1. Australian Smokers Support Stronger Regulatory Controls on Tobacco: Findings from the International Tobacco Control Policy Evaluation Project David Young, Ron Borland, Mohammad Siahpush, Gerard Hastings, K Michael Cummings, Geoffrey T. Fong for the ITC Collaboration ANZJPH 2007; 31:164-9

2. Introduction There are compelling public health arguments for more strongly regulating the tobacco industry Governments seem reluctant to take the necessary action. This is probably due to a combination of factors, including: -The influence of the tobacco companies -The pervasive neo-liberal ideology -The media focus on “grand deaths” -Perceptions among policymakers that stronger regulation would not be supported by smokers -Failure of the tobacco control movement to pursue stronger regulation in a coherent manner.

3. Aims To examine Australian smokers’ attitudes to tobacco companies, regulation of the tobacco industry and passive smoking. In particular: –Support for stronger industry regulation –Support for stronger restrictions on ETS To explore differences in these attitudes: –Between Australia and USA, UK, and Canada –By knowledge, beliefs and intentions about smoking We predicted that support would be strongest among smokers who were best informed about the harms of smoking, who intended to quit and who felt low self- efficacy to do so

4. Methods Sample: 2056 smokers from Australia and 6166 from Canada, US, UK Representative telephone survey Surveyed in August - September 2004 as the 3 rd wave of the International Tobacco Control Survey (ITC), Results presented here are not affected by prior participation in the study, and are essentially replicated for earlier waves

5. Measures Included: Demographics Heaviness of smoking Attitude to smoking Views on tobacco regulation, views on tobacco companies, government intervention and ETS Risk-minimizing beliefs Quitting intention and Self-efficacy for cessation Perceived health benefits of quitting, present and future concerns about smoking health and QOL effects Knowledge of health risks of smoking Frequency of thoughts about: smoking harm, tobacco industry conduct

6. Results 1 Smokers Views by Country AustraliaUSAUKCanada % Agree tobacco companies should be allowed to advertise as they please % Agree tobacco products should be more tightly regulated % Agree government should do more to tackle smoking harm % Agree tobacco companies should take responsibility for harm caused 15.7 68.9 63.9 46.0 33.4 61.7 49.7 41.6 20.6 71.1 66.0 45.0 23.9 63.8 61.6 49.2 Support for regulation scale* (95% CI) 3.69 (3.67-3.71) 3.29 (3.27-3.31) 3.59 (3.57-3.61) 3.53 (3.51-3.55) % Agree combines “Agree” and “Strongly Agree”. *Composite of first 3 items with “advertise” item reverse scored. Score greater than 3 is indicative of net support. Reliability: Alpha=0.7. All overall between country differences significant at p <.001

7. Results 2 Smokers views on ETS restrictions by Country AustraliaUSAUKCanada % agree smoking should not be allowed indoors at all in work places % agree smoking should not be allowed indoors at all in bars/pubs % agree smoking should not be allowed indoors at all in restaurants 66.5 17.6 76.7 45.0 12.5 37.0 38.9 9.4 37.4 54.1 19.1 45.1 Support for ETS restrictions* (95% CI) 2.49 (2.48-2.50) 2.16 (2.15-2.17) 2.20 (2.19-2.21) 2.30 (2.29-2.31) *Composite of above 3 items. Reliability: Alpha=0.67 Smoking shouldn’t be allowed indoors at all=3; allowed in some indoor areas=2; allowed in all indoor areas=1 All overall between country differences significant at p <.001

8. Results 4 Intention to Quit by Key Variables ItemDon’t intend to Quit Intend to Quit Increased regulation of tobacco market 58%72% Tobacco Companies should take responsibility for harm 37%47% Government should do more to tackle harm 55%67% Total ban on smoking in work-place56%70% Total ban on smoking in restaurants72%78% Total ban on smoking in bars13%18% Differences are significant at p <.001

9. Results 5 Predicting Support for Tobacco Regulation Linear relationships were all significant at p <.001 Support for regulation has significant linear relationships with: Holding the industry responsible for the harms caused by tobacco Cynicism about the Government’s role in tobacco control Support for smoke-free places Knowledge of health risks of active and passive smoking Awareness of/Sensitivity to social disapproval of smoking Rejecting risk-minimizing beliefs Not valuing or enjoying smoking Planning to quit sooner rather than later Frequency of thoughts about: the harm smoking might be doing to others, and the bad conduct of tobacco companies Being male

10. Results 6 High Levels of Cynicism Among Smokers AustraliaUSAUKCanada FEW (%) agree that tobacco companies can be trusted to tell the truth about the dangers of their products. MOST (%) agree that the government doesn’t really care about people smoking because it makes so much money from tobacco taxes. 13.4% 77.0% 20.9% 66.4% 20.3% 73.5% 16.5% 67.0% NB. Both overall country differences significant at p <.001

11. Summary of Results Smokers are highly supportive of stronger regulatory action against the tobacco industry. –Australians were generally most supportive with those from the USA least so Support is stronger among smokers who are: –More knowledgeable of, and more likely to be thinking about, smoking health risks to self and others –Inclined to hold tobacco companies responsible for the harms caused, & cynical about the role of government –Male –More sensitive to the social disapproval of smoking; –Planning to quit soon. Support for regulation is not related to self- efficacy for cessation. –No evidence from the regression analysis that regulation is seen as an alternative aid

12. Conclusions Governments should be reassured that they have substantial support from smokers for stronger regulation. The minority opposition to tobacco regulation comes partly from smokers who are poorly informed about the health risks of smoking. Failure of governments to take appropriate action is likely to add to cynicism about government

13. Conclusions (Cont…) Support is highest where regulation is strongest (a “virtuous cycle”). Smokers are waiting for more government action. These conclusions only apply to the four countries studied, but are likely to generalize to other countries with similar traditions.

14. ITCPES Four-Country Survey http://www.itcproject.org Funding for Four-Country Survey