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Azagba S, Ebling T, Korkmaz A. Beyond the smoke: Historical analysis of the revenue implications of state cigarette tax policies, 1989 to 2019. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2024; 127:104408. [PMID: 38631249 DOI: 10.1016/j.drugpo.2024.104408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 03/15/2024] [Accepted: 03/27/2024] [Indexed: 04/19/2024]
Abstract
INTRODUCTION While cigarette taxes are a vital tobacco control tool, their impact on cigarette tax revenue has been largely understudied in the extant literature. This study examines how the level of cigarette taxes affects the revenue generated from cigarettes in the United States over a thirty-year period. METHODS We obtained the Tax Burden Data from the Centers for Disease Control and Prevention (1989-2019). Our dependent variables were gross cigarette tax revenue and per capita gross cigarette tax revenue, and our independent variable was state tax per pack. We used two-way fixed effects to estimate the relationship between state cigarette tax revenue and cigarette taxes, adjusting for state-level sociodemographic characteristics, state-fixed effects, and time trends. RESULTS The study reveals that raising cigarette state tax by 10 % led to a 7.2 % to 7.5 % increase in cigarette tax revenue. We also found state and regional variation in taxes and revenue, with the Northeast region having the highest taxes per pack and tax revenues. In 2019, most states had low or moderate taxes per pack and tax revenues per capita, while a few states had high taxes per pack and tax revenues per capita. CONCLUSIONS Our research demonstrates the positive impact of increased cigarette taxes on state tax revenue over three decades. Not only do higher taxes aid in tobacco control, but they also enhance state revenues that can be reinvested in state initiatives. Some states could potentially optimize their tax rates.
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Affiliation(s)
- Sunday Azagba
- College of Nursing, Pennsylvania State University, University Park, PA 16803, USA.
| | - Todd Ebling
- College of Nursing, Pennsylvania State University, University Park, PA 16803, USA
| | - Alperen Korkmaz
- College of Nursing, Pennsylvania State University, University Park, PA 16803, USA
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Mojtabai R, Susukida R, Nejat K, Amin-Esmaeili M. Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis. J Public Health Policy 2024; 45:100-113. [PMID: 38155242 DOI: 10.1057/s41271-023-00458-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/20/2023] [Indexed: 12/30/2023]
Abstract
The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA
| | | | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA.
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Burris S. Legal Epidemiology: Growth, and Growing Pains. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:1-2. [PMID: 37966949 DOI: 10.1097/phh.0000000000001836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2023]
Affiliation(s)
- Scott Burris
- Center for Public Health Law Research, Temple University Beasley School of Law, Philadelphia, Pennsylvania
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Delnevo CD, Villanti AC. Dramatic Reductions in Cigarette Smoking Prevalence among High School Youth from 1991 to 2022 Unlikely to Have Been Undermined by E-Cigarettes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6866. [PMID: 37835136 PMCID: PMC10572215 DOI: 10.3390/ijerph20196866] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 09/19/2023] [Accepted: 09/29/2023] [Indexed: 10/15/2023]
Abstract
There is concern that youth e-cigarette use could lead youth to initiate cigarette smoking. This study identifies epochs of cigarette smoking among U.S. high school students in three commonly utilized national school-based surveys over three decades without a priori assumptions. We examined trends in ever and current cigarette smoking among high school youth from 1991 to 2022 in three datasets: Monitoring the Future (MTF), the National Youth Risk Behavior Survey (NYRBS) and the National Youth Tobacco Survey (NYTS) via Joinpoint regression. High stable rates of ever smoking were noted from 1991 to 1999 (NYRBS and MTF) and then significantly declined from 1999 to 2013; declines accelerated through to 2022. In the NYTS, ever cigarette smoking significantly declined from 1999 to 2018 and then declines accelerated to 2022. Current cigarette smoking reached its peak in 1997, and then significantly declined from 1997 to 2013 in the NYRBS and MTF and similarly in the NYTS from 1999 to 2018. Declines in current smoking then accelerated in all surveys through to 2022. These findings suggest dramatic successes in reducing youth smoking since the late 1990s, with more rapid declines in prevalence in the past decade.
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Affiliation(s)
- Cristine D. Delnevo
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ 08901, USA;
- Rutgers School of Public Health, Piscataway, NJ 08854, USA
| | - Andrea C. Villanti
- Rutgers Institute for Nicotine & Tobacco Studies, New Brunswick, NJ 08901, USA;
- Rutgers School of Public Health, Piscataway, NJ 08854, USA
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Mendez J, Yomogida K, Figueroa W, Diaz Roldan K, Bavarian N. Examining associations between prescription stimulant misuse frequency and misuse characteristics by race/ethnicity. J Ethn Subst Abuse 2023; 22:402-416. [PMID: 34355999 PMCID: PMC8818055 DOI: 10.1080/15332640.2021.1952128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION The misuse use of prescription stimulants (MPS) among college students is a pressing public health concern. Past research suggests there is variation in MPS frequency by race/ethnicity. According to the Theory of Triadic Influence, a health behavior can increase in frequency based on experiences and characteristics of the behavior. Thus, our aim was to examine the association between experiences and characteristics of MPS with MPS frequency, by race/ethnicity. METHODS A probability sample of students attending two California universities completed a paper-based, psychometrically validated, instrument. Students who reported engaging in MPS in their lifetime were also asked questions about frequency, cost per pill, administration routes, sources, and experience with the drug. We used regression analyses to address our research questions, and conducted analyses by racial/ethnic group (i.e. for students identifying as Asian, Latinx, and White). RESULTS MPS frequency did not vary by race/ethnicity. The influence of characteristics of misuse on frequency varied by race/ethnicity. Additionally, frequency of experiencing the desired outcome was significantly associated with increased MPS frequency across all three racial/ethnic groups. CONCLUSIONS Characteristics of misuse are important to consider when screening for misuse and potential dependence. Particular attention should be given to these characteristics by race/ethnicity. Implications for future research are discussed.
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Shin H, Park S, Yon H, Ban CY, Turner S, Cho SH, Shin YH, Shin JU, Koyanagi A, Jacob L, Smith L, Min C, Lee YJ, Kim SY, Lee J, Kwon R, Koo MJ, Fond G, Boyer L, Hahn JW, Kim N, Rhee SY, Shin JI, Woo HG, Park H, Kim HJ, Lee Y, Kim MS, Lefkir E, Hadalin V, Choi J, Lee SW, Yon DK, Kim S. Estimated prevalence and trends in smoking among adolescents in South Korea, 2005-2021: a nationwide serial study. World J Pediatr 2023; 19:366-377. [PMID: 36645642 PMCID: PMC9842213 DOI: 10.1007/s12519-022-00673-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 12/06/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Although smoking is classified as a risk factor for severe COVID-19 outcomes, there is a scarcity of studies on prevalence of smoking during the COVID-19 pandemic. Thus, this study aims to analyze the trends of prevalence of smoking in adolescents over the COVID-19 pandemic period. METHODS The present study used data from middle to high school adolescents between 2005 and 2021 who participated in the Korea Youth Risk Behavior Web-based Survey (KYRBS). We evaluated the smoking prevalence (ever or daily) by year groups and estimated the slope in smoking prevalence before and during the pandemic. RESULTS A total of 1,137,823 adolescents participated in the study [mean age, 15.04 years [95% confidence interval (CI) 15.03-15.06]; and male, 52.4% (95% CI 51.7-53.1)]. The prevalence of ever smokers was 27.7% (95% CI 27.3-28.1) between 2005 and 2008 but decreased to 9.8% (95% CI 9.3-10.3) in 2021. A consistent trend was found in daily smokers, as the estimates decreased from 5.4% (95% CI 5.2-5.6) between 2005 and 2008 to 2.3% (95% CI 2.1-2.5) in 2021. However, the downward slope in the overall prevalence of ever smokers and daily smokers became less pronounced in the COVID-19 pandemic period than in the pre-pandemic period. In the subgroup with substance use, the decreasing slope in daily smokers was significantly more pronounced during the pandemic than during the pre-pandemic period. CONCLUSIONS The proportion of ever smokers and daily smokers showed a less pronounced decreasing trend during the pandemic. The findings of our study provide an overall understanding of the pandemic's impact on smoking prevalence in adolescents. Supplementary file2 (MP4 64897 KB).
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Affiliation(s)
- Hyoin Shin
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Sangil Park
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyunju Yon
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Chae Yeon Ban
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Stephen Turner
- Maternity and Child Health Division, NHS Grampian Aberdeen, Aberdeen, UK
| | - Seong Ho Cho
- Division of Allergy-Immunology, University of South Florida Morsani College of Medicine, Tampa, FL, USA
| | - Youn Ho Shin
- Department of Pediatrics, CHA Gangnam Medical Center, CHA University School of Medicine, Seoul, South Korea
| | - Jung U Shin
- Department of Dermatology, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Ai Koyanagi
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, ISCIII, Barcelona, Spain
- Catalan Institution for Research and Advanced Studies (ICREA), Pg. Lluis Companys, Barcelona, Spain
| | - Louis Jacob
- Research and Development Unit, Parc Sanitari Sant Joan de Deu, CIBERSAM, ISCIII, Barcelona, Spain
- Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, Montigny-Le-Bretonneux, France
| | - Lee Smith
- Centre for Health, Performance and Wellbeing, Anglia Ruskin University, Cambridge, UK
| | - Chanyang Min
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
| | - Young Joo Lee
- Department of Obstetrics and Gynecology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - So Young Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, South Korea
| | - Jinseok Lee
- Department of Biomedical Engineering, Kyung Hee University, Yongin, South Korea
| | - Rosie Kwon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
- Department of Biomedical Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Min Ji Koo
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
- Department of Human Biology, University of Toronto, Toronto, ON, Canada
| | - Guillaume Fond
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Laurent Boyer
- AP-HM, Aix-Marseille Univ., CEReSS-Health Service Research and Quality of Life Center, Marseille, France
- FondaMental Foundation, Creteil, France
| | - Jong Woo Hahn
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, South Korea
| | - Namwoo Kim
- Department of Neuropsychiatry, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Youl Rhee
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
- Department of Endocrinology and Metabolism, Kyung Hee University School of Medicine, Seoul, South Korea
| | - Jae Il Shin
- Department of Pediatrics, Yonsei University College of Medicine, Seoul, South Korea
| | - Ho Geol Woo
- Department of Neurology, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Hyeowon Park
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
| | - Hyeon Jin Kim
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea
| | - Yoonsung Lee
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Man S Kim
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Eléa Lefkir
- Faculty of Medicine, University of Rennes 1, Rennes, France
| | - Vlasta Hadalin
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Jungwoo Choi
- Department of Medicine, Kyung Hee University College of Medicine, Seoul, South Korea
| | - Seung Won Lee
- Department of Precision Medicine, Sungkyunkwan University School of Medicine, Suwon, South Korea.
| | - Dong Keon Yon
- Center for Digital Health, Medical Science Research Institute, Kyung Hee University Medical Center, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea.
- Department of Pediatrics, Kyung Hee University College of Medicine, 23 Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, South Korea.
| | - Sunyoung Kim
- Department of Family Medicine, Kyung Hee University College of Medicine, 23 Kyungheedae-Ro, Dongdaemun-Gu, Seoul, 02447, South Korea.
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Smith MJ, MacKintosh AM, Ford A, Hilton S. Youth's engagement and perceptions of disposable e-cigarettes: a UK focus group study. BMJ Open 2023; 13:e068466. [PMID: 36948552 PMCID: PMC10040067 DOI: 10.1136/bmjopen-2022-068466] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 03/03/2023] [Indexed: 03/24/2023] Open
Abstract
OBJECTIVES Evidence suggests that use of flavoured disposable electronic cigarettes (e-cigarettes) is increasing. Considering the growing popularity and rapid evolution of e-cigarettes, we explored youth's perceptions and engagement with disposable e-cigarettes. DESIGN Twenty focus groups were conducted between March and May 2022, with 82 youths aged 11-16 living in the Central belt of Scotland. METHODS Youths were asked about smoking and vaping behaviours and disposable e-cigarettes and were shown vaping-related images and videos from social media which were used to stimulate discussion about different messages, presentations and contextual features. Transcripts were imported into NVivo V.12, coded thematically, and analysed. RESULTS Youths described disposable e-cigarettes as 'cool', 'fashionable' and enticing and viewed as a modern lifestyle 'accessory'. Tank models were perceived as being used by older adults. Youths stated that disposable e-cigarettes were designed in a way to target youths and the brightly coloured devices and range of flavourings encouraged youths to want to try the products, particularly sweet flavourings. Participants perceived e-cigarettes to be less harmful compared with combustible cigarettes but noted the uncertainty of ingredients in disposable e-cigarettes. CONCLUSIONS Youths distinguish between e-cigarettes with varying characteristics and social perceptions of users. These findings provide evidence that disposable e-cigarettes are attractive to youths. Future research is needed to understand the factors that contribute to youth perceptions of disposable e-cigarettes. Policymakers should work together to design and implement policies and strategies to prevent youth uptake of vaping.
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Affiliation(s)
- Marissa J Smith
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
| | | | - Allison Ford
- Institute for Social Marketing, University of Stirling, Stirling, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
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Merz L, Puhan MA, Serra-Burriel M. A discrete choice experiment on price and flavour effects on the appeal of nicotine products: a pilot study among young adults in Switzerland. Swiss Med Wkly 2023; 154:3733. [PMID: 38579318 DOI: 10.57187/s.3733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2024] Open
Abstract
AIMS To explore the effects of prices and flavour availability on the appeal of different tobacco and nicotine products, including conventional cigarettes, Electronic Nicotine Delivery Systems (ENDS) and Heated Tobacco Systems (HTS) among an adult population in Switzerland. METHODS We performed a Discrete Choice Experiment among a group of Swiss aged ≥18 years via the online recruiting platform Prolific in a convenience sample. Our sample included both non-smokers and smokers. We used a within-subject, alternative-specific block design in a series of choice sets including different smoking products. We fixed the attributes of nicotine content (high or medium) and harmfulness (in years of life lost) for each product. Attributes of interest included price (ranging from CHF 5 to 25 in increments of 5) and flavour (fruity/menthol vs none/tobacco flavour). We performed a conditional logistic regression on the attributes' influence on the appeal of cigarettes, ENDS and HTS. RESULTS A total of 108 out of 153 participants (n = 25 smokers and n = 83 non-smokers, completion rate = 71%) successfully completed our pilot survey experiment. We found that, in general, increasing the price of combustible cigarettes, ENDS and HTS by one standard deviation (around CHF 7) reduced their appeal by approximately 66% (relative risk [RR]: 0.34; 95% CI: 0.28-0.42). Unflavoured alternative nicotine products were found to be less appealing than flavoured products, especially for non-smokers, with a 86% decrease in appeal (RR: 0.14; 95% CI: 0.13-0.16). For non-smokers, an increase in price by one standard deviation was associated with a decrease in the appeal of any product by approximately 19% (RR: 0.81; 95% CI: 0.72-0.92). For smokers, the effect sizes were smaller, but overall, the appeal of all products decreased with increasing prices and reduced flavours. CONCLUSIONS Our Discrete Choice Experiment suggests that, for the Swiss context, limiting the availability of flavours for alternative smoking products has the potential to reduce their appeal to non-smokers by 86% and that a small but significant increase in prices to CHF 15 for cigarettes, ENDS and HTS could lead to a major (around 66%) decrease in their appeal.
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Affiliation(s)
- Larissa Merz
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Miquel Serra-Burriel
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Friedman AS, Pesko MF. Young adult responses to taxes on cigarettes and electronic nicotine delivery systems. Addiction 2022; 117:3121-3128. [PMID: 35852452 PMCID: PMC9796020 DOI: 10.1111/add.16002] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 06/27/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Although over half of United States states have passed taxes on electronic nicotine delivery systems (ENDS), recent evidence links ENDS tax rates to increases in smoking, suggesting potentially substantive health costs. Overall health implications will depend on how these taxes affect transitions from experimentation to regular smoking and vaping. Current analyses have not assessed ENDS tax rates' effects in young adulthood (ages 18-25). This study measures the relationship between ENDS and cigarette tax rates and ENDS use and smoking in young adulthood, a key period for initiation of regular tobacco use. DESIGN Observational study of data from the Current Population Survey's 2010-2019 Tobacco Use Supplements. SETTING The United States. PARTICIPANTS/CASES A total of 38 906 18 to 25 year-olds MEASUREMENTS: Multivariable linear regressions estimated two-way fixed effects analyses to assess ENDS and cigarette tax rates' relationships to recent and daily smoking and vaping, adjusting for an array of potential sociodemographic and policy confounders along with state and year fixed effects. FINDINGS A $1 increase in ENDS taxes yielded significant reductions in young adults' daily vaping ( β ̂ = -0.025; 95% CI, -0.037, -0.014) alongside increases in recent smoking ( β ̂ = 0.037; 95% CI, 0.013, 0.061), primarily reflecting greater dual use ( β ̂ =2.078; 95% CI, 0.890, 4.852; P = 0.09). A $1 cigarette tax increase yielded 2.1 and 2.5 percentage point increases in recent and daily vaping, with 95% CIs of (0.004, 0.038) and (0.018, 0.032) respectively. CONCLUSIONS In the United States, higher ENDS tax rates are associated with decreased ENDS use but increased cigarette smoking among 18- to 25-year-olds, with associations reversed for cigarette taxes.
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Affiliation(s)
| | - Michael F. Pesko
- Georgia State UniversityAtlantaGAUSA,Institute of Labor EconomicsBonnGermany
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Klitgaard MB, Jarlstrup NS, Lund L, Brink AL, Knudsen A, Christensen AI, Bast LS. Evaluating the Effects of Denmark's New Tobacco Control Act on Young People's Use of Nicotine Products: A Study Protocol of the §SMOKE Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12782. [PMID: 36232080 PMCID: PMC9566198 DOI: 10.3390/ijerph191912782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 09/27/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
(1) Background: In December 2020, a broad majority of political parties in Denmark agreed on a new tobacco control act. In addition, price increases on tobacco in 2020 and 2022 became part of the Danish Finance Act. This study protocol describes the study "§SMOKE-A Study of Tobacco, Behavior, and Regulations" designed to monitor and evaluate the implementation and effect of the new strengthened tobacco control acts. The overall aim is to monitor tobacco use among young people before, during, and after implementation of the new tobacco control legislation, including an increased price on tobacco, a ban on point-of-sale tobacco displays, and plain packaging. Subgoals are to monitor overall use of nicotine products, attitudes, and norms. (2) Methods: This study is designed as a five-year impact evaluation with repeated cross-sectional survey data collections. The baseline survey was conducted before implementing an increased price on tobacco, the first step in the new legislation, initiated 1 April 2020. Study participants (n = 37,500) were a random sample of individuals living in Denmark aged 15 to 29 years. (3) Conclusions: This study examines the impact of the new strengthened tobacco control legislation in Denmark from 2020 to 2025. The findings of this study are relevant to other countries facing implementation of similar measures to explore intended and unintended consequences of the legislation and help to identify how the legislation could be further improved.
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Affiliation(s)
- Marie Borring Klitgaard
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
| | - Nanna Schneekloth Jarlstrup
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
| | - Lisbeth Lund
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
| | - Anne-Line Brink
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Astrid Knudsen
- Danish Cancer Society, Strandboulevarden 49, 2100 Copenhagen, Denmark
| | - Anne Illemann Christensen
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Studiestreade 6, 1455 Copenhagen, Denmark
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Silver D, Bae JY, McNeill E, Macinko J. Do alcohol policies affect everyone equally? An assessment of the effects of state policies on education-related patterns of alcohol use, 2011-2019. Drug Alcohol Depend 2022; 239:109591. [PMID: 35947919 DOI: 10.1016/j.drugalcdep.2022.109591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 07/22/2022] [Accepted: 07/26/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Public policies are a powerful tool to change behaviors that may harm population health, but little is known about how state alcohol policies affect different population groups. This study assesses the effects of a comprehensive measure of the state alcohol regulatory environment (the State Alcohol Policy Score or SAPS) on heavy drinking-a risk factor for premature death-on different population groups, defined by levels of educational attainment, then by race/ethnicity, and sex. METHODS We pool each state's Behavioral Risk Factor Surveillance Survey (BRFSS) 2011-2019 and use robust Poisson regression analyses that control for individual-level factors, state-level factors (1 year lagged SAPS score for each state, state fixed effects), and year fixed effects to assess the relationship between SAPS and heavy drinking behaviors by education group. Interaction terms test whether education moderates the relationship by race/ethnicity and gender. RESULTS SAPS scores increased 2010-2018, but substantial gaps persist between states. A 10 % increase in a state's alcohol policy score is associated with a 2 % lower prevalence in current drinking (APR=0.97, 95 % CI=0.97-0.97, p < 0.0011) although not for those with a high school education or less. A 10 % increase in the SAPS was associated with a 3 % lower prevalence of heavy drinking; interaction terms in models reveal that a 10 % increase in the SAPS was associated with a lower prevalence of heavy drinking among those with less than a college education. CONCLUSION Narrowing gaps in alcohol policies between states may reduce heavy drinking among those with lower educational attainment.
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Affiliation(s)
- Diana Silver
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA.
| | - Jin Yung Bae
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA
| | - Elizabeth McNeill
- Department of Public Health Policy and Management, New York University School of Global Public Health, 708 Broadway, NY 10003, USA
| | - James Macinko
- Departments of Community Health Sciences and Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA 90095, USA
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Parks MJ, Patrick ME, Levy DT, Thrasher JF, Elliott MR, Fleischer NL. Cigarette Pack Price and Its Within-Person Association With Smoking Initiation, Smoking Progression, and Disparities among Young Adults. Nicotine Tob Res 2022; 24:519-528. [PMID: 34633457 PMCID: PMC8887579 DOI: 10.1093/ntr/ntab210] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/08/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND There is a dearth of research on within-person relationships between tobacco price and cigarette smoking initiation and progression in young adulthood. This project examines the within-person association between cigarette pack price and smoking initiation and progression between age 18 and 21/22, focusing on differences across subgroups. METHODS Data came from the longitudinal Monitoring the Future (MTF) project. MTF examines drug use behaviors with nationally representative samples of 12th graders annually. Subsamples of 12th graders are annually selected and followed longitudinally. Among 12th graders from baseline years 2000-2014, we examined past 30-day cigarette smoking initiation among baseline never smokers (N = 15 280) and progression to daily smoking among youth who were not daily smokers at baseline (N = 26 998). We used hierarchical logistic regression and interaction terms to assess differences across sex, race/ethnicity, and parental education. RESULTS The within-person relationship between pack price and smoking indicated that a one-dollar increase in pack price corresponded with a 72% decrease in the odds of initiation (AOR = 0.28, 95% CI = 0.18, 0.44) and 70% decrease in the odds of progression to daily smoking (AOR = 0.30, 95% CI = 0.21, 0.44). There was a linear age trend for both smoking initiation and progression. There were no statistically significant interactions between price and demographics, making it difficult to disentangle differences across subgroups. CONCLUSIONS Exposure to increased cigarette prices during young adulthood was associated with lower odds of cigarette smoking initiation and progression. Additional policies and programs beyond cigarettes prices could help reduce tobacco-related disparities in smoking initiation and progression among young adults. IMPLICATIONS There is a strong, within-person relationship between cigarette prices and smoking initiation and progression during the transition to young adulthood: higher prices are associated with decreased odds of both initiation and progression. Cigarette taxation can help to prevent smoking initiation and progression among youth, but it is less clear how taxes are associated with disparities in smoking experienced by certain subgroups. We could not draw definitive conclusions about the impact of cigarette prices on tobacco-related disparities. Tobacco taxes should be increased on a regular basis to ensure young adults experience within-person increases in prices, and complementary programs geared toward reducing tobacco-related disparities among young adults should be promoted.
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Affiliation(s)
- Michael J Parks
- Institute for Translational Research in Children’s Mental Health, University of Minnesota, Minneapolis, MN, USA
| | - Megan E Patrick
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
- Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Michael R Elliott
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, MI, USA
- Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, MI, USA
| | - Nancy L Fleischer
- Center for Social Epidemiology and Population Health, Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, MI, USA
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Phillips AZ, Ahern JA, Kerr WC, Rodriguez HP. Cigarettes smoked among daily and non-daily smokers following CVS Health's tobacco-free pharmacy policy. Tob Control 2022; 31:25-31. [PMID: 33082285 PMCID: PMC8499493 DOI: 10.1136/tobaccocontrol-2020-055976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In September 2014, CVS Health ceased tobacco sales in all of its 7700 pharmacies nationwide. We investigate the impact of the CVS policy on the number of cigarettes smoked per day among metropolitan daily and non-daily smokers, who may respond to the availability of smoking cues in different manners. METHODS Data are from the US Census Bureau Tobacco Use Supplement to the Current Population Survey 2014-2015 and the Blue Cross and Blue Shield Institute Community Health Management Hub. Adjusted difference-in-difference (DID) regressions assess changes in the number of cigarettes smoked per day among daily smokers (n=10 759) and non-daily smokers (n=3055), modelling core-based statistical area (CBSA) level CVS pharmacy market share continuously. To assess whether the policy had non-linear effects across the distribution of CVS market share, we also examine market share using tertiles. RESULTS CVS's tobacco-free pharmacy policy was associated with a significant reduction in the number of cigarettes smoked by non-daily smokers in the continuous DID (rate ratio=0.985, p=0.022), with a larger reduction observed among non-daily smokers in CBSAs in the highest third of CVS market share compared with those living in CBSAs with no CVS presence (rate ratio=0.706, p=0.027). The policy, however, was not significantly associated with differential changes in the number of cigarettes by daily smokers. CONCLUSION The removal of tobacco products from CVS pharmacies was associated with a reduction in the number of cigarettes smoked per day among non-daily smokers in metropolitan CBSAs, particularly those in which CVS had a large pharmacy market share.
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Affiliation(s)
- Aryn Z Phillips
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Center for Healthcare Organizatonal and Innovation Research, University of California, Berkeley, Berkeley, CA, USA
| | - Jennifer A Ahern
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | | | - Hector P Rodriguez
- Center for Healthcare Organizatonal and Innovation Research, University of California, Berkeley, Berkeley, CA, USA
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
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14
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Social Norms Change and Tobacco Use: A Protocol for a Systematic Review and Meta-Analysis of Interventions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182212186. [PMID: 34831942 PMCID: PMC8618876 DOI: 10.3390/ijerph182212186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/05/2021] [Accepted: 11/15/2021] [Indexed: 11/16/2022]
Abstract
Tobacco use kills more than eight million individuals each year, and results in substantial economic and human capital loss across nations. While effective supply-side solutions to tobacco control exist, these approaches are less effective at promoting cessation among heavy smokers, and less feasible to implement in countries with weaker tobacco control policy environments. Thus, effective demand-side solutions are needed. Shifting social norms around tobacco use is one such promising approach. To this end, a systematic review and meta-analysis of social norms intervention studies to influence tobacco use will be conducted following PRISMA 2020 guidance. Tobacco intervention studies with at least two time points that explicitly mention social norms or social influence as part of an intervention or set of measured variables will be included. Literature sources will comprise PubMed, Scopus, PsycInfo, and the Cochrane Trial Registry, as well as several grey literature sources. Two reviewers will independently screen studies, and risk of bias will be assessed using the Cochrane Risk of Bias 2 and ROBINS-I tools. The primary outcomes will be change in tobacco use and change in social norms. A random-effects meta-analysis will be conducted for both outcomes. Sources of heterogeneity will be explored using meta-regression with key covariates. Non-reporting biases will be explored using funnel plots. PROSPERO: CRD42021251535.
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15
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Lawrence KC, Egbule EO. Can emotional intelligence training cause a cease in tobacco smoking among school-going adolescents? INTERNATIONAL JOURNAL OF ADOLESCENCE AND YOUTH 2021. [DOI: 10.1080/02673843.2021.1959355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Kehinde Clement Lawrence
- Department of Educational Psychology and Special Education, Faculty of Education, University of Zululand, Empangeni, South Africa
| | - Elizabeth Osita Egbule
- Department of Guidance & Counselling, Faculty of Education, Delta State University Abraka, Abraka, Nigeria
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16
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Wang Y, Duan Z, Emery SL, Kim Y, Chaloupka FJ, Huang J. The Association between E-Cigarette Price and TV Advertising and the Sales of Smokeless Tobacco Products in the USA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:6795. [PMID: 34202723 PMCID: PMC8297131 DOI: 10.3390/ijerph18136795] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 11/28/2022]
Abstract
This study aims to examine how e-cigarette prices and advertising, key determinants of e-cigarette demand, are associated with the demand for smokeless tobacco (SLT) products in the US. Market-level sales and price data by year (2010-2017), quarter, and type of retail store were compiled from Nielsen retail store scanner database. E-cigarette TV advertising ratings data were compiled from Kantar Media. Four-way (market, year, quarter, store type) fixed-effect models were used to estimate the associations between e-cigarette price and TV advertising and sales of SLT products (chewing loose leaf, moist snuff, and snus). Our results showed that a 1% rise in own price was associated with a reduction in sales by 1.8% for chewing loose leaf, 1.6% for moist snuff, and 2.2% for snus, respectively. In addition, a 1% rise in disposable e-cigarette price was associated with 0.3% and 0.6% increased sales for moist snuff and snus, respectively. The association between e-cigarette TV advertising and SLT product sales was not significant. Our results suggest that disposable e-cigarettes and certain SLT products (moist snuff and snus) are potential substitutes. Policies aiming to regulate e-cigarette use and sales need to consider their potential link with the demand for SLT products.
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Affiliation(s)
- Yu Wang
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA; (Y.W.); (Z.D.)
| | - Zongshuan Duan
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA; (Y.W.); (Z.D.)
| | - Sherry L. Emery
- NORC at The University of Chicago, Chicago, IL 60637, USA; (S.L.E.); (Y.K.)
| | - Yoonsang Kim
- NORC at The University of Chicago, Chicago, IL 60637, USA; (S.L.E.); (Y.K.)
| | - Frank J. Chaloupka
- School of Public Health, University of Illinois at Chicago, Chicago, IL 60612, USA;
| | - Jidong Huang
- School of Public Health, Georgia State University, Atlanta, GA 30303, USA; (Y.W.); (Z.D.)
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17
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Matsubayashi K, Tabuchi T, Iso H. Tobacco Price Increase and Successful Smoking Cessation for Two or More Years in Japan. Nicotine Tob Res 2021; 23:716-723. [PMID: 32936883 DOI: 10.1093/ntr/ntaa178] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 09/15/2020] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Assessing long-term smoking cessation after tobacco price increases is more valuable than short-term cessation as smokers often relapse after temporary cessation. We investigated whether tobacco price increases were associated with long-term smoking cessation and whether the association differed according to demographic, socioeconomic, and behavioral factors, using a national longitudinal survey of middle-aged individual-level data from 10 waves, every November from 2005 to 2014. METHODS Temporary and long-term at least 1 year (1y+) or 2 years (2y+) quitters were defined by smoking in any one wave and quitting in the subsequent two or three waves in a discrete-time design. November 2006 (after July 11% increase) and November 2010 (after October 37% increase) were used as proxy variables for price increases. Generalized estimating equation models adjusted for demographic, socioeconomic, and behavioral covariates, and analyses stratified by these covariates were performed to estimate the association between price increases and smoking cessation. RESULTS Of 43 630 smokers aged 50-65, 7.7%, 5.6%, and 5.2% of smokers quit temporarily, for at least 1 year and at least 2 years, respectively. 2y+ quitters significantly increased in November 2005-November 2008 (adjusted odds ratio = 1.23, 95% confidence interval: 1.06-1.43) and November 2009-November 2012 (adjusted odds ratio = 1.85, 95% confidence interval = 1.57-2.16). In stratified analyses, higher prices were associated with 2y+ quitters in all subgroups with some exceptions, including participants who smoked 21-30 cigarettes per day and those aged 60-65. CONCLUSIONS Increasing tobacco prices may be effective in promoting long-term smoking cessation in various subgroups among middle-aged Japanese adults. IMPLICATIONS Few longitudinal studies have examined the effect of a tobacco price increase on long-term smoking cessation. In a national longitudinal survey of middle-aged Japanese from 10 waves, the 37% tobacco price increase was found to be a trigger for successful smoking cessation for two or more years. Price increases were significantly associated with 2y+ smoking cessation in most demographic, behavioral, and socioeconomic subgroups. Results indicate that higher tobacco prices may be effective for long-term smoking cessation in almost all subgroups. Raising tobacco taxes and prices may be one of the most effective strategies for promoting long-term smoking cessation.
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Affiliation(s)
- Keisuke Matsubayashi
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan
| | - Takahiro Tabuchi
- Cancer Control Center, Osaka International Cancer Institute, Osaka, Japan
| | - Hiroyasu Iso
- Public Health, Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka, Japan.,Department of Public Health Medicine, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
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Abstract
The use of e-cigarettes, otherwise known as 'vaping', has been increasing at alarming rates among youth and young adults. Although the long-term harms of vaping are still unclear, emerging evidence brings to light potential risks associated with vaping, especially for youth and non-smokers. This paper discusses nine viable policy measures that could limit the appeal of vaping products to youth and young adults and, in turn, reduce the potential harms of vaping.
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Bafunno D, Catino A, Lamorgese V, Del Bene G, Longo V, Montrone M, Pesola F, Pizzutilo P, Cassiano S, Mastrandrea A, Ricci D, Petrillo P, Varesano N, Zacheo A, Galetta D. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review. J Thorac Dis 2020; 12:3844-3856. [PMID: 32802466 PMCID: PMC7399441 DOI: 10.21037/jtd.2020.02.23] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This article investigates the effects of tobacco control policies on smoking initiation, cessation and prevalence by examining the papers published in the last 5 years. Twenty-one articles have been selected by two authors and sorted by four types of tobacco control: tobacco prices, anti-smoking campaigns for young people, mass media intervention and public smoking bans. Price/tax increase has deterrent effect on smoking initiation but does not promote smoking cessation; intervention on young people could reduce the smoking initiation if carried out at an early age and if acted on social skills and with peer-led approach, as opposed to restraining measures which hare generally easily circumvented by young people. The mass media campaigns showed positive effect on attempts to quit among smokers if carried forward over time and by involving multiple communication channels (TV, internet, radio). The bans in public have little effect on smoking cessation but could improve the overall well-being of non-smokers. Heterogeneous results have been described by different studies probably because of different research methodologies, cultural aspects and the really effective implementation of the rules for each country. In conclusion, comprehensive tobacco control interventions to reduce smoking prevalence and modify the smoking behavior are recommended. Moreover, the use of e-cigarettes and heat-not-burn (HnB) products, as possible helping tool for smoke cessation, currently remains controversial.
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Affiliation(s)
- Daniela Bafunno
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Annamaria Catino
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vito Lamorgese
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Gabriella Del Bene
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Vito Longo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Michele Montrone
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Francesco Pesola
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Pamela Pizzutilo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Sandro Cassiano
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | | | - Donata Ricci
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Patrizia Petrillo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Niccolò Varesano
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Antonella Zacheo
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
| | - Domenico Galetta
- Thoracic Oncology Unit, IRCCS Istituto Tumori "Giovanni Paolo II", Bari, Italy
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20
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Fleischer NL, Donahoe JT, McLeod MC, Thrasher JF, Levy DT, Elliott MR, Meza R, Patrick ME. Taxation reduces smoking but may not reduce smoking disparities in youth. Tob Control 2020; 30:264-272. [PMID: 32269173 DOI: 10.1136/tobaccocontrol-2019-055478] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/24/2020] [Accepted: 03/11/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE This study examines the extent to which cigarette taxes affect smoking behaviour and disparities in smoking among adolescents by gender, socioeconomic status (SES) and race/ethnicity. METHODS We used US nationally representative, repeated cross-sectional data from the 2005 to 2016 Monitoring the Future study to evaluate the relationship between state cigarette taxes and past 30-day current smoking, smoking intensity, and first cigarette and daily smoking initiation using modified Poisson and linear regression models, stratified by grade. We tested for interactions between tax and gender, SES and race/ethnicity on the additive scale using average marginal effects. RESULTS We found that higher taxes were associated with lower smoking outcomes, with variation by grade. Across nearly all of our specifications, there were no statistically significant interactions between tax and gender, SES or race/ethnicity for any grades/outcomes. One exception is that among 12th graders, there was a statistically significant interaction between tax and college plans, with taxes being associated with a lower probability of 30-day smoking among students who definitely planned to attend college compared with those who did not. CONCLUSION We conclude that higher taxes were associated with reduced smoking among adolescents, with little difference by gender, SES and racial/ethnicity groups. While effective at reducing adolescent smoking, taxes appear unlikely to reduce smoking disparities among youth.
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Affiliation(s)
- Nancy L Fleischer
- Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - J Travis Donahoe
- Graduate School of Arts & Sciences, Harvard University, Cambridge, Massachusetts, USA
| | - M Chandler McLeod
- Biostatistics Core, Rogel Cancer Center, University of Michigan, Ann Arbor, Michigan, USA
| | - James F Thrasher
- Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, USA.,Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - David T Levy
- Oncology, Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Michael R Elliott
- Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA.,Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan, USA
| | - Rafael Meza
- Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Megan E Patrick
- Institute of Child Development and Institute for Translational Research in Children's Mental Health, University of Minnesota Twin Cities, Minneapolis, Minnesota, USA
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21
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Lee B, Seo DC. Effects of an 80% cigarette price increase on quit attempts, successful quitting and smoking intensity among Korean adult smokers: results from nationally representative longitudinal panel data. Tob Control 2020; 30:336-343. [PMID: 32269171 DOI: 10.1136/tobaccocontrol-2019-055518] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/18/2020] [Accepted: 03/11/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVES South Korea implemented an unprecedented cigarette tax increase in 2015, raising its cigarette price by 80%. This study evaluated the extent to which the 2015 cigarette tax increase affected Korean adult smokers in terms of quit attempts, successful quitting and smoking intensity. METHODS Data were drawn from a nationally representative longitudinal study, the Korean Welfare Panel Study (waves 9-12, 2014-2017). Korean adults who smoked before the 2015 cigarette tax increase comprised the sample (n=2114). We used the multiple logistic regressions to examine factors of quit attempts and successful quitting and the generalised estimating equations to estimate changes in smoking intensity among continued smokers. RESULTS After the cigarette tax increase, 60.9% (n=1334) of baseline smokers attempted to quit and 34.7% of the attempters succeeded in quitting. The smokers aged ≥ 65 years and light smokers both attempted more (p<0.01) and succeeded more (p<0.05) in quitting than smokers aged 35-44 years and heavy smokers, respectively. The successful quitting was not significantly associated with income levels. Depressive symptoms, first cigarette use before age 19 and smoking a pack or more a day at baseline were associated with failures in quitting. Smoking intensity among continued smokers decreased after the cigarette tax increase (p<0.001), but such a decrease was not observed in light smokers, young smokers and high-income smokers. CONCLUSION The current study findings imply that the Korean government may consider implementing periodic increases in cigarette tax which should reflect the rate of inflation and income growth. Smoking cessation programmes need to address depressive symptoms.
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Affiliation(s)
- Boram Lee
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Dong-Chul Seo
- Department of Applied Health Science, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
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Partos TR, Hiscock R, Gilmore AB, Branston JR, Hitchman S, McNeill A. Impact of tobacco tax increases and industry pricing on smoking behaviours and inequalities: a mixed-methods study. PUBLIC HEALTH RESEARCH 2020. [DOI: 10.3310/phr08060] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
Increasing tobacco prices through taxation is very effective for reducing smoking prevalence and inequalities. For optimum effect, understanding how the tobacco industry and smokers respond is essential. Tobacco taxation changes occurred in the UK over the study period, including annual increases, a shift in structure from ad valorem to specific taxation and relatively higher increases on roll-your-own tobacco than on factory-made cigarettes.
Objectives
Understanding tobacco industry pricing strategies in response to tax changes and the impact of tax on smokers’ behaviour, including tax evasion and avoidance, as well as the effect on smoking inequalities. Synthesising findings to inform how taxation can be improved as a public health intervention.
Design
Qualitative analysis and evidence synthesis (commercial and Nielsen data) and longitudinal and aggregate cross-sectional analyses (International Tobacco Control Policy Evaluation Project data).
Setting
The UK, from 2002 to 2016.
Data sources and participants
Data were from the tobacco industry commercial literature and retail tobacco sales data (Nielsen, New York, NY, USA). Participants were a longitudinal cohort (with replenishment) of smokers and ex-smokers from 10 surveys of the International Tobacco Control Policy Evaluation Project (around 1500 participants per survey).
Main outcome measures
(1) Tobacco industry pricing strategies, (2) sales volumes and prices by segments over time and (3) smokers’ behaviours, including products purchased, sources, brands, consumption, quit attempts, success and sociodemographic differences.
Review methods
Tobacco industry commercial literature was searched for mentions of tobacco products and price segments, with 517 articles extracted.
Results
The tobacco industry increased prices on top of tax increases (overshifting), particularly on premium products, and, recently, the tobacco industry overshifted more on cheap roll-your-own tobacco than on factory-made cigarettes. Increasingly, price rises were from industry revenue generation rather than tax. The tobacco industry raised prices gradually to soften impact; this was less possible with larger tax increases. Budget measures to reduce cheap product availability failed due to new cheap factory-made products, price marking and small packs. In 2014, smokers could buy factory-made (roll-your-own tobacco) cigarettes at real prices similar to 2002. Exclusive roll-your-own tobacco and mixed factory-made cigarettes and roll-your-own tobacco use increased, whereas exclusive factory-made cigarette use decreased, alongside increased cheap product use, rather than quitting. Quitting behaviours were associated with higher taxes. Smokers consumed fewer factory-made cigarettes and reduced roll-your-own tobacco weight over time. Apparent illicit purchasing did not increase. Disadvantaged and dependent smokers struggled with tobacco affordability and were more likely to smoke cheaper products, but disadvantage did not affect quit success.
Limitations
Different for each data set; triangulation increased confidence.
Conclusions
The tobacco industry overshifted taxes and increased revenues, even when tax increases were high. Therefore, tobacco taxes can be further increased to reduce price differentials and recoup public health costs. Government strategies on illicit tobacco appear effective. Large, sudden tax increases would reduce the industry’s ability to manipulate prices, decrease affordability and increase quitting behaviours. More disadvantaged, and dependent, smokers need more help with quitting.
Future work
Assessing the impact of tax changes made since 2014; changing how tax changes are introduced (e.g. sudden intermittent or smaller continuous); and tax changes on tobacco initiation.
Funding
This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Timea R Partos
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | | | | | - J Robert Branston
- Centre for Governance and Regulation, School of Management, University of Bath, Bath, UK
| | - Sara Hitchman
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Ann McNeill
- National Addiction Centre, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
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23
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Hiscock R, Augustin NH, Branston JR, Gilmore AB. Standardised packaging, minimum excise tax, and RYO focussed tax rise implications for UK tobacco pricing. PLoS One 2020; 15:e0228069. [PMID: 32053603 PMCID: PMC7017998 DOI: 10.1371/journal.pone.0228069] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 01/07/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Standardised packaging for factory made (FM) and roll your own (RYO) tobacco was fully implemented in the UK in May 2017. Around the same time, several changes to the tax system were applied (a Minimum Excise Tax (MET) for FM products and tax increases weighted towards RYO products). The tobacco industry claims that standardised packaging will lower prices (a disincentive for quitting) by commoditising the product, yet had itself taken advantage of the previous tax regime to achieve large profits from premium brands while also keeping some products' prices relatively low. Here we evaluate the impact of standardised packaging, the MET and the RYO focussed tax changes on price and industry profitability. METHODS AND FINDINGS Nielsen electronic point of sale (EPOS) data (May 2015 to April 2018) were used to calculate real (inflation adjusted) monthly price per stick overall, by cigarette type (FM and RYO) and by seven market segments. Trend estimation, using additive mixed models, assessed weighted average price (weighted by volume of sales) and tobacco industry net revenue changes. The beginning and end of the data series were compared in terms of: (a) average monthly price growth, (b) average monthly net revenue growth, and (c) undershifting and overshifting patterns after tax changes. FM and RYO real prices changed little over the 3-year period-overall prices rose by about 1p per stick. There was no evidence of commoditisation with prices of all FM segments (but not RYO) rising faster after the implementation of standardised packaging than immediately beforehand. The prices of the cheapest FM brands rose with the implementation of the MET. RYO price increases did not close the gap to FM pricing levels despite RYO focussed tax increases. Tax changes following the implementation of standardised packaging and the MET were more widely and quickly passed on to smokers in the form of higher prices than the tax change pre-implementation. The main limitations are first that because we do not know the exact mechanism by which Nielsen scales up sample data to provide UK estimates, we could only use data for a set three year period during which the same adjustments are made. Second, the tax and standardised packaging events were sometimes too close in time to separate their consequences statistically. Third, tobacco prices may also be affected by external factors such as changes in smokers' disposable income or availability of electronic nicotine delivery systems. CONCLUSIONS There was no long-term lowering of tobacco prices after the implementation of standardised packaging as predicted by the industry. The introduction of the MET was successful in increasing the price of the cheapest FM cigarettes and narrowing the price gap between FM brands. The RYO tax increases were, however, insufficient to narrow the price gap between RYO and FM. Overall, undershifting became less extensive indicating that tobacco industry manipulation of the tax system which had previously kept cheap products available had declined. This suggests that standardised packaging and a MET will likely contribute to further declines in UK tobacco use.
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Affiliation(s)
- Rosemary Hiscock
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, England, United Kingdom
| | - Nicole H. Augustin
- Department of Mathematical Sciences, University of Bath, Bath, England, United Kingdom
| | | | - Anna B. Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, England, United Kingdom
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Johnson AL, Collins LK, Villanti AC, Pearson JL, Niaura RS. Patterns of Nicotine and Tobacco Product Use in Youth and Young Adults in the United States, 2011-2015. Nicotine Tob Res 2019; 20:S48-S54. [PMID: 30125012 PMCID: PMC6093370 DOI: 10.1093/ntr/nty018] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/08/2018] [Indexed: 11/19/2022]
Abstract
Introduction As cigarette smoking has decreased among youth and young adults (YAs) in the United States, the prevalence of other tobacco and nicotine product use has increased. Methods This study identified common past 30-day patterns of tobacco and nicotine product use in youth (grades 6–12) and YAs (aged 18–24). Using data from the 2011–2015 National Youth Tobacco Survey (NYTS) and corresponding years of the Truth Initiative Young Adult Cohort Study (TIYAC), past 30-day use of the following products was assessed: cigarettes, e-cigarettes, any type of cigar, smokeless tobacco, hookah, and other tobacco products (pipe, bidis, kreteks, dissolvable tobacco, and snus). A user-generated program in R was used to assess all possible combinations of product-specific and polytobacco use. Results The top five patterns of past 30-day use in youth were exclusive cigarette use (12.0%), exclusive cigar use (10.3%), exclusive e-cigarette use (10.0%), dual use of cigarettes and cigars (6.1%), and exclusive hookah use (5.2%). In YAs, the top five patterns were exclusive cigarette use (46.5%), exclusive cigar use (10.0%), dual use of cigarettes and cigars (6.4%), exclusive hookah use (5.9%), and dual use of cigarettes and e-cigarettes (3.9%). Conclusions As noncigarette tobacco and nicotine products become increasingly popular among tobacco users, further research is needed to identify predictors and correlates of specific tobacco use patterns in youth and YAs. This analysis can inform tobacco prevention efforts focusing on emerging tobacco products such as e-cigarettes and hookah. Educational and other intervention efforts should focus on the diversity of products and use patterns in these age groups. Implications This study uses population-based data to provide new information on the most prevalent patterns of past 30-day nicotine and tobacco use over a 5-year period among youth and young adults. Study findings demonstrate that youth and young adults report using tobacco and nicotine products in different combinations, with varying popularity over time. Additionally, by examining young adults as a separate group, this study highlights the unique patterns of use not previously discussed in the adult literature.
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Affiliation(s)
- Amanda L Johnson
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Lauren K Collins
- Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, DC
| | - Andrea C Villanti
- Department of Psychiatry, Vermont Center on Behavior and Health, University of Vermont, Burlington, VT.,Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | | | - Raymond S Niaura
- College of Global Public Health, New York University, New York, NY
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Matthews PA, Blok AC, Lee JGL, Hitsman B, Sanchez-Johnsen L, Watson K, Breen E, Ruiz R, Scout, Simon MA, Fitzgibbon M, Hein LC, Winn R. SBM recommends policy support to reduce smoking disparities for sexual and gender minorities. Transl Behav Med 2019; 8:692-695. [PMID: 29385561 DOI: 10.1093/tbm/ibx017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The Society of Behavioral Medicine supports the inclusion of gender and sexual minorities in all local, state, and national tobacco prevention and control activities. These activities include surveillance of tobacco use and cessation activities, targeted outreach and awareness campaigns, increasing access to culturally appropriate tobacco use dependence treatments, and restricting disproportionate marketing to lesbian, gay, bisexual, and transgender communities by the tobacco industry, especially for mentholated tobacco products.
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Affiliation(s)
| | - Amanda C Blok
- Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, United States Department of Veterans Affairs, Bedford, MA, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Brian Hitsman
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Lisa Sanchez-Johnsen
- Departments of Psychiatry & Surgery, College of Medicine, University of Illinois at Chicago, Chicago, IL, USA
| | - Karriem Watson
- University of Illinois Cancer Center, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth Breen
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Raymond Ruiz
- College of Nursing, University of Illinois at Chicago, Chicago, IL, USA
| | - Scout
- The Torvus Group, Beverly Hills, CA, USA
| | - Melissa A Simon
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Marian Fitzgibbon
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
| | - Laura C Hein
- University of South Carolina College of Nursing, Columbia, SC, USA
| | - Robert Winn
- University of Illinois College of Medicine at Chicago, Chicago, IL, USA
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Examining quit attempts and successful quitting after recent cigarette tax increases. Prev Med 2019; 118:226-231. [PMID: 30408448 DOI: 10.1016/j.ypmed.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/15/2018] [Accepted: 11/04/2018] [Indexed: 11/20/2022]
Abstract
As cigarette smoking rates decline, an important policy question is whether increasing cigarette taxes will continue to encourage smoking cessation. We tested this question following recent tobacco tax increases. Data were from the Minnesota Adult Tobacco Survey, a serial cross-sectional telephone survey conducted statewide, and was limited to past-year cigarette smokers in 2010 (n = 1029) and 2014 (n = 1382). Weighted estimates were calculated of the prevalence of past year smokers, smokers who attempted to quit smoking, and those who successfully quit by demographics, tobacco use, use of evidence-based cessation assistance to quit, and smoker perceptions of the tax increases. Among past year smokers, almost 60% reported a quit attempt in both years, 12.8% successfully quit in 2010 and 15.6% in 2014. Although older age, daily smoking, mean cigarettes per day, and more days of e-cigarette use, were associated with quit attempts in unadjusted models, only the perceived tax increase effect (AOR = 8.9; 95% CI 6.3-12.5) and low nicotine dependence (AOR = 1.9, 95% CI 1.3-2.7) were associated with making a quit attempt in adjusted models. Successful 12-month quits were predicted by college education (AOR = 3.2, 95% CI 1.3-7.8), the use of cessation support (AOR = 2.1, 95% CI 1.3-3.6), and reporting the tax increase helped maintain a quit (AOR = 12.3, 95% CI 7.5-20.1). These findings suggest that a large tax increase is effective in promoting quitting even in the presence of strong tobacco control measures such as indoor smoking bans and other smoking restrictions, mass media campaigns, and universal access to cessation support.
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Asfar T, Ben Taleb Z, Osibogun O, Ruano-Herreria EC, Sierra D, Ward KD, Salloum RG, Maziak W. How Do Waterpipe Smoking Establishments Attract Smokers? Implications for Policy. Subst Use Misuse 2018; 54:560-571. [PMID: 30430905 PMCID: PMC6443473 DOI: 10.1080/10826084.2018.1524489] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2018] [Revised: 09/05/2018] [Accepted: 09/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Given the unique social nature of waterpipe smoking, an important factor contributing to its popularity is the spread of waterpipe establishments. OBJECTIVES With a focus on implications for regulations, we conducted a qualitative assessment of customers' online reviews on Yelp.com to gain insight into their positive and negative perceptions about waterpipe establishments and products, and identify features that are most important to them. METHODS In June 2016, an online search of Yelp was conducted to identify waterpipe establishments in Miami, Florida. First, we collected information from the websites on establishments' characteristics and their marketing practices. Then we selected customers' waterpipe-related reviews and used an inductive qualitative method to code and identify key themes associated with positive and negative customers' experiences. Thematic analysis was completed upon reaching saturation. The final coding scheme consisted of 32 codes within eight themes. RESULTS The homepage of the establishment was used to promote special discounts and events, while the online waterpipe menu was used to promote the waterpipe products. Our thematic analysis indicated that the variety of flavored tobacco was the most rated positive factor to customers, while the low-quality charcoal and high price were the most negative factors. Conclusions/Importance: Waterpipe online advertisements and promotions should be monitored and restricted. The availability of flavored tobacco, innovative device/accessories, affordable pricing, and charcoal quality are important domains for waterpipe establishments policy/regulation. Regulatory framework for waterpipe establishments should address the complex context of waterpipe including the venue (i.e., physical, website, menu), the tobacco, the device/accessories, and charcoal.
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Affiliation(s)
- Taghrid Asfar
- a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida , USA
- b Sylvester Comprehensive Cancer Center , University of Miami Miller School of Medicine , Miami , Florida , USA
- c Syrian Center for Tobacco Studies , Memphis , Tennessee , USA
| | - Ziyad Ben Taleb
- d Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , Florida , USA
| | - Olatokunbo Osibogun
- d Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , Florida , USA
| | - Estefania C Ruano-Herreria
- a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Danielle Sierra
- a Department of Public Health Sciences , University of Miami Miller School of Medicine , Miami , Florida , USA
| | - Kenneth D Ward
- c Syrian Center for Tobacco Studies , Memphis , Tennessee , USA
- e Division of Social and Behavioral Sciences, School of Public Health , University of Memphis , Memphis , Tennessee , USA
| | - Ramzi G Salloum
- f Department of Health Outcomes and Policy , University of Florida, College of Medicine , Gainesville , Florida , USA
| | - Wasim Maziak
- c Syrian Center for Tobacco Studies , Memphis , Tennessee , USA
- d Department of Epidemiology, Robert Stempel College of Public Health and Social Work , Florida International University , Miami , Florida , USA
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Cantrell J, Bennett M, Mowery P, Xiao H, Rath J, Hair E, Vallone D. Patterns in first and daily cigarette initiation among youth and young adults from 2002 to 2015. PLoS One 2018; 13:e0200827. [PMID: 30096141 PMCID: PMC6086419 DOI: 10.1371/journal.pone.0200827] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2017] [Accepted: 07/03/2018] [Indexed: 11/19/2022] Open
Abstract
This study’s objective was to describe long-term trends and patterns in first cigarette use (cigarette initiation) and daily cigarette use (daily initiation) among youth and young adults in the U.S. We used cross-sectional survey data from the National Survey on Drug Use and Health, 2002–2015, to estimate annual incidence of first cigarette use (N = 270,556) and first daily cigarette use (N = 373,464) for each year by age groups, race/ethnicity and gender, examining trends over time and the average annual change in initiation for each group. Several clear patterns emerged: 1) cigarette initiation and daily initiation significantly decreased over time among those aged 12–14 and 15–17 and these trends were consistent among nearly all racial/ethnic and gender subgroups; 2) among 18–21 year olds, cigarette initiation sharply increased through 2009, surpassing rates among 15–17 year olds, and sharply declined through 2015 while remaining higher than rates among the younger group, and this trend was consistent for almost all racial/ethnic subgroups; 3) daily initiation for those aged 18–21 significantly declined, and this was significant among most subgroups 4) there was no change in cigarette initiation and daily initiation for 22–25 year olds overall and most subgroups; 5) there was a significant increase in cigarette initiation for 22–25 year old Hispanics males and daily initiation for 22–25 year old males. This study provides a comprehensive look at trends in cigarette and daily initiation among U.S. youth and young adults. Despite notable declines in smoking initiation among youth and young adult populations over the last two decades, targeted prevention and policy efforts are needed for subgroups at higher risk, including young adults and Hispanic males.
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Affiliation(s)
- Jennifer Cantrell
- College of Global Public Health, New York University, New York, NY, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- * E-mail:
| | - Morgane Bennett
- Schroeder Institute at Truth Initiative, Washington, DC, United States of America
- Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, Washington, DC, United States of America
| | - Paul Mowery
- Biostatistics, Inc., Atlanta, GA, United States of America
| | - Haijun Xiao
- Schroeder Institute at Truth Initiative, Washington, DC, United States of America
| | - Jessica Rath
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Schroeder Institute at Truth Initiative, Washington, DC, United States of America
| | - Elizabeth Hair
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Schroeder Institute at Truth Initiative, Washington, DC, United States of America
| | - Donna Vallone
- College of Global Public Health, New York University, New York, NY, United States of America
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America
- Schroeder Institute at Truth Initiative, Washington, DC, United States of America
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Thompson AB, Mowery PD, Tebes JK, McKee SA. Time Trends in Smoking Onset by Sex and Race/Ethnicity Among Adolescents and Young Adults: Findings From the 2006-2013 National Survey on Drug Use and Health. Nicotine Tob Res 2018; 20:312-320. [PMID: 28339616 PMCID: PMC5896447 DOI: 10.1093/ntr/ntx010] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 01/16/2017] [Indexed: 11/14/2022]
Abstract
Introduction During the 2000s the number of adolescents who became new smokers in the United States declined while the number of young adults who did so increased. However, we do not know among which demographic groups these changes occurred. Methods We analyzed data from the 2006 to 2013 National Survey of Drug Use and Health (n = 180 079). Multivariate linear regression models were used to assess annual trends in smoking onset and log-binomial regression models to assess changes over time in the risk of smoking onset among young adults (18- to 25-years-old) relative adolescents (12- to 17-years-old). Results From 2006 to 2013, the rate of onset among young adults (6.3%) was greater than among adolescents (1.9%). Time trends demonstrated that annual declines in smoking onset occurred among white young adult males and females. Rates of smoking onset increased among black and Hispanic young adult males with a lower rate of decline among black and Hispanic young adult females. There was a greater risk of smoking onset among young adults relative to adolescents that did not change over time. Conclusions Smoking onset is becoming more concentrated in the young adult than adolescent years. Despite this trend, there were annual declines in young adult smoking onset but not uniformly across racial/ethnic groups. More effective strategies to prevent young adult smoking onset may contribute to a further decline in adult smoking and a reduction in tobacco-related health disparities. Implications Smoking onset is becoming more concentrated in the young adult years across sex and racial/ethnic groups. The United States may be experiencing a period of increasing age of smoking onset and must develop tobacco control policies and practices informed by these changes.
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Affiliation(s)
- Azure B Thompson
- The National Center on Addiction and Substance Abuse, New York, NY
| | | | | | - Sherry A McKee
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT
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Weitzman M. American pediatric society's 2017 John Howland award acceptance lecture: a tale of two toxicants: childhood exposure to lead and tobacco. Pediatr Res 2018; 83:23-30. [PMID: 28945701 DOI: 10.1038/pr.2017.240] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Accepted: 09/18/2017] [Indexed: 11/09/2022]
Abstract
This article summarizes the presentation of the 2017 Howland Award to Michael Weitzman, MD, at the Annual Pediatric Academic Society Meetings. It summarizes the remarkable advances in understanding the effects and pathways of exposure of the two most common and pernicious of our nation's child environmental exposures, namely lead and tobacco. It also summarizes the profound effect of the translation of these findings into prudent and effective clinical and public health policies such that exposure to both has dramatically decreased over the past 40 years due to the tenacious activities of pediatricians, other child-related professionals, government agencies at all levels, and the American Academy of Pediatrics. Research and clinical activities, although essential, were not sufficient to produce these successes, but required extensive mentoring to produce a generation of academic pediatricians capable of conducting the requisite research, and extensive advocacy by pediatricians and others to overcome the formidable inertia and outright opposition to efforts to protect our children from these exposures. Moreover, the article highlights that both of these environmental exposures have roots in social and environmental injustice and neither is solved, and that there is no safe level of exposure to either of these toxicants.
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Affiliation(s)
- Michael Weitzman
- Department of Pediatrics, New York University School of Medicine, New York City, New York
- Department of Environmental Medicine, New York University School of Medicine, New York City, New York
- College of Global Public Health, New York University, New York City, New York
- NYU/Abu Dhabi Public Health Research Center, Abu Dhabi, UAE
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Makadia LD, Roper PJ, Andrews JO, Tingen MS. Tobacco Use and Smoke Exposure in Children: New Trends, Harm, and Strategies to Improve Health Outcomes. Curr Allergy Asthma Rep 2017; 17:55. [PMID: 28741144 DOI: 10.1007/s11882-017-0723-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Every day in the USA, approximately 4000 adolescents begin smoking and the adolescent brain is particularly susceptible to nicotine addiction. We present current pediatric trends on tobacco use and exposures, various new products used by adolescents, the adverse biological and behavioral effects of tobacco use and exposures, and tobacco control strategies to eliminate tobacco-related illnesses and deaths in the pediatric population. RECENT FINDINGS Twelve-20% of women continue to smoke during pregnancy. New research reveals cognitive differences and behavior-control disorders are seen in elementary school children from prenatal and postnatal exposures. Traditional cigarette smoking has decreased in adolescents; novel and appealing tobacco products have captured their attention, particularly electronic cigarettes, and rates double and often triple from middle to high school. Children with asthma and those living in multi-housing units have higher rates of secondhand smoke exposure than non-asthmatics and children living in single-home dwellings. There is no "safe or risk-free" level of tobacco use or exposure. Tobacco use and exposure in childhood and adolescence must be decreased using evidenced-based strategies to improve child health.
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Affiliation(s)
- Luv D Makadia
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | - P Jervey Roper
- Medical College of Georgia, Augusta University, Augusta, GA, USA
| | | | - Martha S Tingen
- Department of Pediatrics, Georgia Prevention Institute, Medical College of Georgia, Augusta University, HS-1755, 1499 Walton Way, Augusta, GA, 30912, USA.
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Harrell PT, Naqvi SMH, Plunk AD, Ji M, Martins SS. Patterns of youth tobacco and polytobacco usage: The shift to alternative tobacco products. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 43:694-702. [PMID: 27668320 PMCID: PMC5440212 DOI: 10.1080/00952990.2016.1225072] [Citation(s) in RCA: 54] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/19/2016] [Accepted: 07/31/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND Despite significant declines in youth cigarette smoking, overall tobacco usage remains over 20% as non-cigarette tobacco product usage is increasingly common and polytobacco use (using 1+ tobacco product) remains steady. OBJECTIVES The present study was designed to identify patterns of youth tobacco use and examine associations with sociodemographic characteristics and tobacco dependence. METHODS The current analysis uses Latent Class Analysis (LCA) to examine the 6,958 tobacco users (n = 2,738 female) in the National Youth Tobacco Survey (2012 and 2013). We used as indicators past month use of tobacco products (cigarettes, cigars, smokeless tobacco, e-cigarettes, hookah, snus, pipes, bidis, and kreteks) and regressed resulting classes on sociodemographic characteristics and tobacco dependence. RESULTS Nine classes emerged: cigarette smokers (33.4% of sample, also included small probabilities for use of cigars and e-cigarettes), cigar smokers (16.8%, nearly exclusive), smokeless tobacco users (12.3%, also included small probabilities for cigarettes, cigars, snus), hookah smokers (11.8%), tobacco smokers/chewers (10.7%, variety of primarily traditional tobacco products), tobacco/hookah smokers (7.2%), tobacco/snus/e-cig users (3.3%), e-cigarette users (2.9%,), and polytobacco users (1.7%, high probabilities for all products). Compared to cigarette smokers, tobacco/hookah smokers and hookah smokers were more likely to report Hispanic ethnicity. Polytobacco users were more likely to report dependence (AOR:2.77, 95% CI:[1.49-5.18]), whereas e-cigarette users were less likely (AOR:0.49, 95% CI:[0.24-0.97]). CONCLUSION Findings are consistent with other research demonstrating shifts in adolescent tobacco product usage towards non-cigarette tobacco products. Continuous monitoring of these patterns is needed to help predict if this shift will ultimately result in improved public health.
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Affiliation(s)
- Paul T Harrell
- a Department of Pediatrics, Eastern Virginia Medical School , Norfolk , VA , USA
| | | | - Andrew D Plunk
- a Department of Pediatrics, Eastern Virginia Medical School , Norfolk , VA , USA
| | - Ming Ji
- b Department of Statistics/Biostatistics, College of Nursing , University of South Florida , Tampa , FL , USA
| | - Silvia S Martins
- c Department of Epidemiology , Columbia University Mailman School of Public Health , New York , NY , USA
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Hiscock R, Branston JR, McNeill A, Hitchman SC, Partos TR, Gilmore AB. Tobacco industry strategies undermine government tax policy: evidence from commercial data. Tob Control 2017; 27:tobaccocontrol-2017-053891. [PMID: 28993519 PMCID: PMC6109235 DOI: 10.1136/tobaccocontrol-2017-053891] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Taxation equitably reduces smoking, the leading cause of health inequalities. The tobacco industry (TI) can, however, undermine the public health gains realised from tobacco taxation through its pricing strategies. This study aims to examine contemporary TI pricing strategies in the UK and implications for tobacco tax policy. DESIGN Review of commercial literature and longitudinal analysis of tobacco sales and price data. SETTING A high-income country with comprehensive tobacco control policies and high tobacco taxes (UK). PARTICIPANTS 2009 to 2015 Nielsen Scantrak electronic point of sale systems data. MAIN OUTCOME MEASURES Tobacco segmentation; monthly prices, sales volumes of and net revenue from roll-your-own (RYO) and factory-made (FM) cigarettes by segment; use of price-marking and pack sizes. RESULTS The literature review and sales data concurred that both RYO and FM cigarettes were segmented by price. Despite regular tax increases, average real prices for the cheapest FM and RYO segments remained steady from 2013 while volumes grew. Low prices were maintained through reductions in the size of packs and price-marking. Each year, at the point the budget is implemented, the TI drops its revenue by up to 18 pence per pack, absorbing the tax increases (undershifting). Undershifting is most marked for the cheapest segments. CONCLUSIONS The TI currently uses a variety of strategies to keep tobacco cheap. The implementation of standardised packaging will prevent small pack sizes and price-marking but further changes in tax policy are needed to minimise the TI's attempts to prevent sudden price increases.
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Affiliation(s)
- Rosemary Hiscock
- Department for Health, University of Bath, Bath, UK
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
| | | | - Ann McNeill
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sara C Hitchman
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Timea R Partos
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Anna B Gilmore
- Department for Health, University of Bath, Bath, UK
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
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McDaniel PA, Lown EA, Malone RE. "It doesn't seem to make sense for a company that sells cigarettes to help smokers stop using them": A case study of Philip Morris's involvement in smoking cessation. PLoS One 2017; 12:e0183961. [PMID: 28846738 PMCID: PMC5573297 DOI: 10.1371/journal.pone.0183961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Accepted: 08/02/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND In the late 1990s, American tobacco companies began offering limited cessation assistance to smokers by posting links on their company websites to government-sponsored smoking cessation resources. Philip Morris USA (PM) went further, funding youth cessation programs and creating its own online cessation program, QuitAssist. We explore why PM entered the cessation arena, and describe the variety of options considered and how PM-supported cessation programs were evaluated and promoted. METHODS We retrieved and analyzed archival PM documents from 1998-2005. We supplemented information from the documents with scholarly articles assessing QuitAssist and archived versions of the PM and QuitAssist websites. RESULTS PM's Youth Smoking Prevention department began funding youth cessation projects and programs soon after its creation in 1998, motivated by the same issue that drove its interest in youth smoking prevention: regulatory threats posed by public and policymaker concern about youth smoking. The department took a similar approach to youth smoking cessation as it did with prevention, rejecting curricula with "anti-industry" themes. In 2002, a "cessation exploration team" examined a variety of rationales for and approaches to company support for adult smoking cessation. Ultimately, PM chose QuitAssist, a limited and less expensive option that nonetheless provided opportunities for engagement with a variety of public health and government officials. Independent research indicates that QuitAssist is not an effective cessation tool. CONCLUSIONS While the transformation of ambitious plans into a mundane final product is a recurring theme with PM's corporate responsibility efforts, it would be inappropriate to dismiss PM's smoking cessation endeavors as half-hearted attempts to appear responsible. Such endeavors have the potential to inflict real harm by competing with more effective programs and by helping to maintain a tobacco-favorable policy environment. If PM truly wanted to support cessation, it could drop legal and other challenges to public policies that discourage smoking.
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Affiliation(s)
- Patricia A. McDaniel
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA, United States of America
- * E-mail:
| | - E. Anne Lown
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA, United States of America
| | - Ruth E. Malone
- Department of Social and Behavioral Sciences, School of Nursing, University of California, San Francisco, San Francisco, CA, United States of America
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West R. Tobacco smoking: Health impact, prevalence, correlates and interventions. Psychol Health 2017; 32:1018-1036. [PMID: 28553727 PMCID: PMC5490618 DOI: 10.1080/08870446.2017.1325890] [Citation(s) in RCA: 297] [Impact Index Per Article: 42.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2017] [Accepted: 04/27/2017] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite reductions in prevalence in recent years, tobacco smoking remains one of the main preventable causes of ill-health and premature death worldwide. This paper reviews the extent and nature of harms caused by smoking, the benefits of stopping, patterns of smoking, psychological, pharmacological and social factors that contribute to uptake and maintenance of smoking, the effectiveness of population and individual level interventions aimed at combatting tobacco smoking, and the effectiveness of methods used to reduce the harm caused by continued use of tobacco or nicotine in some form. RESULTS AND CONCLUSIONS Smoking behaviour is maintained primarily by the positive and negative reinforcing properties of nicotine delivered rapidly in a way that is affordable and palatable, with the negative health consequences mostly being sufficiently uncertain and distant in time not to create sufficient immediate concern to deter the behaviour. Raising immediate concerns about smoking by tax increases, social marketing and brief advice from health professionals can increase the rate at which smokers try to stop. Providing behavioural and pharmacological support can improve the rate at which those quit attempts succeed. Implementing national programmes containing these components are effective in reducing tobacco smoking prevalence and reducing smoking-related death and disease.
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Affiliation(s)
- Robert West
- Department of Behavioural Science and Health, University College London, London, UK
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Best M, Papies EK. Right Here, Right Now: Situated Interventions to Change Consumer Habits. ACTA ACUST UNITED AC 2017. [DOI: 10.1086/695443] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Dai H, Hao J. The effects of tobacco control policies on retailer sales to minors in the USA, 2015. Tob Control 2017; 27:258-260. [PMID: 28219976 DOI: 10.1136/tobaccocontrol-2016-053408] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 01/24/2017] [Accepted: 01/26/2017] [Indexed: 11/03/2022]
Abstract
BACKGROUND Under the 2009 Family Smoking Prevention and Tobacco Control Act, the Food and Drug Administration (FDA) has been routinely inspecting tobacco retailers' compliance with under-age sales laws. We seek to identify factors associated with Retail Violation Rate for sale to minors (RVRm). METHODS We collected the tobacco retailer inspection data for 2015 from the FDA compliance check database. RVRm was calculated at the census tract level and overlaid with tobacco regulations and youth smoking prevalence at the state level. Multi-level spatial analysis was performed to examine the impacts of tobacco jurisdiction variations, youth smoking rates and neighbourhood social characteristics on RVRm. RESULTS A total of 136 816 compliance checks involving minors conducted by the FDA in 2015 were analysed. A higher RVRm was associated with higher youth smoking prevalence (aRR=1.04, p<0.0001). Tobacco regulations show significant relationships with RVRm. For every one dollar increase in cigarette tax per pack, the likelihood of retail violations was reduced by 2% (aRR=0.98, p=0.03). For every 10% increase in tobacco prevention spending towards Centers for Disease Control recommended funding targets, the likelihood of retail violations was reduced by 1% (aRR=0.99, p=0.01). RVRm increased in states that enacted stronger smoke-free air policies (aRR=1.08, p<0.0001). CONCLUSION We observed associations of tobacco regulations and neighbourhood social characteristics with tobacco retailers' compliance with under-age sales laws. This study provides evidence to support stronger tobacco regulations and control policies in reducing youth access to tobacco products.
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Affiliation(s)
- Hongying Dai
- Health Services & Outcomes Research, Children's Mercy Hospital, Kansas City, Missouri, USA.,Department of Biomedical & Health Informatics, University of Missouri, Kansas City, Missouri, USA.,Department of Pediatrics, University of Missouri, Kansas City, Missouri, USA
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Matthews AK, Cesario J, Ruiz R, Ross N, King A. A Qualitative Study of the Barriers to and Facilitators of Smoking Cessation Among Lesbian, Gay, Bisexual, and Transgender Smokers Who Are Interested in Quitting. LGBT Health 2017; 4:24-33. [PMID: 28068208 DOI: 10.1089/lgbt.2016.0059] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE Lesbian, gay, bisexual, and transgender (LGBT) individuals are significantly more likely to smoke compared with their heterosexual and cisgender counterparts. The purpose of this study was to explore barriers to and facilitators of smoking cessation readiness among LGBT smokers. METHODS This descriptive study used a qualitative approach. Four 90-minute focus groups (eligibility criteria: age ≥21, self-identify as LGBT, current smoker, interest in quitting smoking) were conducted. Participants also completed a brief survey that measured additional demographic characteristics and smoking behaviors. Topics explored included quit experiences, attitudes and beliefs, barriers to and facilitators of cessation, and cultural factors related to smoking behaviors. Established qualitative methods were used to conduct the focus groups and data analysis. RESULTS The mean age of participants (N = 31) was 37.1 years with the majority identifying as male (58.1%). The sample group was racially diverse: 32% were African American, 39% were White, and 29% were more than one race. Interest in quitting was high (M = 9.0, range 0-10). Barriers to smoking cessation fell under the broad themes of individual-level factors, cultural factors, psychosocial factors, and access to treatment. Facilitators of smoking cessation included stage of readiness, health concerns, social stigma, a shift in social norms, financial costs, and improving dating prospects. CONCLUSIONS Interest in smoking cessation was high in this sample of LGBT smokers and influenced by a range of facilitators. Nevertheless, several general and culturally specific barriers to smoking cessation readiness were identified. The study results have implications for future research and the development of outreach, prevention, and treatment programs.
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Affiliation(s)
- Alicia K Matthews
- 1 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - John Cesario
- 2 Department of Oncology, University of Illinois Hospital and Health Systems Sciences , Chicago, Illinois
| | - Raymond Ruiz
- 1 Department of Health Systems Science, College of Nursing, University of Illinois at Chicago , Chicago, Illinois
| | - Natalie Ross
- 3 Department of Research, Howard Brown Health Center , Chicago, Illinois
| | - Andrea King
- 4 Department of Psychiatry and Behavioral Neuroscience, University of Chicago , Chicago, Illinois
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Cohn AM, Johnson AL, Rath JM, Villanti AC. Patterns of the co-use of alcohol, marijuana, and emerging tobacco products in a national sample of young adults. Am J Addict 2016; 25:634-640. [PMID: 27706885 DOI: 10.1111/ajad.12456] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2016] [Revised: 09/07/2016] [Accepted: 09/11/2016] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Emerging tobacco product use is on the rise in young adults and has been linked to alcohol and marijuana use. Little is known about which patterns of alcohol, marijuana, and emerging tobacco product co-use are most popular in this age group. OBJECTIVES This study examined the prevalence of a broad spectrum of marijuana, alcohol, and tobacco co-use patterns across a variety of tobacco products in a national sample of young adults. METHODS Data were analyzed from a sub-set of 18-24 year olds (unweighted n = 3,940) from five waves of the Truth Initiative Young Adult Cohort, a national sample of 18-34 year olds. A user-generated statistical program in R was used to assess all possible patterns of past 30-day use of alcohol, marijuana, cigarettes, cigars, e-cigarettes, little cigars/cigarillos, hookah, and other tobacco (pipe, chew, dip, snus, dissolvables). RESULTS No past 30-day use of any substance emerged as the most popular pattern across all years (42%), followed by exclusive past 30-day alcohol use (31%), and past 30-day alcohol use with cigarettes (5%) or marijuana (4%). The popularity of exclusive marijuana use increased over time, but only 1% reported exclusive marijuana use without the combination of either alcohol or a tobacco product. E-cigarette use only emerged in combination with alcohol and was the least popular pattern of co-use relative to other patterns. CONCLUSIONS AND SCIENTIFIC SIGNIFICANCE Patterns stress the importance of alcohol among young people. Successful substance use prevention should focus on alcohol's co-use with a variety of substances of abuse, rather than focus on a single behavior. (Am J Addict 2016;25:634-640).
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Affiliation(s)
- Amy M Cohn
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.,Department of Oncology, Georgetown University Medical Center, Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, Washington, District of Columbia
| | - Amanda L Johnson
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia
| | - Jessica M Rath
- Department of Evaluation Science and Research at Truth Initiative, Washington, District of Columbia.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Andrea C Villanti
- The Schroeder Institute for Tobacco Research and Policy Studies at Truth Initiative, Washington, District of Columbia.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Bold KW, Kong G, Cavallo DA, Camenga DR, Krishnan-Sarin S. Reasons for Trying E-cigarettes and Risk of Continued Use. Pediatrics 2016; 138:peds.2016-0895. [PMID: 27503349 PMCID: PMC5005025 DOI: 10.1542/peds.2016-0895] [Citation(s) in RCA: 84] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/29/2016] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Longitudinal research is needed to identify predictors of continued electronic cigarette (e-cigarette) use among youth. We expected that certain reasons for first trying e-cigarettes would predict continued use over time (eg, good flavors, friends use), whereas other reasons would not predict continued use (eg, curiosity). METHODS Longitudinal surveys from middle and high school students from fall 2013 (wave 1) and spring 2014 (wave 2) were used to examine reasons for trying e-cigarettes as predictors of continued e-cigarette use over time. Ever e-cigarette users (n = 340) at wave 1 were categorized into those using or not using e-cigarettes at wave 2. Among those who continued using e-cigarettes, reasons for trying e-cigarettes were examined as predictors of use frequency, measured as the number of days using e-cigarettes in the past 30 days at wave 2. Covariates included age, sex, race, and smoking of traditional cigarettes. RESULTS Several reasons for first trying e-cigarettes predicted continued use, including low cost, the ability to use e-cigarettes anywhere, and to quit smoking regular cigarettes. Trying e-cigarettes because of low cost also predicted more days of e-cigarette use at wave 2. Being younger or a current smoker of traditional cigarettes also predicted continued use and more frequent use over time. CONCLUSIONS Regulatory strategies such as increasing cost or prohibiting e-cigarette use in certain places may be important for preventing continued use in youth. In addition, interventions targeting current cigarette smokers and younger students may also be needed.
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Affiliation(s)
| | | | | | - Deepa R. Camenga
- Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
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Harvey J, Chadi N. Preventing smoking in children and adolescents: Recommendations for practice and policy. Paediatr Child Health 2016; 21:209-21. [PMID: 27429575 DOI: 10.1093/pch/21.4.209] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Canada has witnessed a general decrease in smoking prevalence among all age groups in recent years. However, despite large numbers of campaigns and interventions, thousands of young Canadians continue to initiate cigarette smoking every year. The increasing popularity of alternative tobacco products and e-cigarettes is also creating new health challenges. Research has shown that the deleterious effects of nicotine and cigarette smoke are significant and long lasting. Health care professionals have key responsibilities in preventing tobacco use among youth and their families, and need to know more about effective smoking prevention and cessation strategies. Clinicians need to integrate tobacco counselling into health assessments of teenagers and be aware of the roles that families, communities and governments can play in promoting tobacco-free environments. Information, effective strategies and opportunities for health care professionals to intervene and advocate for Canadian adolescents are discussed.
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Asfar T, Arheart KL, Dietz NA, Caban-Martinez AJ, Fleming LE, Lee DJ. Changes in Cigarette Smoking Behavior Among US Young Workers From 2005 to 2010: The Role of Occupation. Nicotine Tob Res 2016; 18:1414-23. [PMID: 26508398 DOI: 10.1093/ntr/ntv240] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 10/18/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION Young adult workers (18-24 years) in the United States have been identified as a high-risk group for smoking. This study compares changes in smoking behavior by occupational class among this group between 2005 and 2010. METHODS Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. All respondents 18-24 years who reported that they were employed during the two surveys were selected (n = 1880 in 2005; and n = 1531 in 2010). Weighted percentages and 95% confidence interval were reported. Logistic regression analyses were performed to compare smoking behavior between occupational groups (white-collar, blue-collar, and service) and between years (2005-2010), and to examine correlates of smoking, successful quit attempt, and heavy smoking. RESULTS Smoking prevalence and daily smoking declined in 2010 in white-collar. Smoking prevalence and intensity decreased while age of smoking initiation increased in blue-collar workers. Young workers were more likely to smoke in 2005 than 2010. Service and blue-collar workers were more likely to smoke than white-collar workers. Older young adults, whites, individuals with a high school/or less education, those without health insurance were more likely to smoke. White workers and individuals with a high school/or less education were more likely to be heavy smokers. CONCLUSIONS White-collar workers have benefited the most from tobacco control efforts. Although improvements were seen in smoking behavior among blue-collar workers, smoking prevalence remained the highest in this group. Smoking behavior among service workers did not change. Young service workers and blue-collar are priority populations for workplace tobacco control efforts. IMPLICATIONS The current study examines changes in smoking behavior among young adult workers (18-24 years) by occupational class (white-collar, blue-collar, and service workers) between 2005 and 2010. Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. Smoking prevalence and daily smoking declined significantly in white-collar workers. No change in smoking behavior was observed among service workers. Positive changes in smoking behavior were observed among blue-collar workers, but smoking prevalence remained the highest in this group. Blue-collar and service workers are priority groups for future workplace tobacco control efforts.
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Affiliation(s)
- Taghrid Asfar
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL;
| | - Kristopher L Arheart
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL
| | - Noella A Dietz
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
| | - Alberto J Caban-Martinez
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Environmental and Occupational Medicine and Epidemiology (EOME) Division, Department of Environmental Health, Harvard School of Public Health, Boston, MA
| | - Lora E Fleming
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; European Centre for Environment and Human Health, University of Exeter Medical School; Knowledge Spa, Royal Cornwall Hospital, Cornwall, United Kingdom
| | - David J Lee
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL; Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL
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Shaik SS, Doshi D, Bandari SR, Madupu PR, Kulkarni S. Tobacco Use Cessation and Prevention - A Review. J Clin Diagn Res 2016; 10:ZE13-7. [PMID: 27437378 DOI: 10.7860/jcdr/2016/19321.7803] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 04/15/2016] [Indexed: 11/24/2022]
Abstract
Tobacco use is a major preventable cause of premature death and disease, currently leading to over five million deaths each year worldwide. Smoking or chewing tobacco can seriously affect general, as well as oral health. Oral health professionals play an important role in promoting tobacco free-lifestyles. They should counsel their patients not to smoke; and reinforce the anti-tobacco message and refer the patients to smoking cessation services. Dentists are in a unique position to educate and motivate patients concerning the hazards of tobacco to their oral and systemic health, and to provide intervention programs as a part of routine patient care. Tobacco cessation is necessary to reduce morbidity and mortality related to tobacco use. Strategies for tobacco cessation involves 5 A's and 5 R's approach, quit lines and pharmacotherapy. Additionally, tobacco cessation programs should be conducted at community, state and national levels. Various policies should be employed for better tobacco control. Governments should implement the tobacco control measures to reduce the prevalence of tobacco use and exposure to tobacco smoke. In addition, there should be availability of leaflets, brochures, continuing patient education materials regarding tobacco cessation.
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Affiliation(s)
- Sabiha Shaheen Shaik
- Senior Lecturer, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Dolar Doshi
- Professor, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Srikanth Reddy Bandari
- Reader, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Padma Reddy Madupu
- Reader, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
| | - Suhas Kulkarni
- Professor and Head, Department of Public Health Dentistry, Panineeya Institute of Dental Sciences and Hospital , Hyderabad, Telangana, India
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Harvey J, Chadi N. La prévention du tabagisme chez les enfants et les adolescents : des recommandations en matière de pratiques et de politiques. Paediatr Child Health 2016; 21:209-221. [PMID: 27429576 PMCID: PMC4934165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023] Open
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Harvey J, Chadi N. La prévention du tabagisme chez les enfants et les adolescents : des recommandations en matière de pratiques et de politiques. Paediatr Child Health 2016. [DOI: 10.1093/pch/21.4.215] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Best C, Haseen F, van der Sluijs W, Ozakinci G, Currie D, Eadie D, Stead M, MacKintosh AM, Pearce J, Tisch C, MacGregor A, Amos A, Frank J, Haw S. Relationship between e-cigarette point of sale recall and e-cigarette use in secondary school children: a cross-sectional study. BMC Public Health 2016; 16:310. [PMID: 27075888 PMCID: PMC4831175 DOI: 10.1186/s12889-016-2968-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 03/16/2016] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND There has been a rapid increase in the retail availability of e-cigarettes in the UK and elsewhere. It is known that exposure to cigarette point-of-sale (POS) displays influences smoking behaviour and intentions in young people. However, there is as yet no evidence regarding the relationship between e-cigarette POS display exposure and e-cigarette use in young people. METHODS This cross sectional survey was conducted in four high schools in Scotland. A response rate of 87 % and a total sample of 3808 was achieved. Analysis was by logistic regression on e-cigarette outcomes with standard errors adjusted for clustering within schools. The logistic regression models were adjusted for recall of other e-cigarette adverts, smoking status, and demographic variables. Multiple chained imputation was employed to assess the consistency of the findings across different methods of handling missing data. RESULTS Adolescents who recalled seeing e-cigarettes in small shops were more likely to have tried an e-cigarette (OR 1.92 99 % CI 1.61 to 2.29). Adolescents who recalled seeing e-cigarettes for sale in small shops (OR 1.80 99 % CI 1.08 to 2.99) or supermarkets (OR 1.70 99 % CI 1.22 to 2.36) were more likely to intend to try them in the next 6 months. CONCLUSIONS This study has found a cross-sectional association between self-reported recall of e-cigarette POS displays and use of, and intention to use, e-cigarettes. The magnitude of this association is comparable to that between tobacco point of sale recall and intention to use traditional cigarettes in the same sample. Further longitudinal data is required to confirm a causal relationship between e-cigarette point of sale exposure and their use and future use by young people.
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Affiliation(s)
- Catherine Best
- />School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Farhana Haseen
- />Child and Adolescent Health Research Unit, School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
| | - Winfried van der Sluijs
- />Child and Adolescent Health Research Unit, School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
| | - Gozde Ozakinci
- />School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
| | - Dorothy Currie
- />Child and Adolescent Health Research Unit, School of Medicine, University of St Andrews, St Andrews, KY16 9TF UK
| | - Douglas Eadie
- />Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Martine Stead
- />Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Anne Marie MacKintosh
- />Institute for Social Marketing, School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
| | - Jamie Pearce
- />Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, EH8 9XP UK
| | - Catherine Tisch
- />Centre for Research on Environment Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, EH8 9XP UK
| | | | - Amanda Amos
- />The Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - John Frank
- />The Usher Institute of Population Health Sciences and Informatics, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, EH8 9AG UK
| | - Sally Haw
- />School of Health Sciences, University of Stirling, Stirling, FK9 4LA UK
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Chinese smokers' behavioral response toward cigarette price: individual and regional correlates. Tob Induc Dis 2016; 14:13. [PMID: 27051357 PMCID: PMC4820870 DOI: 10.1186/s12971-016-0078-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2015] [Accepted: 03/29/2016] [Indexed: 11/25/2022] Open
Abstract
Background Many studies have explored smokers’ behavioral response to cigarette prices at the individual level, but none have factored in regional variation and determinants. This study addresses these research gaps in the Chinese context. Methods A cross-sectional multistage sampling process was used to recruit participants in 21 cities in China. Individual-level information was collected using standardized questionnaires. City-level variables were retrieved from a nationall database. Multilevel logistic regression analysis was used to assess price sensitivity variation at both individual and city levels. Results Among 5660 current smokers, 5.9 % used non-self-paying cigarettes, 32.8 % purchased cigarettes in cartons, and 5.2 % decreased their smoking expenditure due to price. Multilevel analysis showed that individual demographic and smoking expenditure characteristics and regional smoking restrictions in work places, cigarette production, and media news coverage are associated with price sensitivity. Conclusions This study adds substantially to the understanding of Chinese smokers’ behavioral responses to cigarette prices. Increasing smoker sensitivity to cigarette prices will require stronger tobacco control and public education campaigns.
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Wagoner KG, Cornacchione J, Wiseman KD, Teal R, Moracco KE, Sutfin EL. E-cigarettes, Hookah Pens and Vapes: Adolescent and Young Adult Perceptions of Electronic Nicotine Delivery Systems. Nicotine Tob Res 2016; 18:2006-12. [PMID: 27029821 DOI: 10.1093/ntr/ntw095] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 03/22/2016] [Indexed: 11/14/2022]
Abstract
INTRODUCTION Most studies have assessed use of "e-cigarettes" or "electronic cigarettes," potentially excluding new electronic nicotine delivery systems (ENDS), such as e-hookahs and vape pens. Little is known about how adolescents and young adults perceive ENDS and if their perceptions vary by sub-type. We explored ENDS perceptions among these populations. METHODS Ten focus groups with 77 adolescents and young adults, ages 13-25, were conducted in spring 2014. Participants were users or susceptible nonusers of novel tobacco products. Focus group transcripts were coded for emergent themes. RESULTS Participants reported positive ENDS attributes, including flavor variety; user control of nicotine content; and smoke trick facilitation. Negative attributes included different feel compared to combustible cigarettes, nicotine addiction potential, and no cue to stop use. Participants perceived less harm from ENDS compared to combustible cigarettes, perhaps due to marketing and lack of product regulation, but noted the uncertainty of ingredients in ENDS. Numerous terms were used to describe ENDS, including "e-cigarette," "e-hookah," "hookah pens," "tanks," and "vapes." Although no clear classification system emerged, participants used product characteristics like nicotine content and chargeability to attempt classification. Perceptions differed by product used. E-hookah users were perceived as young and trendy while e-cigarette users were perceived as old and addicted to nicotine. CONCLUSIONS Young adults and adolescents report distinct ENDS sub-types with varying characteristics and social perceptions of users. Although they had more positive than negative perceptions of ENDS, prevention efforts should consider highlighting negative attributes as they may discourage use and product trial among young nonusers. IMPLICATIONS Our study underscores the need for a standardized measurement system for ENDS sub-types and additional research on how ENDS sub-types are perceived among adolescents and young adults. In addition, our findings highlight negative product attributes reported by participants that may be useful in prevention and regulatory efforts to offset favorable marketing messages.
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Affiliation(s)
- Kimberly G Wagoner
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC;
| | - Jennifer Cornacchione
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Kimberly D Wiseman
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
| | - Randall Teal
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kathryn E Moracco
- Department of Health Behavior, UNC Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Erin L Sutfin
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC
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Mo PKH, Lau JTF. Influenza vaccination uptake and associated factors among elderly population in Hong Kong: the application of the Health Belief Model. HEALTH EDUCATION RESEARCH 2015; 30:706-718. [PMID: 26336905 DOI: 10.1093/her/cyv038] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 08/06/2015] [Indexed: 06/05/2023]
Abstract
The impact of influenza on elderly can be severe and fatal. Influenza vaccination (IV) has been shown to be effective in reducing influenza-related complications, but the IV uptake among elderly in Hong Kong remains low. This study investigated the prevalence and factors associated with IV among Chinese elderly in Hong Kong using the Health Belief Model (HBM). A total of 1101 Chinese elderly aged over 65 was randomly selected and completed a phone interview. Background information, experience of and intention to receive IV and IV-related knowledge and perceptions based on the HBM were measured. Results showed that 48.5 and 49.5% of the participants have ever been vaccinated and intended to receive IV, respectively. Female gender, having chronic disease, and participating in community activities were significantly associated with previous IV. Knowledge of the fact that IV is required every year, lower perceived side effect, IV price lower than HK$150, and recommendations from health care providers was associated with both previous IV and intention to be vaccinated in the next year. Interventions promoting IV among elderly should disseminate knowledge regarding the necessity of IV and correct misconceptions about the side effects of IV.
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Affiliation(s)
- P K H Mo
- Centre for Health Behaviours Research, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China and
| | - J T F Lau
- Centre for Health Behaviours Research, The School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong, The Chinese University of Hong Kong Shenzhen Research Institute, Shenzhen, China and Centre for Medical Anthropology and Behavioral Health, Sun Yat-Sen University, Guangzhou, China
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