The effect of tobacco tax cuts on cigarette smoking in Canada

OBJECTIVE: To assess the effect of the tobacco tax cuts made in 1994 on the smoking habits of Canadians. DESIGN: Population-based retrospective cohort study. DATA: Data from the Survey on Smoking in Canada conducted by Statistics Canada on 11,119 respondents 15 years of age and older, who were interviewed about their smoking habits on 4 occasions, approximately every 3 months from January 1994 to February 1995. OUTCOME MEASURES: Changes in smoking prevalence, incidence, quit rates and mean number of cigarettes smoked per day in the provinces where tobacco taxes were cut and in those where taxes were not cut. RESULTS: During the survey, smoking prevalence decreased in all provinces, whether or not cigarette taxes had been cut. However, the prevalence of smoking was greater in the provinces where tobacco taxes had been cut than in those where they had not, and this difference increased from 2.0% at the beginning of the survey to 3.4% by the end (p < 0.001). In addition, rates of starting cigarette smoking were higher and smoking quit rates were lower in the provinces where taxes had been cut than in those where taxes had not been cut. CONCLUSION: Although smoking rates are declining in Canada, tobacco tax cuts appear to have slowed the rate of decline by inducing more nonsmokers to take up smoking and leading fewer smokers to quit.     

CMA brief offers suggestions as federal commission studies country's blood-gathering system

The CMA hopes the Commission of Inquity on the Blood System, chaired by Mr. Justice Horace Krever, “will restore faith in a system that is essential for the health and safety of all Canadians.” However, the cost implications any recommendations may have for the health care system must also be taken into consideration. The CMA made several recommendations in response to the commission''s interim report.     

Legislation for smoking control in Western Australia.

This historical analysis of public issues relating to smoking control in Western Australia examines relevant Western Australian state and Australian federal laws, their introduction, and their consequences. Public and political support and opinion led by the health professions resulted in two attempts to legislate against all forms of cigarette advertising in 1982 and 1983. Both attempts failed, and public support for such measures has been seen to be affected by the campaigns mounted in opposition by the tobacco and advertising industries. Other smoking control measures which have been successfully introduced in 1983 and 1984 are higher tobacco taxes and a comprehensive coordinated public education and information programme. The activities associated with the legislative initiatives resulted in a greatly increased level of community awareness of the dangers of smoking and acceptance of the need for some action on this major health problem.     

Right to bill may affect amount of tobacco counselling by MDs

Unpublished data from Health Canada indicate that only 32% of Canada''s family physicians believe they can bill their health plans for providing smoking-cessation counselling to patients with no smoking-related illness. A CMA study of provincial billing codes determined that all provinces and territories except British Columbia and Alberta have billing codes for clinical tobacco interventions, which include counselling. Ontario leads the way with 4 separate codes.     

Reducing tobacco consumption: public policy alternatives for Canada.

The costs of smoking are extensive, not only in fiscal terms but also in terms of human suffering. A review of several major public policies reveals that concerted efforts by all levels of government and by the public can have an effect on the rate of consumption of tobacco. Specifically, increases in price through taxation, anti-smoking messages, restrictions on smoking behaviour and increased public pressure are effective in reducing smoking. Serious joint efforts in the area of public policy should be pursued to control the effects of this hazardous practice in Canada.     

Yes,minister, Canadians need strong tobacco-control legislation now!

At a meeting with federal health minister Diane Marleau on Nov. 16, 1995, the CMA and other health organizations were told that the minister plans to propose comprehensive measures to limit the manufacture, sale and marketing of tobacco products. On Dec. 11, 1995, the minister announced a "Blueprint on Tobacco Control," which outlined the scope of her plan to introduce tobacco legislation in the spring. On the basis of adamant support for tobacco control from all levels of the organization, the CMA urges the minister to move quickly. It also advocates regulating tobacco as a hazardous product in the meantime. Physicians can take a wide variety of actions to intervene with patients and add their voice to antitobacco lobbying efforts in 1996.     

Smoking and cancer: smoking cessation.

Smoking is the single most important cause of cancer. The risk of developing cancer is reduced by stopping smoking and decreases substantially after five years. Reduction in smoking must be central to any programme aimed seriously at the prevention of cancer. An individual approach, based in primary care, has the potential to bring about modest but important reductions in risk. Many randomised trials have shown the effectiveness of various smoking cessation interventions in primary care. Given resource limitations in primary care, individual effort should be focused on those at highest risk who are motivated to stop smoking. A population strategy has considerable advantages over the high risk approach as the potential for reducing morbidity and mortality in the whole population is much greater. The government must acknowledge its major responsibility; the outstanding example of its failure to do this is its persistent refusal to ban outright all forms of advertising and promotion of tobacco. There is clear evidence that a ban would contribute to a reduction in smoking prevalence and especially in the uptake of smoking by children.     

Toronto centre hopes to cash in on growing demand for private health services

When the CMA held its 1996 annual meeting, part of the debate on the future of health care involved the "appropriate balance of the roles of the public and private sectors" in delivering health care. The King''s Health Centre in Toronto is now doing its own balancing act: providing publicly funded care to Canadians, and private care to non-Canadians and Canadians who can afford it. This article discusses some of the niche markets King''s is attempting to develop.     

Drinking and Driving

Alcohol misuse generates many health and social problems at a cost that society is increasingly unwilling to sustain. One of the most tragic consequences of alcohol misuse is the result of drinking and driving. Each week, impaired drivers kill 40 Canadian men, women and children and injure 1250 others. The Canadian Medical Association (CMA), in its campaign against drinking and driving, has recommended that a condition of obtaining or renewing a driver''s licence include the individual''s written consent to allow the taking of blood samples by qualified medical personnel when deemed necessary by law enforcement agencies. CMA has recommended to the provinces that the legal age for the purchase and public possession of alcohol be raised to 21. CMA also supports the ban of all alcohol advertising in the electronic media and emphasizes that since alcohol is a drug, all containers should be visibly labelled “Misuse of this Product can be Injurious to Health”. CMA continues to support and encourage the federal and provincial governments in their battle to prevent alcohol-related deaths and injuries through education, control of advertising, use of breathalyzer devices, mandatory blood alcohol testing and legislation enacting stiffer penalties for drinking and driving.     

Protobacco Media Exposure and Youth Susceptibility to Smoking Cigarettes,Cigarette Experimentation,and Current Tobacco Use among US Youth

Purpose

Youth are exposed to many types of protobacco influences, including smoking in movies, which has been shown to cause initiation. This study investigates associations between different channels of protobacco media and susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US middle and high school students.

Methods

By using data from the 2012 National Youth Tobacco Survey, structural equation modeling was performed in 2013. The analyses examined exposure to tobacco use in different channels of protobacco media on smoking susceptibility, experimentation, and current tobacco use, accounting for perceived peer tobacco use.

Results

In 2012, 27.9% of respondents were never-smokers who reported being susceptible to trying cigarette smoking. Cigarette experimentation increased from 6.3% in 6th grade to 37.1% in 12th grade. Likewise, current tobacco use increased from 5.2% in 6th grade to 33.2% in 12th grade. Structural equation modeling supported a model in which current tobacco use is associated with exposure to static advertising through perception of peer use, and by exposure to tobacco use depicted on TV and in movies, both directly and through perception of peer use. Exposure to static advertising appears to directly increase smoking susceptibility but indirectly (through increased perceptions of peer use) to increase cigarette experimentation. Models that explicitly incorporate peer use as a mediator can better discern the direct and indirect effects of exposure to static advertising on youth tobacco use initiation.

Conclusions

These findings underscore the importance of reducing youth exposure to smoking in TV, movies, and static advertising.     

Deaths in Canada from lung cancer due to involuntary smoking.

Recently published evidence indicates that involuntary smoking causes an increased risk of lung cancer among nonsmokers. Information was compiled on the proportion of people who had never smoked among victims of lung cancer, the risk of lung cancer for nonsmokers married to smokers and the prevalence of such exposure. On the basis of these data we estimate that 50 to 60 of the deaths from lung cancer in Canada in 1985 among people who had never smoked were caused by spousal smoking; about 90% occurred in women. The total number of deaths from lung cancer attributable to exposure to tobacco smoke from spouses and other sources (mainly the workplace) was derived by applying estimated age- and sex-specific rates of death from lung cancer attributable to such exposure to the population of Canadians who have never smoked; about 330 deaths from lung cancer annually are attributable to such exposure.     

The anti-tobacco campaign of the Nazis: a little known aspect of public health in Germany, 1933-45.

Historians and epidemiologists have only recently begun to explore the Nazi anti-tobacco movement. Germany had the world''s strongest antismoking movement in the 1930s and early 1940s, encompassing bans on smoking in public spaces, bans on advertising, restrictions on tobacco rations for women, and the world''s most refined tobacco epidemiology, linking tobacco use with the already evident epidemic of lung cancer. The anti-tobacco campaign must be understood against the backdrop of the Nazi quest for racial and bodily purity, which also motivated many other public health efforts of the era.     

The hierarchy of approaches to tobacco control

Tobacco represents the single most preventable cause of disease and death in the world today. Of 260 million male deaths in the developed world between 1950 and 2000, it is estimated that 50 million will be due to smoking. In the oral and craniofacial region tobacco use has been associated with the occurrence of cleft palate, periodontal disease and tooth loss, and a variety of soft tissue lesions including oral cancer. For example, smoking is estimated to account for 92% of cancers of the lip, oral cavity and pharynx. Few studies have examined relative efficiency of the many different approaches to tobacco control but, in general, legislative approaches such as increasing tobacco taxes and prohibiting advertising are most effective and those based on printed educational materials and cessation groups, the least effective. In all cases, advice or intervention by health care professionals ranked among the most effective non-legislative approaches to control. A very wide range of professionally-based interventions have been described, including pharmacologic interventions, behavioral approaches and group counseling. The dental profession has a unique opportunity to influence tobacco use by their patients. Its use is almost always immediately evident to the dentist or dental assistant in terms of odor, staining, poor oral hygiene or obvious oral disease. There is also a tendency for the length of personal contact with the dentist to be greater than with a physician. Guidelines are now available that provide the dental professional with advice on the best approaches to tobacco control with their patients.     

The Influence of Antismoking Television Advertisements on Cessation by Race/Ethnicity,Socioeconomic Status,and Mental Health Status

Disparities in tobacco use and smoking cessation by race/ethnicity, education, income, and mental health status remain despite recent successes in reducing tobacco use. It is unclear to what extent media campaigns promote cessation within these population groups. This study aims to (1) assess whether exposure to antitobacco advertising is associated with making a quit attempt within a number of population subgroups, and (2) determine whether advertisement type differentialy affects cessation behavior across subgroups. We used data from the New York Adult Tobacco Survey (NY-ATS), a cross-sectional, random-digit-dial telephone survey of adults aged 18 or older in New York State conducted quarterly from 2003 through 2011 (N = 53,706). The sample for this study consists of 9,408 current smokers from the total NY-ATS sample. Regression methods were used to examine the effect of New York State’s antismoking advertising, overall and by advertisement type (graphic and/or emotional), on making a quit attempt in the past 12 months. Exposure to antismoking advertising was measured in two ways: gross rating points (a measure of potential exposure) and self-reported confirmed recall of advertisements. This study yields three important findings. First, antismoking advertising promotes quit attempts among racial/ethnic minority smokers and smokers of lower education and income. Second, advertising effectiveness is attributable in part to advertisements with strong graphic imagery or negative emotion. Third, smokers with poor mental health do not appear to benefit from exposure to antismoking advertising of any type. This study contributes to the evidence about how cessation media campaigns can be used most effectively to increase quit attempts within vulnerable subgroups. In particular, it suggests that a general campaign can promote cessation among a range of sociodemographic groups. More research is needed to understand what message strategies might work for those with poor mental health.     

Effect of Exposure to Smoking in Movies on Young Adult Smoking in New Zealand

Onscreen Smoking Is a Form of Tobacco Marketing

Tobacco advertising has been prohibited in New Zealand since 1990, and the government has set a goal of becoming a smokefree nation by 2025. However, tobacco marketing persists indirectly through smoking in motion pictures, and there is strong evidence that exposure to onscreen smoking causes young people to start smoking. We investigated the relationship between exposure to smoking in movies and youth smoking initiation among New Zealand young adults. Data from an online survey of 419 smokers and non-smokers aged 18 to 25 were used to estimate respondents’ exposure to smoking occurrences in 50 randomly-selected movies from the 423 US top box office movies released between 2008 and 2012. Analyses involved calculating movie smoking exposure (MSE) for each respondent, using logistic regression to analyse the relationship between MSE and current smoking behaviour, and estimating the attributable fraction due to smoking in movies.

Effect of Smoking in Movies on New Zealand Youth

Exposure to smoking occurrences in movies was associated with current smoking status. After allowing for the influence of family, friends and co-workers, age and rebelliousness, respondents’ likelihood of smoking increased by 11% for every 100-incident increase in exposure to smoking incidents, (aOR1.11; p< .05). The estimated attributable fraction due to smoking in movies was 54%; this risk could be substantially reduced by eliminating smoking from movies currently rated as appropriate for youth. We conclude that exposure to smoking in movies remains a potent risk factor associated with smoking among young adults, even in a progressive tobacco control setting such as New Zealand. Harmonising the age of legal tobacco purchase (18) with the age at which it is legal to view smoking in movies would support New Zealand’s smokefree 2025 goal.     

The dilemma posed by minority medical traditions in pluralistic societies: The case of China and Canada

Pluralistic societies such as China and Canada frequently find themselves pursuing potentially contradictory goals. China's contradiction results from a desire to preserve cultural diversity while eliminating ‘backward tendencies’ which work against the economic and social development of the country as a whole. Canada's contradiction results from a desire to preserve cultural diversity while maintaining an emphasis upon equality of rights and responsibilities for all Canadians. Behind these differences in ideology, however, is a more basic structural contradiction ‐ namely, that cultural pluralism, while considered an asset as long as it is restricted to preserving unique cultural traditions, is nevertheless a threat to a strong central government if interpreted to imply the power to set policy at the local level. To explore this issue, this article compares China and Canada in terms of three related topics. First, it briefly examines the multicultural policy of China and Canada. This is followed by a discussion of medical pluralism in China and Canada, with an emphasis upon the health of minority groups and the status of minority healing traditions. Finally, common perceptions of shamanic healing traditions in both China and Canada are considered. It is in relation to shamanism that the dilemma posed by cultural pluralism is most clearly delimited.     

Family planning/contraception

It is the position of the Canadian Medical Association (CMA) that family planning advice and assistance should be readily available to all residents of Canada. This is viewed as a responsibility of practising physicians that is to be shared with other health and educational agencies. CMA has recommended the establishment of facilities in addition to physicians'' offices for the dissemination of advice on family planning. These facilities should be developed in consultation with and under the supervision of the medical profession. CMA believes induced abortion should not be an alternative to contraception as a method of responsible family planning. In the event of an unwanted pregnancy, full counselling services should be provided. Within the context of preventive medicine, CMA supports the development of educational programs in family living and the promotion of sex education in the school system by knowledgeable persons sensitive to the needs of students.     

Health risk perception in Canada II: Worldviews,attitudes and opinions

In this article, we present the results of a national survey of 1500 Canadians on their attitudes and opinions about health risks. Ratings of perceived risk, sources of information on health risks and responsibility for risk management were also investigated, with findings reported separately. A high degree of concern about health risks was associated with industrial pollution and chemical products (with the exception of medicines), with almost complete agreement that the land, air and water are more contaminated than ever. In addition, there was widespread belief that a risk‐free environment was an achievable goal, and an unwillingness to accept some health risks to improve the economy. Lifestyle factors such as diet, exercise, and tobacco smoking were perceived to be important modifiers of health risk. On the other hand, many respondents endorsed the idea that they had little control over the risks to their health.