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by Shum, Wing Fai David, Tsang, Leung Lun Lennon. / Thesis (M.B.A.)--Chinese University of Hong Kong, 1992. / Includes bibliographical references (leaves 93-94). / ACKNOWLEDGEMENTS --- p.i / ABSTRACT --- p.ii / TABLE OF CONTENT --- p.vi / Chapter / Chapter I. --- INTRODUCTION --- p.1 / Advertisement Variation --- p.1 / Research Objective and Title --- p.4 / Chapter II. --- LITERATURE REVIEW --- p.5 / Background of the Ban on Cigarette Television Advertising --- p.5 / Situation after Bans in Other Nations --- p.8 / Rationale of the Research --- p.9 / Chapter III. --- THE RESEARCH HYPOTHESES --- p.11 / The Repetition-Variation Hypoptheses and the Elaboration Likelihood Model --- p.11 / Research Hypotheses --- p.14 / Chapter IV. --- RESEARCH METHODOLOGY --- p.17 / Causal Laboratory Experiment --- p.17 / Subjects and Design of the Experiment --- p.18 / Procedure of the Experiment --- p.20 / Non-experimental Independent Variables --- p.21 / Experimental Independent Variables ´ؤ´ؤX --- p.22 / Dependent Measures -- Oij --- p.23 / Consumer Research --- p.24 / Questionnaire Design --- p.24 / Sample Design --- p.25 / Chapter V. --- RESULTS DISCUSSIONS --- p.26 / Results Discussions of the Causal Laboratory Experiment --- p.26 / Brand Name Recall --- p.26 / Overall Attitudes toward the Cigarette Brand --- p.28 / Results Discussion of the Consumer Research --- p.31 / Brand Awareness of the Cigarette and the Corresponding Extended Product --- p.31 / Marlboro Classics --- p.36 / Kent Leisure --- p.37 / Mild Seven Freedom Holidays --- p.39 / Overall Feeling towards the Advertisements --- p.41 / Recall of the Brand's Cigarette when Viewing the Advertisement --- p.42 / Purchase Intent --- p.43 / Chapter VI. --- COMMENTS AND RECOMMENDATIONS --- p.45 / Persuasive Process --- p.45 / Information Processing --- p.47 / Brand Processing --- p.47 / Nonbrand Processing --- p.48 / Implications from Laboratory Experiment --- p.49 / Limitations --- p.50 / Implications from Consumer Research --- p.51 / Brand Product Extension --- p.53 / Chapter VII. --- CONCLUSIONS --- p.56 / APPENDIX / Chapter 1. --- MEDIA EXPENDITURE FOR 1990 一一 CIGARETTE --- p.59 / Chapter 2. --- PROCEDURE FOR THE EXPERIMENT --- p.60 / Chapter 3 . --- OBSERVATIONS OF THE DEPENDENT MEASURES --- p.63 / Chapter 4. --- QUESTIONNAIRE FOR CONSUMER RESEARCH --- p.65 / Chapter 5. --- SCORES OF TOP-OF-MIND AWARENESS --- p.70 / Chapter 6. --- PERCENTAGE OF RESPONDENTS WHO KNOW ABOUT THE PRODUCT EXTENSION OF THE CIGARETTE BRANDS THEY HAVE NAMED IN Q1 --- p.71 / Chapter 7. --- PERCENTAGE OF RESPONDENTS WHO HAVE SEEN ADVERTISEMENTS OF THE EXTENDED PRODUCT --- p.72 / Chapter 8. --- PERCENTAGE BREAKDOWN OF CHANNELS FROM WHICH THE RESPONDENTS SAW THE ADVERTSIEMENTS --- p.73 / Chapter 9. --- ATTITUDE TOWARDS THE ADVERTISEMENT OF MARLBORO CLASSICS --- p.74 / Chapter 10. --- ATTITUDE TOWARDS THE ADVERTISEMENT OF KENT LEISURE --- p.77 / Chapter 11. --- ATTITUDE TOWARDS THE ADVERTISEMENT OF MILD SEVEN FREEDOM HOLIDAYS --- p.80 / Chapter 12. --- OVERALL FEELING TOWARDS THE ADVERTISEMENT OF THE EXTENDED PRODUCT --- p.83 / Chapter 13. --- PURCHASE INTENT OF THE CORRESPONDING CIGARETTE --- p.84 / Chapter 14. --- PHOTOGRAPHS OF THE DUMMY PRINT-ADVERTISEMENTS --- p.86 / Chapter 15. --- PHOTOGRAPH OF THE PRINT-ADVERTISEMENT OF THE TESTING CIGARETTE --- p.91 / Chapter 16. --- PHOTOGRAPH OF THE PRINT-ADVERTISEMENT OF THE EXTENDED PRODUCT --- p.92 / BIBLIOGRAPHY --- p.93

This dissertation 1) described prevalence and correlates of poly-tobacco use among US youth and young adults; 2) addressed positive and negative transitions of e-cigarettes among US youth and adults and 3) examined the 2-year transition of dual e-cigarette/cigarette use among US adults in relation to nicotine dependence (ND) symptoms, interest in quitting, and cardiovascular disease (CVD) factors. Data from 2013-2016 of the Population Assessment of Tobacco and Health Study were used. In the first study, 3.6% of youth (12-17years) and 18.3% of young adults (18-34years) were current poly-tobacco users between 2013-2014. Common poly-tobacco products combination was cigarettes and e-cigarettes for youth and young adults. Among youth, heavy drinking was associated with higher odds of poly-tobacco use. Factors associated with higher odds of poly-tobacco use among young adults included males, younger adults (18-24years), those with lower levels of educational attainment, residing in the South, heavy drinking, and marijuana use. In the second study, between 2013-2016, e-cigarette use increased only in youth. Young e-cigarette users were more likely to be never cigarette smokers compared to older users. Among youth e-cigarette users at each wave, the proportion of never cigarette smokers rose from 24.1% in Wave 1 to 42.6% in Wave 3 (p=0.0001 for trends). Among adult e-cigarette dual users in Wave 1, 8.8% transitioned to no tobacco use at Wave 3, 6.2% to mono e-cigarette use, while 85% either relapsed to cigarettes (53.5%) or continued dual use (31.5%). In the final study, among 1,870 adult dual tobacco users from Wave 1, 25·8% (95% CI 23·5-28·3) remained dual users 2 years later, 11·9% (95% CI 10·5-13·5) reported no tobacco use (cessation transition), 7·0% (95% CI 5·5-8·7) reported e-cigarette mono use (harm reduction transition), and 55·3% (95% CI 52·6-58·0) reported cigarette mono use (relapse transition). In the adjusted regression analysis, ND severity was associated with lower odds of cessation (OR 0·36; 95% CI 0·15-0·88) and harm reduction (OR 0·18; 95% CI 0·04-0·82) transitions. Interest in quitting and CVD factors were not associated with cessation or harm reduction. Collectively, our study findings emphasize the need for stricter tobacco regulatory policies to prevent another tobacco epidemic.

Thesis (M. Soc. Sc.)--University of Hong Kong, 1994. / Includes bibliographical references (leaves 87-89).

Thesis (M.Soc.Sc.)--University of Hong Kong, 1994. / Includes bibliographical references (leaves 87-89) Also available in print.

Vapour products (e-cigarettes) have rapidly grown in sales. While competing claims about the effects of vaping are fiercely debated within the public health community, no studies have examined the claims accepted in the regulatory arena. In the first article of this manuscript-based dissertation, my co-authors and I utilized narrative policy framework to identify the claims about vapour devices in legislation recommendation reports from Queensland Australia, Canada, and the European Union, and the United States. The vast majority of claims represented vapour devices as a threat, while the potential benefits were very rarely presented, resulting in bans and strict regulations. Evidence on two claims, youth vaping as a risk for nicotine dependence, and vapour products as a cessation aid, was evaluated with systematic reviews. For the youth claim, we retrieved population surveys on (1) the first product used, (2) non-nicotine vaping, (3) the prevalence of infrequent users among past-30-day users, and (4) cannabis vaping. Surveys indicated that a near majority of students who were past-30-day users vaped only once or twice a month, and an appreciable number, 25% and more, reported consuming non-nicotine liquids. Furthermore, 80% to 90% of ever-users tried cigarettes first. Far fewer youth are at a risk for nicotine addiction than indicated by any past-30-day use. On the other hand, vaping as a mode of administration of other drugs has received little attention, and presents an unknown risk to youth. We evaluated the claims about cessation with a review of systematic reviews (umbrella review). Three reviews, Hartmann-Boyce et al. (2016), Malas et al. (2016) and El-Dib et al. (2017) received the better quality ratings. They were unable to reach a definitive conclusion due to the limited number of randomized controlled trials and the low quality of most of the studies. We considered the reviewers’ tentative statements on their findings, the findings of the quality cohort studies, the potential underestimation of effectiveness in the studies, and the improved nicotine delivery of newer models. The weight of the evidence allowed us to state our optimism that vapour products have potential as a cessation aid. In the jurisdictions studied in this dissertation, vapour products have been claimed to be a threat by leading youth to smoking and impeding cessation. Does the evidence support the claims? The possible risk of youth becoming dependent on nicotine from vaping is substantially lower than indicated by the metric of any past-30-day use. There is reasonable evidence that vapour products may be an effective cessation aid. With a better understanding of these two claims, we in public health should revisit the regulations, policies, and interventions for vapour products so that they are in line with the evidence, not unsupported claims. / Graduate / 2019-04-02

Electronic nicotine delivery systems (ENDS), or electronic cigarettes (e-cigarettes), are battery-powered handheld devices designed to aerosolize a solution of nicotine and other chemicals for inhalation. The specific mechanical and chemical features of different ENDS affect the systemic exposure and bioavailability of the different chemicals in e-juices. E-cigarettes can come with different cartridge sizes, power outputs, e-liquid constituents, and nicotine delivery. User puff topography also contributes to varying toxicant exposure. ENDS have demonstrated potential as a cessation tool or alternative cigarette product due to its safety profile relative to the combustible cigarette. E-cigarettes have significantly lower concentrations of biomarkers of tobacco-related toxicant exposure and produce less and less harmful second-hand smoke compared to CC. However, ENDS users have significantly greater concentrations of those same biomarkers, highlighting that e-cigarettes do pose a harm to users’ health, even if that may be lower than CC. The same is observed in e-cigarette second-hand smoke as nicotine and aerosol particles were detected in statistically significant amounts. Its toxicity is only amplified by the misconception that they are safer than CC and thus pose no absolute risk, misleading users to use without caution. Therefore, although ENDS do have the potential in reducing smoking in adults who are already addicted to nicotine, it comes with the risk of dual use of conventional and electronic cigarettes and of attracting non-smokers, especially as seen in the youth. The rise in adolescent e-cigarette use can be attributed to its appeal, of both its flavored e-liquids and its image amongst youth that is perpetuated through the intentional marketing of e-cigarette manufacturers. The latent consequences of e-cigarettes are compounded in adolescents, who are in critical stages of brain development, habit formation, and social development. Youth report having experienced short-term clinical symptoms such as cough, lightheadedness, headache, and shortness of breath. Physiologically, vaping has been found to affect the pulmonary and cardiovascular systems. Vaping alters the equilibrium of the mucociliary clearance system in the pulmonary system and increases the risk of chronic bronchitis, cough, and phlegm. There is increased in pro-inflammatory cytokine secretions, increased alveolar macrophage apoptosis, impairment of phagocytosis, decreased ciliary beating, inhibition of the CFTR channel, and increased mucin expression. In the cardiovascular system, e-cigarette aerosol extract alters angiogenesis, oxidative stress, endothelial dysfunction, sympathetic nerve system activation, platelet activation and anticoagulation inhibition, and cardiac remodeling. E-cigarettes and e-cigarette smoke have also been associated with carcinogenesis in lung epithelium and possibly urothelium. Although e-cigarettes have, on average, less nicotine compared to CC, the significant risk for adolescents to graduate to combustible cigarettes renders this moot. The factors influencing this graduation is modeled through the catalyst model, which details the transition from ‘no use’ to ‘e-cigarette use’ and the transition from ‘e-cigarette use’ to ‘tobacco use.’ Schneider and Diehl hypothesized that the first transition is facilitated through a variety of factors, including flavor, health, price, role models, concealment, and acceptance. The subsequent transition can be attributed to the addiction hypothesis, accessibility hypothesis, and the experience hypothesis. It is clear from the numerous studies conducted, which show students who used e-cigarettes were 4-7 times more likely to report CC use, that e-cigarettes play a catalytic role in enabling the transition to conventional cigarettes. And with increased nicotine exposure, adolescents are subject to impairments in working and verbal memory during abstinence, changes in drug sensitivity and reward-related manifestations in adulthood, more severe dependence during adolescence, and deficits in attentional performance, impaired serial pattern learning, impaired context conditioning and increased anxiety and depressive-like behaviors in adults. They also have reduced control of motivation, reward, and pleasure. This culminates to the gateway hypothesis which states that nicotine can serve as a gateway drug that lowers the youths’ threshold for addiction to opioids, alcohol, and other agents. Recently, there has been a dramatic increase in cases of EVALI or e-cigarette or vaping associated lung injury, particularly in the adolescent population that is more likely to use illicit e-cigarettes than their adult counterparts. EVALI presents with a wide range of respiratory, gastrointestinal, and constitutional symptoms and is characterized as a sterile exogenous pneumonitis-like reaction with variable degrees of diffuse alveolar damage. Vitamin E acetate, common in illicit products, is strongly linked to this outbreak due to its presence in a vast majority of bronchoalveolar lavage fluid samples of confirmed EVALI cases. As ENDS use has increased amongst adolescents, so have its latent consequences. A coordinated effort from policy makers, public health agencies, healthcare providers, researchers, and especially parents and educators is essential for successful protection of this vulnerable population.

The problem with which this investigation is concerned is that of determining whether or not the history of cigarette advertising in broadcasting developed a pattern from which a model could be abstracted and applied to other product advertisements deemed "controversial" in broadcasting. The history of broadcast cigarette advertising is analyzed in an attempt to abstract a model, The .assumption is made that this model could be capable of predicting future regulation or elimination of broadcast advertising of controversial products.

This dissertation comprises three studies with the overarching goal of investigating effective messaging strategies to encourage e-cigarette cessation among youth who use e-cigarettes. Study one employs the McGuire’s Communication/ Persuasion model to identify research gaps in the literature on health messages targeting youth e-cigarette use. The systematic review reveals a lack of research specifically targeting vaping cessation among youth who currently use e-cigarettes. As a result, the subsequent studies in this dissertation focus on youth vaping cessation to address this research gap. Study two presents a content analysis of existing vaping-cessation related TikTok videos. The findings of study 2 suggest that themes pertaining to physical health outcomes, nicotine addiction, harmful chemicals, and relatable message sources were associated with higher engagement, underscoring the importance of tailored messaging content and relatable sources to engage the young audience on TikTok. Study 3 consists of an experimental study that specifically examines the effects of message frames (gain vs. loss) and two types of expert message sources (formal vs. informal expert sources) on youth intention to quit vaping. The study found that TikTok videos employing gain-framed messages hold promise in promoting positive emotional responses and, consequently, intention to quit vaping among youth. Lastly, chapter 5 provides a summary of the findings within this dissertation, offering insights into future research directions and proposing practical implications derived from the three studies.

I use an instrumental variable approach to estimate the effect of excise taxes on cigarette smuggling. The IV approach addresses the potential endogeneity of excise taxes while controlling for other determinants of smuggling. I use panel data on 47 states from 1990-2009. The main results confirm the validity of the instrument, the percent of Democrats in the upper house of state legislatures, but do not reject exogeneity of excise taxes. Robustness tests using an alternative measure of cigarette smuggling find the opposite result. All models find that per capita income and the number of federal police per 100,000 residents are significant determinants of smuggling.