2,たばこ業界との基本和解合意とたばこの雑誌広告

The Master Settlement Agreement with the Tobacco Industry and Cigarette Advertising in Magazines
Charles King III, and Michael Siegel
N Engl J Med 2001; 345 : 504 - 11

背　景
1998 年に，46 州の司法長官が，米国のたばこ会社の最大手 4 社との基本和解合意（a Master Settlement Agreement）に署名した．
この合意は，18 歳未満の若者を標的としたたばこ広告を禁止している．

方　法
1995 〜 2000 年のあいだに 38 種類の雑誌に掲載された，特定の15 銘柄のたばこの広告費用と，そのたばこ広告への若者の
曝露について，傾向を分析した．1998 年に，8 学年，10 学年，および 12 学年の喫煙者の 5%以上によって吸われていたたばこの
銘柄を，「若者」銘柄と定義した；その他の銘柄はすべて，「成人」銘柄とみなした．
読者の少なくとも 15%，あるいは少なくとも 200 万人の読者が 12 〜17 歳であった雑誌を，若者向け雑誌として分類した．
広告への曝露の標準尺度の一つである「広告到達率」は，任意の1年間に，ある特定の 1 銘柄のたばこの広告が掲載された雑誌を
少なくとも 1 冊は読んだ若者の人数として定義した．

結　果
2000 年のドル換算で，38 雑誌に掲載された 15 銘柄のたばこの総広告費用は，1995 年が＄238.2 百万，1998 年が＄219.3 百万，1999 年が＄291.1 百万，2000 年が＄216.9 百万であった．
若者向け雑誌に掲載された若者銘柄の広告費用は，1995 年が$ 56.4 百万，1998 年が＄58.5 百万，1999 年が＄67.4 百万，2000 年が＄59.6 百万であった．
若者向け雑誌に掲載された成人銘柄の広告費用は，それぞれ，＄72.2 百万，＄82.3 百万，＄108.6 百万，および＄67.6 百万であった．
2000 年には，若者銘柄のたばこの雑誌広告は，米国の若者の80%以上に到達し，広告への平均曝露回数は若者一人あたり 17 回であった．

結　論
たばこ業界との基本和解合意は，雑誌へのたばこの広告と，これらの広告への若者の曝露に対してほとんど効果がなかったと思われる．




3, School smoking policies and smoking prevalence among adolescents:
multilevel analysis of cross-sectional data from Wales Laurence Moorea,
Chris Robertsb, Chris Tudor-Smithb a Cardiff School of Social Sciences,
Cardiff University, Cardiff, UK, b Health Promotion Division, National Assembly for Wales, Cardiff, UK

Tob Control 2001;10:117-123 ( Summer )

Correspondence to: Dr L Moore, Cardiff School of Social Sciences, Cardiff University,
Glamorgan Building, King Edward VII Avenue, Cardiff, CF10 3WT, UK MooreL1@cf.ac.uk
Received 22 October 2000; Revision received 3 January 2001; Accepted 25 January 2001


OBJECTIVE
To examine the association between school smoking policies and smoking prevalence among pupils.

DESIGN
Multilevel analysis of cross-sectional data from surveys of schools and pupils.

SETTING
55 secondary schools in Wales.

SUBJECTS
55 teachers and 1375 pupils in year 11 (aged 15-16).

MAIN OUTCOME MEASURES
Self-reported smoking behaviour.

RESULTS
The prevalence of daily smoking in schools with a written policy on smoking for pupils, teachers, and other
adults, with no pupils or teachers allowed to smoke anywhere on the school premises, was 9.5% (95% confidence
interval (CI) 6.1% to 12.9%). In schools with no policy on pupils' or teachers' smoking, 30.1% (95% CI 23.6% to 36.6%) of pupils reported daily smoking. In schools with an intermediate level of smoking policy, 21.0% (95% CI 17.8% to 24.2%) smoked every day. School smoking policy was associated with school level variation in daily smoking (p = 0.002). In multilevel analysis, after adjusting for pupils' sex, parents' and best friends' smoking status, parental expectations, and alienation from school, there was less unexplained school level variation, but school smoking policy remained significant (p = 0.041). The association of smoking policy with weekly smoking was weaker than for daily smoking, and not significant after adjustment for pupil level variables. Both daily and weekly smoking prevalence were lower in schools where pupils' smoking restrictions were always enforced. Enforcement of teacher smoking restrictions was not significantly associated with pupils' smoking.

CONCLUSIONS
This study demonstrates an association between policy strength, policy enforcement, and the prevalence of smoking among pupils, after having adjusted for pupil level characteristics. These findings suggest that the wider introduction of comprehensive school smoking policies may help reduce teenage smoking.

以下､金沢大学医学部附属病院総合診療部の野村英樹先生が翻訳しました.

目　　的：　学校の喫煙に関する規則と、生徒の喫煙率の関係を調査する

デザイン：　学校および生徒の調査により得られた横断的データの多変量解析

設　　定：　ウェールズの55のセカンダリースクール（中学〜高校に相当？）

対　　象：　教師55名と11年生（15歳〜16歳）1375名

主なアウトカム測定：　自己申告された喫煙習慣

結　　果：
　学校の敷地内における全ての生徒と教師の喫煙を禁じる、生徒・教師および他の成人を対象とした、
成文化された規則を有する学校における日常的喫煙の頻度は、9.5%（95%信頼区間6.1〜12.9%）であった。
生徒や教師の喫煙に関する規則のない学校では、30.1%（95%CI 23.6%〜36.6%）の生徒が日常的に喫煙
していると解答した。
中間のレベルの喫煙に関する規則を有する学校では、20.1%（17.8%〜24.2%）が毎日喫煙していた。
　学校の喫煙に関する規則は、学校毎の日常的喫煙頻度のばらつきに関連が認められた（p = 0.002）。
　多変量解析では、生徒の性別、親および親友の喫煙状況、親の期待、および登校状況（alienation from school）
で補正後には、説明できない学校毎のばらつきは減少したが、学校の喫煙に関する規則はなお有意であった（p = 0.041）。
　喫煙に関する規則と週単位の喫煙の関連は、日常的喫煙との関連に比較して弱く、生徒側の要因で補正後は
有意ではなかった。
日常的および週単位の喫煙の頻度の何れもが、生徒の喫煙禁止が常に強制力を持って運用されている
学校の方が低かった。
教師の禁煙の強制的な運用は、生徒の喫煙に有意に関連してはいなかった。

結　　論：
　この研究は、規則の強さおよび規則の強制的な運用と、生徒の喫煙率の間には、生徒側の要因で
補正後にも関連があることを示している。
これらの知見からは、包括的な学校の喫煙に関する規則の導入を多くの学校に拡げることが、未成年の
喫煙率を減少させる助けになることを示唆している。





4, Effect of health messages about "Light" and "Ultra Light" cigarettes on beliefs and quitting intent
Tob Control 2001;10(Suppl 1):i24-i32 ( Winter )

Saul Shiffman^{* a}, Janine L Pillitteri^b, Steven L Burton^c, Jeffrey M Rohay^a, Joe G Gitchell^d
a Pinney Associates and ^* University of Pittsburgh, Pittsburgh, Pennsylvania, USA,
^b Pinney Associates, Seattle, Washington, USA, ^c GlaxoSmithKline, Pittsburgh,
Pennsylvania, USA, ^d Pinney Associates, Bethesda, Maryland, USA

OBJECTIVE
To test the impact of three health messages focusing on vent holes, sensory effects of Light and Ultra Light
cigarettes, or health consequences of smoking, respectively, on beliefs and quitting intentions.

DESIGN
In the course of a random digit dialed telephone survey, subjects were randomised to hear one of three messages.
To test the effects of the messages, beliefs and quitting intentions were assessed both pre- and post-message.

PARTICIPANTS
Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA.
The sample was weighted to match the US smoker population on age, sex, and ethnicity.

MAIN OUTCOME MEASURES
Beliefs were summarised on three dimensions: Safety (reduced health risk), Delivery (lower tar and nicotine delivery),
and Sensation (less harsh).
Quitting interest was captured by the "quit index", an aggregate measure of quitting interest and intent.

RESULTS
The message focusing on smokers' sensory perceptions of Light and Ultra Light cigarettes resulted in the
most positive change in beliefs about safety, delivery, and intent to quit, and was particularly effective among
those who believed that these cigarettes were less harsh.
The effect was most pronounced among young adults, and among smokers of Light and Ultra Light brands who
most endorsed their sensory benefits.

CONCLUSIONS
Addressing smokers' sensory experience that Light and Ultra Light cigarettes feel less harsh may be a promising
strategy for changing their misconceptions about these cigarettes and enhancing their interest in quitting.
Media counter-advertising on Lights and Ultra Lights, focusing on sensory aspects of these cigarettes, may be
an important part of tobacco control efforts.

Keywords: Light; Ultra Light; smokers' beliefs; health messages; vent holes




5,Smokers' beliefs about "Light" and "Ultra Light" cigarettes
Tob Control 2001;10(Suppl 1):i17-i23 ( Winter )

Saul Shiffman^{* a}, Janine L Pillitteri^b, Steven L Burton^c, Jeffrey M Rohay^a, Joe G Gitchell^d
a Pinney Associates and ^* University of Pittsburgh, Pittsburgh, Pennsylvania, USA, ^b Pinney Associates, Seattle,
Washington, USA, ^c GlaxoSmithKline, Pittsburgh, Pennsylvania, USA, ^d Pinney Associates, Bethesda, Maryland, USA

OBJECTIVE
To assess beliefs about the tar and nicotine delivery characteristics and health benefits of Light and
Ultra Light cigarettes among cigarette smokers.

DESIGN
Random digit dialed telephone survey conducted in September 1999.

SUBJECTS
Daily smokers (n = 2120) of Regular (46%), Light (39%), and Ultra Light (15%) cigarettes in the USA.
The sample was weighted to match the US smoker population on age, sex, and ethnicity.

MAIN OUTCOME MEASURES
Beliefs about Light and Ultra Light cigarettes were summarised on three dimensions:
Safety (reduced health risk), Delivery (lowered tar and nicotine delivery), and Sensation (less harsh).

RESULTS
Most smokers believed Lights and Ultra Lights were less harsh and delivered less tar and nicotine.
On average, smokers believed that Lights afforded a 25% reduction in risk, and Ultra Lights a 33% reduction in risk.
Light and Ultra Light cigarette smokers evaluated the risks of their own cigarette types more favourably.
Light smokers had greater interest in quitting than Ultra Light smokers.
Quitting intention was modestly related to beliefs about these cigarettes. Believing that Lights and Ultra
Lights delivered less tar and nicotine and that they were less harsh each independently contributed to
the belief that these cigarettes were safer.

CONCLUSIONS
Many Light and Ultra Light smokers believe that smoking these cigarettes impart a substantial health benefit,
due in part to their experience that these cigarettes are less harsh and the belief that these cigarettes deliver less tar.

Keywords: Light; Ultra Light; smokers' beliefs




6, Second hand smoke and risk assessment: what was in it for the tobacco industry?
Tob Control 2001;10:375-382 ( Winter )

Norbert Hirschhorn^a, Stella Aguinaga Bialous^b
a New Haven, Connecticut, USA, ^b University of California, San Francisco, San Francisco, California, USA

OBJECTIVE
To describe how the tobacco industry attempted to trivialise the health risks of second hand smoke
(SHS) by both questioning the science of risk assessment of low dose exposure to other environmental toxins,
and by comparing SHS to such substances about which debate might still exist.

METHODS
Analysis of tobacco industry documents made public as part of the settlement of litigation in the
USA (Minnesota trial and the Master Settlement Agreement) and available on the internet.
Search terms included: risk assessment, low dose exposure, and the names of key players and organisations.

RESULTS/CONCLUSION
The tobacco industry developed a well coordinated, multi-pronged strategy to create doubt about
research on exposure to SHS by trying to link it to the broader discussion of risk assessment of low
doses of a number of toxins whose disease burden may still be a matter of scientific debate, thus trying
to make SHS their equivalent; and by attempting, through third party organisations and persons, to impugn
the agencies using risk assessment to establish SHS as a hazard.

Keywords: tobacco industry; risk assessment; environmental tobacco smoke; ETS; second hand smoke; SHS