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Mojtabai R, Riehm KE, Cohen JE, Alexander GC, Vernick JS, Thrul J. Cigarette excise taxes, clean indoor air laws, and use of smoking cessation treatments: A mediation analysis. Prev Med 2020; 136:106098. [PMID: 32333928 PMCID: PMC7246130 DOI: 10.1016/j.ypmed.2020.106098] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Revised: 04/12/2020] [Accepted: 04/18/2020] [Indexed: 11/22/2022]
Abstract
The role of smoking cessation treatments in the link between clean indoor air laws and cigarette taxes with smoking cessation is not known. This study examined whether the use of smoking cessation treatments mediates the association between clean indoor air laws and cigarette excise taxes, on the one hand, and recent smoking cessation, on the other hand. Using data on 62,165 adult participants in the 2003 and 2010-2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we employed structural equation models to quantify the degree to which smoking cessation treatments (prescription medications, nicotine replacement therapy, counseling/support groups, quitlines, and internet-based resources) mediate the association between clean indoor air laws, cigarette excise taxes and recent smoking cessation. Recent smoking cessation was associated with clean indoor air laws in 2003 and with both clean indoor air laws and excise taxes in 2010-2011. Smoking cessation treatments explained between 29% to 39% of the effect of clean indoor air laws and taxes on recent smoking cessation. While clean indoor air laws remained significantly associated with the recent smoking cessation over the first decade of the 2000s, excise taxes gained a more prominent role in later years of that decade. The influence of these policies was partly mediated through the use of smoking cessation treatments, underscoring the importance of policies that make these treatments more widely available.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
| | - Kira E Riehm
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Institute for Global Tobacco Control, 2213 McElderry Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, 1800 Orleans Street, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Jon S Vernick
- Department of Health Policy and Management, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Johannes Thrul
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
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Mojtabai R, Riehm KE, Cohen JE, Alexander GC, Rutkow L. Clean indoor air laws, cigarette excise taxes, and smoking: Results from the current population survey-tobacco use supplement, 2003-2011. Prev Med 2019; 126:105744. [PMID: 31173803 PMCID: PMC6697615 DOI: 10.1016/j.ypmed.2019.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
There was an increase in the number and coverage of state and local clean indoor air laws in the US during the past fifteen years. These laws coincided with increases in federal, state, and local cigarette excise taxes. In light of these changes, the objective of this study was to examine the association between clean indoor air laws, cigarette excise taxes and smoking patterns between 2003 and 2011. Using data on 62,165 adult participants in the 2003 and 2010/2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we examined the association of state and county workplace, bar, and restaurant clean indoor air laws and cigarette excise taxes with quitting and current every-day smoking. Between 2003 and 2011, quitting increased and daily smoking among those who continued to smoke decreased significantly. Participants living in states and counties with higher excise taxes and more comprehensive clean indoor air laws had a higher likelihood of quitting and lower likelihood of everyday smoking. Based on the assumption of no uncontrolled confounding, changes in taxes and laws accounted for 64.8% of the increase in smoking cessation and all of the reduction in everyday smoking. Implementation of state and county-level clean indoor air laws and cigarette taxes appears to have achieved the intended goal of encouraging smokers to either quit or reduce their frequency of smoking.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kira E Riehm
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Institute for Global Tobacco Control, 2213 McElderry Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, 1800 Orleans Street, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Lainie Rutkow
- Department of Health Policy and Management, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
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Mader EM, Lapin B, Cameron BJ, Carr TA, Morley CP. Update on Performance in Tobacco Control: A Longitudinal Analysis of the Impact of Tobacco Control Policy and the US Adult Smoking Rate, 2011-2013. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2016; 22:E29-35. [PMID: 26618847 PMCID: PMC5035147 DOI: 10.1097/phh.0000000000000358] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
CONTEXT Tobacco use remains the leading cause of preventable death in the United States. States and municipalities have instituted a variety of tobacco control measures (TCMs) to address the significant impact tobacco use has on population health. The American Lung Association annually grades state performance of tobacco control using the State of Tobacco Control grading framework. OBJECTIVE To gain an updated understanding of how recent efforts in tobacco control have impacted tobacco use across the United States, using yearly State of Tobacco Control TCM assessments. DESIGN The independent TCM variables of smoke-free air score, cessation score, excise tax, and percentage of recommended funding were selected from the American Lung Association State of Tobacco Control reports. Predictors of adult smoking rates were determined by a mixed-effects model. SETTING/PARTICIPANTS The 50 US states and District of Columbia. MAIN OUTCOME MEASURE Adult smoking rate in each state from 2011 to 2013. RESULTS The average adult smoking rate decreased significantly from 2011 to 2013 (21.3% [SD: 3.5] to 19.3% [SD: 3.5], P = .016). All forms of TCMs varied widely in implementation levels across states. Excise taxes (β = -.812, P = .006) and smoke-free air regulations (β = -.057, P = .008) were significant, negative predictors of adult smoking. Cessation services (β = .015, P = .46) did not have a measurable effect on adult smoking. CONCLUSION Tobacco control measures with the strongest influence on adult smoking include the state excise tax and state smoke-free air regulations. The lack of robust funding for tobacco cessation services across the majority of US states highlights an important shortfall in current tobacco control policy.
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Affiliation(s)
- Emily M. Mader
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Brittany Lapin
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Brianna J. Cameron
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Thomas A. Carr
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
| | - Christopher P. Morley
- Departments of Family Medicine (Mss Mader and Cameron and Dr Morley), Public Health and Preventive Medicine (Ms Cameron and Dr Morley), and Psychiatry (Dr Morley), SUNY Upstate Medical University, Syracuse, New York; Research Institute, Center for Biomedical Research Informatics, NorthShore University HealthSystem, Evanston, Illinois (Dr Lapin); and American Lung Association National Headquarters, Washington, District of Columbia (Mr Carr)
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