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Li et-al -impact-of-point-of-sale-anti-smoking-warnings1
- 1. Presentation at the 15th CATC National Conference on Tobacco Control, Xi’ an, China, April 2011 烟草销售点控烟警示信息 对吸烟者戒烟行为的影响研究 Impact of point-of-sale anti-smoking warnings on smokers’ quit intentions and attempts 李林， Ron Borland, Hua-Hie Yong, et al 澳大利亚维多利亚州癌症研究所烟草控制中心 Corresponding author: Lin Li, PhD; E-mail: lin.li@cancervic.org.au
- 2. 报告的主要内容 Outline of presentation • 研究背景和目的 Background and research objective • 方法 Methods • 主要结果及讨论 Main results and discussion • 问题 Any questions?
- 3. 研究背景及目的 Background and objective • 烟草行业把烟草销售点 (point-of-sale ，或 POS) 的促销作为其营销烟草的主要策 略之一，在其他烟草营销渠道已被禁止的国家和地区尤为如此。 Point-of-sale (POS) tobacco promotion has become an important marketing channel for the tobacco industry as other marketing opportunities have been banned. • 为了遏制此势头澳大利亚等一些国家政府在烟草销售场所引进控烟警示信息以保护消 费者的健康。 To address this serious problem some countries most notably Australia has introduced anti-smoking information at the retail to protect consumers’ health.
- 4. 销售场所控烟警示信息的例子 Examples of POS health warnings • Eg,“Tobacco products are addictive and kill 1 out of every 2 long-term smokers” （烟草 制品导致成瘾，长期吸烟者每 2 人中会有 1 人因吸烟而死亡） ( 加拿大安大略省 Ontario, Canada,2006-) • Eg,“Smoking seriously harms you and others around you” （吸烟严重伤害你及 你身边的人） ( 英国 UK, 2004-) • “Smoking is addictive. Call the Quitline 131 848” （吸烟会成瘾。拨打戒烟热线 131 848 ） ( 澳大利亚新南威尔士州 NSW, Australia, 1999-) (See a real example in a supermarket in NSW. Source: Simon Chapman)
- 5. 销售场所控烟警示信息的例子 Examples of POS health warnings • Eg,“Smoking damages almost every organ” （吸烟损伤几乎所有器官） ( 澳大利亚维多利亚 Victoria,Australia,2006-) • Eg,“Smoking causes mouth cancer” （吸烟导致口腔癌） ( 澳大利亚塔斯马尼亚 Tasmania,Australia,2004)
- 6. 研究背景及目的 Background and objective • 目前还很少有关于销售点控烟警示信息对成人吸烟者戒烟行为的影响的 研究报道 Little has been documented about the impact of the POS anti-smoking information on adult smokers’ quitting behaviours. • 本课题旨在研究四个西方国家的成人吸烟者暴露于销售场所控烟警示信 息与其戒烟意愿 / 行为之间的关系，并与从中国得到的初步研究结果做 比较。 This paper aimed to examine the association between exposure to POS anti-smoking warning and quitting behaviours among adult smokers in four western countries and compare it with some preliminary findings from China.
- 7. 方法 Methods • 本课题使用的是来自“国际烟草控制政策评估项目中国问卷调查” （ International Tobacco Control Policy Evaluation China Survey ，即 ITC 中国问卷调查 ) 和 “ ITC 四国问卷调查”（包括 澳大利亚、加拿大、美国、英国）的前瞻性队列研究数据。 Longitudinal data from the International Tobacco Control Policy Evaluation China Survey (ITC China Survey) and the ITC Four Country Survey were used. • 在 2006 年 4 月的第一轮问卷调查中，共计有 4732 名来自北京、沈阳 、上海、长沙、广州和银川的成人吸烟者完成 ITC 中国问卷；其中 ， 3863 名调查对象在 2007 年年底开展的第二轮调查中被成功回访并 完成问卷 。 In China, a total of 3,863 smokers who were first surveyed in 2006 and recontacted in 2007 were included in the study.
- 8. 方法 Methods • ITC 四国从 2002 年 -2008 年共调查了 7 轮（每年一次），共有 21613 名成人吸烟者完成了至少一轮的调查，并纳入统计分析 。 In ITC-4 countries (Australia, Canada, the UK and US) a total of 21,613 smokers who completed at least one of the seven waves of the Survey (from 2002-2008) were included in the analysis. • 除单因素分析外，我们使用广义估计方程（ Generalized Estimating Equation, GEE ）分析探索对销售点控烟警示信息的暴露与戒烟意愿 （ quit intentions) 和戒烟尝试行为（ quit attempts ）之间的关系。 Both bivariate and multivariate analyses (including generalized estimating equations (GEE) modelling) were employed to examine the associations between exposure to POS warnings and smokers’ quit intentions (cross-sectional) and quit attempts at follow-up using the cohort design across the whole study period.
- 9. 结果 Results 澳大利亚的吸烟者在研究期间对销售点控烟警示信息的暴露水平远高于其他的 3 个西方国家 smokers in Australia reported higher levels of noticing POS health warnings over the study period than did their counterparts in the other 3 western countries Noticing POS health warnings in shops by wave in ITC-4 countries 70.0% 60.0% Australia Percent(yes) 50.0% 40.0% Canada 30.0% UK 20.0% USA 10.0% 0.0% W1- W2- W3- W4- W5- W6- W7- 2002 2003 2004 2005 2006 2007 2008
- 10. Wave6 (2007) Wave7 (2008) Wave1 (2002) Wave2 (2003) Wave3 (2004) Wave4 (2005) Wave5 (2006) not exp exposed not exp exposed exposed not exp exposed not exp exposed not exp exposed not exp exposed not exp 82.3 81.1 80.3 80.7 74.9 77.2 75.8 76.2 74.4 75.1 78.6 74.5 74.8 72.9 Canada - % Intended# 45.8 43.2 46.5 43.9 43.0 42.9 43.4 42.8 41.9 42.6 45.5 46.9 - - %Attempted## 71.4 75.6 68.4 72.0 69.0 69.2 64.2 69.9* 71.2 71.2 71.8 69.6 70.9 68.5 US - % Intended 37.3 36.3 44.7 38.9 47.2 41.1 43.4 40.3 41.6 44.7 48.1 46.1 - - %Attempted 59.0 65.5* 54.3 61.3* 58.0 63.0 66.9 63.9 79.9** 60.1 61.5 56.7 62.6* 57.9 UK - % Intended 30.2 31.8 34.3 38.3 44.1 44.9 39.0 41.1 40.5 41.3 40.0 40.8 - - %Attempted 76.9 75.3 75.6 72.3 77.5** 72.2 77.8** 70.9 76.7** 69.8 77.6*** 68.6 71.7** 64.9 Australia -% Intended 34.6 34.1 47.4* 41.9 50.4** 41.9 50.6 47.5 46.1 46.7 49.6 49.1 - - %Attempted
- 11. 结果 Results 在澳大利亚，暴露于警示信息的吸烟者中有 戒烟意愿 的比例总的来说高于没有暴露的吸烟者。 类似的差异也出现在戒烟尝试的比例中（特别是第 2 、 3 轮中），即看到健康警示的更有可 能采取行动。数据表明其他三个国家没有这种明显的趋势。 Overall in Australia over the waves those exposed to POS warnings were more likely to report having quit intentions, and such a clear trend was not found in other 3 countries. Quit intention rate over waves in Australia, by POS exposure status 80 75 Percent 70 exposed 65 not-exposed 60 55 2 3 4 5 6 7 e1 e e e e e e av av av av av av av W W W W W W W
- 12. 结果 Results 广义估计方程分析结果 1 ：澳大利亚吸烟者对控烟警示信息的暴露与其 戒烟意愿 之间有统计学 正相关 ( 同轮 / 横段面关联），但这种关联在其他 3 个西方国家没有统计学意义 In Australia (but not in the other three countries) there was a significantly positive association between exposure to POS health warnings and quit intentions (cross-sectional association) Adjusted Odds 95% CI p-value Ratio 调整比值比 Australia 1.200 1.103~1.306 <.001 澳 Canada 加 .994 . 901~1.097 .907 UK 英 1.026 . 928~1.135 .614 US 美 .945 1.861~1.037 . 230
- 13. 结果 Results 广义估计方程分析结果 2 ：仅在澳大利亚发现对警示信息的暴露与后来的 戒烟尝试 之间有统计 学正相关 ( 纵向关联） In Australia (but not in the other three countries) there was a significantly positive association between exposure to POS health warnings and subsequent quit attempts (longitudinal association) Adjusted Odds 95% CI p-value Ratio 调整比值比 Australia 1.181 1.090~1.279 <.001 澳 Canada 加 .961 .875~1.055 .399 UK 英 .935 . 841~1.039 .213 US 美 1.017 .925~.118 . 727
- 14. 结果 （续） Results • ITC 中国初步结果表明，那些表示暴露于销售商店中的控 烟警示信息的吸烟者比那些未暴露的更可能在第二轮表示 有戒烟意愿（ 31% 比 26%, 调整的比值比 adjusted OR=1.27, p<0.05)* 。 In China, after similar adjustment for covariates, smokers who reported being exposed to anti-smoking information in stores were more likely to have subsequent intentions to quit than those who were not exposed (31% vs 26%, adjusted odds ratio=1.27, p<0.05)*.
- 15. ITC中国第一、二轮戒烟意愿比例 40.00% 33.70% 35.00% 29.60% 30.00% 26.30% 27.70% 25.00% Percent 暴露组 20.00% 非暴露组 15.00% 10.00% 5.00% 0.00% Wave1 Wave 2
- 16. 主要结果小结 Key results so far • 研究结果显示澳大利亚的烟草销售商店中的控烟警示信息能提高 成人吸烟者戒烟的意愿和尝试。 The results from Australia suggest that shop POS anti-smoking warnings can lead to increased quitting. • 中国的数据也表明吸烟者注意到销售点控烟警示信息能预测他们 今后的戒烟意愿。 Noting POS warnings in China predicted future intentions.
- 17. 讨论 Discussion 与西方四国相比较， (1) 中国吸烟者中有戒烟意愿的比例最低！提示有必要想方设法提高中国吸 烟者的戒烟意愿 -- 因为我们的研究表明较强的戒烟意愿与戒烟行为紧密相连（ Li et al 2011). 如何提高？销售点警示信息与戒烟意愿之间的正向关联的研究结果为此指出了方向。 Compared to smokers in 4 western countries, smokers in China had lowest quit intention rate. Efforts need to be made to increase Chinese smokers’ quit intentions. But How? The findings that noticing POS warnings in China predicted future intentions has some important implications. 五国第一轮戒烟意愿比较 Baseline quit intention rate 90% 81% 80% 76% 75% 70% 65% 60% Percent 50% 40% 27% 30% 20% 10% 0% China Australia Canada UK US
- 18. 讨论 Discussion (cont’) 与西方四国相比较， (2) 中国吸烟者中做戒烟尝试的比例也最低！“只有尝试才有可能成功”， 有必要促使国人，尤其是烟民，采取行动。要使其行动，先让其“心动” – 销售场所控烟警示 对此可有所作为。 Compared to 4 Western countries, fewer smokers in China made quit attempts. It suggest that implementing strong shop warnings can be promising: it can reinforce smokers’ quit intentions, and enhanced intentions in turn will lead to more quit attempts, and hopefully with more smokers attempting to quit more of them may succeed. 第一、二轮调查期间尝试戒烟的比例 Reported quit attempt rate between Waves 1 and 2 50.00% 44% 40.00% 36% 34% 31% 30.00% 25.30% Percent 20.00% 10.00% 0.00% 中国China 英国UK 澳Australia 美国USA 加Canada
- 19. 讨论及启示 Discussion ITC 四国的研究结果也不尽相同，其中澳大利亚销售场所警示信息的作用最为明显，因为澳大利 亚的健康警示更显眼（包括要求的图片警示及其大小）、实施更全面（包括结合烟包、大众媒体 等综合宣传警示信息），而且有不断加强的趋势。这些做法中国可以借鉴。 The effect of POS anti-smoking warnings differed across the four western countries. Australia had the most obvious outcomes, mainly due to its more salient, comprehensive and consistent warning interventions (including on the packs and mass media). Source:ASH Australia
- 20. 结论 Conclusion • 本项研究表明在有效实施醒目、综合的控烟警示干预的国家（澳 大利亚），成人吸烟者对销售场所控烟警示信息的暴露与其戒烟 意愿和戒烟尝试行为之间有正向关联； • 结果提示在中国可以通过在烟草销售场所引入显眼而有效的控烟 警示促使更多的烟民戒烟 。 The results provide evidence to support policy initiatives that include more salient, comprehensive and consistent health warnings (as has been done in Australia) in order to encourage more smokers to take action to quit. The finding that noting POS in China predicted future intentions suggests that shop POS warnings would be likely to encourage more Chinese smokers to try to quit.
- 21. 有必要及时采取行动！ Take actions now! YES ! NO !
- 22. 本文作者感谢 ITC 中国、 ITC 四国项目组其他成员的支持。 The authors would like to thank other members of the ITC China and ITC-4 teams for their supports. 经费来源 （ Sources of funding ） This work was funded by grants from the National Cancer Institute of the United States (P50 CA111326)(P01 CA138389)(R01 CA100362)(R01 CA125116)(P50 CA111236-05S1), Robert Wood Johnson Foundation (045734), Canadian Institutes of Health Research (57897 and 79551), National Health and Medical Research Council of Australia (265903 and 450110), Cancer Research UK (C312/ A3726), and Canadian Tobacco Control Research Initiative (014578), with additional support from the Centre for Behavioural Research and Program Evaluation, National Cancer Institute of Canada/ Canadian Cancer Society, and Chinese Center for Disease Control and Prevention.
- 24. 谢谢大家！ Thank you! 联系人 : 李林博士，具体联系信息如下： Lin Li, PhD VicHealth Centre for Tobacco Control The Cancer Council Victoria ( 澳大利亚维多利亚州癌症研究所烟草控制中心 ) 100 Drummond Street, Carlton, Victoria 3053 Australia T: +61 3 9635 5605 F: +61 3 9635 5440 E-mail: Lin.Li@cancervic.org.au
Hinweis der Redaktion
- * 感谢邀请我参加这次重要的学术研讨会
- 我报告的主要内容包括
- * 在新的时期 * 在其他烟草营销渠道（如通过电视广告营销） 文献表明， The vast majority of studies on smoking cessation have been conducted and reported in Western developed countries.
- * 所说的 销售场所控烟警示信息是什么样子的呢？我先简单举几个例子。警示信息可以是文字的，也可能是图片式的。 例 1. 吸烟成瘾，长期吸烟者中每 2 人中就有一人因吸烟而死亡 例 2. 吸烟严重伤害你及你身边的人 * in Ontario the Smoke-Free Ontario Act (enacted in May 2006) also requires that *In NSW, under the Public Health (Tobacco) Regulation 1999, it is an offence for an occupier of premises not to conspicuously display health warnings where tobacco products are sold.
- *Victoria (22% of Australian population) introduced under the Amendments to the Tobacco Act 1987 * 塔斯马尼亚 规定这个图片警示同时出现在销售点和烟盒上 *In NSW, under the Public Health (Tobacco) Regulation 1999, it is an offence for an occupier of premises not to conspicuously display health warnings where tobacco products are sold.
- 现有文献表明， The vast majority of studies on smoking cessation have been conducted and reported in Western developed countries.
- * 第一轮 ITC 中国问卷调查（调查员入户面对面调查） * 第二轮调查中被成功回访并完成问卷（随访率为 82% ） *As mentioned earlier, the data for this paper came from the ITC China survey… *with a retention rate of 81.6%. These 3863 respondents were included in the analyses. *Results are compared to those found in four developed countries that are also part of the International Tobacco Control Policy Evaluation project
- * 暴露与戒烟意愿之间是横断面之间的关系（同一轮） ；暴露与戒烟尝试之间是纵向的关系（下一轮） 。 *As mentioned earlier, the data for this paper came from the ITC China survey… *with a retention rate of 81.6%. These 3863 respondents were included in the analyses. *Results are compared to those found in four developed countries that are also part of the International Tobacco Control Policy Evaluation project
- * 我先报告西方四国的结果 . 我们先来看看暴露情况。什么样的情况才叫暴露呢？ * 问卷问题：在过去 6 个月中，你是否在你买烟的商场的橱窗或商场内看到过谈论吸烟危害或鼓励戒烟的广告或信息？ In the last 6 months, have you noticed advertising or information that talks about the dangers of smoking, or encourages quitting on store windows or inside stores where tobacco is sold? * 在 3863 名调查对象中有 979 名表示他们在第一、二轮间尝试过戒烟，尝试戒烟率为 25 。 3% 。 Note: T here was only a 7 month period of time between Wave 1 and Wave 2 in the 4C Survey. In China the interval was about 18 months.
- 我们再来看看各国戒烟意愿和戒烟尝试的变化。这个表具体列出了吸烟者所报告的戒烟意愿和戒烟尝试的比例。因数据太多看得不是很清楚，我以澳大利亚戒烟意愿比例的变化为例子做了一个图，大家请看
- * 暴露和戒烟意愿及戒烟行为之间有些什么关系呢？ * 该图显示在澳 * 戒烟意愿与暴露为同一轮的变量 * 对相关变量进行控制处理后结果显示 Controlling for a range of possible covariates, * 在 3863 名调查对象中有 979 名表示他们在第一、二轮间尝试过戒烟，尝试戒烟率为 25 。 3% 。 Note: T here was only a 7 month period of time between Wave 1 and Wave 2 in the 4C Survey. In China the interval was about 18 months.
- * 暴露和戒烟意愿及戒烟行为之间的关系用 广义估计方程模型可以更直观地表现出来。 * 对相关变量进行控制处理后结果显示 Controlling for a range of possible covariates, * 在 3863 名调查对象中有 979 名表示他们在第一、二轮间尝试过戒烟，尝试戒烟率为 25 。 3% 。 Note: T here was only a 7 month period of time between Wave 1 and Wave 2 in the 4C Survey. In China the interval was about 18 months.
- * 在 3863 名调查对象中有 979 名表示他们在第一、二轮间尝试过戒烟，尝试戒烟率为 25 。 3% 。 Note: T here was only a 7 month period of time between Wave 1 and Wave 2 in the 4C Survey. In China the interval was about 18 months.
- * 无论是同轮还是下轮结果类似。同轮数据 -wave1:30% 比 26% ， p=0.07 marginally sig;wave2: 34%to 28%,p<.001;wave 3:39%to32%,p<.001 * 暴露对戒烟尝试的影响还不够明显 * 从以上结果可以看出， * 包括中国 So one question for us is … Actually I think this is a very interesting question. At this stage I would like to hear your comments and insights.
- * 从以上结果可以看出， * 包括中国 So one question for us is … Actually I think this is a very interesting question. At this stage I would like to hear your comments and insights.
- * 下面我把中国的结果和西方四国的结果放一起进行比较讨论 *(put into the slides) 在使用综合策略提供中国吸烟者戒烟的意愿（心动）并促成行为改变（行动）：先看几个国家有戒烟意愿的吸烟者比例（中国最低！）只有尝试才能成功！ * 就是同年比较（ 2006 年）跨国比较，我们的也最低（其他四国基本上在 70% 以上）；因此要想方设法提高吸烟者的戒烟意愿，从 ITC 中国研究结果来看，在商店实施控烟警示信息是可以提高吸烟者（其后，第二轮）的戒烟意愿的，而我们的另一研究用发现 more immediate quit intentions 较强的戒烟意愿与戒烟行为紧密相连，因此用销售点健康警示增加烟民对吸烟危害的认识和强化其戒烟意愿是可以激发其戒烟尝试的，而众多烟民的众多戒烟尝试会导致更多的成功（尤其在烟瘾较小的人中），这样说明健康警示是可以有所作为的！ * 我们先来看看暴露情况。什么样的情况才叫暴露呢？ * 问卷问题：在过去 6 个月中，你是否在你买烟的商场的橱窗或商场内（街头摊贩及其周围）看到过谈论吸烟危害或鼓励戒烟的广告或信息？ In the last 6 months, have you noticed advertising or information that talks about the dangers of smoking, or encourages quitting on store windows or inside stores where tobacco is sold? * 在 3863 名调查对象中有 979 名表示他们在第一、二轮间尝试过戒烟，尝试戒烟率为 25 。 3% 。 Note: T here was only a 7 month period of time between Wave 1 and Wave 2 in the 4C Survey. In China the interval was about 18 months.
- * 在 3863 名调查对象中有 979 名表示他们在第一、二轮间尝试过戒烟，尝试戒烟率为 25 。 3% 。 Note: T here was only a 7 month period of time between Wave 1 and Wave 2 in the 4C Survey. In China the interval was about 18 months.
- *(put into the slides) 在使用综合策略提供中国吸烟者戒烟的意愿（心动）并促成行为改变（行动）：先看几个国家有戒烟意愿的吸烟者比例（中国最低！）只有尝试才能成功！ * 就是同年比较（ 2006 年）跨国比较，我们的也最低（其他四国基本上在 70% 以上）；因此要想方设法提高吸烟者的戒烟意愿，从 ITC 中国研究结果来看，在商店实施控烟警示信息是可以提高吸烟者（其后，第二轮）的戒烟意愿的，而我们的另一研究用发现 more immediate quit intentions 较强的戒烟意愿与戒烟行为紧密相连，因此用销售点健康警示增加烟民对吸烟危害的认识和强化其戒烟意愿是可以激发其戒烟尝试的，而众多烟民的众多戒烟尝试会导致更多的成功（尤其在烟瘾较小的人中），这样说明健康警示是可以有所作为的！ * 我们先来看看暴露情况。什么样的情况才叫暴露呢？ * 问卷问题：在过去 6 个月中，你是否在你买烟的商场的橱窗或商场内（街头摊贩及其周围）看到过谈论吸烟危害或鼓励戒烟的广告或信息？ In the last 6 months, have you noticed advertising or information that talks about the dangers of smoking, or encourages quitting on store windows or inside stores where tobacco is sold? * 在 3863 名调查对象中有 979 名表示他们在第一、二轮间尝试过戒烟，尝试戒烟率为 25 。 3% 。 Note: T here was only a 7 month period of time between Wave 1 and Wave 2 in the 4C Survey. In China the interval was about 18 months.
- * 从中我们可以得到什么结论、核心信息呢？ * 从以上结果可以看出， * 包括中国 So one question for us is … Actually I think this is a very interesting question. At this stage I would like to hear your comments and insights.
- 本课题的经费来源有以下一些：
- 要了解更多 ITC 项目的相关情况你们可以看看这个网站。
- 下面是我的联系信息，谢谢大家！