Smokeless tobacco use 1992-2002: trends and measurement in the Current Population Survey-Tobacco Use Supplements.

BACKGROUND: As smoking prevalence declines in the United States, it is important to understand if smokeless tobacco (SLT) use is also changing and if so, among what groups. METHODS: We examine the prevalence of SLT use and smoking, 1992-2002, using the Current Population Survey-Tobacco Use Supplements (CPS-TUS), which used US nationally representative samples based on stratified clusters of households. RESULTS: Consistent with declines in smoking, the prevalence of current SLT use declined over the period 1992-2002 for males and females ages 18 and older. The overall separate declines in SLT use and in smoking are mirrored by a decline in concurrent use of SLT and cigarettes. SLT use is becoming more associated with white males, but use is declining faster among the youngest males. CONCLUSIONS: The findings indicate that relative reductions in smoking prevalence are exceeded by relative reductions in SLT use, with sizeable reductions in concurrent use. These results suggest that the stricter cigarette policies of recent years may not only reduce cigarette use, but also the use of alternative tobacco products. In light of potential policy implications of SLT use as a potential reduced exposure product (PREP), current survey methods require more careful measurement of SLT use in terms of initiation, duration, quantity, and cessation.

Smokers' beliefs about "Light" and "Ultra Light" cigarettes.

OBJECTIVE: To assess beliefs about the tar and nicotine delivery characteristics and health benefits of Light and Ultra Light cigarettes among cigarette smokers. DESIGN: Random digit dialed telephone survey conducted in September 1999. SUBJECTS: Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA. The sample was weighted to match the US smoker population on age, sex, and ethnicity. MAIN OUTCOME MEASURES: Beliefs about Light and Ultra Light cigarettes were summarised on three dimensions: Safety (reduced health risk), Delivery (lowered tar and nicotine delivery), and Sensation (less harsh). RESULTS: Most smokers believed Lights and Ultra Lights were less harsh and delivered less tar and nicotine. On average, smokers believed that Lights afforded a 25% reduction in risk, and Ultra Lights a 33% reduction in risk. Light and Ultra Light cigarette smokers evaluated the risks of their own cigarette types more favourably. Light smokers had greater interest in quitting than Ultra Light smokers. Quitting intention was modestly related to beliefs about these cigarettes. Believing that Lights and Ultra Lights delivered less tar and nicotine and that they were less harsh each independently contributed to the belief that these cigarettes were safer. CONCLUSIONS: Many Light and Ultra Light smokers believe that smoking these cigarettes impart a substantial health benefit, due in part to their experience that these cigarettes are less harsh and the belief that these cigarettes deliver less tar.

Effect of health messages about "Light" and "Ultra Light" cigarettes on beliefs and quitting intent.

OBJECTIVE: To test the impact of three health messages focusing on vent holes, sensory effects of Light and Ultra Light cigarettes, or health consequences of smoking, respectively, on beliefs and quitting intentions. DESIGN: In the course of a random digit dialed telephone survey, subjects were randomised to hear one of three messages. To test the effects of the messages, beliefs and quitting intentions were assessed both pre- and post-message. PARTICIPANTS: Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA. The sample was weighted to match the US smoker population on age, sex, and ethnicity. MAIN OUTCOME MEASURES: Beliefs were summarised on three dimensions: Safety (reduced health risk), Delivery (lower tar and nicotine delivery), and Sensation (less harsh). Quitting interest was captured by the "quit index", an aggregate measure of quitting interest and intent. RESULTS: The message focusing on smokers' sensory perceptions of Light and Ultra Light cigarettes resulted in the most positive change in beliefs about safety, delivery, and intent to quit, and was particularly effective among those who believed that these cigarettes were less harsh. The effect was most pronounced among young adults, and among smokers of Light and Ultra Light brands who most endorsed their sensory benefits. CONCLUSIONS: Addressing smokers' sensory experience that Light and Ultra Light cigarettes feel less harsh may be a promising strategy for changing their misconceptions about these cigarettes and enhancing their interest in quitting. Media counter-advertising on Lights and Ultra Lights, focusing on sensory aspects of these cigarettes, may be an important part of tobacco control efforts.

Test of "Light" cigarette counter-advertising using a standard test of advertising effectiveness.

OBJECTIVE: To evaluate systematically the effectiveness of six advertising strategies (two message strategies presented in three different contexts) designed to promote smoking cessation by addressing smokers' misperceptions about Light cigarettes. DESIGN: Smokers viewed one of six, 30 second test television concept advertisements, which varied by message (one emphasising how the sensory effects of Lights can be deceptive, the other describing the effects of vent blocking) and by ad context (non-commercial public service announcement (PSA), promotion of unbranded nicotine replacement therapy (NRT), or promotion of branded NRT). The effectiveness of each advertisement was determined using a validated advertising testing system in which ads were viewed in the context of reviewing a pilot television programme. Response to ads is assessed through shifts in subject choices of products offered as prizes before and after viewing the test advertisements. Included among the possible prizes were cigarettes and various pharmacotherapies for smoking cessation. SUBJECTS: Daily smokers (n = 1890) of Regular (34%), Light (47%), and Ultra Light (19%) cigarettes recruited from eight US cities. MAIN OUTCOMES MEASURES: The primary outcome of interest was the shift away from cigarettes as the selected prize following exposure to the test advertisements. Secondary outcomes of interest included movement away from Light cigarettes and movement towards assisted quitting products. RESULTS: Smokers who saw the advertisement emphasising the sensory characteristics of Light cigarettes were more likely than subjects who saw the advertisement emphasising the effect of vent blocking to move away from cigarettes (OR = 1.97, 95% confidence interval CI 1.25 to 3.09; chi(2)(1) = 8.69, p = 0.003). Similarly, subjects who saw the advertisement framed as a PSA, rather than as a promotion for either a branded or unbranded NRT product, were also somewhat more likely to move away from cigarettes (OR = 1.51, 95% CI 0.94 to 2.40; chi(2)(1) = 2.97, p = 0.085). The effect was observed regardless of sex, age, or type of cigarette smoked. CONCLUSIONS: Addressing smokers' sensory perceptions of Light cigarettes and presenting this information in an impartial way is likely to be an effective communication strategy for counter-marketing Light cigarettes.

The efficacy of computer-tailored smoking cessation material as a supplement to nicotine patch therapy.

The study evaluated the efficacy of the Committed Quitters Program (CQP), a computer-tailored set of printed behavioral support materials offered free to purchasers of NicoDerm CQ patches, as a supplement to the nicotine patch and the standard brief User's Guide (UG) and audiotape. Callers to the CQP enrollment were randomized to either CQP (n=1854) or just the UG (n=1829). Abstinence and use of program materials were assessed by telephone interview at 6 and 12 weeks (the latter falling 2 weeks after patch use was to be discontinued). Considering all respondents, abstinence rates did not differ significantly between the UG and CQP groups. As expected, among those who reported they used their assigned materials (80.1% of the sample) smokers who received CQP demonstrated higher quit rates at both 6 weeks (38.8% v. 30.7%) and 12 weeks (18.2% v. 11.1%), compared to the UG group. Among those who used it, the Committed Quitters Program proved to be an effective behavioral treatment, improving quit rates over nicotine replacement therapy and a brief untailored written guide and audiotape.

Review and needs assessment of materials designed to prevent tobacco use.

Over the past 25 years, numerous educational materials and strategies have been developed for the prevention and control of tobacco use. However, there has been no comprehensive assessment of the available materials designed to educate the public to avoid the use of tobacco. A search for materials and a review process was conducted in the fall of 1993, and a panel of experts reviewed the materials that were collected. In conducting the search, 240 persons and organizations associated with tobacco control efforts across the United States were contacted, and 207 materials were identified and evaluated. All materials were assessed by at least two members of the expert panel. Of the 207 items, 188 were found to be acceptable according to standardized review criteria. The authors drew conclusions about the current availability of tobacco use prevention materials and present recommendations for increasing the availability of materials to community-level and other control programs.