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Gunasekaran K, Singh P, Ng DX, Koh EYL, Lee HY, Tan R, Wang Y, Tan NC. Youths' awareness and attitudes towards raising the minimum legal age of smoking and passive smoking in Singapore. Front Public Health 2024; 12:1359929. [PMID: 39056076 PMCID: PMC11271020 DOI: 10.3389/fpubh.2024.1359929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2024] [Accepted: 06/06/2024] [Indexed: 07/28/2024] Open
Abstract
Objectives Early smoking initiation has been associated with a higher risk of developing long-term smoking habit. There is a growing global consensus that demands raising the minimum legal age (MLA) for smoking as an approach to address this problem. Singapore successfully raised the MLA from 18 to 21 years in 2021. This study aimed to evaluate the awareness and attitude of multi-ethnic Asian youth (aged 15-24) on raising MLA to 21 and passive smoking. Methods A cross-sectional survey comprising of 23 items was circulated via a secure internet-based platform, FORMSG between September and November 2022. Data were analyzed for descriptive statistics. Categorical variables were compared for association with receptivity toward change in MLA using Chi-Squared test and multivariable logistic regression analysis using Rstudio. Post-hoc Bonferroni correction were further utilized for pairwise comparison. Results Majority (80.3%) of the 608 participants expressed their support for MLA 21 implementation. Participants' age was a significant variable as those aged 15-17 years old (OR = 2.1, 95%CI = 1.01-4.32, p = 0.048) showed a higher likelihood of supporting MLA implementation compared to those aged 21 and above. In addition, majority (89.8%) of them were also aware of the harmful effects of passive smoking. When it came to discouraging smoking among youth, family influence (64%) and school education (55.6%) emerged as the top strategies. Conclusion Most of the youth express strong support for raising the MLA to 21, with over 80% in favor of such change, reflects a significant harmony among youth in favor of tobacco-free environment.
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Affiliation(s)
| | - Prashwin Singh
- Faculty of Medicine, Universiti Malaya, Kuala Lumpur, Malaysia
| | - Ding Xuan Ng
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
| | | | | | - Rei Tan
- Hwa Chong Institution, Singapore, Singapore
| | - Yier Wang
- Hwa Chong Institution, Singapore, Singapore
| | - Ngiap Chuan Tan
- Department of Research, SingHealth Polyclinics, Singapore, Singapore
- SingHealth-Duke NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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Kock L, Shahab L, Moore G, Shortt NK, Pearce J, Brown J. Assessing the profile of support for potential tobacco control policies targeting availability in Great Britain: a cross-sectional population survey. Tob Control 2024; 33:221-231. [PMID: 36008128 DOI: 10.1136/tc-2022-057508] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/04/2022] [Indexed: 11/04/2022]
Abstract
AIM To examine the level of support for tobacco availability policies across Great Britain (GB) and associations between support for policy and sociodemographic, smoking and quitting characteristics. METHODS A cross-sectional representative survey (the Smoking Toolkit Study) of adults in GB (n=2197) during September 2021. Logistic regressions estimated the associations between support for each policy and sociodemographic and smoking characteristics. FINDINGS There was majority support for requiring retailers to have a license which can be removed if they sell to those under-age (89.6%) and for restrictions on the sale of cigarettes and tobacco near schools (69.9%). More supported than opposed raising the legal age of sale of cigarettes and tobacco to 21 (49.2% supported; 30.7% opposed; 20.1% unsure) and reducing the number of retailers selling tobacco in neighbourhoods with a high density of tobacco retailers (46.5% supported; 23.3% opposed; 30.2% unsure). More opposed than supported a ban on the sale of cigarettes and tobacco to everyone born after a certain year from 2030 onward (a 'tobacco-free generation') (41.3% opposed; 34.5% supported; 24.2% unsure). Age was positively associated with support for raising the age of sale and inversely associated with requiring tobacco retailer licenses. Women were more likely to support raising the age of sale and reducing the number of retailers. CONCLUSIONS Requiring tobacco retailer licensing and restrictions on sales near schools received majority support. Other tobacco availability policies received substantial support despite considerable opposition.
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Affiliation(s)
- Loren Kock
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lion Shahab
- Department of Behavioural Science and Health, University College London, London, UK
| | - Graham Moore
- School of Social Sciences, Cardiff University, Cardiff, UK
| | - Niamh K Shortt
- School of Geosciences, Univerity of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- School of Geosciences, Univerity of Edinburgh, Edinburgh, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
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Reiter A, Hébert-Losier A, Mylocopos G, Filion KB, Windle SB, O'Loughlin JL, Grad R, Eisenberg MJ. Regulatory Strategies for Preventing and Reducing Nicotine Vaping Among Youth: A Systematic Review. Am J Prev Med 2024; 66:169-181. [PMID: 37553038 DOI: 10.1016/j.amepre.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 08/01/2023] [Accepted: 08/01/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Many jurisdictions have implemented different regulatory strategies to reduce vaping among youth. The objective of this systematic review is to synthesize the evidence of the effectiveness of different regulatory strategies for preventing and reducing nicotine vaping among youth. METHODS Five electronic databases were searched from January 1, 2004 to July 17, 2022 for primary studies examining state/provincial or national regulations targeting vaping among youth (aged 12-21 years) in high-income countries. The primary outcome was vaping prevalence. Included studies were qualitatively synthesized through systematic review. RESULTS The systematic review included 30 studies. There was insufficient evidence to recommend age restrictions (n=16), restrictions on location of use (n=1), and mixed/combined regulations (n=3). Flavor bans (n=4), sales licenses (n=2), and taxation (n=2) were generally shown to be associated with decreased rates of youth vaping. Warning labels (n=2) were associated with a decreased desire to initiate vaping. Included studies had moderate-to-serious risks of bias. DISCUSSION Although several regulatory interventions have been shown to be effective at reducing vaping among youth, evidence is insufficient to recommend a specific type of regulation. Regulatory authorities could implement various regulations targeting the price, accessibility, and desirability (i.e., flavors and packaging) of E-cigarettes.
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Affiliation(s)
- Anna Reiter
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Andréa Hébert-Losier
- Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Genevieve Mylocopos
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada
| | - Kristian B Filion
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Sarah B Windle
- Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada
| | - Jennifer L O'Loughlin
- Department of Social and Preventive Medicine, Université de Montréal, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Roland Grad
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Department of Family Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada
| | - Mark J Eisenberg
- Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Center for Clinical Epidemiology (CCE), Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Quebec, Canada; Department of Epidemiology, Biostatistics and Occupational Health, School of Population and Global Health, McGill University, Montreal, Quebec, Canada; Department of Medicine, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada; Division of Cardiology, Jewish General Hospital, Faculty of Medicine and Health Sciences, McGill University, Montreal, Quebec, Canada.
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Cosgrave EJ, Blake M, Murphy E, Sheridan A, Doyle F, Kavanagh P. Is the public ready for a tobacco-free Ireland? A national survey of public knowledge and attitudes to tobacco endgame in Ireland. Tob Control 2023:tc-2023-057958. [PMID: 37236784 DOI: 10.1136/tc-2023-057958] [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: 01/25/2023] [Accepted: 04/25/2023] [Indexed: 05/28/2023]
Abstract
AIM Ireland will not meet the tobacco endgame goal set in its 2013 Tobacco-Free Ireland (TFI) policy of reducing smoking prevalence to less than 5% by 2025. Public opinion on tobacco endgame, a key lever to realise this goal, is uncharted in Ireland. This study aimed to measure public knowledge and attitudes to tobacco endgame. METHODS A telephone-administered cross-sectional survey of 1000 randomly dialled members of the general public was conducted in 2022. Prevalence of awareness, perceived achievability and support for the TFI goal and tobacco endgame measures was calculated and compared across tobacco product use status. Logistic regression identified factors independently associated with goal support. FINDINGS Although TFI goal awareness was low (34.0%), support was high (74.6%), although most (60.2%) believed it achievable beyond 2025. Product-focused measures were popular while support for supply-focused measures was mixed: for example, 86.1% supported nicotine content reduction while 40.3% supported user licencing. Phasing out tobacco sales was highly supported (82.8%); for most, this was contingent on support for currently addicted users. TFI goal support was independently associated with female sex (adjusted odds ratio (aOR) 1.47, 95% CI 1.05 to 2.07), higher education (aOR 1.80, 95% CI 1.21 to 2.66) and non-tobacco product use (aOR 2.67, 95% CI 1.66 to 4.30). CONCLUSIONS Despite low awareness, tobacco endgame support is strong in Ireland. Public appetite for radically reducing tobacco product appeal and availability combined with public views on endgame achievability subject to extended timelines should be used to re-invigorate tobacco endgame discussion and planning in countries at risk of failing to meet declared targets.
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Affiliation(s)
| | - Martina Blake
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Edward Murphy
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Aishling Sheridan
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
| | - Frank Doyle
- Department of Health Psychology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Paul Kavanagh
- HSE Tobacco-Free Ireland Programme, Health Service Executive, Dublin, Ireland
- Department of Public Health and Epidemiology, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin, Ireland
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Reid JL, Burkhalter R, Kasza K, Seo YS, East K, Hyland A, Hammond D. Minimum legal age laws and perceived access to cigarettes, e-cigarettes, and other substances among youth in Canada, England, and the United States: 2017-2021. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2023; 115:104003. [PMID: 36965305 PMCID: PMC10370475 DOI: 10.1016/j.drugpo.2023.104003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 03/01/2023] [Accepted: 03/01/2023] [Indexed: 03/27/2023]
Abstract
BACKGROUND Minimum legal age (MLA) restrictions are a core policy to reduce youth use of tobacco, e-cigarettes, and other substances. We examined trends in perceived ease of access to tobacco and other substances across three countries with differing MLA policies, including the United States (US), which increased the federal MLA for tobacco products from 18 to 21 in 2019. METHODS Repeat cross-sectional data were analyzed from seven waves of the International Tobacco Control (ITC) Youth Tobacco and Vaping Survey conducted between 2017 and 2021. Online surveys were conducted with non-probability samples of 91,647 youth aged 16-19 in Canada, England, and the US. Regression models were used to examine differences in perceived ease of accessing each of 7 substances (analyzed as "very easy" or "fairly easy" versus else), and differences between countries and over time (including before and after any MLA changes) for cigarettes, e-cigarettes, cannabis, and alcohol; additional models examined sub-national variation in MLA. RESULTS Perceived access varied by substance and across countries: in August/September 2021, perceived ease of accessing cigarettes and e-cigarettes was greater in Canada where MLA was 18-19 (61.7% cigarettes, 66.4% e-cigarettes) and England where MLA was 18 (66.9%, 69.6%), compared to the US where MLA was 21 (48.0%, 60.9%; p < 0.001 for all). Perceived ease of accessing cannabis was greatest in Canada (53.3%), followed by the US (44.1%) and England (34.0%; p < 0.001 for all). Following the federal MLA increase for tobacco products in the US, perceived ease of access decreased significantly for cigarettes (65.1% in 2019Aug to 59.7% in 2020Feb; aOR=0.80 (95%CI=0.71-0.89)) and e-cigarettes (72.4% in 2019Aug to 69.4% in 2020Feb; aOR=0.87 (95%CI=0.77-0.98)). CONCLUSIONS Higher MLA was strongly associated with fewer youth perceiving easy access to substances: perceived access varied between countries with differing MLA, as well as within-country before and after changes to MLA.
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Affiliation(s)
- Jessica L Reid
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
| | - Robin Burkhalter
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1
| | - Karin Kasza
- Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA
| | - Young Sik Seo
- Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA
| | - Katherine East
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1; National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, Addictions Sciences Building, 4 Windsor Walk, Denmark Hill, London SE5 8BB, UK
| | - Andrew Hyland
- Roswell Park Comprehensive Cancer Center, Elm & Carlton Streets, Buffalo, NY 14263, USA
| | - David Hammond
- School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, Ontario, Canada, N2L 3G1.
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Affiliation(s)
- Sanjay Agrawal
- University Hospitals of Leicester NHS Trust, Leicester, UK
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7
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Edwards R, Johnson E, Stanley J, Waa A, Ouimet J, Fong GT. Support for New Zealand's Smokefree 2025 goal and key measures to achieve it: findings from the ITC New Zealand Survey. Aust N Z J Public Health 2021; 45:554-561. [PMID: 34181292 DOI: 10.1111/1753-6405.13129] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 03/01/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To assess support among smokers and recent quitters for the Smokefree New Zealand (NZ) 2025 goal and measures to facilitate its achievement. METHODS Data from CATI interviews with 1,155 (386 Māori) smokers and recent quitters in Wave 1 (August 2016-April 2017) and 1,020 (394 Māori) in Wave 2 (June-December 2018) of the International Tobacco Control (ITC) NZ Survey. RESULTS (Wave 2 unless stated): Almost all (95%) participants were aware of and more than half (56%) supported the smokefree goal. Support was highest (69-92%) for measures to reduce smoking uptake and protect children from exposure to secondhand smoke. Support was also high for other smokefree policies including mandated denicotinisation of smoked tobacco products (73%) and tobacco retailer licensing (70%, Wave 1). Support was lowest (<30%) for increasing the tobacco tax, but higher (59%) if additional revenue raised was used to help smokers to quit. Support for Smokefree 2025 and key measures to achieve it was generally higher among ex-smokers than smokers but mostly similar among Māori and non-Māori participants. CONCLUSIONS There is substantial support among smokers and ex-smokers for the Smokefree 2025 goal and many measures that could help achieve it. Implications for public health: Implementing a comprehensive strategy to achieve Smokefree 2025 is likely to be acceptable among New Zealand's smokers and ex-smokers.
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Affiliation(s)
- Richard Edwards
- Department of Public Health, University of Otago, New Zealand
| | - Ellie Johnson
- Department of Public Health, University of Otago, New Zealand
| | - James Stanley
- Department of Public Health, University of Otago, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, New Zealand
| | - Janine Ouimet
- Department of Psychology, University of Waterloo, Ontario, Canada
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Ontario, Canada
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Smith TT, Nahhas GJ, Borland R, Cho YJ, Chung-Hall J, Fairman RT, Fong GT, McNeill A, Popova L, Thrasher JF, Cummings KM. Which tobacco control policies do smokers support? Findings from the International Tobacco Control Four Country Smoking and Vaping Survey. Prev Med 2021; 149:106600. [PMID: 33957152 PMCID: PMC8580201 DOI: 10.1016/j.ypmed.2021.106600] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 04/27/2021] [Accepted: 05/01/2021] [Indexed: 11/22/2022]
Abstract
As governments consider policy action to reduce smoking, a key factor in creating political will is the level of public support, particularly among smokers who are most affected by the policies. The goal of this paper is to assess and compare the level of support in Canada, the United States, England, and Australia for five smoking control policies: 1) banning menthol in cigarettes, 2) banning cigarette additives, 3) reducing nicotine in cigarettes to make them less addictive, 4) raising the minimum age to purchase cigarettes to 21 years and older, and 5) requiring pictorial warning labels on cigarette packs (examined in the US only). Data for these analyses come from 8165 daily cigarette smokers who responded to the 2016 International Tobacco Control Four Country Smoking and Vaping Survey. In all countries, the highest level of support was for raising the legal age for purchase to 21 years and older (62-70%) and reducing the nicotine content of cigarettes to make them less addictive (57-70%). Smokers who were less dependent on cigarettes and those expressing interest in quitting were more likely to support all policies. When asked how they would respond to a nicotine reduction policy, the most common response given was to try the non-nicotine cigarettes to see how they liked them (42-48%), with the next most common response being to quit smoking entirely (16-24%). The high level of support for these proposed policies among daily smokers provides important evidence for policymakers to counteract claims that such policies would be unpopular.
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Affiliation(s)
- Tracy T Smith
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States.
| | - Georges J Nahhas
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
| | - Ron Borland
- School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Yoo Jin Cho
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - Janet Chung-Hall
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Robert T Fairman
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada; Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
| | - Ann McNeill
- Addictions Department, King's College London, London, United Kingdom
| | - Lucy Popova
- School of Public Health, Georgia State University, Atlanta, GA, 30302, United States
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, SC, 29208, United States
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, United States; Cancer Control and Prevention, Hollings Cancer Center, Charleston, SC 29425, United States
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