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Levy DT, Tam J, Kuo C, Fong GT, Chaloupka F. The Impact of Implementing Tobacco Control Policies: The 2017 Tobacco Control Policy Scorecard. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2019; 24:448-457. [PMID: 29346189 PMCID: PMC6050159 DOI: 10.1097/phh.0000000000000780] [Citation(s) in RCA: 97] [Impact Index Per Article: 19.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The Tobacco Control Scorecard, published in 2004, presented estimates of the effectiveness of different policies on smoking rates. Since its publication, new evidence has emerged. We update the Scorecard to include recent studies of demand-reducing tobacco policies for high-income countries. We include cigarette taxes, smoke-free air laws, media campaigns, comprehensive tobacco control programs, marketing bans, health warnings, and cessation treatment policies. To update the 2004 Scorecard, a narrative review was conducted on reviews and studies published after 2000, with additional focus on 3 policies in which previous evidence was limited: tobacco control programs, graphic health warnings, and marketing bans. We consider evaluation studies that measured the effects of policies on smoking behaviors. Based on these findings, we derive estimates of short-term and long-term policy effect sizes. Cigarette taxes, smoke-free air laws, marketing restrictions, and comprehensive tobacco control programs are each found to play important roles in reducing smoking prevalence. Cessation treatment policies and graphic health warnings also reduce smoking and, when combined with policies that increase quit attempts, can improve quit success. The effect sizes are broadly consistent with those previously reported for the 2004 Scorecard but now reflect the larger evidence base evaluating the impact of health warnings and advertising restrictions.
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Affiliation(s)
- David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Jamie Tam
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Charlene Kuo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Geoffrey T. Fong
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
| | - Frank Chaloupka
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia (Dr Levy and Ms Kou); Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan (Ms Tam); Department of Psychology and School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada (Dr Fong); Ontario Institute for Cancer Research, Toronto, Ontario, Canada (Dr Fong); and Health Policy Center, Institute for Health Research and Policy, The University of Illinois at Chicago, Chicago, Illinois (Dr Chaloupka)
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Mojtabai R, Riehm KE, Cohen JE, Alexander GC, Rutkow L. Clean indoor air laws, cigarette excise taxes, and smoking: Results from the current population survey-tobacco use supplement, 2003-2011. Prev Med 2019; 126:105744. [PMID: 31173803 PMCID: PMC6697615 DOI: 10.1016/j.ypmed.2019.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 11/30/2022]
Abstract
There was an increase in the number and coverage of state and local clean indoor air laws in the US during the past fifteen years. These laws coincided with increases in federal, state, and local cigarette excise taxes. In light of these changes, the objective of this study was to examine the association between clean indoor air laws, cigarette excise taxes and smoking patterns between 2003 and 2011. Using data on 62,165 adult participants in the 2003 and 2010/2011 Current Population Survey-Tobacco Use Supplement who reported smoking cigarettes in the past year, we examined the association of state and county workplace, bar, and restaurant clean indoor air laws and cigarette excise taxes with quitting and current every-day smoking. Between 2003 and 2011, quitting increased and daily smoking among those who continued to smoke decreased significantly. Participants living in states and counties with higher excise taxes and more comprehensive clean indoor air laws had a higher likelihood of quitting and lower likelihood of everyday smoking. Based on the assumption of no uncontrolled confounding, changes in taxes and laws accounted for 64.8% of the increase in smoking cessation and all of the reduction in everyday smoking. Implementation of state and county-level clean indoor air laws and cigarette taxes appears to have achieved the intended goal of encouraging smokers to either quit or reduce their frequency of smoking.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Kira E Riehm
- Department of Mental Health, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Institute for Global Tobacco Control, 2213 McElderry Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States
| | - G Caleb Alexander
- Center for Drug Safety and Effectiveness, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Department of Epidemiology, 615 North Wolfe Street, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States; Division of General Internal Medicine, 1800 Orleans Street, Johns Hopkins Medicine, Baltimore, MD, United States
| | - Lainie Rutkow
- Department of Health Policy and Management, Hampton House, 624 North Broadway, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, United States.
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Lång E, Nystedt P. Blowing up money? The earnings penalty of smoking in the 1970s and the 21st century. JOURNAL OF HEALTH ECONOMICS 2018; 60:39-52. [PMID: 29909201 DOI: 10.1016/j.jhealeco.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 05/25/2018] [Accepted: 05/25/2018] [Indexed: 06/08/2023]
Abstract
We analyze the earnings penalty of smoking among Swedish twins in two social contexts: the 1970s, when smoking was common and widely accepted and when there were relatively few tobacco laws aiming to reduce smoking; and the 2000s, when smoking had become more expensive, stigmatizing and less common, and when tobacco laws and regulations had intensified. The results show that the short-term earnings penalty of smoking was much higher in the 21st century than in the 1970s for men. For women, smokers had on average higher annual earnings compared to nonsmokers in the 1970s, but lower annual earnings in the 2000s. In the long run, there was an earnings gap for men between never-smokers and continuous smokers, whereas there was a pronounced earnings 'bonus' of smoking cessation for women. The results emphasize the importance of social context and the long-term horizon when evaluating the consequences of smoking for earnings.
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Affiliation(s)
- Elisabeth Lång
- FOI, Swedish Defence Research Agency, 16490 Stockholm, Sweden.
| | - Paul Nystedt
- Jönköping International Business School, Box 1026, 55111 Jönköping, Sweden; Jönköping Academy for Improvement of Health and Welfare, Jönköping, Sweden.
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Tam J, Levy DT, Jeon J, Clarke J, Gilkeson S, Hall T, Feuer EJ, Holford TR, Meza R. Projecting the effects of tobacco control policies in the USA through microsimulation: a study protocol. BMJ Open 2018; 8:e019169. [PMID: 29574440 PMCID: PMC5875683 DOI: 10.1136/bmjopen-2017-019169] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION Smoking remains the leading cause of preventable death in the USA but can be reduced through policy interventions. Computational models of smoking can provide estimates of the projected impact of tobacco control policies and can be used to inform public health decision making. We outline a protocol for simulating the effects of tobacco policies on population health outcomes. METHODS AND ANALYSIS We extend the Smoking History Generator (SHG), a microsimulation model based on data from the National Health Interview Surveys, to evaluate the effects of tobacco control policies on projections of smoking prevalence and mortality in the USA. The SHG simulates individual life trajectories including smoking initiation, cessation and mortality. We illustrate the application of the SHG policy module for four types of tobacco control policies at the national and state levels: smoke-free air laws, cigarette taxes, increasing tobacco control programme expenditures and raising the minimum age of legal access to tobacco. Smoking initiation and cessation rates are modified by age, birth cohort, gender and years since policy implementation. Initiation and cessation rate modifiers are adjusted for differences across age groups and the level of existing policy coverage. Smoking prevalence, the number of population deaths avoided, and life-years gained are calculated for each policy scenario at the national and state levels. The model only considers direct individual benefits through reduced smoking and does not consider benefits through reduced exposure to secondhand smoke. ETHICS AND DISSEMINATION A web-based interface is being developed to integrate the results of the simulations into a format that allows the user to explore the projected effects of tobacco control policies in the USA. Usability testing is being conducted in which experts provide feedback on the interface. Development of this tool is under way, and a publicly accessible website is available at http://www.tobaccopolicyeffects.org.
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Affiliation(s)
- Jamie Tam
- Department of Health Management and Policy, University of Michigan, Ann Arbor, Michigan, USA
| | - David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Jihyoun Jeon
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
| | - John Clarke
- Cornerstone Systems Northwest Inc., Lynden, Washington, USA
| | | | - Tim Hall
- Cornerstone Systems Northwest Inc., Lynden, Washington, USA
| | - Eric J Feuer
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan, Ann Arbor, Michigan, USA
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Becker CM, Lee JGL, Hudson S, Hoover J, Civils D. A 14-year longitudinal study of the impact of clean indoor air legislation on state smoking prevalence, USA, 1997-2010. Prev Med 2017; 99:63-66. [PMID: 28188797 DOI: 10.1016/j.ypmed.2017.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/21/2017] [Accepted: 01/28/2017] [Indexed: 11/17/2022]
Abstract
While clean indoor air legislation at the state level is an evidence-based recommendation, only limited evidence exists regarding the impact of clean indoor air policies on state smoking prevalence. Using state smoking prevalence data from 1997 to 2010, a repeated measures observational analysis assessed the association between clean indoor air policies (i.e., workplace, restaurant, and bar) and state smoking prevalence while controlling for state cigarette taxes and year. The impacts from the number of previous years with any clean indoor air policy, the number of policies in effect during the current year, and the number of policies in effect the previous year were analyzed. Findings indicate a smoking prevalence predicted decrease of 0.13 percentage points (p=0.03) for each additional year one or more clean indoor air policies were in effect, a predicted decrease of 0.12 percentage points (p=0.09) for each policy in effect in the current year, and a predicted decrease of 0.22 percentage points (p=0.01) for each policy in effect in the previous year on the subsequent year. Clean indoor air policies show measurable associations with reductions in smoking prevalence within a year of implementation above and beyond taxes and time trends. Further efforts are needed to diffuse clean indoor air policies across states and provinces that have not yet adopted such policies.
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Affiliation(s)
- Craig M Becker
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA.
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Suzanne Hudson
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA
| | - Jeanne Hoover
- Joyner Library, East Carolina University, Greenville, NC, USA
| | - Donald Civils
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
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Du J, Leigh JP. Effects of wages on smoking decisions of current and past smokers. Ann Epidemiol 2015; 25:575-582.e1. [PMID: 26066536 DOI: 10.1016/j.annepidem.2015.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2014] [Revised: 03/05/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE We used longitudinal data and instrumental variables (IVs) in a prospective design to test for the causal effects of wages on smoking prevalence among current and past smokers. METHODS Nationally representative U.S. data were drawn from the 1999-2009 waves of the Panel Study of Income Dynamics. Our overall sample was restricted to full time employed persons, aged 21-65 years. We excluded part time workers and youths because smoking and wage correlations would be complicated by labor supply decisions. We excluded adult never smokers because people rarely begin smoking after the age of 20 years. IVs were created with state-level minimum wages and unionization rates. We analyzed subsamples of men, women, the less educated, the more educated, quitters, and backsliders. Validity and strength of instruments within the IV analysis were conducted with the Sargan-Hansen J statistic and F tests. RESULTS We found some evidence that low wages lead to more smoking in the overall sample and substantial evidence for men, persons with high school educations or less (<13 years of schooling), and quitters. Results indicated that 10% increases in wages lead to 5.5 and 4.6 percentage point decreases in smoking for men and the less educated; they also increased the average chance of quitting among base-year smokers from 17.0% to 20.4%. Statistical tests suggested that IVs were strong and valid in most samples. Subjects' other family income, including spouses' wages, was entered as a control variable. CONCLUSIONS Increases in an individual's wages, independent of other income, decreased the prevalence of smoking among current and past smokers.
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Affiliation(s)
- Juan Du
- Department of Economics, Strome College of Business, Old Dominion University, Norfolk, VA
| | - J Paul Leigh
- Division of Epidemiology, Department of Public Health Sciences, Center for Healthcare Policy and Research, University of California Davis, Davis.
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Marti J. The impact of tobacco control expenditures on smoking initiation and cessation. HEALTH ECONOMICS 2014; 23:1397-1410. [PMID: 24038447 DOI: 10.1002/hec.2993] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2011] [Revised: 07/31/2013] [Accepted: 08/05/2013] [Indexed: 06/02/2023]
Abstract
Between 1997 and 2007, smoking prevalence declined from 33% to 28% in Switzerland. Over the same period, funding for tobacco control activities significantly increased, resulting in the implementation of a large variety of national and regional interventions. In this paper, I exploit variation over time and across cantons of tobacco control expenditures to examine the impact of these policies on smoking decisions. I use retrospective smoking information from the Swiss Health Survey (2007) and find that tobacco control expenditures decreased the probability of smoking initiation among adolescents and young adults and increased cessation rates in the general population of smokers. I estimate that if funding had been kept at the 1997 level, there would have been 107,000 additional smokers in 2007.
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Chang FC, Sung HY, Zhu SH, Chiou ST. Impact of the 2009 Taiwan tobacco hazards prevention act on smoking cessation. Addiction 2014; 109:140-6. [PMID: 24033589 DOI: 10.1111/add.12344] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Revised: 05/01/2013] [Accepted: 08/19/2013] [Indexed: 12/01/2022]
Abstract
AIMS In January 2009, the government of Taiwan amended the 1997 Tobacco Hazards Prevention Act by extending smoke-free areas to include almost all enclosed work-places and public places, adding graphic health warnings to cigarette packages, totally banning tobacco advertisements, promotion and sponsorship and increasing tobacco taxes. This study examined the impact of the 2009 amended Act on smoking cessation in Taiwan. DESIGN Taiwan Adult Tobacco Surveys 2007 and 2010, each with a nationally representative sample of adults aged 18 years and older (n = 16 588, and n = 16 295, respectively). PARTICIPANTS All recent active smokers (current smokers plus former smokers who quit smoking within the past 12 months) were used for the analyses (n = 3783 in 2007, and n = 2777 in 2010). MEASUREMENTS Quit attempt rate and annual cessation rate (defined as having succeeded in quitting for at least 3 months) among recent active smokers were compared between the pre-Act (2007) and post-Act (2010) periods. FINDINGS The quit attempt rate increased significantly from 39.4% in 2007 to 42.9% in 2010. The annual cessation rate increased significantly from 7.1 to 8.9%. A multivariate analysis, controlling for demographic characteristics, showed that the implementation of the 2009 Act was associated with an increase in the quit attempt rate [odds ratio (OR) = 1.14; 95% confidence interval (CI) = 1.03-1.25] and the annual cessation rate (OR = 1.28; 95% CI = 1.08-1.53). CONCLUSIONS The comprehensive tobacco control programme introduced in 2009 in Taiwan, which combined smoke-free legislation with a tobacco tax increase, graphic health warning labels and a total ban on tobacco advertisements, was associated with increases in quit attempt rate and annual cessation rate.
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