Background:The International Tobacco Control (ITC) Four Country Survey (ITC-4) is a prospective cohort study designed to evaluate the psychosocial and behavioural impact of national-level tobacco control policies enacted in the Australia, Canada, the UK, and the USA. Wave 1 of ITC-4 survey was conducted between October 2002 and December 2002. Wave 2 survey was conducted between May 2003 and August 2003.Objective:To test for individual-level predictors of smoking cessation behaviours (that is, quit attempts and smoking cessation) among cigarette smokers in the ITC Four Country Study measured between Wave 1 and Wave 2. This set of predictors will serve as the base for evaluating the added effect of tobacco control policies and other factors.Methods:Respondents included in this study are 6682 adult current smokers in the Wave 1 main survey who completed the Wave 2 follow-up (1665 were in Canada, 1329 were in the USA, 1837 were in the UK and 1851 were in Australia).Results:Factors predictive of making a quit attempt included intention to quit, making a quit attempt in the previous year, longer duration of past quit attempts, less nicotine dependence, more negative attitudes about smoking, and younger age. Lower levels of nicotine dependence were the main factor that predicted future cessation among those that made a quit attempt.Conclusion:Intention to quit and other cognitive variables were associated with quit attempts, but not cessation. Behavioural variables related to task difficulty, including measures of dependence, predicted both making attempts and their success. Predictors of making quit attempts and cessation were similar for each of the four countries, but there were some differences in predictors of success.

Despite the fact that most smokers expressed a strong desire to stop smoking in 1988, the majority, especially the most dependent heavy smokers (>25 cigarettes/day), struggled unsuccessfully to achieve this goal.

Objectives: To gain an understanding of the role of pack design in tobacco marketing. Methods: A search of tobacco company document sites using a list of specified search terms was undertaken during November 2000 to July 2001. Results: Documents show that, especially in the context of tighter restrictions on conventional avenues for tobacco marketing, tobacco companies view cigarette packaging as an integral component of marketing strategy and a vehicle for (a) creating significant in-store presence at the point of purchase, and (b) communicating brand image. Market testing results indicate that such imagery is so strong as to influence smoker's taste ratings of the same cigarettes when packaged differently. Documents also reveal the careful balancing act that companies have employed in using pack design and colour to communicate the impression of lower tar or milder cigarettes, while preserving perceived taste and "satisfaction". Systematic and extensive research is carried out by tobacco companies to ensure that cigarette packaging appeals to selected target groups, including young adults and women. Conclusions: Cigarette pack design is an important communication device for cigarette brands and acts as an advertising medium. Many smokers are misled by pack design into thinking that cigarettes may be "safer". There is a need to consider regulation of cigarette packaging.

Objective:To report on prevalence, trends and determinants of smoke-free home policies in smokers’ homes in different countries and to estimate the effects of these policies on smoking cessation.Design:Two waves of the International Tobacco Control (ITC) Four Country Survey (ITC-4), a cohort survey of smokers conducted by telephone. Wave 1 was conducted in October/December 2002 with broadly representative samples of over 2000 adult (⩾ 18 years) cigarette smokers in each of the following four countries: Canada, the United States, the United Kingdom, and Australia, 75% of whom were followed up at Wave 2 on average seven months later.Key measures:Levels of smoking restrictions in homes (both waves).Results:Australian smokers were most likely to live in smoke-free homes and UK smokers least likely (34%v15% at Wave 1). Levels of smoke-free homes increased between waves. Logistic regressions indicated that the main independent predictors of smokers reporting smoke-free homes or implementation of a smoke-free policy between waves included household factors such as having a child, particularly a young child, and having other non-smoking adults in the household. Positive attitudes to smoke-free public places and/or reported presence of smoke-free public places were independent predictors of having or implementing smoke-free homes, supporting a social diffusion model for smoking restrictions. Intentions to quit at Wave 1 and quitting activity between survey waves were associated with implementing bans between Waves 1 and 2. Presence of bans at Wave 1 was associated with significantly greater proportions of quit attempts, and success among those who tried at Wave 2. There was no significant interaction between the predictive models and country.Conclusions:Smoke-free public places seem to stimulate adoption of smoke-free homes, a strategy associated with both increased frequency of quit attempts, and of the success of those attempts.

No abstract

No abstract

Introduction Tobacco use is associated with poor outcomes in cancer patients, but there is little information on the practice patterns or perceptions of tobacco use and smoking cessation by oncology providers. Methods An online survey of practices, perceptions, and barriers to tobacco assessment and cessation in cancer patients was conducted in members of the International Association for the Study of Lung Cancer (IASLC). Responses of physician level respondents were analyzed and reported. Results Responses from 1,507 IASLC members who completed the survey are reported representing 40.5% of IASLC members. Over 90% of physician respondents believe current smoking affects outcome and that cessation should be a standard part of clinical care. At the initial patient visit, 90% ask patients about tobacco use, 79% ask patients if they will quit, 81% advise patients to stop tobacco use, but only 40% discuss medication options, 39% actively provide cessation assistance, and fewer yet address tobacco at follow-up. Dominant barriers to physician cessation effort are pessimism regarding their ability to help patients stop using tobacco (58%) and concerns about patient resistance to treatment (67%). Only 33% report themselves adequately trained to provide cessation interventions. Discussion Physicians who care for lung cancer patients recognize the importance of tobacco cessation as a necessary part of clinical care, but many still do not routinely provide assistance to their patients. Increasing tobacco cessation will require increased assessment and cessation at diagnosis and during follow-up, increased clinician education, and improved tobacco cessation methods.

Regret may be a key variable in understanding the experience of smokers, the vast majority of whom continue to smoke while desiring to quit. We present data from the baseline wave (October-December 2002) of the International Tobacco Control Policy Evaluation Survey, a random-digit-dialed telephone survey of a cohort of over 8,000 adult smokers across four countries--Canada, the United States, the United Kingdom, and Australia--to estimate the prevalence of regret and to identify its predictors. The proportion of smokers who agreed or agreed strongly with the statement "If you had to do it over again, you would not have started smoking" was extremely high--about 90%--and nearly identical across the four countries. Regret was more likely to be experienced by older smokers, women, those who had tried to quit more often, those who perceived quitting as conferring benefits, those with higher levels of perceived addiction, those who worried about future damage to health, those who perceived smoking as lowering their quality of life, those who perceived higher monetary costs of smoking, and those who believed that smoking is not socially acceptable. This predictive model was the same in all four countries. Regret is thus a near-universal experience among smokers in all four countries, and the factors that predict regret are universal across these four countries. Among other implications for cessation treatment and smoking prevention, this near universality of regret casts doubt on the view of some policy analysts and economists that the decisions to take up and continue smoking are welfare-maximizing for the consumer.