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 /

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 /

Australian adult smokers\u27 responses to plain packaging with larger graphic health warnings 1 year after implementation: results from a national cross-sectional tracking survey

AbstractBackground We assessed whether the Australian plain packs with larger graphic health warnings (GHWs) achieved three specific objectives of reducing the appeal of tobacco, increasing health warning effectiveness and reducing the ability of packaging to mislead about smoking harms.Methods We compared responses from continuous cross-sectional telephone surveys of n=2176 cigarette smokers during pre-plain packaging (April&ndash;September 2012, pre-PP) with n=759 surveyed in the transition period (October&ndash;November 2012) and n=4240 during the first year of implementation (December 2012&ndash;November 2013, PP year 1), using multivariate logistic regression analyses.Results From pre-PP to PP year 1, more smokers disliked their pack (p&lt;0.001), perceived lower pack appeal (p&lt;0.001), lower cigarette quality (p&lt;0.001), lower satisfaction (p&lt;0.001) and lower value (p&lt;0.001) and disagreed brands differed in prestige (p=0.003). There was no change in perceived differences in taste of different brands. More smokers noticed GHWs (p&lt;0.001), attributed much motivation to quit to GHWs (p&lt;0.001), avoided specific GHWs when purchasing (p&lt;0.001), and covered packs (p&lt;0.001), with no change in perceived exaggeration of harms. PP year 1 saw an increased proportion believing that brands do not differ in harmfulness (p=0.004), but no change in the belief that variants do not differ in strength or the perceived harmfulness of cigarettes compared with a year ago. Interactions signified greater change for four outcomes assessing aspects of appeal among young adults and two appeal outcomes among mid-aged adults.Conclusions The specific objectives of plain packaging were achieved and generally sustained among adult smokers up to 12 months after implementation.<br /

Are quitting-related cognitions and behaviours predicted by proximal responses to plain packaging with larger health warnings? Findings from a national cohort study with Australian adult smokers

Background: Implementation of tobacco plain packaging (PP) with larger graphic health warnings (GHWs) in Australia had positive effects on responses reflecting the specific objectives of the PP policy and on follow-up quitting-related cognitions and behaviours. The aim of this study was to examine predictive relationships bewteen these proximal and distal outcomes.Methods: A nationally representative sample of Australian adult cigarette smokers completed a baseline survey and a 1-month follow-up survey within the first year of policy implementation (n(weighted)=3215). Logistic regression analyses tested whether baseline measures of cigarette appeal, GHW effectiveness, perceived harm and concern/enjoyment predicted each of seven follow-up measures of quitted-related cognitions and behaviours, adjusting for baseline levels of the outcome and covariates.Results: In multivariable models, we found consistent evidence that several baseline measures of GHW effectiveness positively and significantly predicted the likelihood that smokers at follow-up reported thinking about quitting at least daily, intending to quit, having a firm date to quit, stubbing out cigarettes prematurely, stopping oneself from smoking and having attempted to quit. Two of the quitting-related outcomes were also predicted by feeling more smoking-related concern than enjoyment. A smaller number of the appeal variables were prospectively associated with quitting-related outcomes, while believing that brands do not differ in harmlessness did not positively predict any outcomes.Conclusions: These findings provide an initial insight into the pathways through which PP with larger GHWs may lead to changes in smoking behaviour. Future research should examine whether the effects are conditional on individual demographic and smoking characteristics.<br /

Short-term changes in quitting-related cognitions and behaviours after the implementation of plain packaging with larger health warnings : findings from a national cohort study with Australian adult smokers

ABSTRACTBackground: Plain packaging (PP) with larger graphic health warnings (GHWs) was implemented in Australia in late 2012. This study examined effects of these packaging changes on short-term changes in quitting-related cognitions and behaviours.Methods: We used a series of cohorts of Australian adult cigarette smokers originally sourced from a nationally representative cross-sectional tracking survey, followed up approximately 1 month after their baseline interview (n(weighted)=5441). Logistic regression analyses compared changes in seven quitting-related outcomes over this 1-month follow-up period for the cohorts surveyed before PP, over the period of transition to PP, and during the first year of PP, adjusting for baseline levels of the outcome and covariates.Results: Compared to the referent group of smokers who completed their follow-up survey pre-PP, those who were followed-up in the early transition period showed greater increases in rates of stopping themselves from smoking (OR=1.51, 95% CI (1.08 to 2.10)) and higher quit attempt rates (OR=1.43, 95% CI (1.00 to 2.03)), those followed-up in the late transition period showed greater increases in intentions to quit (OR=1.42, 95% CI (1.06 to 1.92)) and pack concealment (OR=1.55, 95% CI (1.05 to 2.31)), and those followed- up in the first year of PP showed higher levels of pack concealment (OR=1.65, 95% CI (1.01 to 2.72)), more premature stubbing out of cigarettes (OR=1.55, 95% CI (1.01 to 2.36)), and higher quit attempt rates (OR=1.52, 95% CI (1.01 to 2.30)).Conclusions: These findings provide some of the strongest evidence to date that implementation of PP with larger GHWs was associated with increased rates of quitting cognitions, microindicators of concern and quit attempts among adult cigarette smokers.<br /

The effects of cumulative natural disaster exposure on adolescent psychological distress

Natural disasters are becoming more frequent and destructive due to climate change and have been shown to be associated with a variety of adverse mental health outcomes in children and adolescents. This study utilizes data from three cohort studies of Hurricane Katrina survivors—including low-income mothers from New Orleans; displaced and highly impacted families from Louisiana and Mississippi; and Vietnamese immigrants in New Orleans—to examine the relationship between cumulative natural disaster exposure and adolescent psychological distress approximately 13 years after Katrina. Among 648 respondents with children ages 10-17, 112 (17.2%) reported that their child had exhibited one or more symptoms of psychological distress in the past month. Overall, respondents had experienced an average of 0.6 (SD 1.0) natural disasters following Hurricane Katrina. Each additional natural disaster experienced by the respondent was associated with 1.41 (95% CI 1.05, 1.88) greater odds of his or child experiencing psychological distress in the past month. This relationship was not significantly moderated by any measures of family resilience or vulnerability, nor by race/ethnicity or socioeconomic status, although family functioning, parental coping, and caregiver mental health were independently associated with adolescent psychological distress. The results of this analysis suggest that natural disasters have cumulative, detrimental impacts on adolescent mental health

Mental health during the COVID-19 pandemic in a longitudinal study of Hurricane Katrina survivors

While the COVID-19 pandemic is known to have caused widespread mental health challenges, it remains unknown how the prevalence, presentation, and predictors of mental health adversity during the pandemic compare to other mass crises. We shed light on this question using longitudinal survey data (2003–2021) from 424 low-income mothers who were affected by both the pandemic and Hurricane Katrina, which struck the U.S. Gulf Coast in 2005. The prevalence of elevated posttraumatic stress symptoms was similar 1-year into the pandemic (41.6%) as 1-year post-Katrina (41.9%), while elevated psychological distress was more prevalent 1-year into the pandemic (48.3%) than 1-year post-Katrina (37.2%). Adjusted logistic regression models showed that pandemic-related bereavement, fear or worry, lapsed medical care, and economic stressors predicted mental health adversity during the pandemic. Similar exposures were associated with mental health adversity post-Katrina. Findings underscore the continued need for pandemic-related mental health services and suggest that preventing traumatic or stressful exposures may reduce the mental health impacts of future mass crises