Smokers’ Responses to the Introduction of Reduced-Ignition Propensity (RIP) Cigarettes in Massachusetts Fourth International Conference on “Fire Safer” Cigarettes October 29, 2009 Andrew Seidenberg, MPH Hillel R. Alpert, ScM

RIP Cigarette Legislation 49 US states Canada South Africa Australia European Union

49 US states

Canada

South Africa

Australia

European Union

Effect of RIP Cigarettes Connelly et al found no change in cigarette volume sales after implementation of New York’s RIP law O’Connor et al found no difference in reported taste, quit intentions, and quit attempts between RIP cigarette smokers in New York and non-RIP cigarette smokers elsewhere in the United States

Connelly et al found no change in cigarette volume sales after implementation of New York’s RIP law

O’Connor et al found no difference in reported taste, quit intentions, and quit attempts between RIP cigarette smokers in New York and non-RIP cigarette smokers elsewhere in the United States

Objective Assess smokers responses to the introduction of RIP cigarettes: Cigarette Characteristics Purchasing patterns Smoking topography Perceptions of fire-risk Fire-risk behaviors and events Quitting intentions

Assess smokers responses to the introduction of RIP cigarettes:

Cigarette Characteristics

Purchasing patterns

Smoking topography

Perceptions of fire-risk

Fire-risk behaviors and events

Quitting intentions

Massachusetts 2007: 2,097 smoking material fires 19 civilian deaths 49 civilians and 44 fire service injuries $22.7 million “ An Act Relative to the Loss of Life Due to Fires Caused By Cigarettes” signed into law on July 8 th , 2006 Effective January 1, 2008 Retailers allowed to sell off remaining inventory of non-RIP cigarettes

2007: 2,097 smoking material fires

19 civilian deaths

49 civilians and 44 fire service injuries

$22.7 million

“ An Act Relative to the Loss of Life Due to Fires Caused By Cigarettes” signed into law on July 8 th , 2006

Effective January 1, 2008

Retailers allowed to sell off remaining inventory of non-RIP cigarettes

Methods A random-digit-dialed telephone survey Interviewed before and eight months after the state mandated sale of RIP cigarettes McNemar’s χ 2 statistic

A random-digit-dialed telephone survey

Interviewed before and eight months after the state mandated sale of RIP cigarettes

McNemar’s χ 2 statistic

Population 620 adult smokers interviewed before the sale of RIP cigarettes between 8/3/07 and 11/20/07 353 (57%) interviewed after the sale of RIP cigarettes between 8/26/08 and 10/4/08

620 adult smokers interviewed before the sale of RIP cigarettes

between 8/3/07 and 11/20/07

353 (57%) interviewed after the sale of RIP cigarettes

between 8/26/08 and 10/4/08

Population Race/Ethnicity White 90.63% Other 9.37% Household Income ($1000s) < 30 27.67% 30-60 33.96% 60-90 22.64% >90 15.72% Gender Female 55.68% Male 44.32% Age (years) 18-24 6.27% 25-39 10.54% 40-54 33.90% > 55 49.29%

Cigarette Characteristics Baseline OR 95% CI Taste very or somewhat unpleasant 15.10% 1.54 0.91-2.63 Not at all or only a little satisfying 11.00% 0.68 0.36-1.26 Lit end or live ash fall off 39.67% 0.69 0.45-1.05 Goes out between puffs 51.64% 4.28 2.54-7.60 Goes out between puffs often 29.50% 2.71 1.44-5.42

Purchasing Patterns Baseline OR 95% CI Internet 1.96% 5.00 0.56-236.49 Native American Reservation 5.56% 1.55 0.68-3.65 Foreign country 4.25% 0.71 0.18-2.61 Different state 46.41% 1.70 1.06-2.76

Smoking Topography Baseline OR 95% CI Inhale deeply into chest or as deeply as possible 52.86% 0.53 0.32-0.86 Smoke > 20 cigarettes per day 22.04% 0.25 0.08-0.63 Don't inhale into chest 3.37% 0.83 0.20-3.28 Take as many puffs as possible 46.32% 0.78 0.49-1.24 Take only a few puffs 6.32% 1.85 0.90-3.95

Perceptions of Fire-risk Baseline OR 95% CI Worry about starting a fire 30.82% 0.55 0.33-0.90 Worry about burning others 13.11% 1.89 1.06-3.50 Worry about burning self 13.11% 1.73 0.88-3.52 Worry about burning objects 17.11% 0.88 0.47-1.63

Perceptions of Fire-risk Baseline OR 95% CI Smokers will be more careful 49.53% 0.46 0.30-0.70 Smokers will see little change in their cigarettes 51.47% 0.61 0.42-0.88 There will be fewer fires in MA 72.83% 0.40 0.26-0.59 Smokers will smoke in bed more often 17.83% 0.91 0.54-1.54 Smokers will buy black market cigarettes 36.74% 1.30 0.87-1.96

Fire-risk Behaviors Baseline OR 95% CI Left a cigarette unattended 25.41% 1.17 0.73-1.89 Smoked in bed 19.34% 1.10 0.42-2.89 Dozed off while smoking 3.29% 2.33 0.53-13.98 Fallen asleep while smoking 1.63% 1.00 0.01-78.50

Fire Events Baseline OR 95% CI Home fire 0.33% 0.00 0.00-39.00 Burn clothing 13.95% 1.4 0.76-2.62 Burn furniture 5.26% 1.27 0.54-3.10

Quitting -13% of respondents quit smoking Baseline OR 95% CI Want to quit smoking 82.78% 1.73 0.78-4.02 Set a quit date 20.44% 0.62 0.32-1.16 Plan to quit in next 6 months 42.71% 1.04 0.68-1.59

Quitting Baseline OR 95% CI Concern for personal health 91.19 2.0 0.69-6.49 Price of cigarettes 81.15 1.92 0.95-4.09 Smoking restrictions 38.62 1.48 0.90-2.46 Advice to quit from doctor 62.18 0.81 0.47-1.41 Changes in usual brand of cigarettes 17.80 1.43 0.79-2.63 Don't enjoy smoking as much 65.26 0.76 0.44-1.31

Conclusions The introduction of RIP cigarettes in MA did not have adverse effects in terms of smokers’ experience with cigarettes or fire-risk behaviors and events; however fire-risk perceptions of smokers in response to the law are variable. Further research is needed to evaluate the law’s effectiveness with regards to cigarette fire incidence.

The introduction of RIP cigarettes in MA did not have adverse effects in terms of smokers’ experience with cigarettes or fire-risk behaviors and events; however fire-risk perceptions of smokers in response to the law are variable.

Further research is needed to evaluate the law’s effectiveness with regards to cigarette fire incidence.

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