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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.

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SELECTED SLIDES FROM THE ORIGINAL PPT

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  1. 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

  2. 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)

  3. 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

  4. Bhutan Mauritius

  5. 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

  6. 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

  7. 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

  8. 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

  9. Cross-Country Comparisons Across the ITC Project Countries Example of China vs. other ITC countries 11

  10. 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

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

  12. 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.”

  13. Warning Labels: FCTC Article 11 Evidence from the ITC Project 18

  14. 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

  15. 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

  16. 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

  17. 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

  18. 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.

  19. Warning Labels of Seven ITC Countries at the Time of the 2005 Survey Wave Canada Australia U.K. U.S. Malaysia Thailand China

  20. 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.

  21. 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.

  22. 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

  23. Evaluating Graphic Warnings in Thailand 2005 2006 Thailand Malaysia 28

  24. 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

  25. 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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