The Effect of Nicotine Replacement Therapy Advertising on Youth Smoking

This paper examines the effect of nicotine replacement therapy (NRT) advertising on youth smoking. NRT advertising could decrease smoking by informing smokers that the product can make quitting easier and thus inducing more smokers to try and quit. However, a moral hazard is created because NRT advertising increases the expectation that cessation is relatively easy. NRT advertising could thus induce youth to smoke, to smoke more and/or to delay quit attempts. Data from Nielsen Media Research (Nielsen) and the Monitoring the Future Surveys (MTF) have been used in the empirical work. The Nielsen data are matched to the MTF data by month, year and market. The availability of lagged advertising data allow for calculation of an advertising stock variable. The Nielsen data also measure exposure to national advertising on a local level which allows for use of national advertising data. An exogenous shock allows for bypassing problems of endogeneity. The results indicate that NRT advertising has no effect on participation but increases smoking by youth who do smoke. The elasticity of smoking with respect to NRT advertising is about .10 and the elasticity of smoking with respect to price is about -1.03. Since average youth smoking is about 5.77 cigarettes per day, an increase of 10 percent in NRT advertising would increase this average to about 5.82 cigarettes per day. It is also estimated that a ban on NRT advertising would be equivalent to a 10 percent increase in cigarette prices.

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This is an electronic version of an article published in Addiction: Complete citation information for the final version of the paper, as published in the print edition of Addiction, is available on the Blackwell Synergy online delivery service, accessible via the journal’s Web site a

Use of illicit tobacco following introduction of standardised packaging of tobacco products in Australia: results from a national cross-sectional survey

ABSTRACTObjectives: To assess whether following standardisation of tobacco packaging in Australia, smokers were, as predicted by the tobacco industry, more likely to use illicit tobacco.Methods: National cross-sectional telephone surveys conducted continuously from April 2012 (6 months before implementation of plain packaging (PP)) to March 2014 (15 months after) using responses from current cigarette smokers (n=8679). Changes between pre-PP, the transition to PP and PP phase were examined using logistic regression models.Results: Among those whose factory-made cigarettes were purchased in Australia, compared with pre-PP, there were no significant increases in the PP phase in use of: &lsquo;cheap whites&rsquo; (&lt;0.1%; OR=0.24, 95% CI 0.04 to 1.56, p=0.134); international brands purchased for 20% or more below the recommended retail price (0.2%; OR=3.49, 95% CI 0.66 to 18.35, p=0.140); or packs purchased from informal sellers (&lt;0.1%; OR=0.24, 95% CI 0.04 to 1.47, p=0.124). The prevalence of any use of unbranded illicit tobacco remained at about 3% (adjusted OR=0.79, 95% CI 0.58 to 1.08, p=0.141).Conclusions: While unable to quantify the total extent of use of illicit manufactured cigarettes, in this large national survey we found no evidence in Australia of increased use of two categories of manufactured cigarettes likely to be contraband, no increase in purchase from informal sellers and no increased use of unbranded illicit &lsquo;chop-chop&rsquo; tobacco.<br /

Has the introduction of plain packaging with larger graphic health warnings changed adolescents\u27 perceptions of cigarette packs and brands?

Objective To examine the impact of plain packaging of cigarettes with enhanced graphic health warnings on adolescents&rsquo; perceptions of pack image and perceived brand differences.Methods Cross-sectional school-based surveys conducted in 2011 (prior to introduction of new cigarette packaging) and in 2013 (7&ndash;12 months afterwards). Students aged 12&ndash;17 years (2011 n=6338; 2013 n=5915) indicated whether they had seen a cigarette pack in previous 6 months. Students rated the character of four popular cigarette brands, indicated level of agreement regarding differences between brands in ease of smoking, quitting, addictiveness, harmfulness and look of pack; and indicated positive and negative perceptions of pack image. Changes in responses of students seeing cigarette packs in the previous 6 months (2011: 60%; 2013: 65%) were examined.Results Positive character ratings for each brand reduced significantly between 2011 and 2013. Changes were found for four of five statements reflecting brand differences. Significantly fewer students in 2013 than 2011 agreed that &lsquo;some brands have better looking packs than others&rsquo; (2011: 43%; 2013: 25%, p&lt;0.001), with larger decreases found among smokers (interaction p&lt;0.001). Packs were rated less positively and more negatively in 2013 than in 2011 (p&lt;0.001). The decrease in positive image ratings was greater among smokers.Conclusions The introduction of standardised packaging has reduced the appeal of cigarette packs. Further research could determine if continued exposure to standardised packs creates more uncertainty or disagreement regarding brand differences in ease of smoking and quitting, perceived addictiveness and harms.<br /

Size matters but when, why and for whom?

Pack size of tobacco products, including factory-made cigarettes and loose tobacco, is an important but neglected aspect of tobacco control policy. Understanding the nature of the relationship between pack size and consumption, as well as the underlying mechanisms, is key for informing effective policy and reducing smoking prevalenc

Changes in use of types of tobacco products by pack sizes and price segments, prices paid and consumption following the introduction of plain packaging in Australia

Objectives: To describe changes among smokers in use of various types of tobacco products, reported prices paid and cigarette consumption following the standardisation of tobacco packaging in Australia.Methods: National cross-sectional telephone surveys of adult smokers were conducted from April 2012 (6 months before transition to plain packaging (PP) to March 2014 (15 months afterwards). Multivariable logistics regression assessed changes in products, brands and pack types/sizes; multivariable linear regression examined changes in inflation-adjusted prices paid and reported cigarette consumption between the pre-PP and three subsequent periods &ndash; the transition phase, PP year 1 and PP post-tax (post a 12.5% tax increase in December 2013).Results: The proposition of current smokers using roll-your-own (RYO) products fluctuated over the study period. Proportions using value brands of factory-made (FM) cigarettes increased from pre-PP (21.4%) to PP year 1 (25.5%; p=0.002) and PP post-tax (27.8%; p&lt;0.001). Inflation-adjusted prices paid increased in the PP year 1 and PP post-tax phases; the largest increases were among premium FM brands, the smallest among value brands. Consumption did not change in PP year 1 among daily, regular or current smokers declined significantly in PP post-tax (mean=14.0, SE=0.33) compared to PP year 1 (mean=14.8, SE=0.17; p=0.037).Conclusions: Introduction of PP was associated with an increase in use of value brands, likely due to increased numbers available and smaller increases in prices for value relative to premium brands. Reported consumption declined following the December 2013 tax increase.<br /

Standardised packaging and new enlarged graphic health warnings for tobacco products in Australia--legislative requirements and implementation of the Tobacco Plain Packaging Act 2011 and the Competition and Consumer (Tobacco) Information Standard, 2011

This paper describes the development, content and implementation of two pieces of Australian tobacco control legislation: one to standardise the packaging of tobacco products and the other to introduce new, enlarged graphic health warnings. It describes the process of legislative drafting, public consultation and parliamentary consideration. It summarises exactly how tobacco products have been required to look since late 2012. Finally, it describes implementation, most particularly, the extent to which packs compliant with the legislation became available to consumers over time.<br /

What is the role of tobacco control advertising intensity and duration in reducing adolescent smoking prevalence? Findings from 16 years of tobacco control mass media advertising in Australia

ABSTRACTObjective: To examine how the intensity and duration of tobacco control advertising relate to adolescent smoking prevalence.Methods: Australian students (aged 12&ndash;17 years) participating in a national survey conducted triennially between 1993 and 2008 (sample size range 12 314&ndash;16 611). The outcome measure was students&rsquo; smoking in the previous 4 weeks collected through anonymous, self-completed surveys. For each student, monthly targeted rating points (TRPs, a measure of television advertising exposure) for tobacco control advertising was calculated for the 3 and 12 months prior to surveying. For each time period, cumulative TRPs exposure and exposure to three intensity levels (&ge;100 TRPs/month; &ge;400 TRPs/month; &ge;800 TRPs/month) over increasing durations (eg, 1 month, 2 months, etc) were calculated. Logistic regression examined associations between TRPs and adolescent smoking after controlling for demographic and policy variables.Results: Past 3-month cumulative TRPs were found to have an inverse relationship with smoking prevalence. Low TRPs exposure in the past 12 months was positively associated with adolescent smoking prevalence. However, smoking prevalence reduced with cumulative exposure levels above 5800 cumulative TRPs. Additionally, exposure to &ge;400 TRPs/month and &ge;800 TRPs/month were associated with reduced likelihood of smoking, although the duration needed for this effect differed for the two intensity levels. When intensity was &ge;400 TRPs/month, the odds of smoking only reduced with continuous exposure. When intensity was &ge;800 TRPs/month, exposure at levels less than monthly was associated with reductions in smoking prevalence.Conclusions: Both antismoking advertising intensity and duration are important for ensuring reductions in adolescent smoking prevalence.<br /

Adolescents’ use of purpose built shade in secondary schools: cluster randomised controlled trial

Objective To examine whether students use or avoid newly shaded areas created by shade sails installed at schools