms-length” advocacy groups to create false controversy around packaging regulations. </p>
<p>For instance, the <a href="http://www.stopcontrabandtobacco.ca/">National Coalition Against Contraband Tobacco</a> argues that “plain packaging has increased contraband tobacco in other countries and will likely do the same in Canada” without providing evidence of increased illicit activity elsewhere.</p>
<p>The coalition receives funding from <a href="https://www.stopcontrabandtobacco.ca/about-us/">the tobacco industry</a> and lists the Tobacco Manufactures Association as one of its members. </p>
<p>The Canadian Convenience Store Association, which has also received tobacco industry funding, argues that plain packaging would hurt small business, basing its claim on “detailed studies from Australia,” which were commissioned by British American Tobacco Australia and Philip Morris Australia. </p>
<p>What is presented as concern for the unfair treatment of small, local businesses is in fact the desire of some of the largest and most profitable global corporations to protect their profits at the expense of public health.</p>
<h2>Diversionary tactics</h2>
<p>A <a href="https://globalnews.ca/news/4291911/tobacco-plain-packaging-consultation/">recent poll</a> by Global News found that 63 per cent of respondents in Canada did not think standardized packaging would reduce smoking rates. This not only suggests that tobacco industry public relations campaigns are working, they’re also muddying the debate by framing success of the policy in terms of immediate smoking reductions. </p>
<p>This is a diversionary tactic also used in Australia, with <a href="http://www.abc.net.au/news/2014-01-22/philip-morris-wrong-plain-packaging/5137682">some success</a>, and it is now being reproduced in Canada. </p>
<p>Proponents of standardized packaging do not claim the policy will result in immediate smoking reductions. The long-term goals are to discourage people (especially youth) from taking up smoking, to encourage smokers to quit and to avoid relapse among ex-smokers. <a href="https://doi.org/10.1111/ans.14679">Evidence from Australia</a> demonstrates that standardized packaging is making progress in achieving these goals. </p>
<p>Canadian policymakers can anticipate ongoing opposition from tobacco companies when they enact packaging legislation. Experiences from Australia and elsewhere suggest that industry campaigns do not end with implementation, but continue on after new laws are introduced in an attempt to discredit and ultimately repeal the policy. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/236991/original/file-20180918-143281-r1f993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/236991/original/file-20180918-143281-r1f993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=803&fit=crop&dpr=1 600w, https://images.theconversation.com/files/236991/original/file-20180918-143281-r1f993.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=803&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/236991/original/file-20180918-143281-r1f993.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=803&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/236991/original/file-20180918-143281-r1f993.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1009&fit=crop&dpr=1 754w, https://images.theconversation.com/files/236991/original/file-20180918-143281-r1f993.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1009&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/236991/original/file-20180918-143281-r1f993.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1009&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">An example of a cigarette package is displayed during a news conference in New Zealand in 2013. New Zealand moved ahead with plain tobacco packaging in 2016.</span>
<span class="attribution"><span class="source">(AP Photo/Nick Perry)</span></span>
</figcaption>
</figure>
<p>Policy advocates must therefore remain vigilant and prepared to counter industry misinformation. </p>
<p>Adopting standardized packaging policy is not only crucial to protect the health of Canadians, but will have international significance. </p>
<p>In implementing the regulations, Canada stands with those countries <a href="https://www.tobaccofreekids.org/assets/global/pdfs/en/standardized_packaging_developments_en.pdf">that have introduced similar legislation</a> (France, the U.K., Norway, New Zealand, Ireland, Hungary, Slovenia and <a href="https://www.vrt.be/vrtnws/en/2018/09/07/plain-packaging-for-cigarettes-and-rolling-tobacco.app/">Belgium</a>) and acts as a model to those countries considering the policy. As this policy spreads, momentum will build, including in low- and middle-income countries that may have less established tobacco control policies in place.</p>
<p>Through standardized packaging measures, Canada can not only secure the health of its citizens and future generations, it will reinforce its role as a global leader in tobacco control and public health.</p><img src="https://counter.theconversation.com/content/102874/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ross MacKenzie receives funding support from the National Institutes of Health. He he has previously worked on research projects supported by the Rockefeller Foundation, and Cancer Council NSW.</span></em></p><p class="fine-print"><em><span>Benjamin Hawkins, Jappe Eckhardt, and Julia Smith do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>The Canadian government is currently drafting regulations on plain packaging for cigarettes. Tobacco companies are trying to weaken the regulations via lobbying and misleading PR campaigns.Julia Smith, Research Associate, Simon Fraser UniversityBenjamin Hawkins, Assistant Professor, London School of Hygiene & Tropical MedicineJappe Eckhardt, Lecturer in Politics and International Relations, University of YorkRoss MacKenzie, Lecturer in Health Studies, Macquarie UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/528892016-01-11T14:27:11Z2016-01-11T14:27:11ZWhy e-cigarettes could be holding back your plans to quit smoking<figure><img src="https://images.theconversation.com/files/107667/original/image-20160108-3334-19z81va.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/rpavich/19388697256/">rpavich/flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>E-cigarettes could now be prescribed by doctors as a way of giving up smoking, after regulators granted one such product a drug licence <a href="http://uk.reuters.com/article/uk-health-bat-ecigarette-idUKKBN0UI1FV20160104">for the first time</a>. This marks a significant point in the growing popularity of vaping, which has created a global market for e-cigarettes now worth <a href="http://www.telegraph.co.uk/finance/newsbysector/retailandconsumer/11692435/Vaping-takes-off-as-e-cigarette-sales-break-through-6bn.html">over US$6 billion</a>. Yet the technology remains highly controversial.</p>
<p>Proponents of e-cigarettes argue that they have helped increase the rate at which people are <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4378973/">quitting smoking</a>. But sceptics fear that vaping might make smoking a more socially acceptable habit again, that it could become popular among children who may <a href="http://archpedi.jamanetwork.com/article.aspx?articleid=1840772&resultclick=3">then move on to conventional cigarettes</a>, and that it even poses a possible <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0116861">direct health risk</a> due to the chemicals it involves. </p>
<p>One important area identified for further research <a href="http://www.biomedcentral.com/1741-7015/13/32">by academics</a>, <a href="http://www.fda.gov/downloads/TobaccoProducts/Labeling/RulesRegulationsGuidance/UCM394914.pdf">organisations</a> <a href="http://www.reuters.com/article/2015/03/26/us-usa-health-ecigarettes-idUSKBN0MM2BW20150326">and government</a> is the nature and impact of the dual-use of electronic and conventional cigarettes. Instead of simply assuming that vaping is a way for all people to cut down on smoking for health reasons, we should consider that they may be complementary activities for some. Regular smokers are often subject to regulation and social pressure. For example, they may no longer be able to smoke in their workplace or in places where they meet with friends or family. </p>
<h2>Substituters vs complementers</h2>
<p>E-cigarette use, on the other hand, is often unregulated and provides both the nicotine fix associated with cigarette use and some of the social element. So smokers now have the option to smoke regular cigarettes where they can and complement this with the use of e-cigarettes where it is not possible or appropriate to smoke tobacco.</p>
<p>If e-cigarettes were only adopted as substitutes and helped more people to quit smoking, they could increase the associated health and financial benefits that come with this by cutting tobacco use. But where e-cigarettes act as a complementary product, they could instead blunt regular anti-smoking regulation and keep more people smoking for longer.</p>
<p>We conducted <a href="http://www2.warwick.ac.uk/fac/soc/economics/research/workingpapers/2015/twerp_1064_doyle.pdf">an online survey</a> of 2,406 people in the US and found that 37% of smokers who use e-cigarettes view them primarily as a complementary product to traditional cigarettes, rather than a substitute. We also found that while 55% of “substituters” were trying to quit, only 40% of “complementers” were.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/107666/original/image-20160108-3329-14qfucb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/107666/original/image-20160108-3329-14qfucb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/107666/original/image-20160108-3329-14qfucb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/107666/original/image-20160108-3329-14qfucb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/107666/original/image-20160108-3329-14qfucb.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/107666/original/image-20160108-3329-14qfucb.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/107666/original/image-20160108-3329-14qfucb.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Cigarette break.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
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</figure>
<p>Together with publicly available data <a href="http://www.cdc.gov/tobacco/data_statistics/fact_sheets/adult_data/cig_smoking/index.htm">from US</a> <a href="http://www.smokinginengland.info/">and UK</a> sources, this research allowed us to <a href="http://www2.warwick.ac.uk/fac/soc/economics/research/workingpapers/2015/twerp_1064_doyle.pdf">calculate a new measure</a> of how financially beneficial e-cigarettes are in terms of public health savings. If 37% of dual-users are taken to be “complementers”, the estimated benefits of e-cigarettes drop by as much as 57% in the US – the equivalent of US$3.3 billion to US$4.9 billion a year in health-cost savings.</p>
<p>We also found that this problem is likely not to receive the attention it deserves because non-smokers underestimate the extent to which e-cigarettes act as a complementary product. While 37% of dual-users in our sample viewed vaping primarily as a complementary activity, only 27% of non-smokers thought e-cigarettes would be used in this way rather than as a substitute. This perception gap suggests some people overestimate the benefits of e-cigarettes. This is especially worrying because non-smokers make up the majority of the general population, which likely includes many policy-makers and health experts.</p>
<p>The difference in perceptions may be due to the <a href="http://www.bbc.co.uk/news/health-27485954">early success stories</a> of those smokers who used e-cigarettes to quit smoking. In line with this, our research found that ex-smokers who successfully quit were the least likely to have used e-cigarettes primarily as complements (20%). This was followed by dual-users who were trying to quit (30%), and finally by those with no intention of quitting (44%).</p>
<h2>Bigger than you think</h2>
<p>If the public is focused on the success stories of those who have used e-cigarettes and ceased smoking, they will underestimate the extent of complementary vaping. It is likely that the early years of e-cigarette use will have been dominated by those wanting to substitute them for tobacco <a href="https://theconversation.com/electronic-cigarettes-hope-from-the-hype-may-harm-your-health-27444">in order to quit</a>. But as those quitters succeed, the proportion of complementary users will rise.</p>
<p>However, just because some people use e-cigarettes as a complement to tobacco doesn’t mean they don’t want to quit. Our research actually found that complementary users were more likely to be using another quitting method or product, such as nicotine gum or patches, in addition to e-cigarettes. This suggests that for some trying to quit, their progress may be hindered by e-cigarettes.</p>
<p>But because complementary use can significantly dampen the health benefits of cigarettes and may make some smokers worse off if they prolong their habit, the product could undermine regulation that aims to help reduce smoking. What’s more, increasing regulation of regular cigarettes will have a knock-on effect on cigarette use but also could encourage more people to take up complementary vaping, increasing the impact of the problem. Health authorities such as the NHS should take the issue of complementary use into consideration when designing policy. Making e-cigarettes available on prescription, for example, may well help some smokers, but harm others.</p><img src="https://counter.theconversation.com/content/52889/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Doctors can now prescribe e-cigarettes as a quitting tool but the benefits of vaping may have been overstated.David Ronayne, Teaching Fellow and PhD Candidate in Economics, University of WarwickChris Doyle, Principal Teaching Fellow, University of WarwickDaniel Sgroi, Associate professor, University of WarwickLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/441702015-07-21T10:20:36Z2015-07-21T10:20:36ZCan social media help you quit smoking?<figure><img src="https://images.theconversation.com/files/88980/original/image-20150720-12572-1d5ulzu.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">From one hand-held habit to another.</span> <span class="attribution"><span class="source">Shutterstock</span></span></figcaption></figure><p>Tobacco is still the <a href="http://www.who.int/mediacentre/factsheets/fs339/en/">biggest cause</a> of preventable death in the world. Although the total number of smokers <a href="http://www.who.int/mediacentre/news/releases/2015/trends-tobacco-use/en/">is falling</a>, a high percentage of teenagers and young people in their 20s continue to smoke. </p>
<p>Although many young people want to quit, <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1931471/">few are successful</a>. Most do not access face-to-face or telephone cessation services and so may be missing out on the support they need to quit successfully. It may be that quitting smoking presents a different set of issues for young people than for older adults.</p>
<p>For example, they may be more concerned with how smoking affects their social identity than their long-term health concerns. So the more medicalised cessation services, such as consulting a healthcare professional or trying nicotine replacement therapy (NRT), may be less relevant and appealing.</p>
<p>These traditional cessation services may also be outdated and out of sight from young people’s perspectives. As a result, it’s important to understand the role of more modern communication channels such as social media in supporting smoking cessation. When young people think about quitting smoking, do they first seek help from their GP or do they turn to their close friends or social media contacts for support?</p>
<h2>New research</h2>
<p>A recently published <a href="http://ntr.oxfordjournals.org/content/early/2015/06/03/ntr.ntv119.abstract?keytype=ref&ijkey=zzRtTDteA3ODtvT">quasi-experimental study</a> tried to determine the effectiveness of social media as a quitting tool by studying the Canadian “Break It Off” (BIO) campaign aimed at smokers aged between 19 and 29. The researchers compared BIO to a telephone smokers’ helpline service.</p>
<p>The BIO website featured details of traditional cessation methods (telephone counselling and NRT) but also encouraged users to upload a YouTube video of their quitting experience and announce their resolve to friends via Facebook. There was also a BIO smartphone app that offered instant advice messages and personal progress-tracking to help deal with cravings.</p>
<p>The campaign narrative likened quitting smoking to breaking off a romantic relationship turned toxic. This was a pertinent means of getting this message through to young people, given that their romantic relationships are typically characterised by instability.</p>
<p>Of the website’s 37,325 unique visitors from January to March 2012, 339 used the Facebook and YouTube components of BIO while only 21 subsequently accessed the telephone helpline.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/88982/original/image-20150720-12572-jwecbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/88982/original/image-20150720-12572-jwecbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/88982/original/image-20150720-12572-jwecbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/88982/original/image-20150720-12572-jwecbz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/88982/original/image-20150720-12572-jwecbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/88982/original/image-20150720-12572-jwecbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/88982/original/image-20150720-12572-jwecbz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Social activity.</span>
<span class="attribution"><span class="source">Shutterstock</span></span>
</figcaption>
</figure>
<p>The researchers asked participants to complete a follow-up questionnaire about their smoking behaviour and their use and opinion of cessation services. More than half of participants dropped out of the study and those that stayed were different from typical helpline users, who were more likely than BIO participants to be female, daily smokers and intending to quit within a month. This means the conclusions we can draw are limited. However, BIO participants had significantly higher seven-day and 30-day quit rates compared with helpline users.</p>
<p>The <a href="http://www.go-gulf.com/blog/smartphone/">majority of young people</a>, certainly in the developed world, now own smartphones and spend a <a href="http://www.pewinternet.org/data-trend/social-media/social-media-use-by-age-group/">significant amount of time</a> using social media every day. So it may have the upper hand over standalone websites for delivering smoking cessation information. </p>
<p>Given consumer demand for instant information, bite-sized chunks of advice and support presented little and often (for example Twitter feeds) may be more palatable than a whole website of material.</p>
<h2>All about image</h2>
<p>We also know that youth is a time when relationships and social networks mean so much to young people’s developing self-image and perceived place in society. So perhaps, regardless of the platform for the BIO campaign, its core messages around relationships were more compelling and relevant to young people’s motivations for quitting than the more clinically oriented smokers’ helpline.</p>
<p>However, the online platform of BIO may have additional benefits as a smoking cessation intervention. It provides scope for community support, as people can receive support from their friends within their online communities (such as Facebook) and learn from others’ experiences and quitting attempts (YouTube videos). It’s also more informal and accessible than a one-to-one consultation with a healthcare professional, where perhaps formality is a barrier to young people accessing health services.</p>
<p>Unfortunately, with the available evidence, it isn’t possible to unpack these various potential mechanisms and gain an understanding of what works, why and for whom. Social media is commonly just one component of a smoking cessation intervention. What we don’t yet know is whether it makes other components more effective. </p>
<p><em>Alice Pennington, an undergraduate medical student at Cardiff University, conducted background research for this article.</em></p><img src="https://counter.theconversation.com/content/44170/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ria Poole is trial manager of an evaluation of a multi-component smoking prevention programme in further education settings.</span></em></p><p class="fine-print"><em><span>Graham Moore's post is funded by the Medical Research Council. He is co-applicant on an evaluation of a multi-component smoking prevention programme in further education settings. He has also previously received Welsh Government funding for research relating to tobacco control and young people.
</span></em></p>Services like Facebook and YouTube may have the upper hand when it comes to getting people to give up cigarettes.Ria Poole, Research Associate, School of Social Sciences, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/425492015-06-18T20:10:51Z2015-06-18T20:10:51ZNext step for tobacco control? Make cigarettes less palatable<figure><img src="https://images.theconversation.com/files/85518/original/image-20150618-23239-i8uepw.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Smokers respond to more filtered or more diluted cigarettes by taking bigger puffs and more of them. </span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-287436329/stock-photo-man-smoking-cigarette.html?src=M2GZNSHi9c62ORDzzBzwVw-1-19">Pe3k/F/Shutterstock</a></span></figcaption></figure><p>Australia has been a world leader in tobacco control. We were the first to introduce <a href="https://www.cancervic.org.au/plainfacts/">plain cigarette packaging</a> in 2012. </p>
<p>We were also one of the early jurisdictions to <a href="https://www.accc.gov.au/media-release/accc-resolves-light-and-mild-cigarette-issue-with-bat-and-philip-morris">ban</a> “light” or “mild” labelling on packs in 2005 and to remove tar, nicotine and carbon monoxide labelling on packs in 2006. Those steps were taken after it had become clear so-called “low tar” cigarettes were not less harmful.</p>
<p>The problem is these tobacco control measures stop outside of the pack, while the cigarettes inside <a href="http://www.tobaccoinaustralia.org.au/downloads/chapters/ch12_tobacco.pdf">remain</a> essentially the same. A logical next step is to regulate how companies engineer cigarettes to promote their use. </p>
<h2>Why regulate cigarettes?</h2>
<p>Taking regulation inside the packs to control cigarettes themselves can potentially achieve three broad aims. </p>
<p>The first is to reduce the <a href="http://tobaccocontrol.bmj.com/content/17/2/132.full.pdf+html">doses</a> of cancer-causing agents and other toxins received per cigarette. Regulators would first need to identify those harmful substances in tobacco smoke that can be reduced and then mandate reductions to specific harmful substances. If achieved, this would reduce the harms for current smokers, to some degree, especially long-termers who are unlikely to quit. </p>
<p>The second is to reduce their addictiveness, by controlling the doses of nicotine available to smokers. Getting the right dose of nicotine at the right dose rate is <a href="http://www.wisebrain.org/media/Papers/NeurobiologyofNicotineAddictionImplicationsfor.pdf">what gives smokers</a> that little buzz of enjoyment they seek but it is also precisely what makes smoking addictive. Addictiveness drives long-term smoking so reducing nicotine availability would also mean reducing harm at a population level, as more people successfully quit.</p>
<p>The third – and often overlooked – aim is to reduce the attractiveness or palatability of cigarettes to particular user groups separately from reducing nicotine availability. This means limiting the range of flavour varieties and flavour strengths available, as well as the tobacco industry’s ability to create impressions of reduced harmfulness. </p>
<p>Such restrictions would make it harder for teenagers experimenting with smoking to transition to being regular smokers and make it harder for long-term smokers to avoid thinking about the harmfulness of smoking. </p>
<h2>Less harmful? Not quite</h2>
<p>In 2006, Australia <a href="http://tobaccocontrol.bmj.com/content/12/suppl_3/iii61.full.pdf">ended</a> on-pack labelling of tar, nicotine and carbon monoxide yield figures, after having adopted it by voluntary agreement with the tobacco industry in 1981. </p>
<p>Tar, nicotine and carbon monoxide yield figures were a key part of the failed “low tar” harm-reduction system. The cigarettes labelled “light” or “mild” had reassuringly low tar, nicotine and carbon monoxide figures printed on the side of the pack and many smokers believed these cigarettes were less harmful. </p>
<p>Those cigarettes also had sensory <a href="http://cdrwww.who.int/fctc/guidelines/ArtElevenKozlowskiFive.pdf">characteristics</a> that are appealing to many smokers: less flavour strength, less “impact” or “catch” in the throat, and less lingering irritation on the throat and chest after smoking.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/85520/original/image-20150618-23223-een8oa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/85520/original/image-20150618-23223-een8oa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/85520/original/image-20150618-23223-een8oa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/85520/original/image-20150618-23223-een8oa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/85520/original/image-20150618-23223-een8oa.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/85520/original/image-20150618-23223-een8oa.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/85520/original/image-20150618-23223-een8oa.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">The terms light and mild have been replaced with smooth and fine.</span>
<span class="attribution"><a class="source" href="https://www.flickr.com/photos/pyxopotamus/3565505580/in/photolist-6r59A9-r2BA4F-6qZXmP-6qZY9i-q5MjbX-6r5akJ-CJ1T3-6TdKFU-edfMM-d8aEj-e3nAp2-9Afpv-9AiV1-7ve4se-9AiUZ-6Kyhku-aiVm1g-q5yGFy-29zNZ-4fGnid-4JkCry-9kimqC-qWjjFQ-6r2SdV-6S1DDQ-6r5a7f-4WsVp2-bU9Pj4-b2Q3qe-Bsyws-6r5awC-8XEAjv-4QXydP-jCApZ-8v8nn8-cMot7-6UGbM1-84UUgx-mhhEjc-mhirmz-fteXc8-GzFUT-7PWVzm-5azjs9-6hDjoZ-3akKT7-3akKYs-efz9F-qfgU1S-a8mwyi">me and the sysop/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<p>Getting those figures off packs was an important step, once it became established they told smokers nothing about their actual intakes of harmful smoke constituents. But the “low tar” deception is part of a bigger problem of differences between cigarettes that smokers latch onto as evidence that some of them are less harmful. </p>
<p>After banning the <a href="https://www.accc.gov.au/media-release/accc-resolves-light-and-mild-cigarette-issue-with-bat-and-philip-morris">terms</a> “light” or “mild” in 2006, our tobacco industry simply replaced them, using “smooth” and “fine” as the new <a href="http://tobaccocontrol.bmj.com/content/14/3/214.extract">code words</a>. Each major brand family still has six or seven varieties, ranging from “original”, through “smooth” and “fine”, to “ultimate” – and that’s without counting the menthol varieties. </p>
<p>Smokers still select the taste strength and harshness level that best suits them, then can fine tune further by unconsciously <a href="http://cdrwww.who.int/fctc/guidelines/ArtElevenKozlowskiFive.pdf">adjusting</a> how they puff. </p>
<h2>Regulating filters</h2>
<p>It’s time for the government to ban filter ventilation to reduce the palatability of cigarettes. The government should regulate filters, specifying the sizes and designs that are permissible.</p>
<p>Since the 1960s, tobacco companies have used two engineering features to reduce the unpleasant sensations of smoking on the throat. Larger filters and tiny holes in the filter tipping paper called “filter vents” introduce fresh air into each puff and make smoking easier on the throat. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/84046/original/image-20150605-14125-12612jn.png?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/84046/original/image-20150605-14125-12612jn.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=408&fit=crop&dpr=1 600w, https://images.theconversation.com/files/84046/original/image-20150605-14125-12612jn.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=408&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/84046/original/image-20150605-14125-12612jn.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=408&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/84046/original/image-20150605-14125-12612jn.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=513&fit=crop&dpr=1 754w, https://images.theconversation.com/files/84046/original/image-20150605-14125-12612jn.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=513&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/84046/original/image-20150605-14125-12612jn.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=513&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Filter vents.</span>
<span class="attribution"><span class="source">Bill King</span></span>
</figcaption>
</figure>
<p>But smokers compensate for this. Smokers seek constant nicotine doses of around one milligram per cigarette. They respond to more filtered or more diluted cigarettes by taking bigger puffs and more of them. </p>
<p>There is <a href="http://chinancd.cn/contents/pdf/incomplete%20compensation%20does%20not%20imply%20reduced%20harm.pdf">evidence</a> that increasing filtration efficiency decreases smokers’ exposures to just a few carcinogens (a group called semi-volatiles) but increases their exposures to most of the <a href="http://www.ncbi.nlm.nih.gov/pubmed/17654296">harmful smoke components</a> in the vapour phase of tobacco smoke. (The vapour phase passes straight through standard cigarette filters.)</p>
<p>There is also <a href="http://www.surgeongeneral.gov/library/reports/50-years-of-progress/">evidence</a> that filter ventilation increases smokers’ exposures to a range of carcinogens by encouraging them to take more puffs from each cigarette, which are effectively smaller at the burning end of the cigarette (meaning more products of incomplete combustion). </p>
<p>Filter ventilation is also likely to contribute to smoke particles penetrating deeper into the lungs.</p>
<p>This evidence thoroughly undercuts any “we might make things worse by meddling” justifications for not acting to regulate the engineering of cigarettes. </p>
<h2>Regulating additives</h2>
<p>The government should also ban the use of all but a very limited number of <a href="http://www.who.int/tobacco/industry/product_regulation/factsheetingredients/en/">additives</a> in cigarettes. Sugars, honey, cocoa, liquorice and spices are <a href="http://www.tobaccoinaustralia.org.au/downloads/chapters/ch12_tobacco.pdf">added to cigarettes</a> to add the right “flavour notes”, cover unpleasant ones and also reduce other unpleasant sensations. </p>
<p>Additives provide the secondary means for the Australian tobacco industry to fine tune the sensory characteristics of cigarettes, making them easier to use and harder to quit. </p>
<p>Canada and Brazil have <a href="http://www.who.int/tobacco/industry/product_regulation/factsheetingredients/en/">already taken the lead</a> internationally by banning most additives, although Brazil unfortunately left sugars off the list. Canada exempted menthol cigarettes, but that might change soon, with Manitoba introducing a province-wide ban. </p>
<p>If Australia could set the strongest example so far by comprehensively regulating both of the industry’s tools for optimising the sensory characteristics of cigarettes – filters and additives – the benefits to public health would be substantial and we would once again be at the forefront of tobacco control.</p><img src="https://counter.theconversation.com/content/42549/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bill King is currently funded by a tobacco harm reduction research grant from the Victorian Health Promotion Foundation. His salary has previously been supported by grants and consultancies to research teams at the Cancer Council from the Australian National Health and Medical Research Council (NHMRC), US National Institutes of Health (NIH), Australian Competition and Consumer Commission and Australian Department of Health and Ageing. Bill King conducted research for the ACCC investigation into lights and milds. Their report to the ACCC is confidential.</span></em></p>Past tobacco control measures have changed the pack, while the cigarettes inside remain the same. A logical next step is to regulate how companies engineer cigarettes to promote their use.Bill King, Senior research officer, Cancer Council VictoriaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/326172014-10-10T04:53:52Z2014-10-10T04:53:52ZWhy our kids are sending the future of tobacco brands up in smoke<figure><img src="https://images.theconversation.com/files/61211/original/9s3fm6ym-1412816038.jpg?ixlib=rb-1.1.0&rect=40%2C35%2C919%2C570&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children are highly impressionable to marketing.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/finnsnaps/3996729768/in/photolist-76bhvW-6metF1-pDJm-6mewwS-6meHzq-6maxn6-5xBcyD-6rNCji-4xFtyS-9tQqx-djDzUs-6Jwxyn-8UfPZi-5FFtDa-7PgLrx-8V59B4-7TyLzz-A9EMA-ojD15K-6LfwK8-6LfyYv-6Lfygt-9SUYAV-b5vQS2-drTob7-9FRrZB-Aw33u-9L5KV4-9bp3KA-dhFKnX-6JwFPR-2MLoGJ-2JjMwk-2JjKxg-7cUkgu-55CjcP-zKmJV-c5EkhY-3dANg5-6kfQXT-7tXtE6-ay54xq-pqX21e-4c9tXj-hoXxkb-9KNMxP-8zLkLQ-5S4ghB-7Ns4i9-5U1EeD">Flickr/Finn Mac Ginty</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span></figcaption></figure><p><a href="http://www.cancerinstitute.org.au/news-events/latest-news/smoking-rates-fall-in-young-people">Smoking rates</a> among 12- to 24-year old Australians fell from 15% to 11% in the two years following bans on displaying cigarettes at the point of sale. </p>
<p>So does this mean that placing cigarettes out of sight and in plain packs seems to be having exactly the effect on young people that tobacco companies dread? </p>
<p>The power of a brand logo is incredible; one image can make us recall a whole range of information and experiences about the brand itself. </p>
<p>But with brands out of sight, they are also slipping out of minds, especially young minds. Tobacco companies losing their weapon of mass consumption </p>
<h2>Seen enough yet?</h2>
<p>Brand logos are designed to capture as much attention as possible, not only to raise our awareness of them but to ensure we can also recall information. No brand, no attention, and no desire to have that brand or product. </p>
<p>This is why plain packaging works so well at reducing the smoking rates among children: there simply is no awareness and no desire for the product. Existing smokers, of course, are hooked on the product so for them plain packaging is less of an issue as they are already usually familiar with brands from prior experiences. </p>
<p><a href="http://www.youtube.com/watch?v=c_z-4S8iicc">This Youtube video</a> is part of a campaign by health advocacy group Cancer Research UK to pressure the UK into following Australia in adopting plain packaging of cigarettes. Inspecting the designs of cigarette packets, one child says, “The pictures look quite nice – ice cubes and mint!” </p>
<p>Another likes the bright colours: “I think it would be quite fun to play with. It just makes you happy just by looking at it.” While the girls are impressed with the pink packets: “I think this one looks quite pretty.”</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/c_z-4S8iicc?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Cancer Research UK campaign, The answer is plain - Campaign for plain cigarette packaging.</span></figcaption>
</figure>
<p>The video perfectly illustrate the power of marketing on impressionable young minds. </p>
<p>It also shows just how easy it is to develop a positive brand experience with the use of some fairly simple but subtle marketing techniques such as branding, packaging and colours. Just ask the creators of the <a href="http://simpsons.wikia.com/wiki/Laramie_Cigarettes">Simpsons</a>, who parody the marketing of cigarettes to children with fictional brand Laramie Cigarettes. </p>
<p>Finally, the video reveals how implementing plain packaging has damaged the ability of major tobacco brands to establish a foothold in children’s minds. </p>
<p>Despite their protests that they do not actively market to children, this seems to be one of the key reasons tobacco brands have fought so hard to stop plain packaging – it severely limits their ability to establish a presence as a product of choice for the future generations.</p>
<h2>Getting into your mind <em>and</em> wallet</h2>
<p>But make no mistake either. Tobacco brands are not the only ones to use colour, packaging and branding to target children successfully.
<a href="http://archneur.jamanetwork.com/article.aspx?articleid=570933">Fast food brands</a> have for decades, especially through bundling of toys or novelty items that come in a nice package intended to add excitement to what otherwise might be a very average meal. </p>
<p>And of course go to any “show” and see how showbags can grab the attention of children. </p>
<p>This effect lasts long past when we are children. <a href="http://journals.ama.org/doi/abs/10.1509/jmkg.68.2.36.27794">Attention capture in advertising</a> is of particular interest to researchers and practitioners alike as they seek more subtle but effective ways to target consumers increasingly more alert to overt marketing tactics aimed at influencing their behaviour.</p>
<h2>E-cigarettes</h2>
<p>The empire is striking back. <a href="http://www.abc.net.au/health/features/stories/2014/08/18/4069328.htm">Electronic cigarettes</a> are allowing smoking to be seen as cool again. </p>
<p>Electronic cigarettes containing tobacco cannot legally be sold in Australia, but you can purchase tobacco-free vapourisers and flavoured “juice”. While sales of these products might be only small, and while they might have few of the side effects of normal cigarettes, this is not their only use as a product in the eyes of the tobacco industry. </p>
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<iframe width="440" height="260" src="https://www.youtube.com/embed/8fkY3GpsSXI?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Smoking advertisements on US television.</span></figcaption>
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<p>They can be marketed far differently to normal nicotine-based cigarettes. Brands can display themselves in all their glory, unabashed bright colours are on display to capture the attention of the old and the young alike at point of sale counters around the nation. </p>
<p>Importantly, they can trigger recall of brand images in existing consumers minds, and capture attention of young minds. They can establish that all important connection, or relationship, between young consumer and brand. </p>
<p>This connection can be beneficial for existing tobacco brands seeking to maintain market share. Essentially e-cigarettes are the new weapon of mass consumption for the tobacco industry.</p>
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<img alt="" src="https://images.theconversation.com/files/61346/original/rmtm62x6-1412912185.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/61346/original/rmtm62x6-1412912185.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=785&fit=crop&dpr=1 600w, https://images.theconversation.com/files/61346/original/rmtm62x6-1412912185.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=785&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/61346/original/rmtm62x6-1412912185.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=785&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/61346/original/rmtm62x6-1412912185.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=987&fit=crop&dpr=1 754w, https://images.theconversation.com/files/61346/original/rmtm62x6-1412912185.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=987&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/61346/original/rmtm62x6-1412912185.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=987&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">James Dean’s iconic images inadvertently did much for the tobacco industry.</span>
<span class="attribution"><a class="source" href="http://upload.wikimedia.org/wikipedia/commons/7/76/James_Dean-cigarette-crop.JPG">Wikimedia commons</a>, <a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></span>
</figcaption>
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<p>Although <a href="http://www.youtube.com/watch?v=rmx7X_uxwDg">ads like these</a> haven’t made their way onto our screens here, to the eyes of a child, they would offer excitement and the allure of being seen as an adult.
A cool adult. A rebel adult. A very 2014 version of James Dean.</p>
<p>In Australia, though, there is little doubt that plain packaging has burnt the hopes of the tobacco industry in trying to get the attention, and engagement, of the next generation of consumers. </p>
<p>Perhaps it will be that innocence and naivety of tobacco brands and packets that will start the beginning of the end of the final chapter of the tobacco industry in Australia.</p><img src="https://counter.theconversation.com/content/32617/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Andrew Hughes does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Smoking rates among 12- to 24-year old Australians fell from 15% to 11% in the two years following bans on displaying cigarettes at the point of sale. So does this mean that placing cigarettes out of sight…Andrew Hughes, Lecturer, Research School of Management, Australian National UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/209042013-12-03T19:32:10Z2013-12-03T19:32:10ZBarangaroo smoking exemption gambles with worker health<figure><img src="https://images.theconversation.com/files/36724/original/stfynmfm-1386027659.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Casino staff at the new Crown Sydney Hotel Resort in Barangaroo will be forced to breathe secondhand cigarette smoke.</span> <span class="attribution"><span class="source">Thomas Hawk</span></span></figcaption></figure><p>In November 2019, James Packer’s Crown Resorts VIP exclusive gambling and hotel complex will open at Barangaroo on the Sydney foreshore. In a disappointing development, the New South Wales government has granted the casino an exemption to the state’s hard-fought-for indoor smoking ban.</p>
<p>The move begs a question about how exclusive a casino that measures 20,000 square metres in floor space (that’s about the same size as the <a href="http://www.mcg.org.au/The%20MCG%20Stadium/Facts%20and%20Figures.aspx">Melbourne Cricket Ground</a> arena) can be. </p>
<p>According to the <a href="http://www.parliament.nsw.gov.au/prod/parlment/nswbills.nsf/0/696b07db482e35a9ca257c21001637c0/$FILE/2R%20Casino%20Control%20Am.pdf">New South Wales state government</a>, it’s so exclusive that the normal laws of occupational health and safety need not apply. </p>
<p>So, when the “VIP gaming floor” at the new Crown Sydney Hotel Resort in Barangaroo opens, casino staff will be forced to breathe toxic, cancer-causing secondhand cigarette smoke while doing their jobs.</p>
<p>The exemption is made possible by the precedent set when the Sydney Star City Casino was granted a smoking ban exemption for its “high-roller” room. </p>
<p>Both exemptions were granted on the proviso that the general public wouldn’t be exposed to secondhand smoke (all gamblers who enter the VIP areas must be members) – so it’s perfectly acceptable to allow patrons to puff away. But provided you’re willing to spend a minimum of A$20 per hand of blackjack, you can become a VIP member at the Barangaroo casino.</p>
<p>Clearly, this is not a small facility that will cater only to a handful of super-rich players. Rather, it’s expected to pull in A$1 billion in gaming taxes in the first 15 years of operation alone. </p>
<p>Indeed, it seems a much more plausible reason for the exemption is that the revenue generated from such a facility is worth sacrificing the health and safety of workers.</p>
<p>The case clearly demonstrates how privileging influential business interests over public health is a slippery slope to undoing progress in improving population health. </p>
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<img alt="" src="https://images.theconversation.com/files/36736/original/78wcmr9g-1386032234.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/36736/original/78wcmr9g-1386032234.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/36736/original/78wcmr9g-1386032234.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/36736/original/78wcmr9g-1386032234.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/36736/original/78wcmr9g-1386032234.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/36736/original/78wcmr9g-1386032234.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/36736/original/78wcmr9g-1386032234.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Anyone willing to spend a minimum of A$20 a hand on blackjack will be allowed to become a VIP member, and smoke.</span>
<span class="attribution"><span class="source">~maja*majika~/Flickr</span></span>
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<p>While the <a href="http://www.austlii.edu.au/au/legis/nsw/consol_act/sea2000247/">Smoke Free Environment Act 2000</a> protects the general public from being exposed to secondhand smoke, the law is firmly <a href="http://www.tobaccoinaustralia.org.au/chapter-15-smokefree-environment/15-1-why-implement-smokefree-environments-">rooted in employee rights</a> to a safe work environment.</p>
<p>Without the implementation of comprehensive smoking bans, workplaces are the <a href="http://www.surgeongeneral.gov/library/reports/secondhandsmoke/factsheet5.html">major source of secondhand smoke exposure</a> for adults. Such smoke contains hundreds of chemicals <a href="http://www.surgeongeneral.gov/library/reports/secondhandsmoke/factsheet6.html">known to be toxic or cancer-causing</a>, including formaldehyde, benzene, vinyl chloride, arsenic, ammonia, and hydrogen cyanide. </p>
<p>For these reasons, the <a href="http://www.safeworkaustralia.gov.au/sites/SWA/about/Publications/Documents/252/GuidanceNote_EliminationOfEnvironmentalTobaccoSmoke_Workplace_NOHSC3019-2003_PDF.pdf">National Occupational Health and Safety Commission recommended</a> in 2003 that exposure to secondhand smoke should be eliminated in all Australian workplaces. </p>
<p>Public health groups have long argued that gambling exemptions to smoke-free laws make a mockery of fair work policies. Allowing the playgrounds of the wealthy to poison the workplaces of ordinary people belongs in a Dickens novel, not modern Australia.</p>
<p>The exemption is dressed up as being perfectly safe with the suggestion that air filters, ventilation and diligent air quality monitoring will be enough to keep employees safe. </p>
<p>This <a href="http://www.tobaccoinaustralia.org.au/chapter-15-smokefree-environment/15-3-opposition-to-and-weakening-of-smokefree-envi">argument was used</a> by the tobacco industry, and dismissed for being entirely without merit, when smokefree laws were first introduced in the 1980 and 1990s.</p>
<p>There’s simply no safe level of secondhand smoke exposure in enclosed spaces, especially when staff are exposed to it daily.</p>
<p>In 2015, New South Wales is <a href="http://www.health.nsw.gov.au/tobacco/Pages/smokefree-legislation.aspx">set to join other jurisdictions</a> in banning smoking in all outdoor commercial dining areas. While this will be a welcome step forward in further improving work conditions for those working in the hospitality industry, employees at James Packer’s Barangaroo casino will have no choice but to accept outdated working conditions. </p>
<p>The Barangaroo development has been declared as “<a href="http://www.barangaroo.com/discover-barangaroo/overview.aspx">the future of Sydney</a>” and boasts of its focus on sustainability and innovation. It’s a pity that this ethos has been granted an exemption inside the walls of the casino.</p><img src="https://counter.theconversation.com/content/20904/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Becky Freeman PhD receives funding from the Australian National Preventive Health Agency and has previously received funding from the National Heath and Medical Research Council of Australia. </span></em></p>In November 2019, James Packer’s Crown Resorts VIP exclusive gambling and hotel complex will open at Barangaroo on the Sydney foreshore. In a disappointing development, the New South Wales government has…Becky Freeman, Research Fellow/Lecturer, University of SydneyLicensed as Creative Commons – attribution, no derivatives.