SELECTED SLIDES FROM THE ORIGINAL PPT. The Framework Convention on Tobacco Control and the Evaluation Framework to Support Its Strong Implementation: Findings from the ITC Project Geoffrey T. Fong, Ph.D. University of Waterloo and Ontario Institute for Cancer Research.
The Framework Convention on Tobacco Control and the Evaluation Framework to Support Its Strong Implementation:
Findings from the ITC Project
Geoffrey T. Fong, Ph.D.
University of Waterloo and
Ontario Institute for Cancer Research
Workshop on Effective Implementation of FCTC Policies, SRNT/IAHF Conference on Tobacco Control, October 13, 2009
BangladeshThe International Tobacco Control Policy Evaluation Project (the ITC Project)
– Ongoing efforts to make survey questions as functionally equivalent as possible across countries
– UK (2003): Text –Mauritius (2009): Graphic
– UK (2009): Graphic
– Thailand (2006): Graphic
– Australia (2006): Graphic
– Canada (2010): Graphic, Round 2
– China (2008): Text
– Mexico (2008): Graphic
– Uruguay (2006,09): Graphic
– Brazil (2008/09): Graphic, Round 3
– Malaysia (2008): Graphic
– India (2008/09): Graphic
– UK (2003): Comprehensive
– Canada (2003): Last part of Comp.
– Thailand (2006): POS bans
– Mexico (2008): Comprehensive
– Canada (2008+): Re-emergence of
“descriptive” ads & possible new ban
– China (2011): Comprehensive
– Many other countries: Partial
– Ireland (2004) – Mexico (2008+)
– Scotland (2005) – Brazil (2008+)
– England (2007) – Bangladesh (2009+)
– Uruguay (2006) – Bhutan (2009+)
– France (2007/08)
– Germany (2007/08+)
– China (partial in 2008+ & Olympics)
– Netherlands (Part 2–2008/09)
– All countries
– UK (EU): 10-1-10 regulation
– US/Canada: Reduced ignition propensity
– All countries: product; product x behavior
– UK (2003)
– Australia (2005)
– Canada (2006)
– Brazil + others (2009+)
– China (2008): prevalence
– Additional in Canada/U.S.: close to reserves
– Bhutan (2009+): total ban on sales in country
and policy content
170-200 Qs focusing on policy impact
contentContent of the ITC Surveys
Throughout the policy sections there are measures relevant to monitoring
• Quit Attempts
• Successful Quitting
• Consumption changes
• Brand switching
• Tax/price avoidance
• Attitude/belief changes
(e.g., justifications)Conceptual Model of the ITC Project
• Label salience
• Perceived cost
• Ad/promo awareness
• Awareness of
• Proximal behaviors
(forgoing a cigarette
because of labels)
• Outcome expectancies
• Beliefs & Attitudes
• Perceived Risk
• Perceived Severity
Perc. Beh Control
• Normalization beliefs
• Quit intentions
(e.g., age, sex, SES, ethnic background)
(e.g., smoking history, CPD, quit attempts)
(e.g., time perspective)
Potential Exposure to Policy
Depth of Processing
Mediational Model(s) of Policy Effects
Different policies operate differently, but can be described by the same general model
Example of China vs. other ITC countries
– Beijing, Shanghai, Guangzhou, Changsha, Yinchuan, Shenyang, Kunming (just started at Wave 3)
Wave 1: April–August 2006
Wave 2: October 2007–January 2008
Wave 3: April–September 2009
There IS demand for cessation assistance throughout the world—even in China. The question is: what kind of supply should be provided?
A little lower means more loving care! Low-harm cigarettes give you more loving care!Cigarettes contain conflicting elements of pleasure and harm. Zhongnanhai has always focused on research and development of low-harm cigarette technology. Every product fuses the world’s most advanced low-harm cigarette technology, offering a guarantee of health for your smoking life.(Advertisement for Zhongnanhai Lights Cigarettes published in the September, 2006 issue of the company’s monthly magazine Zhongnanhai World.)
“A little lower means more loving care!”
“Low-harm cigarettes give you more loving care.”
“...the world’s most advanced low-harm cigarette technology, offering a guarantee of health for your smoking life.”
Warning Labels: FCTC Article 11 give you more loving care!
Evidence from the ITC Project
Hammond et al. Am J Prev Med (2007)
Comparing Canada (pictorial) to UK (text-only) at the same time after introduction (2.5 years): Canada is higher on this important measure of impact.
Do warning labels increase knowledge? give you more loving care!
Only Canada had a warning label about impotence at Wave 1, but then U.K. added an impotence label between Wave 1 and Wave 2
Do warning labels increase knowledge? give you more loving care!
Substantial increase in knowledge about impotence in the U.K. compared to the other three countries after the label on impotence was introduced in the U.K.
Four Country—Change in Avoiding Labels give you more loving care!
Borland et al. Tob Control (2009)
Significance: avoiding labels predicts future quit attempts.
Example of the mediational model for warnings: Pictorial warnings are linked to future quit attempts because they first create reactions that are associated with future quitting
“...It cannot be assumed, therefore, that the tobacco control strategies being implemented in industrialized countries will be just as effective and appropriate when implemented in developing countries. There is an urgent need to expand the number of such tobacco policy studies, particularly in low-income and middle-income countries.”
– Global Analysis Project Team, Bulletin of the WHO (2000), 78, 913-9.
Noticing/Salience of warning labels is generally HIGHER in LMICs than the four high-income countries. WHY? Because LMICs have fewer OTHER sources of information about the harms of smoking. And thus labels = greater proportion of information in LMICs. Conclusion: warning labels are MORE important in LMICs as a source of information than in HICs.
Although the LMICs than the four high-income countries. WHY? Because LMICs have fewer OTHER sources of information about the harms of smoking. And thus labels = greater proportion of information in LMICs. Conclusion: warning labels are MORE important in LMICs as a source of information than in HICs.potential for benefit is very high (high levels of noticing), the potential is NOT met: lowest impact in China and Malaysia (and U.S.—the three countries with labels on the side of the pack). This is a huge missed opportunity.
– 30% on front and back
– Text-only labels
– 50% on front and back
– Graphic images
Evaluating the impact of changing from the FCTC minimum to the recommended level within a single country
(rather than making comparisons across countries)
Enlarging the labels and adding graphic images led to substantial increases in the percentage of Thai smokers reporting that warnings make them think about health risks
Enlarging the labels and adding graphic images also led to large increases in the percentage of Thai smokers reporting that warnings make them more likely to quit