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      Impact of reduced ignition propensity cigarette regulation on consumer smoking behavior and quit intentions: evidence from 6 waves (2004–11) of the ITC Four Country Survey

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          Abstract

          Background

          Although on the decline, smoking-related fires remain a leading cause of fire death in the United States and United Kingdom and account for over 10% of fire-related deaths worldwide. This has prompted lawmakers to enact legislation requiring manufacturers to implement reduced ignition propensity (RIP) safety standards for cigarettes. The current research evaluates how implementation of RIP safety standards in different countries influenced smokers’ perceptions of cigarette self-extinguishment, frequency of extinguishment, and the impact on consumer smoking behaviors, including cigarettes smoked per day and planning to quit.

          Methods

          Participants for this research come from Waves 3 through 8 of the International Tobacco Control (ITC) Four Country Survey conducted longitudinally from 2004 through 2011 in the United States, United Kingdom, Australia, and Canada.

          Results

          Perceptions of cigarette self-extinguishment and frequency of extinguishment increased concurrently with an increase in the prevalence of RIP safety standards for cigarettes. Presence of RIP safety standards was also associated with a greater intention to quit smoking, but was not associated with the number of cigarettes smoked per day. Intention to quit was higher among those who were more likely to report that their cigarettes self-extinguish sometimes and often, but we found no evidence of an interaction between frequency of extinguishment and RIP safety standards on quit intentions.

          Conclusions

          Overall, because these standards largely do not influence consumer smoking behavior, RIP implementation may significantly reduce the number of cigarette-related fires and the associated death and damages. Further research should assess how implementation of RIP safety standards has influenced smoking-related fire incidence, deaths, and other costs associated with smoking-related fires.

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          Most cited references11

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          Methods of the International Tobacco Control (ITC) Four Country Survey.

          This paper outlines the design features, data collection methods and analytic strategies of the International Tobacco Control (ITC) Four Country Survey, a prospective study of more than 2000 longitudinal respondents per country with yearly replenishments. This survey possesses unique features that sets it apart among surveys on tobacco use and cessation. One of these features is the use of theory-driven conceptual models. In this paper, however, the focus is on the two key statistical features of the survey: longitudinal and "quasi-experimental" designs. Although it is often possible to address the same scientific questions with a cross-sectional or a longitudinal study, the latter has the major advantage of being able to distinguish changes over time within individuals from differences among people at baseline (that is, differences between age and cohort effects). Furthermore, quasi-experiments, where countries not implementing a given new tobacco control policy act as the control group to which the country implementing such a policy will be compared, provide much stronger evidence than observational studies on the effects of national-level tobacco control policies. In summary, application of rigorous research methods enables this survey to be a rich data resource, not only to evaluate policies, but also to gain new insights into the natural history of smoking cessation, through longitudinal analyses of smoker behaviour.
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            Prevalence and attributes of roll-your-own smokers in the International Tobacco Control (ITC) Four Country Survey.

            Roll-your-own (RYO) cigarettes are often substantially less expensive than factory made (FM) cigarettes, and appear to be increasing in popularity-perhaps because smokers seek out less expensive options to maintain their nicotine addiction. There is surprisingly little research available on the actual prevalence of RYO cigarette usage, and even less on the attributes of those who smoke RYO cigarettes. This study has two objectives: (1) to compare the prevalence of RYO versus FM cigarette usage among adult smokers in Australia, Canada, the United Kingdom, and the United States; and (2) to compare the attributes of exclusive FM smokers, exclusive RYO smokers, and those who report "mixed" RYO and FM use. The data were collected from the International Tobacco Control (ITC) Four Country Survey (ITC-4), a random digit dialed telephone survey of representative samples of over 9046 adult smokers from the following four countries: Australia (n = 2301), Canada (n = 2,206), the UK (n = 2400), and the USA (n = 2,139), surveyed between October and December 2002, and on 6075 smokers followed-up, on average, seven months later. The prevalence of RYO cigarette usage varied widely across the four countries, with a low of 6.7% in the USA, to 28.4% in the UK. Exclusive use of RYO cigarettes was more common in the UK than in the other three countries. The use of RYO cigarettes was associated with having a lower annual income, male sex, younger average age, higher level of nicotine addiction, a stronger belief that RYO tobacco is less harmful compared to other forms of tobacco, and a more positive perception of tobacco use. Prevalence of RYO use was relatively stable within each of the four countries between the baseline and follow-up survey. RYO use was unrelated to quitting activity at follow-up, although mixed RYO users who had made a quit attempt were more likely to relapse than either exclusive FM or exclusive RYO smokers. Patterns of RYO use vary considerably across Australia, Canada, the USA, and the UK. RYO smokers are a heterogeneous group; however, the factors associated with RYO use appear to be the same across the four countries studied.
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              A comparison of several approaches for choosing between working correlation structures in generalized estimating equation analysis of longitudinal binary data.

              The method of generalized estimating equations (GEE) models the association between the repeated observations on a subject with a patterned correlation matrix. Correct specification of the underlying structure is a potentially beneficial goal, in terms of improving efficiency and enhancing scientific understanding. We consider two sets of criteria that have previously been suggested, respectively, for selecting an appropriate working correlation structure, and for ruling out a particular structure(s), in the GEE analysis of longitudinal studies with binary outcomes. The first selection criterion chooses the structure for which the model-based and the sandwich-based estimator of the covariance matrix of the regression parameter estimator are closest, while the second selection criterion chooses the structure that minimizes the weighted error sum of squares. The rule out criterion deselects structures for which the estimated correlation parameter violates standard constraints for binary data that depend on the marginal means. In addition, we remove structures from consideration if their estimated parameter values yield an estimated correlation structure that is not positive definite. We investigate the performance of the two sets of criteria using both simulated and real data, in the context of a longitudinal trial that compares two treatments for major depressive episode. Practical recommendations are also given on using these criteria to aid in the efficient selection of a working correlation structure in GEE analysis of longitudinal binary data. Copyright 2009 John Wiley & Sons, Ltd.
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                Author and article information

                Journal
                Tob Induc Dis
                Tob Induc Dis
                Tobacco Induced Diseases
                BioMed Central
                2070-7266
                1617-9625
                2013
                21 December 2013
                : 11
                : 1
                : 26
                Affiliations
                [1 ]Department of Health Behavior, Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY 14263, USA
                [2 ]The Cancer Council Victoria, Melbourne, Victoria, Australia
                [3 ]Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC, USA
                [4 ]School of Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
                [5 ]Department of Psychology, University of Waterloo, Waterloo, ON, Canada
                [6 ]Ontario Institute for Cancer Research, Toronto, ON, Canada
                Article
                1617-9625-11-26
                10.1186/1617-9625-11-26
                3878096
                24359292
                029e7852-ff06-420b-94cb-743c81dbbd58
                Copyright © 2013 Adkison et al.; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 8 October 2013
                : 17 December 2013
                Categories
                Research

                Respiratory medicine
                reduced ignition propensity,fire-safe cigarettes,consumer perceptions,generalized estimating equations (gee)

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