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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.

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Selected slides from the original ppt

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

Workshop on Effective Implementation of FCTC Policies, SRNT/IAHF Conference on Tobacco Control, October 13, 2009

1


The international tobacco control policy evaluation project the itc project

United States

Canada

Australia

United Kingdom

Ireland

Thailand

South Korea

Malaysia

China

Mexico

France

Uruguay

Netherlands

New Zealand

Bhutan

Brazil

India

Mauritius

Germany

Bangladesh

The International Tobacco Control Policy Evaluation Project (the ITC Project)


The itc surveys

The ITC Surveys

  • Extensive surveys of probability samples of adult smokers in each country

  • Longitudinal cohort design

  • Measures of smoking behaviour, history of smoking and of quit attempts, psychosocial variables (beliefs, attitudes, knowledge), and of each FCTC demand policy

  • Identical/similar methods/measures in all countries

    – Ongoing efforts to make survey questions as    functionally equivalent as possible across countries


Selected slides from the original ppt

Bhutan

Mauritius


Itc evaluation of fctc policies partial list

ITC Evaluation of FCTC Policies (Partial List)

  • Warning labels

    – 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

  • Advertising/Promotion

    – 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

  • Smoke-free

    – 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)

  • Taxation

    – All countries

  • Product policies

    – UK (EU): 10-1-10 regulation

    – US/Canada: Reduced ignition propensity

    – All countries: product; product x behavior

  • Light/mild bans

    – UK (2003)

    – Australia (2005)

    – Canada (2006)

    – Brazil + others (2009+)

  • Illicit trade

    – China (2008): prevalence

    – Additional in Canada/U.S.: close to reserves

    – Bhutan (2009+): total ban on sales in country

7


Content of the itc surveys

Surveillance

content

Mixed Surveillance

and policy content

Unique ITC

Content:

170-200 Qs focusing on policy impact

Surveillance

content

Content of the ITC Surveys

Throughout the policy sections there are measures relevant to monitoring


Conceptual model of the itc project

Policy-Relevant Outcomes

• Quit Attempts

• Successful Quitting

• Consumption changes

• Brand switching

• Tax/price avoidance

• Attitude/belief changes

(e.g., justifications)

Conceptual Model of the ITC Project

Policy-Specific

Variables

• Label salience

• Perceived cost

• Ad/promo awareness

• Awareness of

alternative products

• Proximal behaviors

(forgoing a cigarette

because of labels)

Psychosocial Mediators

• Outcome expectancies

• Beliefs & Attitudes

• Perceived Risk

• Perceived Severity

• Self-Efficacy/

Perc. Beh Control

• Normalization beliefs

• Quit intentions

Policy

Moderators

Country

Sociodemographics

(e.g., age, sex, SES, ethnic background)

Past Behavior

(e.g., smoking history, CPD, quit attempts)

Personality

(e.g., time perspective)

Psychological State

(e.g., stress)

Potential Exposure to Policy

(e.g.,employment status)

Economic

Impact

Public

Health

Impact


Selected slides from the original ppt

Proximal Variables

(Policy-Specific)

Distal Variables

(Psychosocial Mediators)

Policy

Behavior

Label Salience

Perc Effectiveness

Depth of Processing

Perceived risk

Perceived severity

Intentions

to Quit

Quit

Attempt

Labels

Denorm beliefs

Social accept

Subjective norms

Advertising salience

Positive assns

Intentions

to Quit

Quit

Attempt

Ad Ban

Mediational Model(s) of Policy Effects

Different policies operate differently, but can be described by the same general model


Selected slides from the original ppt

Cross-Country Comparisons Across the ITC Project Countries

Example of China vs. other ITC countries

11


Selected slides from the original ppt

ITC China Survey

  • Probability samples of adult smokers (N=800) and non-smokers (N=200) in each of 7 cities:

    – Beijing, Shanghai, Guangzhou, Changsha, Yinchuan, Shenyang, Kunming (just started at Wave 3)

  • Partnership with China Office of Tobacco Control(Dr. Jiang Yuan) and with City/Provincial CDCs

  • Three waves so far:

    Wave 1: April–August 2006

    Wave 2: October 2007–January 2008

    Wave 3: April–September 2009

12


Selected slides from the original ppt

There IS demand for cessation assistance throughout the world—even in China. The question is: what kind of supply should be provided?


Selected slides from the original ppt

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.”


Selected slides from the original ppt

Warning Labels: FCTC Article 11

Evidence from the ITC Project

18


Labels and thinking about quitting

Labels and thinking about quitting

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.

19


Selected slides from the original ppt

Do warning labels increase knowledge?

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

20


Selected slides from the original ppt

Do warning labels increase knowledge?

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.

21


Selected slides from the original ppt

Four Country—Change in Avoiding Labels

UK: Text

Jan 2003

Aust: pictorial

Mar 2006

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


What is the relevance of tobacco control policies in high income countries to developing countries

What is the relevance of tobacco control policies in high-income countries to developing countries?

“...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.


Warning labels of seven itc countries at the time of the 2005 survey wave

Warning Labels of Seven ITC Countries at the Time of the 2005 Survey Wave

Canada

Australia

U.K.

U.S.

Malaysia

Thailand

China


Selected slides from the original ppt

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.


Selected slides from the original ppt

Although the 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.


Evaluating graphic warnings in thailand

Evaluating Graphic Warnings in Thailand

2005

2006

FCTC Minimum

– 30% on front and back

– Text-only labels

FCTC Recommendation

– 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)

27


Evaluating graphic warnings in thailand1

Evaluating Graphic Warnings in Thailand

2005

2006

Thailand

Malaysia

28


Selected slides from the original ppt

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

29


Selected slides from the original ppt

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

30


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