Bridging the gap: challenging attitudes towards smoking in pregnancy among healthcare professionals

Background Clean Air for Babies is a Global Bridges project to reduce smoking in pregnancy in a healthcare organization, 'Meuhedet', with 1.2M members. One aim is empowering health professionals to provide brief smoking cessation interventions. In this study we assessed the effectiveness of an education program for nurses and ultrasound technicians. Methods The program consists of 8 hours, and includes smoking and ETS effects during pregnancy, practical tools and behavioral interventions. Evaluation includes before and after questionnaires based on Global Bridges tools, and focus groups. We are at the initial stage of analysis. We will conduct another round of questionnaires 3 months post intervention. Results We conducted 6 courses for 120 maternal health nurses and 60 technicians. Qualitative analysis demonstrates ambivalence regarding ability to intervene (“This will damage the therapeutic space”) and identification with smokers (“I have seen how difficult it is to stop, my husband became unbearable.”). A second theme was hesitance in approaching Muslim or Jewish-Orthodox spouses due to gender-based hierarchies in the cultural context (“In our culture it is hard for the women to tell a man what to do…"). A common theme among technicians was insecurity regarding their role in smoking cessation. We completed analysis of 29 nurses´ questionnaires pre and immediately post intervention. Using paired-t-test analysis we found a significant improvement in the level of knowledge (mean knowledge items 3.27 to 4.38 on a scale of 5, p< 0.001). No difference was found in self efficacy or reported behavior. Conclusions Initial results indicate that it is possible to identify specific barriers among caregivers that create resistance to smoking cessation interventions. Addressing them creates an opportunity for real organizational change. The improvement in knowledge is indicative of the appropriateness of the training sessions. We expect that improvement in self efficacy and reported behavior at the 3 month evaluation

Assessment of IQOS Marketing Strategies at Points-of-Sale in Israel at a Time of Regulatory Transition

Introduction: IQOS, a tobacco heating system, and accompanying tobacco sticks (HEETS) entered the Israeli market in 2016, prior to rapid regulatory change. This study assessed IQOS marketing strategies and regulatory compliance at IQOS and/or HEETS point-of-sale (POS) in Israel in December 17, 2019 to January 7, 2020, after the ban on advertisement went into effect in March 8, 2019. Aims and Methods: Research staff audited 80 randomly selected IQOS and/or HEETS POS in four cities using a structured form to assess store types, product placement, price, promotional strategies, and regulatory compliance. POS data were linked to neighborhood characteristics, including socioeconomic status, ethnicity, and proximity (under 300 m) to schools. Results: Almost half of the stores (48.7%) were convenience stores. HEETS were visible to the customers in 46.1% of POS, 35% carried at least four HEETS colors, 20.0% had IQOS and/or HEETS special displays, and 13.8% displayed HEETS near youth-oriented merchandise. Mean HEETS pack price was US $8.7 (range: US$7.5-11.3), 27% more than the least expensive cigarette pack, and 39% less than the most expensive cigarette. HEETS promotions were uncommon. Compliance with the newly introduced advertisement ban was fairly high for HEETS (94.8%). Only one POS was located in a low-socioeconomic status area; 68.7% were near a school. Conclusions: The relatively limited IQOS and/or HEETS marketing at POS suggests that, with regulatory changes, online or other forms of marketing might be prioritized. IQOS may be promoted to higher socioeconomic status populations, as indicated by pricing and POS neighborhood characteristics. Access near schools and placement near youth-oriented merchandise are potential concerns necessitating further research. Implications: Globally, the POS is considered the least regulated channel for advertising and marketing of tobacco products. Assessing IQOS marketing strategies at the POS provides valuable findings that can inform regulatory efforts in Israel and other countries as well. Limited IQOS and/or HEETS marketing at POS suggests that primary marketing strategies may shift to online or other channels as regulatory contexts become more progressive and/or restrictive. Ongoing surveillance of IQOS via online marketing and POSs, specifically with regard to product placement and proximity to schools, is needed

PMI\u27s IQOS and cigarette ads in Israeli media: a content analysis across regulatory periods and target population subgroups

BACKGROUND: IQOS, manufactured by Philip Morris International (PMI), is the highest selling heated tobacco product globally. IQOS went through several regulatory changes in Israel: from no oversight to minimal tobacco legislation, to progressive legislation that included a partial advertisement ban (exempting print media) and plain packaging. We examined how PMI\u27s advertising messages changed during these regulatory periods for both IQOS and cigarettes. METHODS: Content analysis of PMI\u27s IQOS and cigarette ads was performed using a predefined framework. Ad characteristics included regulatory period, target population, setting, product presentation, age and use restrictions, retail accessibility, additional detail cues (eg, QR code) and promotions. Ad themes included product features, legislation-related elements, social norms and comparative claims. Comparisons between IQOS and cigarette ads, and across regulatory periods, were examined using χ test or Fisher\u27s exact test. RESULTS: The dataset included 125 IQOS ads and 71 cigarette ads. IQOS ads featured more age restrictions, retail accessibility and additional detail cues, compared with cigarette ads (93.6% vs 16.9%; 56.0% vs 0.0%; and 95.2% vs 33.8%, p\u3c0.001 for all). Cigarette ads featured mostly price promotions (52.1% vs 10.1% of IQOS ads, p\u3c0.001). The main ad themes were technology for IQOS (85.6%) and quality for cigarettes (50.7%). In later (vs earlier) restrictive regulatory periods, IQOS ads featured more direct comparisons to cigarettes, QR codes and indoor settings, and did not feature product packaging. CONCLUSIONS: IQOS advertisement content shifted as more restrictions went into effect, with several elements used to circumvent legislation. Findings from this study point to the necessity of a complete advertisement ban and ongoing marketing surveillance