Chapter 2

REVIEW OF RELATED LITERATURE

This aspect of the study reviews the various literature and studies related to the

study.

Foreign Literature

Tobacco product is defined as any manufactured product made of leaf tobacco

that is used for smoking, sucking, chewing, or snuffing (WHO FCTC, 2005). There

arethree types of tobacco preparation. The first one is the roll of tobacco which is smoked.

Cigarette is the best example of this. The second type is pipe like water pipes. The third

is the oral preparation which is chewed, held in mouth or placed in nose. Examples are

snuff, snus, betel and quid (WHO, 2006). Tobacco contains nicotine and many

carcinogens. Hence, it is an addictive plant (WHO, 2006).

Scientific evidences show that the consumption and exposure to tobacco smoke

cause these three: (1) Death, (2) Disease, and (3) Disability. Aside from this, it has been

found out that there is a time interval between the exposure to smoking and the start of

tobacco-related diseases (WHO FCTC, 2005).

Smoking indeed causes pre-mature deaths. Around half of the continuing cigarette

smokers, which are approximately 650 million people, who are still alive will sooner or

later die from tobacco-related disease if they still smoke. Right now, the higher burden of

tobacco-related diseases and deaths is fast shifting to developing countries (WHO, 2006).

Cigarettes are considered to be among the most deadly and addictive products

made by men. If the users will smoke cigarettes according to the intention of the cigarettes

manufacturers, cigarette smoking can kill half of its users (WHO, 2006).
 On the other hand, it’s not only the tobacco consumers who are susceptible to its

negative effects. The second-hand tobacco smoke which is also known as passive

smoking has exposed millions of people including half of the world’s children to the

negative effects of tobacco consumption. Evidences link second-hand smoking to the

increased risk of cardiovascular diseases, lung cancer and other cancer, asthma and

other respiratory diseases, ear infection and sudden infant death syndrome in children.

The above mentioned diseases are but a few of second-hand smoking’s harmful effects

(WHO, 2006).

The tobacco epidemic is rising rapidly hence the regulation of tobacco products is

critical. All tobacco products can cause disease and death aside from the fact that they

are harmful and addictive (WHO, 2006).

Tobacco consumption has harmful effects to smokers and non-smokers. It is

harmful to children causing them to have respiratory problems and other health problems

(USDHHS, 2000). Annually, secondhand smoke causes an estimated 3000 lung cancer

deaths and 62,000 coronary heart disease deaths in California (NCI, 1999).

All tobacco products are dangerous and addictive. Government effort should be

made to discourage the use of tobacco in any forms as well as to raise awareness about

its harmful and deadly effects (WHO, 2006). However, in order to maintain profit, tobacco

companies continue to develop new products. These companies cover the tobacco

products’ harmful effects by portraying tobacco products as attractive and less harmful

(WHO, 2006).

Tobacco-related diseases have been widely reviewed. According to WHO (2006):

It is now also known that tobacco use contributes to cataracts, pneumonia, acute myeloid
leukemia, abdominal aortic aneurysm, stomach cancer, pancreatic cancer, cervical

cancer, kidney cancer, periodontitis and other diseases. These diseases join the familiar

list of tobacco-related diseases, including cancer of the lung, vesicle, esophagus, larynx,

mouth and throat; chronic pulmonary disease, emphysema and bronchitis; stroke, heart

attacks and other cardiovascular diseases. In fact, we know today that tobacco causes

90% of all lung cancers. Tobacco seriously damages the reproductive system too,

contributing to miscarriage, premature delivery, low birth weight, sudden infant death and

pediatric diseases, such as attention hyperactivity deficit disorders. Babies born to women

who smoke are, on average, 200 grams lighter than babies born to comparable mothers

who do not smoke. (p.13)

Nowadays, the prevalence of smoking is commonly very high among adolescents

in many countries. It is said that people start smoking with median age of less than 15

years old (GYTS, 2007). The risk of death from smoking-related diseases increases when

people started smoking at younger ages. Young people who start smoking early will be

likely to die at lower age, and they will often find it difficult to quit smoking. It is said that

half of them will die from their tobacco consumption (GYTS, 2007).

B. Exposure and Recall to Anti-Smoking Advertisements

According to the study of Terry-Mcelrath (2005), all anti-smoking advertisements

were not alike in their characteristics, their thematic content, the level to which they

engage youth, or how youth were likely to respond. Advocates attempting to develop

increasingly successful anti-smoking campaigns should consider the characteristics of

proposed ads. The use of personal testimonials or visceral negative executions or both
that include themes of health effects may increase the likelihood that fewer youth would

smoke in the future. Message content format and approach must be considered to have

asuccessful anti-smoking campaign. Personal and real life testimonials could be helpful

to get the attention of the intended audience. These would serve as evidences of the

hazards imposed by smoking and would serve as warning to the public of the smoking

dangers.

Siegel (2000) found a significant effect of exposure to television’s anti-smoking

advertising on progression to establish smoking during a 4-year period that was specific

to younger adolescents but found no significant effect of exposure to radio or outdoor

advertisements. He also found that youths exposed to antismoking television

advertisements were more likely to have an accurate as opposed to an inflated perception

of youth smoking prevalence. The effect was significant only to younger adolescents. The

study indicated that TV was the most widely used medium for anti-smoking campaigns.

Thus youths were most likely to be informed thru watching.

In order to address the challenges brought by the increasing tobacco epidemic,

the WHO Framework Convention was made. This aims to reduce the burden of disease

and death caused by tobacco (WHO, 2006). Anti-smoking advertisements are

encouraged in this framework convention through Article 20 which is about the

achievement of product regulation goals by means of research, surveillance and

exchange of information (WHO FCTC, 2005).

One of the types of anti-smoking advertisements is the pictorial warning labels.

These pictorial warning labels are said to be an important opportunity to communicate

bthe risk of tobacco consumption. The pictorial warning labels are vital since the tobacco
companies are using the tobacco packages as a way of promotion. Growing evidence

shows that larger, bold and pictorial warning labels have an impact on the awareness of

tobacco consumption risks. Many countries introduce stronger labels; evaluation shows

that effective warning labels increase knowledge about the smoking risks as well as it can

persuade smokers to quit (Hammond, Fong, McNeill, Borland & Cummings, 2006). It’s

found out that smokers receive more information about smoking risks from the tobacco

product package than from any other source except television (Hammond et al, 2006

&Hammond, 2008). Picture warning labels on tobacco products increase knowledge

about tobacco consumption risks, reduce adolescents’ intentions to smoke, and motivate

smokers to quit. These labels counter the tobacco industry advertisements. It was found

out that pictorial warning labels had a greater impact than text-only labels (White,

Webster & Wakefield, 2008, Hammond, 2008). These pictorial warning labels could be

recognized by children and low-literacy audiences. According to a study (Hammond,

Fong, Mc Donald, Cameron & Brown, 2003) in Canada, the exposure of smokers to

images printed on packs is at least 20 times a day every time they buy and use cigarettes.

This exposure was an opportunity to bring ant-smoking messages at critical stage which

was the time of smoking. Thus the use of pictorial images increased the impact of the

anti-smoking messages.

On the other hand, the public awareness about the true dangers of smoking is low

even in countries with widespread anti-smoking campaigns (Ayanian & Cleary, 1999). Yet

the exposure to anti-smoking media messages is rising compared to pro-smoking media

messages. The tobacco industry’s advertising influence is still asserted. Children and
adolescents will continue to be persuaded by the pro-smoking messages in the media if

there will be no total ban on advertisements (GYTS, 2007).

Philippines GYTS (2007) found out that among the Filipino youths, there’s a

significant increase in the prevalence of “current” use of cigarettes, from 10.6% in 2003

to 27.3% in 2007(39.3% change). In addition, there was a significant increase also to

second-hand smoke at home, public places, and around peers.

Regarding the exposure of Filipino youths to anti-smoking advertisements there

was a decreased percentage of students who had seen anti-smoking media messages.

In the Philippines, youths are likely to buy the most heavily advertised brands. They are

three times more affected by advertising than the adults (GYTS, 2007). The youths are

exposed to smoking promotion and advertisements where smoking is portrayed as

glamorous, social and normative (GYTS, 2007).

Wakefield (2002) conducted a study to determine the characteristics of

antismoking ads that were more or less likely to be potentially effective in influencing

teenage smoking. The study was designed to determine which ad characteristics were

associated with higher teen ratings on standard advertising response scales and which

advertisement characteristics were associated with higher rates of recall, thinking about

the ad and discussion about the ad at follow-up. Ming Ji (2007) study about the

effectiveness of anti-smoking media campaigns by recall and rating scores made use of

a statistical modeling approach for systematically assessing the effectiveness of

antismoking media campaigns based on ad recall rates and rating scores. The study

found out the effectiveness of advertising messages in a laboratory environment before

put them in mass media. These studies proved that recall of those anti-smoking
advertisements could verify the effectiveness of the ads. Effective recall was linked with

the characteristics of the ads. The youth with a stored memory of the characteristics of

the ads most likely recall that advertisement.

In a study done in Canada (Youth Smoking Survey, 1997), it was found out that

among Canadian youth, the three most frequently recalled pack warning labels were

“Smoking during pregnancy can harm your baby”, “Smoking is the major cause of lung

cancer,” and “Cigarettes can kill you”. On the other hand, the least-recalled anti-smoking

mmessages were “Smoking causes strokes” and “Smoking can harm your children”.

Recall of these anti-smoking messages increased with age and smoking experience.

C. Other Sources of Information about Smoking

Parental expectations that their child will avoid smoking have been shown to affect

levels of adolescent tobacco use. Among those polled in the Who’s Who survey (1997)

out of the 68% of students who never tried smoking, most (86 %) were told by parents

never to smoke. In comparison of those who had smoked, almost one-third said their

parents never discussed smoking with them. Indeed, parents play a significant role in

influencing their children. Parental guidance is needed to regulate behavior of the youth

and to protect them from the hazards of the environment.

Ethnicity also affects the people’s attitudes toward smoking. Strong ethnic ties like

those in Asians are more likely to favor anti-smoking messages from their family

compared to non-Asians (Nicotine Tobacco Research, 1999). This is because the Asian

cultures value more their family needs. It is said that the positive messages from a wife,

mother, or sister powerfully influence the smoking behavior of the male family members

(Health Education Research, 1999). A study (Grace, Maa, Steven, Shiveb, YinTan, Jamil
et al, 2005) found out that fathers and brothers had greater social influence on male youth

smoking behavior.

On the other hand, the school also affects the youth smoking prevalence (GYTS,

2007). In Canada, three quarters (76%) of their youths reported that their schools had

taught them about the health effects of smoking. In Quebec, 64% of their youths reported

that they were receiving smoking school-based education (Youth Smoking Survey, 1997).

In the Philippines, according to GYTS (2007), majority of the youth received

teachings about the dangers of smoking in their schools but the survey did not include

the details of the curriculum and how it was taught. The survey also found out that majority

of the youth smokers wanted to stop smoking. However, there were no concrete programs

available in schools to help the current youth smokers to stop.