The impact of tobacco control expenditures on smoking initiation and cessation

Effect of price on the decision to experiment with cigarette smoking among Gambian children: a survival analysis using the Gambia 2017 Global Youth Tobacco Survey data

OBJECTIVES

To investigate the relationship between cigarette prices and smoking experimentation among children in the Gambia, and thereby expanding the evidence base of the likely impact of excise taxes on cigarette demand in low-income and middle-income countries.

DESIGN

A survival analysis using the Gambia 2017 Global Youth Tobacco Survey data.

SETTING

The Gambia.

PARTICIPANTS

The survey sample was 12 585 youths, aged 12-17 years, but our analysis was restricted to 11 030 respondents with information on smoking status.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our outcome variable was smoking experimentation defined as the first time the respondent smoked (at least part of) a cigarette.

RESULTS

A 1% increase in the price of cigarettes reduces the probability to experiment with smoking by 0.7%. We also found that children are more likely to experiment with smoking if they have at least one smoking parent, friends who smoke and see teachers who smoke. The probability to experiment with cigarette smoking increases with age and is higher among boys than girls.

CONCLUSION

There is strong evidence that increasing excise taxes can play an effective role in discouraging children from experimenting with cigarette smoking. Considering the relatively low excise tax burden in the Gambia, the government should consider substantially increasing the excise tax burden.

The impact of tobacco control policies on smoking initiation in eleven European countries

We investigate the effect of tobacco control policies on smoking initiation in eleven European countries. Based on individual data about age of onset of smoking, we use hazard rate models to study smoking initiation. Thus, we are able to take into account observed and unobserved personal characteristics as well as the effect of the introduction of a variety of tobacco control policies including price and and non-price policies, i.e., bans on tobacco advertisements, smoke-free air regulation, health warnings on packages of cigarettes, and treatment programs to help smokers quit smoking. We find that higher tobacco prices have a negative effect on the initiation into smoking for males but not for females. We find no effect of non-price tobacco control policies on smoking initiation.

A 10-year observational study on the trends and determinants of smoking status

INTRODUCTION

Most studies on motivation and intention to quit smoking have been conducted among adolescents and young adults but little is known regarding middle-aged subjects. We aimed to assess the trends and determinants of smoking status in a population-based cohort.

METHOD

Observational, prospective study with a first mean follow-up at 5.6 years and a second at 10.9 years. Data from 3999 participants (49.2% women, aged 35-75 years) living in Lausanne (Switzerland).

RESULTS

Baseline prevalence of never, former and current smokers was 41.3, 34.3 and 24.3%, respectively. During the study period, more than 90% of never and former and almost 60% of current smokers at baseline retained their status after 10.9 years. Among 973 current smokers, 216 (22.2%) had quit for at least 5 years. Multivariable analysis showed increasing age to be positively associated with quitting (p-value for trend <0.001). Among 1373 former smokers, 149 (10.9%) had relapsed; increasing age (p-value for trend <0.001) was negatively associated and family history of lung disease was positively associated with relapse [OR and 95% CI: 1.53 (1.06-2.21)]. Among 1653 never smokers, 128 (7.7%) initiated smoking; Male gender [1.46 (1.01-2.12)] and living in coupled relationship [0.66 (0.45-0.97)] were associated with smoking initiation.

CONCLUSION

Most middle-aged never and former smokers did not change their status with time, while 22.2% of current smokers sustained quitting. This is encouraging and could be improved with adequate supportive methods. In comparison to available data, this study confirms the difficult task of identifying subjects at risk of a negative behavioral change.

Determinants of regular smoking onset in South Africa using duration analysis

OBJECTIVES

South Africa has achieved significant success with its tobacco control policy. Between 1994 and 2012, the real price of cigarettes increased by 229%, while regular smoking prevalence decreased from about 31% to 18.2%.

METHODS

Cigarette prices and socioeconomic variables are used to examine the determinants of regular smoking onset. We apply duration analysis techniques to the National Income Dynamics Study, a nationally representative survey of South Africa.

RESULTS

We find that an increase in cigarette prices significantly reduces regular smoking initiation among males, but not among females. Regular smoking among parents is positively correlated with smoking initiation among children. Children with more educated parents are less likely to initiate regular smoking than those with less educated parents. Africans initiate later and at lower rates than other race groups.

CONCLUSIONS

As the tobacco epidemic is shifting towards low-income and middle-income countries, there is an increasing urgency to perform studies in these countries to influence policy. Higher cigarette excise taxes, which lead to higher retail prices, reduce smoking prevalence by encouraging smokers to quit and by discouraging young people from starting smoking.