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Despite substantial declines in cigarette smoking in England since the 1970s, around 20 per cent of the adult population still smokes. In Sweden, 10 per cent of adult males and 12 per cent of adult females smoke cigarettes, while snus use is prevalent among 19 per cent of adult males and 4 per cent of adult females. Traditional cessation‐only approaches may need to be supplemented with broader tobacco harm reduction measures to reduce smoking prevalence further. General practitioners (GPs) are well placed to give patients advice on tobacco harm reduction. This paper seeks to address these issues.

The authors administered an online survey to assess knowledge, perceptions and attitudes to tobacco and nicotine products to 220 GPs (100 in England and 120 in Sweden).

Most GPs (96 [96 per cent] England, 115 [98 per cent] Sweden) addressed smoking cessation with patients as part of their regular practice. Most GPs (87 [87 per cent] England, 102 [85 per cent] Sweden) felt extremely or fairly knowledgeable about the risks associated with cigarettes, but less so about nicotine in tobacco products and pharmaceutical nicotine. When asked to rank various products on a risk continuum, GPs rated cigarettes as riskiest and tobacco cessation and nicotine‐containing products as least risky. However, when asked to rank components of cigarettes based on their health risks, GPs ranked nicotine as the third riskiest (74 [74 per cent] England, 104 [87 per cent] Sweden), after tar and carbon monoxide, but before smoke or tobacco. When asked questions about a hypothetical nicotine replacement therapy (NRT) product that looks like a cigarette and is licensed for harm reduction, GPs perceived that sensory experience and tobacco harm reduction could be benefits to patients, but perceived appeal to children and risk for abuse could be drawbacks.

Most respondent GPs are well informed about the relative risks of nicotine and tobacco, but more research needs to be done to investigate their concerns over the long‐term substitution of cigarettes with alternative nicotine products.

As part of a tobacco farmer diversification randomized intervention study in 14 eastern North Carolina counties, a media content analysis of 16 local newspapers was conducted. All available issues of each of the newspapers from the period 1 November 1996, through 31 December 1999, were reviewed, and all relevant articles were clipped, coded, and entered into a database. Media coverage intensity was compared, qualitatively, with data from interviews with local civic, health, and religious leaders. There was, on average, only one tobacco diversification article in every 100 newspaper issues. The hypothesis that coverage of tobacco diversification and tobacco control would become more favorable in the intervention counties over time was not supported. Interview data showed that organizational leaders placed a higher priority on tobacco diversification policy issues than evidenced by media coverage.

Taxing tobacco is one of the most effective means to reduce smoking but concerns about the impact on poor smokers are a barrier. New Zealand resumed increasing tobacco taxes in April 2010. The paper hypothesised smokers would attempt to stop smoking and/or adapt, changing their smoking behaviours in response to price increases. The paper aims to discuss these issues.

The authors conducted a door knock survey of smokers and recent ex-smokers who were home when visited. Participants (n=428) were from socioeconomically deprived neighbourhoods of Auckland with large proportions of Māori and Pacific Island people.

Many smokers (66 per cent) attempted to quit an average of 3 times. More than 40 per cent stopped for at least 24 hours without intending to quit altogether, monthly or more. Consumption reduced among 40 per cent of participants, by an average 7.1 cigarettes daily. More than a fifth of participants switched to cheaper brands. Switching from factory made cigarettes to roll your own tobacco (6 per cent) or vice versa (5 per cent) was uncommon.

The method resulted in a low response rate. Tobacco tax is associated with reduced consumption and high levels of frequent quit attempts in socioeconomically deprived communities therefore our study supports tax increases as a means of reducing smoking.

This is the first paper to investigate the effect of large recent New Zealand tobacco tax increases on low-income smokers’ adaptive behaviours.

This study aims to examine the factors associated with household expenditure share on tobacco at different ranges of the expenditure share among Malaysian households.

The analyses were based on pooled cross-sectional data of the Malaysian Household Expenditure Survey. A quantile regression was used to estimate the differentials in the share of monthly household expenditure on tobacco across different socio-economic, demographic and household groups at the 0.1, 0.25, 0.5, 0.75 and 0.9 quantiles of the tobacco expenditure share.

Characteristics of household heads (age, gender, ethnicity, marital status, education level, employment status) and household location were significant factors. Households headed by individuals aged 29 years or less spent a bigger share of their expenditure on tobacco than those headed by individuals older than 59 years. Households with heads who were employed and had primary-level education devoted a greater share of their expenditure for tobacco than households with heads who were unemployed and had tertiary-level education. The corresponding differentials were between 0.2% and 2.3%.

The results identify the target groups based on not only the socio-economic and demographic factors but also the distributional effects of tobacco expenditure share for the design of public policy to reduce the prevalence of smoking-induced illnesses.

This study represents new attempts to use pooled cross-sectional data and a quantile regression to take into account the heterogeneous tobacco expenditure behaviour according to different levels of tobacco spending among Malaysian households.

The purpose of this paper is to examine the prevalence of tobacco use and associated factors influencing the use of tobacco among adolescents in a school setting.

A cross-sectional descriptive study was conducted amongst Bhutanese adolescents studying at high schools in the district of Wangdue Phodrang in May 2016. A total of 378 eighth-grade students from four schools participated in the study. A self-administered questionnaire was used to collect data. Bivariate and multivariate logistic regressions were carried out to describe the predictors of tobacco use.

Of the 378 student participants, 52.90 percent were girls and 47.10 percent boys. The age ranged from 11 to 19 years, and the majority lived in school hostels (82 percent). The prevalence of smoking was 10.80 percent while smokeless tobacco users constituted 11.10 percent in the month preceding the study. Gender, tobacco use by siblings and friends, ever having tried alcohol, consumption of alcohol in the last 30 days, previous experimentation with cigarettes/bidi and smokeless tobacco/baba (p-value <0.05) were significantly related to the use of tobacco among students. In multivariate analysis, tobacco use by friends (AdjOR=1.09; 95%CI=0.01–2.48), ever having tried alcohol (AdjOR=2.24; 95%CI=1.75–3.72), current alcohol use (AdjOR=2.63; 95%CI=1.52–4.31), experimentation with cigarettes/bidi (AdjOR =39.46; 95%CI=11.91–90.63) or with smokeless tobacco/baba (AdjOR=32.61; 95%CI=11.78–90.30) were observed as the strong predictors of current tobacco use among adolescents.

These study results re-emphasized the rising public health concern of tobacco use among younger boys and girls. The findings may help the Bhutanese policy makers and managers to better understand the present situation of adolescent tobacco use and its associated determinants, and formulate appropriate tobacco control strategies for adolescents.

Nicotine is widely known as a tobacco constituent and for its use as a tobacco cessation aid. The development of new devices for nicotine delivery in recent years has led to uncertainty among consumers regarding the health risks of nicotine relative to tobacco. The purpose of this study was to discover if current and former consumers of tobacco and tobacco harm reduction (THR) products could distinguish between “nicotine” and “cigarettes” and examined the preceding media dialogue to determine if conflicting messages by the media influence public perceptions.

A quantitative survey was administered online in Norway (NO), Japan (JP), the United Kingdom (UK) and the United States (US), while face-to-face computer-aided interviews were conducted with randomly selected samples in India (IN), Greece (GR) and South Africa (SA). Participants were between 18 and 69 years of age and either current users of tobacco and THR products or previous users who quit within the past five years. Questions assessed beliefs about harmfulness of nicotine. Nicotine and other products and substances were also independently rated for harmfulness on a scale of 1–10 and subsequently compared. In addition, the authors examined the media dialogue of top media outlets in four countries to assess the potential influence on people’s beliefs.

A total of 54,267 participants (NO: 1,700, JP: 2,227, UK: 2,250, USA: 2,309, IN: 41,633, GR: 1,801, SA: 2,359) were sampled with the percentage of women participants ranging from 14.8% (IN) to 53.8% (UK). Between 68.3% (men, IN) and 88.7% (men, USA) of current consumers believed nicotine is harmful. Current consumers who agreed with the statement that nicotine is the primary cause of tobacco-related cancer ranged from 43.7% (men, UK) to 78.0% (men, SA). In six countries nicotine was rated nearly as harmful as cigarettes and alcohol, while other substances such as sugar, salt or caffeine, were usually rated as less harmful.

A large proportion of consumers across all surveyed countries view nicotine and cigarettes similarly. Clearer communication on the harmful properties of both by the media is needed to help consumers make informed decisions about products across the continuum of risk. Messaging to consumers, especially via the media, propagates misinformation about the relative harms of tobacco and nicotine through reporting that is often incomplete and biased toward more negative aspects.

This study specifically assessed public perceptions of nicotine as opposed to products containing nicotine, which is the focus of previous studies. Apart from showing that consumers often incorrectly perceive nicotine and cigarettes as similar in terms of harmfulness, the authors highlight the need for more accurate and complete reporting by the media to clarify widespread misunderstandings and mitigate public uncertainty.

This paper aims to provide an overview of the illicit tobacco market in Australia. It attempts to build a picture of the sources of demand, size of the market and methods of supply.

This paper is based on collation of disparate government reports, industry research, media and court documents. It is a preliminary paper in the absence of better source data.

The market is driven by the extremely high tax on tobacco in Australia. Australia’s geography emphasises on large shipments from overseas rather than small-scale smuggling. The likely market is for migrant communities with much higher smoker rates than in the mainstream community.

It is not yet possible to conduct a well-focused research because of limited official documentation.

Few government agencies focus on tobacco smuggling, and there are no publications providing a strategic picture of the illicit market. This paper fills this gap by collating multiple sources to produce a market profile.

The Australian Government loses $1bn per year in tobacco tax because of smuggling. The illicit supply also means that the social goal of the tax, namely, dissuading tobacco consumption, is undermined.

There are no academic or government publications describing the Australian illicit tobacco market. The only publications are based on research funded by the tobacco industry, which has a vested interest in overstating the size of the illicit market.

Graphic novels have a concept known as the origin story. The origin story is background information on how a hero or villain came into being. The purpose of this paper is to explore the origin story of corporate social responsibility at British American Tobacco (BAT). The CSR origin story is unpacked by examining corporate documents from BAT that discuss the initial development of the company’s CSR program. The BAT documents are part of the Legacy Tobacco Documents Library (LTDL), a searchable, digital archive developed and managed by the University of California, San Francisco. It contains 85,569,326 pages in 14,360,422 documents. The library was created as part of the tobacco company settlement of a major law suit in the USA.

For this case study, the authors searched the archive for documents from BAT that had the key words “corporate social responsibility.” The documents were then analyzed using qualitative content analysis to identify key themes related to BAT’s created of its CSR programs.

The two dominant themes were business case BAT made for CSR and the environmental factors that shaped CSR. The business case had sub-themes of the new operating environment and reinforcing employees. The environmental sub-themes were the importance of NGOS and the top issues to be addressed in CSR efforts. The themes helped to explain why BAT was engaging in CSR, the factors shaping the start of its CSR programs, and the issues it intended to address through CSR.

The analysis is limited to one organization and does not include interviews to go with the archived documents.

The paper considers the implications of the analysis for theory and practice for internal CSR communication.

The documents provide a rare glimpse inside a corporate decision to begin a CSR program and how the managers “talked” about CSR. Instead of examining external CSR communication, it examines the early days of internal CSR communication at a specific firm. The yields of the document analysis provide insights into how BAT conceptualized CSR and communicated the rationale for creating a CSR program internally. Research has relied primarily upon speculation of corporate motives or corporate public discourse designed to frame their CSR efforts. The internal documents provide an unfiltered examination of the motives for a CSR program. This allows us to better understand why a CSR program was created including the motives, targets, and desired outcomes.

Although the threat of protest may be a barrier toward implementing a tobacco policy on college campuses in the USA, the prevalence and severity of such opposition has yet to be investigated. The purpose of this paper was to determine how often campus communities protest against smoke-free policies and rate the disruptiveness of the protests.

Researchers located and analyzed news reports regarding 21 protests over newly implemented or proposed policies on college campuses in the USA.

Protests over college campus smoking policies are typically non-disruptive and consist of a small group of students who publicly smoke tobacco products and attempt to gain support of fellow students.

Those advocating for campus tobacco policies should be aware that the campus community may protest, but that a heightened concern of a protest's effect on the campus community may be unfounded.

To authors’ knowledge, research studies regarding opposition to anti-tobacco policies cannot be found in the literature. This paper may be used as a practical resource by advocates to educate campus administrators about the low turnout and lack of severity of any possible protest to a new campus tobacco policy.

The purpose of this paper is to review the barriers in the dissemination of effective smoking cessation treatments and services globally. Offering tobacco users help to stop using tobacco is a key demand reduction measure outlined under Article 14 of the World Health Organisation (WHO) Framework Convention on Tobacco Control (FCTC). Implementing Article 14 can reap great dividends for the billion plus tobacco users around the world and their families, friends and societies.

A review of the status of the global implementation of Article 14 using available literature on smoking cessation products, services and national guidelines. Discussing innovative approaches being currently explored in South Asia that can lead to faster adoption and implementation of Article 14 globally.

Major gaps remain in cessation products’ availability and resource allocation for cessation services globally. Current licensed products are falling short on delivering and sustaining smoking cessation. Innovation in cessation products and services needs to build on learnings in nicotine pharmacokinetics, behavioural insights from consumer research and tap into 21st century tools such as mobile based apps. National implementation of FCTC’s Article 14 needs to follow guidelines that encourage integration into existing health programmes and health-care practitioners’ (HCPs) upskilling.

Smoking cessation is a desirable health outcome and nicotine replacement products are a means of achieving cessation through tobacco harm reduction. E-cigarettes are sophisticated nicotine replacement products. Innovation is urgently needed to fill the gaps in smoking cessation products and services, and for converting global policy into local practice. In low- and middle-income countries (LMICs), HCPs’ knowledge, attitudes and practice regarding tobacco use and cessation may hold the key to rapidly scaling up cessation support and delivery to achieve FCTC objectives sooner. Additionally, HCPs can play an important role in offering smoking cessation support in existing national health programmes for TB, cancer screening and maternal and child health. Also, widely prevalent smartphone devices may deliver smoking cessation through telemedicine in LMICs sooner, leapfrogging the hurdles of the existing health-care infrastructure.