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Taiwan anti-smoking policies show small effect on teens

By Kathryn Doyle

NEW YORK (Reuters Health) - Fewer teens are smoking in Taiwan since 2009, when strict smoke-free policies, cigarette advertising bans and other anti-tobacco measures were put into place, according to a new study.

But researchers were expecting to see a bigger dip in adolescent smoking.

"It seemed to deter mostly teenagers who were experimenting with smoking," said lead researcher Song-Lih Huang of National Yang Ming University in Taipei. "There was little effect on those who were regular smokers."

The World Health Organization advocates evidence-based measures including price increases, advertising bans, smoke-free policies and graphic warning images to curb tobacco use, and those policies were part of an anti-smoking law implemented in Taiwan in 2009.

Cigarette promotions, such as coupons or gifts, were also banned. And all secondary schools became smoke-free zones.

"It's like the whole bucket of ammunition available to public health workers," Huang told Reuters Health.

Despite that all-out approach, the policies seemed to have limited success, he said.

The researchers gathered data from surveys of 100,000 junior high school students ages 13 to 15 in Taiwan before and after the comprehensive anti-smoking policy was instituted.

Students who reported ever having smoked decreased from 27 percent in 2004 to 23 percent in 2011. Among smokers, those who reported trying their first cigarette before age 10 decreased from 38 percent in 2004 to 28 percent in 2011.

Though Huang was somewhat disappointed with the results, which are published in the journal Addiction, other researchers called the measures a success.

"Since there was a significant effect in the relatively large sample, I would definitely not call this a coincidence, and (would) say it was successful," said Christina Schnohr, an assistant professor of public health at the University of Copenhagen in Denmark.

Though adult smoking in Taiwan had declined every year from 2004 to 2011, teen smoking didn't start to decline until 2010, the authors note. The smoke-free policies appeared to have the strongest effect on teens in rural areas.

"It is clear that for teenagers in cities, the trend was still going up," Huang said. For kids in urban areas, boys who were current smokers increased from five to 10 percent, and girls stayed at about two percent from 2004 to 2011.

In the U.S. in 2011, four percent of middle school students and 18 percent of high school students were current smokers, according to the Centers for Disease Control and Prevention.

Because the Taiwan study noted a drop in the number of kids reporting smoking less than one cigarette daily or smoking cigarettes that someone else had purchased, Huang's team believes the reduction in teen smoking was primarily among kids in the earliest stages of trying tobacco.

"This was the same group who responded strongly to the California Tobacco Control program," said John Pierce of the University of California, San Diego's Moores Cancer Center, who studies statewide tobacco control programs in the U.S.

"This is a strong validation that these public health programs are true prevention programs," Pierce told Reuters Health. "They prevent young people from taking the earliest steps toward becoming a smoker."

Though the U.S. has signed the United Nations' Framework Convention on Tobacco Control, it has not been ratified in Congress, Pierce said. The treaty calls for graphic warning labels on cigarette packages, which have been implemented in Taiwan but were not supported in the U.S.

Taiwan also bans cigarette ads in print media and in convenience stores, but that marketing continues in America, Pierce said.

In Taiwan, almost all public places and schools are required to be entirely smoke free, which is still not the case here, he said.

SOURCE: http://bit.ly/Zji7S0 Addiction, online July 24, 2013.

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