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Cox S. The ends do not justify the means when it comes to Australia's vaping policy. Addiction 2024; 119:1691-1692. [PMID: 38946521 DOI: 10.1111/add.16591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 06/07/2024] [Indexed: 07/02/2024]
Affiliation(s)
- Sharon Cox
- Faculty of Population Health Sciences, University College London, London, UK
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Park AH, Park J, Choi J, Noh S, Choo J. Cigarette Sales to Underage Youth in Seoul, South Korea: Findings From a Mystery Shopping Study. Asia Pac J Public Health 2024; 36:636-645. [PMID: 39158019 DOI: 10.1177/10105395241273235] [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] [Indexed: 08/20/2024]
Abstract
This study aimed to identify the rates of cigarette sales to underage youth and the factors associated with these sales using a mystery shopping technique. Of the convenience stores selling cigarettes in Seoul, South Korea, 2600 were sampled in 2019 and 2020. Personal and environmental factors were independent variables. Cigarette sales to underage youth were the outcome variable, defined as cases where a seller sold cigarettes to a youth shopper. A multiple logistic regression analysis was performed. Rates of cigarette sales to underage youth were 17.9% in 2019 and 16.3% in 2020, significantly higher when the seller was younger and the store was located in a central area. Administrative actions are needed to enforce strong warnings and training guidelines for convenience store sellers. Differentiation in surveillance intensity based on the location of convenience stores in Seoul is also recommended.
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Affiliation(s)
- Ah-Hyun Park
- Expert Group on Health Promotion for the Seoul Metropolitan Government, Seoul, South Korea
| | - Jinbeom Park
- Expert Group on Health Promotion for the Seoul Metropolitan Government, Seoul, South Korea
| | - Jihae Choi
- Smart Health Division, Seoul Metropolitan Government, Seoul, South Korea
| | - Songwhi Noh
- College of Nursing, Korea University, Seoul, South Korea
- Transdiciplinary Major in Learning Health Systems, Department of Healthcare Science, Graduate School, Korea University, Seoul, South Korea
| | - Jina Choo
- College of Nursing, Korea University, Seoul, South Korea
- Transdiciplinary Major in Learning Health Systems, Department of Healthcare Science, Graduate School, Korea University, Seoul, South Korea
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3
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Hoek J, Lee E, Teddy L, Fenton E, Ball J, Edwards R. How do New Zealand youth perceive the smoke-free generation policy? A qualitative analysis. Tob Control 2024; 33:346-352. [PMID: 36283832 DOI: 10.1136/tc-2022-057658] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/19/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Aotearoa New Zealand (NZ) plans to introduce a smoke-free generation (SFG) policy, alongside denicotinisation and reducing the availability of tobacco products. The SFG has a clear rationale, yet we know little about how young people, those the policy targets, perceive it. To inform policy design, communication and implementation, we explored how NZ youth perceived the SFG. METHODS We undertook in-depth interviews with a sample of 20 youth aged 17 or 18 and explored their knowledge of the SFG, and how they perceived its individual and societal implications. We interpreted the data using a reflexive thematic analysis approach. RESULTS We identified two overarching themes. The first theme, 'societal good and protection from harm', reflected benefits participants associated with the SFG, which outweighed perceptions of lost freedoms. The second theme, 'privileging personal choice', corresponded to two small groups within the sample. The first preferred measures they considered less restrictive, such as increasing the purchase age, and some came to support the SFG as they rationalised their views. The second subgroup expressed more entrenched opposition and felt the SFG deprived them of a choice. CONCLUSIONS Young people's deep reflection on the SFG led most to view it as liberating rather than restrictive. Communications that avoid prompting heuristic-based responses could encourage youth to reflect on the policy and elicit strong support from the group the SFG aims to benefit.
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Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ell Lee
- University of Otago Medical School, Dunedin, New Zealand
| | - Lani Teddy
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Elizabeth Fenton
- Bioethics Centre, University of Otago Bioethics Centre, Dunedin, New Zealand
| | - Jude Ball
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
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Ruokolainen O, Ollila H, Laatikainen T, Pätsi SM, Carreras G, Gorini G, Carnicer-Pont D, Cselkó Z, Guignard R, Karekla M, Kilibarda B, Koprivnikar H, Lambrou A, Nguyen-Thanh V, Papachristou E, Schoretsaniti S, Vasic M. Tobacco endgame measures and their adaptation in selected European countries: A narrative review synthesis. Tob Prev Cessat 2024; 10:TPC-10-18. [PMID: 38638446 PMCID: PMC11025294 DOI: 10.18332/tpc/186402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Revised: 03/22/2024] [Accepted: 03/22/2024] [Indexed: 04/20/2024]
Abstract
Due to the continued detrimental effects of tobacco use, a growing number of countries are embracing the idea of tobacco endgame, meaning ending the tobacco epidemic instead of controlling it. This narrative review aims to synthesize and update the evidence from earlier scientific reviews on effective tobacco endgame measures, as well as to assess their integration to current national strategies among European countries with official tobacco endgame goals. The synthesis of the prior scientific literature found most evidence on product-focused and some evidence for supply-focused policies. Little evidence was detected for user- and institutional-focused measures. An update for the tobacco-free generation measure showed uncertainty in reducing smoking prevalence, especially for adolescents' reactions to age-restrictive laws. All the countries that established a tobacco endgame strategy have included product standards in their measures, predominantly based on European Union regulations on conventional tobacco products, yet standards above this level and considering other products were also common. Cessation measures were given strong emphasis in strategies, yet none of the countries linked these to specific endgame measures. Despite commonly mentioning vulnerable groups, such as youth and pregnant women, adoption of measures to reduce tobacco use among these groups was scarce. Lastly, the decline in tobacco use seems to be modest, implying challenges in meeting the endgame goals. To meet these goals, European countries should reinforce the implementation of known effective tobacco control measures such as tax increases. Furthermore, new innovative strategies and measures to meet the objective of an endgame should be explored.
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Affiliation(s)
- Otto Ruokolainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Hanna Ollila
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Tiina Laatikainen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
- Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland
| | - Salla-Maaria Pätsi
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Giulia Carreras
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Giuseppe Gorini
- Institute for Cancer Research, Prevention and Clinical Network, Florence, Italy
| | - Dolors Carnicer-Pont
- Grupo de Investigación en Control del Tabaco, Institut d'Investigació Biomèdica de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias, Madrid, Spain
- Programa de Prevenció i Control del Càncer, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Zsuzsa Cselkó
- National Korányi Institute of Pulmonology, Budapest, Hungary
| | - Romain Guignard
- Prevention and Health Promotion Department, Santé publique France, Saint-Maurice, France
| | | | - Biljana Kilibarda
- Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Belgrade, Serbia
| | | | - Angeliki Lambrou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Viêt Nguyen-Thanh
- Prevention and Health Promotion Department, Santé publique France, Saint-Maurice, France
| | - Efstathios Papachristou
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Sotiria Schoretsaniti
- Directorate of Epidemiology and Prevention of Non-Communicable Diseases and Injuries, National Public Health Organization, Athens, Greece
| | - Milena Vasic
- Institute of Public Health of Serbia ‘Dr Milan Jovanovic Batut’, Belgrade, Serbia
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West TA, Awadalla J, Ackerman C, Sesay M, Hrywna M, Giovenco DP, Kong AY, Lee JGL. "If You Just Tell Me You're 18, I'll Still Sell to You": A Qualitative Study of Underage Tobacco Product Purchasing Experiences in a Tobacco 21 Compliance Study. Nicotine Tob Res 2024; 26:461-466. [PMID: 37831929 PMCID: PMC10959155 DOI: 10.1093/ntr/ntad204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 09/15/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Tens of thousands of underage tobacco buy attempts are conducted each year for research, compliance, and public health surveillance. However, little research has qualitatively examined the perceptions and experiences of underage buyers participating in these programs. We sought to understand underage buyers' experiences and gather recommendations for protocol improvements. METHODS We conducted semi-structured interviews in the fall of 2022 to assess experiences with underage tobacco product purchasing. Participants (N = 19, 58% male, 42% White) were research assistants aged 18-20 in New Jersey, New York, or North Carolina. Interviews examined purchasing experiences in relation to store characteristics, clerk interactions, and buyer identities. We used deductive and inductive thematic coding to explore key themes related to buyer experiences. RESULTS We identified four themes: (1) non-chain stores lacked consistency in verifying age; (2) female data collectors experienced uncomfortable situations more frequently than male data collectors; (3) not identifying with the store's typical demographics impacted purchase attempts; and (4) participants suggested improvements for inspections and research during training. DISCUSSION Retailer education, widespread adoption of ID scanners, and enforcement could increase standardization of ID requests and verification. Male and female buyers can be trained on what they might expect based on their gender, as well as how to maneuver through unwanted situations. Consideration of shared identity is important for future waves of data collection and research. Efforts to improve training include more extensive mock purchase training with supervisors well-versed in this area. IMPLICATIONS Electronic ID verification and promoting compliance at non-chain retailers could impact access to tobacco products for underage buyers. Training for underage buyers in research and compliance assessments should focus on ways to enhance data collectors' confidence when making a purchase attempt, which may improve the validity of the rate of sales to individuals under 21.
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Affiliation(s)
- Tyler A West
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Josephine Awadalla
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Christopher Ackerman
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Mahdi Sesay
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Mary Hrywna
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers University, New Brunswick, NJ, USA
| | - Daniel P Giovenco
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Amanda Y Kong
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
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Phetphum C, Chomson S, Wangwonsin A, Prajongjeep A, Keeratisiroj O. Perception of and legal compliance with the law prohibiting cigarette sales to minors in Thailand following the raising of the minimum selling age to 20 years: a cross-sectional survey. BMJ Open 2023; 13:e072411. [PMID: 37923349 PMCID: PMC10626856 DOI: 10.1136/bmjopen-2023-072411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVES The minimum age for cigarette sales in Thailand was increased from 18 to 20 years, as stipulated in the Tobacco Products Control Act B.E. 2017. This study investigated tobacco retailers' perceptions, cigarette sales behaviour and other factors relevant to selling cigarettes to people younger than 20 years in areas surrounding schools in Thailand. DESIGN Cross-sectional survey. SETTING Tobacco shops within a radius of 500 m of secondary schools across four regions of Thailand. Data collection took place between May and August 2019. PARTICIPANTS 1440 tobacco retailers (grocery or convenience stores) were sampled via a stratified, two-stage cluster sampling method. 1021 retailers completed the self-administered questionnaire. OUTCOME MEASURES Tobacco sales to people younger than 20 years. RESULTS The prevalence of the retailers' cigarette sales to youth younger than 20 years was 38.20% (95% CI 35.2% to 41.3%). Multivariable logistic regression analysis revealed associations with sale of single cigarettes (adjusted OR (AOR) 23.14, 95% CI 15.13 to 35.39), self-service sale of cigarettes (4.21, 2.59 to 6.86) and display of cigarettes at the point of sale (2.39, 1.47 to 3.89). Cigarette sales to underage youth were higher among retailers located in the northeast region (AOR 2.09, 95% CI 1.20 to 3.64) and among those who did not perceive the prosecution of violators in the past year (1.85, 1.16 to 2.96). CONCLUSION A large percentage of cigarette retailers violated the laws related to underage cigarette sales. Measures to minimise retailers' legally non-compliant sales behaviours should be implemented along with improved legal enforcement.
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Affiliation(s)
- Chakkraphan Phetphum
- Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
- Tobacco Control Research Unit, Naresuan University, Phitsanulok, Thailand
| | - Supatana Chomson
- Faculty of Public Health, Naresuan University, Phitsanulok, Thailand
| | | | - Atchara Prajongjeep
- Department of Community Public Health, Sirindhorn College of Public Health, Phitsanulok, Thailand
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Cox DW, Rodriguez L, Grigg J. Statement on Tobacco 21 from the European Respiratory Society Tobacco Control Committee. Eur Respir J 2023; 61:61/3/2300134. [PMID: 36958744 DOI: 10.1183/13993003.00134-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 02/22/2023] [Indexed: 03/25/2023]
Affiliation(s)
- Des W Cox
- Respiratory Department, Children's Health Ireland, Dublin, Ireland
- University College Dublin, Dublin, Ireland
| | | | - Jonathan Grigg
- Centre for Child Health, Blizard Institute, Queen Mary University of London, London, UK
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8
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Scheffels J, Tokle R, Linnansaari A, Rasmussen SKB, Pisinger C. E-cigarette use in global digital youth culture. A qualitative study of the social practices and meaning of vaping among 15-20-year-olds in Denmark, Finland, and Norway. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 111:103928. [PMID: 36527908 DOI: 10.1016/j.drugpo.2022.103928] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 11/28/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The introduction of e-cigarettes on the tobacco market has brought new regulatory challenges, and particular concerns relate to e-cigarette uptake among young people. The aim of this study was to explore the use and social meaning of e-cigarettes among Nordic young people and to discuss this in the context of current legislation. METHODS Thirteen focus groups were conducted with 46 Danish, Finnish, and Norwegian young people (24 boys) with vaping experience aged 15-20 years (mean age 17 years). RESULTS Young people's vaping stood out as an inherently social practice that was commonly interlinked with experimental use patterns. Relative to smoking, vaping was seen as socially acceptable and less harmful to health. Product innovations like flavour additives and nicotine-free liquid options added to perceptions of low harm, and innovative device design features facilitated new and playful user practices. Finally, digital markets eased the young people's access to e-cigarettes, and the digital world also represented an arena for e-cigarette exposure and self-presentation. They commonly viewed vaping-related content in their social media feeds and also produced such content themselves. CONCLUSION Young people's vaping is a social practice interwoven in contemporary digital and global youth culture. Transnational regulations are needed to support individual countries in preventing e-cigarette use and exposure among young people.
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Affiliation(s)
- Janne Scheffels
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Oslo, Norway.
| | - Rikke Tokle
- Norwegian Institute of Public Health, Department of Alcohol, Tobacco and Drugs, Oslo, Norway; Norwegian Social Research, Oslo Metropolitan University, Oslo, Norway
| | - Anu Linnansaari
- Faculty of Social Sciences, Unit of Health Sciences, Tampere University, Finland
| | - Sofie K B Rasmussen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Charlotta Pisinger
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Danish Heart Foundation, Copenhagen, Denmark
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9
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Szklo AS, Bertoni N. Law compliance, why do we need it? Comparative data from the Brazilian National Survey of School Health (PeNSE) on adolescents’ access to cigarettes. CAD SAUDE PUBLICA 2023. [DOI: 10.1590/0102-311xen145722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
In recent decades, Brazil has made significant progress in fighting the tobacco epidemic. However, recent national data suggest a probable stagnation in the reduction of smoking initiation among youth and adolescents. The objective of this study was to evaluate the evolution over time of compliance with the law that prohibits the sale of cigarettes to minors in Brazil. To this end, data from the Brazilian National Survey of School Health conducted in 2015 and 2019 were used. Percentages were estimated for “sequential” indicators created by combining answers to the questions “Did anyone refuse to sell you cigarettes?” and “How did you obtain your cigarettes?” There was a decrease between 2015 and 2019 in the percentage of smokers aged 13 to 17 who tried to buy cigarettes in the 30 days prior to the survey (72.3% vs. 66.4%; p-value ≤ 0.05). However, regardless of the survey year, approximately 9 out of 10 adolescent smokers were successful in an attempt to buy cigarettes. Of those, approximately 7 out of 10 used direct purchase as the main method of obtaining cigarettes, with purchases at licensed commercial establishments (vs. street vendors) increasing between 2015 and 2019 (81.1% vs. 89.6%; p-value ≤ 0.05). In 2019, 70% of teenagers who bought cigarettes at licensed commercial establishments purchased single cigarettes. Non-compliance with laws aimed at preventing smoking initiation is a huge obstacle to reducing the proportion of smokers. Increased implementation of legislative measures and oversight of cigarettes sales, combined with educational and awareness actions with retailers, is key to protecting new generations from the harmful effects of tobacco use.
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Affiliation(s)
| | - Neilane Bertoni
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Brazil
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10
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Szklo AS, Bertoni N. Law compliance, why do we need it? Comparative data from the Brazilian National Survey of School Health (PeNSE) on adolescents' access to cigarettes. CAD SAUDE PUBLICA 2023; 39:e00145722. [PMID: 36888815 DOI: 10.1590/0102-311xpt145722] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 01/12/2023] [Indexed: 02/22/2023] Open
Abstract
In recent decades, Brazil has made significant progress in fighting the tobacco epidemic. However, recent national data suggest a probable stagnation in the reduction of smoking initiation among youth and adolescents. The objective of this study was to evaluate the evolution over time of compliance with the law that prohibits the sale of cigarettes to minors in Brazil. To this end, data from the Brazilian National Survey of School Health conducted in 2015 and 2019 were used. Percentages were estimated for "sequential" indicators created by combining answers to the questions "Did anyone refuse to sell you cigarettes?" and "How did you obtain your cigarettes?" There was a decrease between 2015 and 2019 in the percentage of smokers aged 13 to 17 who tried to buy cigarettes in the 30 days prior to the survey (72.3% vs. 66.4%; p-value ≤ 0.05). However, regardless of the survey year, approximately 9 out of 10 adolescent smokers were successful in an attempt to buy cigarettes. Of those, approximately 7 out of 10 used direct purchase as the main method of obtaining cigarettes, with purchases at licensed commercial establishments (vs. street vendors) increasing between 2015 and 2019 (81.1% vs. 89.6%; p-value ≤ 0.05). In 2019, 70% of teenagers who bought cigarettes at licensed commercial establishments purchased single cigarettes. Non-compliance with laws aimed at preventing smoking initiation is a huge obstacle to reducing the proportion of smokers. Increased implementation of legislative measures and oversight of cigarettes sales, combined with educational and awareness actions with retailers, is key to protecting new generations from the harmful effects of tobacco use.
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Affiliation(s)
- André Salem Szklo
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
| | - Neilane Bertoni
- Instituto Nacional de Câncer José Alencar Gomes da Silva, Rio de Janeiro, Brasil
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11
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Ahmad F, Khan Z, Siddiqi K, Khan MN, Kibria Z, Forberger S, Bauld L, Kanaan M, Zeeb H. Awareness, perceptions of and compliance with tobacco control policies among naswar vendors in Khyber Pakhtunkhwa Pakistan. Tob Control 2022; 31:e111-e117. [PMID: 34226260 DOI: 10.1136/tobaccocontrol-2020-056377] [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: 11/19/2020] [Accepted: 05/03/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Regulatory compliance in the retail environment is integral to the success of tobacco control. We assessed compliance among naswar (smokeless tobacco product widely used in South Asia) vendors with tobacco control laws. We also assessed their awareness of tobacco-related harms and policies and perceived effect of policies on their sales. METHODS We surveyed 286 naswar vendors in three districts of the Khyber Pakhtunkhwa province of Pakistan. We recruited general and specialty vendors from urban and rural areas through multistage cluster sampling. Compliance was measured for promotion, sale to/by minors and tax paid on naswar. We used logistic regression analyses for assessing the association between the outcome variables (awareness of tobacco harms and laws, perceptions about the effect of policies on business and compliance with laws) and their predictors. RESULTS Most vendors (70%) were aware of tobacco-related harms of naswar. Although educated vendors were more aware of tobacco control policies, the greatest awareness was for a ban on sales to/by minors (21% overall). The majority of vendors (76%) violated this policy (measured by self-report), and violations were more common among rural than urban vendors (OR 2.27, 95% CI 1.05 to 4.96). Most vendors (71%) violated a ban on promotion of naswar. Vendors perceived tax increases and sales ban to/by minors as most detrimental for business. CONCLUSIONS There was poor awareness and compliance among naswar vendors in Pakistan with tobacco control laws. This study finds potential areas for policy interventions that can reduce urban/rural disparities in implementation of and compliance with tobacco control laws.
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Affiliation(s)
- Fayaz Ahmad
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Zohaib Khan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Kamran Siddiqi
- Institute of Health Sciences, University of York, UK, York, UK
| | - Muhammad Naseem Khan
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
| | - Zeeshan Kibria
- Institute of Public Health and Social Sciences, Khyber Medical University, Peshawar, Pakistan
- Office of Research, Innovation and Commercialization, Khyber Medical University, Peshawar, Pakistan
| | - Sarah Forberger
- Leibniz Institute for Prevention Research and Epidemiology, Bremen, Germany
| | - Linda Bauld
- Usher Institute and UK Centre for Tobacco and Alcohol Studies, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Mona Kanaan
- Health Sciences, University of York, York, UK
| | - Hajo Zeeb
- Prevention and Evaluation, Leibniz-Institute for Prevention Research and Epidemiology, Bremen, Germany
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12
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Berrick J. Drawing on Adolescent Psychology to Achieve Tobacco-Free Generations. Public Health Rev 2022; 43:1604321. [PMID: 36211226 PMCID: PMC9533236 DOI: 10.3389/phrs.2022.1604321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background: In 2021, the European Union called for creation of a “tobacco-free generation.” We consider the means to this end. The persistence of youthful noncompliance with current minimum age laws (leading to widespread subsequent addiction, morbidity and mortality) raises questions whether such laws are truly aligned with adolescent psychology.Evidence: The ubiquity of minimum-age laws limits direct evidence of their effectiveness, so we seek indirect evidence. Qualitative findings originally intended for tobacco manufacturers indicate counterproductive aspects of minimum-age laws. Further evidence about adolescent reactions is provided by a recent review and meta-analysis of greater youth defiance of under-age laws than whole-of-life laws in the domain of motorcycle helmets.Policy Options and Recommendations: As an alternative to minimum-age laws, we consider the Tobacco-Free Generation proposal (TFG), which phases out sales on an age cohort basis and has recently gained prominence.Conclusion: The Tobacco-Free Generation proposal (TFG) seems well aligned with adolescent psychology, and is therefore especially worthy of attention. It has recently been introduced or endorsed by a number of jurisdictions, both local and national.
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13
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van der Eijk Y, Chen JIP. Case for raising the minimum legal age of tobacco sale to 25. Tob Control 2022; 31:487-492. [PMID: 33414266 DOI: 10.1136/tobaccocontrol-2020-055964] [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: 05/28/2020] [Revised: 10/15/2020] [Accepted: 11/17/2020] [Indexed: 11/03/2022]
Abstract
Restricting youth access to tobacco is an essential component of a comprehensive tobacco control policy. While there has been a growing movement to raise the minimum legal age (MLA) of purchasing tobacco from 18 to 21, more restrictive measures, such as raising the MLA to 25 (MLA25), have been criticised as being overly restrictive on adult's free choice. We argue that, even within a policy approach that prioritises freedom of choice, there is a strong case for MLA25 in view of neurobiological evidence which shows that, before age 25, people are neurobiologically vulnerable to developing an addiction. We discuss further considerations for an MLA25 policy, in particular its potential impact on the free choice of young adults to start or quit smoking, potential public health impact and potential effectiveness considering that most underage youth source cigarettes from older peers.
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Affiliation(s)
- Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jacinta I-Pei Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
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14
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Monshi SS, Wu J, Collins BN, Ibrahim JK. Youth susceptibility to tobacco use in the Gulf Cooperation Council Countries, 2001–2018. Prev Med Rep 2022; 26:101711. [PMID: 35145839 PMCID: PMC8819131 DOI: 10.1016/j.pmedr.2022.101711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 01/05/2022] [Accepted: 01/23/2022] [Indexed: 11/30/2022] Open
Abstract
Analysis of the susceptibility to initiating tobacco use identifies youth at higher risk of initiating tobacco. Susceptibility to initiate tobacco use in increased in the United Arab Emirates while decreased in Bahrain and Qatar. FCTC may have an independent impact on initiating tobacco use among youth. The study helps policymakers identify impactful policies and prioritize resources accordingly.
The Gulf Cooperation Council (GCC) countries – Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates (UAE) – ratified the Framework Convention on Tobacco Control (FCTC) in 2006. Yet, GCC countries predict a slight reduction in tobacco use compared to the Eastern Mediterranean region’s significant downward trend. The purpose of this study was to examine changes in self-reported intention to initiating tobacco use (susceptibility) among youth over time in five GCC countries and the relationship between susceptibility and key FCTC provisions. Complex sample logistic regression analyses were conducted using data from the 2001 to 2018 Global Youth Tobacco Survey (n = 349,878 adolescents). Since the ratification of FCTC in GCC countries, susceptibility to initiate tobacco use significantly decreased in Bahrain and Qatar while it increased in UAE (P < 0.001). Exposure to smoking in public places increased the odds of susceptibility to tobacco use in Bahrain (AOR = 1.6, 95% CI = [1.2–2.2), Kuwait (AOR = 1.6, 95% CI = [1.2–2.0]), Qatar (AOR = 1.9, 95% CI = [1.4–2.6]), and UAE (AOR = 2.1, 95% CI = [1.6–2.7]). Susceptibility to tobacco use was significantly associated with exposure to tobacco imagery in media in the UAE (AOR = 1.7, 95% CI = [1.2–2.3]) and with tobacco industry activities like promotion in Bahrain (AOR = 2.8, 95% CI = [1.9–4.2]) and Kuwait (AOR = 2.2, 95% CI = [1.5–3.1]). In conclusion, the impact of FCTC provisions on tobacco use differs across countries. Findings suggested that the implementation of tobacco control policies may independently influence the initiation of tobacco use.
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Affiliation(s)
- Sarah S. Monshi
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA, USA
- Department of Health Services Management, Umm Al-Qura University, Mecca, Saudi Arabia
- Corresponding author at: Department of Health Services Administration & Policy, College of Public Health, Temple University, 1301 Cecil B. Moore Avenue, Philadelphia, PA 19122, USA.
| | - Jingwei Wu
- Department of Epidemiology and Biostatistics, Temple University, Philadelphia, PA, USA
| | - Bradley N. Collins
- Department of Social and Behavioral Sciences, Temple University, Philadelphia, PA, USA
| | - Jennifer K. Ibrahim
- Department of Health Services Administration and Policy, Temple University, Philadelphia, PA, USA
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15
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Ayedi Y, Harizi C, Skhiri A, Fakhfakh R. Linking Global Youth Tobacco Survey (GYTS) data to the WHO Framework Convention on Tobacco Control (FCTC): The case for Tunisia. Tob Induc Dis 2022; 20:07. [PMID: 35125990 PMCID: PMC8796851 DOI: 10.18332/tid/143994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/31/2021] [Accepted: 11/16/2021] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION The World Health Organization (WHO) had launched the Framework convention on Tobacco Control (FCTC) in 2003 in order to curve the epidemic of tobacco use worldwide. Since most smokers begin to smoke before the age of 18 years, Global Youth Tobacco Survey (GYTS) has been developed in order to monitor tobacco smoking among adolescents. Our aim was to assess smoking among Tunisian youth using GYTS 2017 data. METHODS GYTS is cross-sectional, two cluster school-based survey to produce a representative sample of students aged 13-15 years. It was conducted in 2017 in 67 secondary schools in Tunisia. The investigation tool was an anonymously answered questionnaire, which contained core questions about six majors tobacco related topics. RESULTS Lifetime cigarettes and waterpipe prevalence were 7.8% (14.4% of boys, 1.6% of girls, p<0.001) and 7.2% (13% of boys, 2.8% of girls, p<0.001), respectively. Among cigarette smokers, 62.5% were able to buy their own cigarettes. Overall, 23.5% of cigarette smokers and 41.5% of waterpipe smokers were not able to buy their products because of their age. Sixty percent of smokers wanted to quit and 56.4% had already tried to stop. Half of the respondents were exposed to SHS in their homes and 62.1% in indoor public places. CONCLUSIONS In Tunisia, tobacco prevalence among youth is high. Youth have free access to tobacco products and smoke-free regulations are only partially respected.
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Affiliation(s)
- Yosr Ayedi
- Department of Epidemiology and Biostatistics, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Chahida Harizi
- Department of Epidemiology and Biostatistics, Abderrahmen Mami University Hospital, Ariana, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Afef Skhiri
- Department of Epidemiology and Biostatistics, Abderrahmen Mami University Hospital, Ariana, Tunisia
| | - Radhouane Fakhfakh
- Department of Epidemiology and Biostatistics, Abderrahmen Mami University Hospital, Ariana, Tunisia
- Faculty of Medicine of Tunis, University of Tunis El Manar, Tunis, Tunisia
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16
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Duran AC, Mialon M, Crosbie E, Jensen ML, Harris JL, Batis C, Corvalán C, Taillie LS. [Soluciones relacionadas con el entorno alimentario para prevenir la obesidad infantil en América Latina y en la población latina que vive en Estados Unidos]. Obes Rev 2021; 22 Suppl 5:e13344. [PMID: 34708531 DOI: 10.1111/obr.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ana Clara Duran
- Núcleo de Estudos e Pesquisas em Alimentação (NEPA), Universidade Estadual de Campinas, Campinas, Brasil.,Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brasil
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublín, Irlanda
| | - Eric Crosbie
- School of Community and Health Sciences, University of Nevada, Reno, Nevada, EE. UU
| | - Melissa Lorena Jensen
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, EE. UU.,Escuela de Nutrición, Universidad de Costa Rica, San José, Costa Rica
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, EE. UU
| | - Carolina Batis
- CONACYT, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Camila Corvalán
- Instituto de Nutricion y Tecnologia de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, Carolina del Norte, EE. UU
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17
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Beard E, Brown J, Jackson SE, West R, Anderson W, Arnott D, Shahab L. Who would be targeted by increasing the legal age of sale of cigarettes from 18 to 21? A cross-sectional study exploring the number and characteristics of smokers in England. Addiction 2021; 116:2187-2197. [PMID: 33565612 PMCID: PMC8436755 DOI: 10.1111/add.15421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 04/07/2020] [Accepted: 01/13/2021] [Indexed: 01/01/2023]
Abstract
AIMS To establish the number of smokers in England who would be targeted by increasing the age of sale of cigarettes from 18 to 21 years and to assess the smoking and socio-demographic profile of those smokers. DESIGN AND SETTING Nationally representative cross-sectional survey of adults in England conducted between January 2009 and July 2019. PARTICIPANTS A total of 219 720 adults. MEASUREMENTS All participants reported their current smoking status and socio-demographic characteristics (i.e. age, gender, home ownership, social grade and ethnicity). Smokers reported motivation to quit, urges to smoke and the Heaviness of Smoking Index (HIS). Weighted prevalence statistics were calculated. Multinomial regression and logistic regression were used to assess differences in smoking characteristics among smokers and socio-demographic characteristics relative to non-smokers. FINDINGS The prevalence of smoking between January 2009 and July 2019 was highest among those aged 21-30. In 2019, 15.6% [95% confidence interval (CI) = 12.8-18.8%] of 18-20-year-olds reported smoking, which is estimated to represent 364 000 individuals in England. Relative to smokers aged 18-20, older smokers (aged 21+) had a higher motivation to quit smoking [odds ratios (ORs) = 1.40-1.45 range] and higher nicotine dependency as measured by urges to smoke (ORs = 1.06-1.24 range) and HSI (ORs = 1.05-2.85 range). Compared with non-smokers aged 18-20, smokers in this age group had lower odds of being female (OR = 0.89) and higher odds of being of white ethnicity (OR = 2.78) and from social grades C1-E (lower social grades) compared with AB (higher social grades) (OR = 1.19-1.83 range). CONCLUSION Increasing the age of sale of cigarettes to 21 years in England would currently target approximately 364 000 lower dependent smokers from more disadvantaged backgrounds aged 18-20, who have less motivation to quit.
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Affiliation(s)
- Emma Beard
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Jamie Brown
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Sarah E. Jackson
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | - Robert West
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
| | | | - Deborah Arnott
- Action on Smoking and Health (ASH)LondonUK
- Division of Epidemiology and Public Health, School of MedicineUniversity of Nottingham
| | - Lion Shahab
- Department of Behavioural Science and HealthUniversity College LondonLondonUK
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18
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Shriprasad H, Kallihal K. Tobacco Use and Alcohol Consumption Among College Students: A Behavioural Study in Belagavi City, Karnataka. JOURNAL OF HEALTH MANAGEMENT 2021. [DOI: 10.1177/09720634211011567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Tobacco and alcohol consumption is a major social problem and public health issue worldwide. A review of literature on the studies of tobacco and alcohol consumption among the students across the country reveals that there is considerable prevalence among boys and girls. In this context, a cross-sectional study was conducted on tobacco use and alcohol consumption among college-going students in Belagavi corporation area in Karnataka. The study found that, as a whole, 70%–80% of all students know the harmful health effect of different forms of abuses. Among the three abuses, alcohol ever users are the highest, followed by people smoking tobacco and smokeless tobacco. The ever users of smoking tobacco are almost four times higher among males than females. The age group comprising 16–20 years is a very sensitive age group for initiating smoking and alcohol consumption. Interestingly though students had their first experience for the first time with their friends; their own curiosity was the prime cause to set off any habit. The current users of alcohol (7.2%) were higher than the current users of smoking tobacco (4.7%) and smokeless tobacco (0.37%). The daily users of smoking tobacco and alcohol were 0.87% and 1.8%, respectively. Further, occasional users of smoking tobacco were three times higher than daily users, and occasional users of alcohol were almost four times higher than daily users. None of the students were daily users of smokeless tobacco. The 19–22-year age group and those staying outside home were more vulnerable towards getting into this habit. Therefore, policy intervention is required to this age group. Friends’ assistance is the single largest source to seek advice to quit from any abuse, while least assistance is taken by the professionals. This finding of the study has some critical implication for policy priority at the institutional level. This really calls for the more roles of professional counsellors to address the problem. As a whole, any single solution is not enough, however. Both exogenous and endogenous approaches are required for behavioural changes of youth.
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Affiliation(s)
- H. Shriprasad
- Population Research Centre Dharwad, Koushalya Building, JSS Institutes, Vidhayagiri Dharwad, Karnataka, India
| | - K.G. Kallihal
- Population Research Centre Dharwad, Koushalya Building, JSS Institutes, Vidhayagiri Dharwad, Karnataka, India
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19
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Duran AC, Mialon M, Crosbie E, Jensen ML, Harris JL, Batis C, Corvalán C, Taillie LS. Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States. Obes Rev 2021; 22 Suppl 3:e13237. [PMID: 34152071 PMCID: PMC8365715 DOI: 10.1111/obr.13237] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.
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Affiliation(s)
- Ana Clara Duran
- Center for Food Studies and Research (NEPA)University of CampinasCampinasBrazil
- Center for Epidemiological Studies in Nutrition and HealthUniversity of São PauloSão PauloBrazil
| | - Melissa Mialon
- Trinity Business SchoolTrinity College DublinDublinIreland
| | - Eric Crosbie
- School of Community and Health SciencesUniversity of NevadaRenoNevadaUSA
| | - Melissa Lorena Jensen
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordConnecticutUSA
- School of Nutrition, University of Costa RicaSan JoséCosta Rica
| | - Jennifer L. Harris
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordConnecticutUSA
| | - Carolina Batis
- CONACYT, Health and Nutrition Research CenterNational Institute of Public HealthCuernavacaMexico
| | - Camila Corvalán
- Instituto de Nutricion y Tecnologia de AlimentosUniversity of ChileSantiagoChile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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20
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Nuyts PAW, Hewer RMF, Kuipers MAG, Lorant V, Grard A, Hill S, Amos A. Youth Access to Cigarettes Across Seven European Countries: A Mixed-Methods Study. Nicotine Tob Res 2021; 22:1989-1996. [PMID: 31535686 PMCID: PMC7593358 DOI: 10.1093/ntr/ntz180] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Accepted: 09/12/2019] [Indexed: 11/13/2022]
Abstract
Background Despite widespread age-of-sale restrictions on tobacco, adolescents continue to obtain cigarettes and experiment with smoking. This mixed-methods study aimed to understand how European adolescents access cigarettes and how the policy context may influence this process, using a realist evaluation approach. This is the first study to assess access to cigarettes across various European contexts. Methods A survey of 4104 students was combined with qualitative data from focus groups among 319 adolescents aged 14–19 across seven European countries. Data were synthesized to explore mechanisms via which young people obtain cigarettes despite age-of-sale restrictions. Results While purchasing cigarettes from supermarkets was widely regarded as difficult, many participants purchased cigarettes from noncompliant retailers (often in smaller shops or cafes). Other contra-mechanisms included circumventing age checks, proxy purchases, and/or social sources. Dominant forms of access differed across the seven contexts, with direct purchases more common where perceived enforcement was low (eg, Belgium) and proxy purchases more important where perceived enforcement of age-of-sale laws was high (eg, Finland). The effectiveness of age-of-sale restrictions in reducing youth access appears to be influenced by a range of contextual factors including retailer compliance, the availability of vending machines, and the specific minimum age-of-sale. Conclusions Our findings illustrate the relevance of programme theory in understanding the contra-mechanisms that undermine the effectiveness of age-of-sale laws in discouraging youth smoking. Young people’s access to cigarettes could be further limited by addressing these contra-mechanisms, including an increase in the legal sales age (particularly in Belgium), banning vending machines, and strengthening enforcement. Implications Despite widespread implementation of age-of-sale laws, a substantial proportion of minors continue to access cigarettes. Young people use a number of contra-mechanisms to circumvent age-of-sale restrictions. These include accessing cigarettes via social sources, proxy sales or by circumventing age checks. Our findings show that in contexts where perceived enforcement of age-of-sale restrictions is high, young people are more reliant on irregular forms of access such as proxy sales. Young people’s access to cigarettes may be further reduced by policy interventions that address these contra-mechanisms—for example, banning vending machines, strengthening enforcement of age-of-sale laws, and increasing the minimum age-of-sale.
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Affiliation(s)
- Paulien A W Nuyts
- Department of Public Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Rebecca M F Hewer
- UK Centre for Tobacco and Alcohol Studies, Usher Institute for Population Health Sciences and Informatics University of Edinburgh, Edinburgh, UK
| | - Mirte A G Kuipers
- Department of Public Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Vincent Lorant
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | - Adeline Grard
- Institute of Health and Society, Université Catholique de Louvain, Brussels, Belgium
| | | | - Sarah Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- UK Centre for Tobacco and Alcohol Studies, Usher Institute for Population Health Sciences and Informatics University of Edinburgh, Edinburgh, UK
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21
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Smith CE, Hill SE, Amos A. Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions. Tob Control 2020; 30:tobaccocontrol-2020-055874. [PMID: 32994297 PMCID: PMC8666809 DOI: 10.1136/tobaccocontrol-2020-055874] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 08/06/2020] [Accepted: 08/25/2020] [Indexed: 01/11/2023]
Abstract
BACKGROUND While price increases and targeted cessation support have been found to reduce inequalities in smoking by socioeconomic status (SES), evidence on other measures is mixed. We aimed to update the most recent (2014) previous review by identifying and appraising evidence published since 2013 on the equity impact of population tobacco control measures. METHODS Systematic searching of 10 electronic databases and hand-searching of four key journals identified 68 primary research articles published since 2013 that sought to examine the equity impact of population tobacco control measures in high-income countries with a negative socioeconomic gradient in smoking. Reported equity impacts were categorised as positive (greater impact among lower SES), neutral (no difference by SES), negative (greater impact among higher SES) or mixed/unclear. RESULTS There was substantial growth in research seeking to evaluate the equity impact of tobacco control interventions, but the majority of new studies showed mixed/unclear results. Findings for price increases and targeted cessation support continue to suggest an equity-positive impact, but limitations in the available evidence make further assessment difficult. Substantial differences in the context, scale and implementation of tobacco control policies make straightforward comparison of findings from the previous 2014 and current reviews problematic. CONCLUSION Researchers need to adopt more sophisticated, multidisciplinary approaches in evaluating the equity impact of tobacco control measures-developing robust measures of equity effect and using frameworks that take account of context, existing systems/processes and the likely mechanisms of action. Socioeconomic differences in intervention impact within low-income and middle-income countries require evaluation.
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Affiliation(s)
| | - Sarah E Hill
- Global Health Policy Unit, University of Edinburgh, Edinburgh, UK
| | - Amanda Amos
- Usher Institute, University of Edinburgh, Edinburgh, UK
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22
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Minary L, Agrinier N, Dugas EN, Sylvestre MP, O'Loughlin J. The Natural Course of Cigarette Smoking among Adolescent Daily Smokers in France and Quebec. Tob Use Insights 2020; 13:1179173X20943549. [PMID: 32922106 PMCID: PMC7446263 DOI: 10.1177/1179173x20943549] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2019] [Accepted: 06/25/2020] [Indexed: 11/25/2022] Open
Abstract
Objective: To describe the natural course of cigarette smoking and nicotine dependence (ND) over 1-year in daily smokers ages 15 to 17 living in different social contexts. Method: Cigarette smoking and ND indicators were measured at baseline and 3- and 12-months thereafter among 95 daily smokers with a total of 123 observations from the Nicotine Dependence in Teens (NDIT) Study in Quebec, Canada, and in 111 daily smokers from the TABagisme chez les ADOlescents (TABADO) Study in Lorraine, France. Results: NDIT and TABADO participants initiated smoking a mean (SD) of 3.9 (1.6) and 3.7 (2.0) years prior to baseline, respectively. Despite baseline differences in age, sex, age at initiation, number of cigarettes smoked per day and social context, 85% of participants in both samples reported cravings and responded “yes” to “felt like you really need a cigarette”. Mean (SD) number of cigarettes smoked per day increased from 9.4 (8.1) to 11.8 (8.0) over 1 year in NDIT (adjusted mean difference (95% CI) = 2.4 (0.8, 3.0)), and from 11.5 (6.5) to 13.5 (6.7) in TABADO (adjusted mean difference (95% CI) = 2.0 (0.8, 3.1)). However, most ND indicators in both samples were stable over time and cessation was infrequent. Conclusion: Despite notable differences across samples, the natural course of cigarettes smoked per day, ND symptoms and cessation was similar, suggestive of an underlying biologic rather than social process. To quit, adolescents who smoke daily will likely need (pharmacologic) intervention to counter the biological mechanisms underpinning ND, as well as complementary strategies targeting the social context such as creating social environments favoring cessation success.
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Affiliation(s)
| | - Nelly Agrinier
- Université de Lorraine, APEMAC, Nancy, France.,CHRU-Nancy, INSERM, Université de Lorraine, CIC, Epidémiologie Clinique, Nancy, France
| | - Erika N Dugas
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Marie-Pierre Sylvestre
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, Quebec, Canada
| | - Jennifer O'Loughlin
- Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montréal, QC, Canada.,Department of Social and Preventive Medicine, School of Public Health, University of Montréal, Montréal, Quebec, Canada
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23
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Leão T, Perelman J, Clancy L, Mlinarić M, Kinnunen JM, Nuyts PAW, Mélard N, Rimpelä A, Lorant V, Kunst AE. Economic Evaluation of Five Tobacco Control Policies Across Seven European Countries. Nicotine Tob Res 2020; 22:1202-1209. [PMID: 31350556 PMCID: PMC7291799 DOI: 10.1093/ntr/ntz124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 08/08/2019] [Indexed: 11/25/2022]
Abstract
Introduction Economic evaluations of tobacco control policies targeting adolescents are scarce. Few take into account real-world, large-scale implementation costs; few compare cost-effectiveness of different policies across different countries. We assessed the cost-effectiveness of five tobacco control policies (nonschool bans, including bans on sales to minors, bans on smoking in public places, bans on advertising at points-of-sale, school smoke-free bans, and school education programs), implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. Methods Cost-effectiveness estimates were calculated per country and per policy, from the State perspective. Costs were collected by combining quantitative questionnaires with semi-structured interviews on how policies were implemented in each setting, in real practice. Short-term effectiveness was based on the literature, and long-term effectiveness was modeled using the DYNAMO-HIA tool. Discount rates of 3.5% were used for costs and effectiveness. Sensitivity analyses considered 1%–50% short-term effectiveness estimates, highest cost estimates, and undiscounted effectiveness. Findings Nonschool bans cost up to €253.23 per healthy life year, school smoking bans up to €91.87 per healthy life year, and school education programs up to €481.35 per healthy life year. Cost-effectiveness depended on the costs of implementation, short-term effectiveness, initial smoking rates, dimension of the target population, and weight of smoking in overall mortality and morbidity. Conclusions All five policies were highly cost-effective in all countries according to the World Health Organization thresholds for public health interventions. Cost-effectiveness was preserved even when using the highest costs and most conservative effectiveness estimates. Implications Economic evaluations using real-world data on tobacco control policies implemented at a large scale are scarce, especially considering nonschool bans targeting adolescents. We assessed the cost-effectiveness of five tobacco control policies implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. This study shows that all five policies were highly cost-effective considering the World Health Organization threshold, even when considering the highest costs and most conservative effectiveness estimates.
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Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal.,Local Health Unit of Matosinhos, Matosinhos, Portugal
| | - Julian Perelman
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Lisboa, Portugal.,Centro de Investigação em Saúde Pública, Lisboa, Portugal
| | - Luke Clancy
- TobaccoFree Research Institute Ireland, Dublin, Ireland
| | - Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Jaana M Kinnunen
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | | | - Nora Mélard
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Arja Rimpelä
- Unit of Health Sciences, Faculty of Social Sciences, Tampere University, Tampere, Finland.,Department of Adolescent Psychiatry, Tampere University Hospital, Tampere, Finland
| | - Vincent Lorant
- Institute of Health and Society, Université catholique de Louvain, Brussels, Belgium
| | - Anton E Kunst
- Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
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24
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Nuyts PAW, Kuipers MAG, Willemsen MC, Kunst AE. An Increase in the Tobacco Age-of-Sale to 21: For Debate in Europe. Nicotine Tob Res 2020; 22:1247-1249. [PMID: 31408159 PMCID: PMC7291794 DOI: 10.1093/ntr/ntz135] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 07/30/2019] [Indexed: 11/24/2022]
Abstract
A debate on the adoption of a tobacco age-of-sale of 21 in Europe has not occurred, with the recent exception of the United Kingdom. The current legally set age of 18 years is proving to be inadequate as adolescents continue to access cigarettes. Tobacco 21 laws have the potential to further limit access to cigarettes by minors. We believe that soon the time will be ripe for this discussion to spread throughout Europe, specifically among countries that have adopted a smoke-free generation movement.
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Affiliation(s)
- Paulien A W Nuyts
- Department of Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Mirte A G Kuipers
- Department of Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, CAPHRI School for Public Health and Primary Care, Maastricht University, Maastricht, The Netherlands
- Netherlands Expertise Center for Tobacco Control (NET), Trimbos Institute, Utrecht, The Netherlands
| | - Anton E Kunst
- Department of Public Health, University of Amsterdam, Amsterdam UMC, Amsterdam, The Netherlands
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Nuyts PA, Kuipers MA, Willemsen MC, Lorant V, Kunst AE. Never-smoking adolescents' perceived accessibility of cigarettes following an increase in the tobacco age-of-sale from 16 to 18: A quasi-experimental study of two cities in the Netherlands and Belgium. Addict Behav 2020; 104:106288. [PMID: 31978758 DOI: 10.1016/j.addbeh.2020.106288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Revised: 12/16/2019] [Accepted: 01/02/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The Netherlands increased the tobacco age-of-sale from 16 to 18 in 2014, paired with mass-media campaigns. We evaluated changes in perceived accessibility of cigarettes between 2013 and 2016 among adolescent never-smokers in the Netherlands compared with Belgium, where the age-of-sale remained 16 and no campaigns were conducted. METHODS Repeated cross-sectional surveys were conducted in 2013 and 2016 among 4112 13-17-year-olds at a total of 22 schools in Amersfoort (the Netherlands) and Namur (Belgium). Multilevel Poisson regression quantified changes over time in prevalence of easy perceived accessibility to cigarettes (i.e., thinking it would be fairly/very easy to get cigarettes). Interaction terms were used to test whether changes differed between the Netherlands and Belgium. Analyses were stratified by age (13-15 and 16-17 years), sex (male and female), family smoking (0 and ≥1 smoking family members), and friend smoking (no and at least some smoking friends). RESULTS Perceived accessibility to cigarettes decreased in the Netherlands (Prevalence Ratio (PR): 0.82; 95% CI: 0.72-0.93) and Belgium (PR: 0.78; 95% CI: 0.70-0.87), to a similar extent (PR interaction: 1.04; 95% CI: 0.90-1.21). Results by sex, age, and family/friend smoking were similar to those for the total population; there were no significant differences in the decrease in perceived access over time between the Netherlands and Belgium within each of these subgroups. CONCLUSION This study found approximately the same rate of decline between 2013 and 2016 in adolescent never-smokers' perceived access to cigarettes in the Netherlands as in Belgium. This implies that we did not find clear evidence for an effect of the 2014 increase in legal age of tobacco sales from 16 to 18 years in the Netherlands.
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Weiger CV, Alexander TN, Moran MB. Are national antitobacco campaigns reaching high-risk adolescents? A cross-sectional analysis from PATH Wave 2. HEALTH EDUCATION RESEARCH 2020; 35:44-59. [PMID: 31965169 PMCID: PMC6991619 DOI: 10.1093/her/cyz036] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 12/10/2019] [Indexed: 06/10/2023]
Abstract
Smoking education and prevention campaigns have had marked success in reducing rates of tobacco use among adolescents, however, disparities in use continue to exist. It is critical to assess if adolescents at risk for tobacco use are being exposed to antitobacco campaigns. We used data from Wave 2 of the Population Assessment of Tobacco and Health Study to assess the relationship between exposure to three antitobacco campaigns and key characteristics related to higher risk of cigarette use using full-sample weights and Poisson regression models with robust variance. Adjusted models identified that exposure to antitobacco campaigns was more common among racial and sexual minority adolescents and adolescents who: reported exposure to tobacco marketing, spent more time using media and had household income greater than $25 000. While some high-risk youth are more likely to report exposure to campaigns, there are some priority groups that are not being reached by current efforts compared with non-priority groups, including youth living in households with income below the poverty line and adolescents who are susceptible to cigarette smoking. Future campaigns should consider targeting these groups specifically in order to reduce tobacco use disparities.
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Affiliation(s)
- C V Weiger
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - T N Alexander
- Public Health Research and Translational Science, Battelle Memorial Institute, Battelle Public Health Center for Substance Use Research, 6115 Falls Rd #200, Baltimore, MD 21209, USA
| | - M B Moran
- Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
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Nguyen HV. Association of Canada's Provincial Bans on Electronic Cigarette Sales to Minors With Electronic Cigarette Use Among Youths. JAMA Pediatr 2020; 174:e193912. [PMID: 31682725 PMCID: PMC7017978 DOI: 10.1001/jamapediatrics.2019.3912] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE Banning electronic cigarette (e-cigarette) sales to minors has been a key policy to protect children from e-cigarettes in the United States and Canada, but to date little is known about the outcome of such a ban. OBJECTIVES To investigate the association of banning e-cigarette sales to minors in Canada with e-cigarette use among youths and the mechanisms through which a ban might be associated with their e-cigarette use. DESIGN, SETTING, AND PARTICIPANTS This quasi-experimental difference-in-differences and triple-differences study used data from the nationally representative Canadian Tobacco, Alcohol and Drugs Survey (2013-2017) and Canadian Student Tobacco, Alcohol and Drugs Survey (2014-2017). Study samples consisted of respondents aged 15 to 18 years (in difference-in-differences analysis; n = 8212) and aged 15 to 25 years (in triple-differences analysis; n = 20 934) in the Canadian Tobacco, Alcohol and Drugs Survey, and students in grades 6 to 12 (in difference-in-differences analysis; n = 78 650) in the Canadian Student Tobacco, Alcohol and Drugs Survey. INTERVENTIONS Canada's provincial bans on e-cigarette sales to youths younger than 18 or 19 years (depending on province) implemented between 2015 and 2017. MAIN OUTCOMES AND MEASURES The primary outcome was past 30-day e-cigarette use among youths. Secondary outcomes were difficulty of access to e-cigarettes, perception of e-cigarette harm, and use of social sources of e-cigarettes. RESULTS After the bans, e-cigarette use among youths increased in all provinces, but the increase was 3.1 percentage points (95% CI, 0.2-6.0; P = .04), or 79%, lower in provinces with a ban than in provinces without a ban. Youths in provinces with a ban were 2.6 percentage points (95% CI, 1.5-3.7; P = .001), or 18%, less likely to believe that regular e-cigarette use poses no harm and 6.2 percentage points (95% CI, 1.1-11.4; P = .02), or 16%, more likely to self-report greater difficulty in obtaining e-cigarettes. Among youths who reported using e-cigarettes, the likelihood of obtaining e-cigarettes from social sources was 17.3 percentage points (95% CI, 5.2 -29.4; P = .01), or 29%, higher in provinces with a ban. These findings were robust to several sensitivity analyses. CONCLUSIONS AND RELEVANCE Banning e-cigarette sales to minors was associated with a significant reduction in the rate of increase in e-cigarette use by youths, but this policy alone could not reverse the overall increase in e-cigarette use. The findings from this study suggest that this policy should be supplemented with other measures that can reduce young people's desire to obtain e-cigarettes through social sources, such as a ban on e-cigarettes with flavors that appeal to youths and children.
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Affiliation(s)
- Hai V. Nguyen
- School of Pharmacy, Memorial University of Newfoundland, St John’s, Newfoundland and Labrador, Canada
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Leão T, Kunst AE, Schreuders M, Lindfors P, Kuipers MA, Perelman J. Adolescents' smoking environment under weak tobacco control: A mixed methods study for Portugal. Drug Alcohol Depend 2019; 204:107566. [PMID: 31568935 DOI: 10.1016/j.drugalcdep.2019.107566] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/10/2019] [Accepted: 07/11/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Bans on smoking in public places and on sales to minors have been widely implemented across the globe. However, many countries have either adopted non-comprehensive (i.e., partial) bans and/or weakly enforce those bans. Little is known, from the adolescents' perspective, how this affects their smoking-related perceptions and behaviors. We studied the case of Portugal, where bans are partial and/or weakly enforced. We sought to understand how the bans affect adolescents' access to cigarettes from commercial sources, the visibility of smoking in public places, and smoking locations. MATERIAL AND METHODS We used a mixed methods design on data gathered in 2016. Quantitative, cross-sectional surveys were conducted in six schools (n = 2,444) in Coimbra, Portugal. In two of these schools, qualitative data were collected in eight single-sex focus group interviews (n = 42). RESULTS Ninety-five percent of the adolescents who tried to buy cigarettes were able to do so from commercial sources, through vending machines, or directly from the vendor. Bans on smoking on school premises and at enclosed public places did not prevent these adolescents from observing smoking outside school gates (84.0%), in cafes and restaurants (97%), or from smoking at cafes, bars, or nightclubs (72.9%). DISCUSSION Partial and/or weakly enforced policies seem to not prevent adolescents from having access to cigarettes, frequently seeing smoking, and finding ample opportunities to smoke in public places. Adopting and enforcing comprehensive policies are necessary efforts to prevent unfavorable responses and more effectively reduce adolescents' smoking behavior.
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Affiliation(s)
- Teresa Leão
- Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal; Public Health Unit, Matosinhos Local Health Unit, Rua Dr. Eduardo Torres, 4464-513, Senhora da Hora, Portugal.
| | - Anton E Kunst
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Michael Schreuders
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Pirjo Lindfors
- Faculty of Social Sciences, 33014 Tampere University, Finland
| | - Mirte Ag Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, the Netherlands
| | - Julian Perelman
- Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade NOVA de Lisboa, Avenida Padre Cruz, 1600-560, Lisboa, Portugal
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Abstract
Abstract Tobacco continues to kill about 0.48 million Americans per year and there are currently 34.3 million smokers in the USA. As a consequence of the First Surgeon General’s Report on Tobacco in 1964, tobacco control interventions on part of the government led to a significant decline in conventional tobacco product usage over the last few decades. However, more recently, a new entity in the form of electronic cigarettes has risen rapidly and has exposed a younger population to a plethora of dangerous consequences. Looking at e-cigarettes from the perspective of tobacco control however raises a lot of challenges. There is little doubt that existing smokers of combustible cigarettes who switch to e-cigarettes will be switching to a less harmful product. However, if the younger generation begins using e-cigarettes as a result of targeted marketing, appealing flavors and ‘safer alternative’ perception, decades of progress made in conventional tobacco control will be negated. Governments at the federal, state, and local levels have a mandate to once again implement new public health policies to ensure that non-conventional tobacco products like e-cigarettes are available as smoking cessation tools for existing smokers but at the same time do not play a role in ruining the health of future generations through addiction and disease. Purpose of Review To review the present scenario of regulations and policies impacting public health with respect to electronic nicotine delivery systems (ENDS) with the objective of providing a meaningful and balanced view of the challenges at hand with plausible recommendations. Recent Findings Nicotine in tobacco is known to cause addiction and dependence. It is particularly potent in children and young adults. E-cigarettes can deliver high concentrations of nicotine, and these concentrations can vary depending on the numerous constituents within the e-cigarette which vary greatly from one another. Use of e-cigarettes is implicated as a risk factor for future cigarette use in young adults. Moreover, e-cigarette usage patterns also depend on several sociodemographic factors. Banning tobacco products has shown to reduce smoking risk in youth and as such, strong e-cigarette regulation measures are needed for prevention. Summary Effective regulation of ENDS faces a multitude of challenges. One such challenge is to prevent youth and non-smokers from getting habituated to nicotine through e-cigarettes. The intention of tobacco companies to sustain sales through harmful marketing strategies that tone down the risks and highlight e-cigarettes as a “much safer alternative” while promoting flavors appealing to children should be immediately prohibited. Another hazard is the endorsement of ENDS as devices meant for enhancing social interaction which opens a path for youth to make erroneous choices under peer pressure. On the other hand, several studies have reported that e-cigarettes significantly reduce an existing smoker’s risk of being exposed to toxic tobacco smoke constituents that are normally present in cigarette smoke. This leads to the conclusions that e-cigarettes can be a tool for smoking cessation for current smokers. Public policy must take a multi-dimensional approach to balance these two extremes.
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Kuijpers TG, Kunst AE, Willemsen MC. Policies that limit youth access and exposure to tobacco: a scientific neglect of the first stages of the policy process. BMC Public Health 2019; 19:825. [PMID: 31242893 PMCID: PMC6595563 DOI: 10.1186/s12889-019-7073-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Accepted: 05/29/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Policymakers can adopt and implement various supply-side policies to limit youth access and exposure to tobacco, such as increasing the minimum age of sale, limiting the number or type of tobacco outlets, or banning the display of tobacco products. Many studies have assessed the impact of these policies, while less is known about the preceding policy process. The aim of our review was to assess the available evidence on the preceding process of agenda setting, policy formulation, and policy legitimation. METHODS A systematic literature search was conducted using the PubMed and the Social Sciences Citation Index databases. After selection, 200 international peer-reviewed articles were identified and analyzed. Through a process of close reading, evidence based on scientific enquiry and anecdotal evidence on agenda setting, policy formulation and policy legitimation was abstracted from each article. RESULTS Scientific evidence on the policy process is scarce for these policies, as most of the evidence found was anecdotal. Only one study provided evidence based on a scientific analysis of data on the agenda setting and legitimation phases of policy processes that led to the adoption of display bans in two Australian jurisdictions. CONCLUSION The processes influencing the adoption of youth access and exposure policies have been grossly understudied. A better understanding of the policy process is essential to understand country variations in tobacco control policy.
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Affiliation(s)
- Thomas G Kuijpers
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands.
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
| | - Anton E Kunst
- Department of Public Health, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc C Willemsen
- Department of Health Promotion, CAPHRI Care and Public Health Research Institute, Maastricht University, P. Debyeplein 1, 6229, HA, Maastricht, The Netherlands
- Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands
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