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Pichon-Riviere A, Bardach A, Rodríguez Cairoli F, Casarini A, Espinola N, Perelli L, Reynales-Shigematsu LM, Llorente B, Pinto M, Saenz De Miera Juárez B, Villacres T, Peña Torres E, Amador N, Loza C, Castillo-Riquelme M, Roberti J, Augustovski F, Alcaraz A, Palacios A. Health, economic and social burden of tobacco in Latin America and the expected gains of fully implementing taxes, plain packaging, advertising bans and smoke-free environments control measures: a modelling study. Tob Control 2024; 33:611-621. [PMID: 37142423 DOI: 10.1136/tc-2022-057618] [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: 06/28/2022] [Accepted: 04/06/2023] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To investigate the tobacco-attributable burden on disease, medical costs, productivity losses and informal caregiving; and to estimate the health and economic gains that can be achieved if the main tobacco control measures (raising taxes on tobacco, plain packaging, advertising bans and smoke-free environments) are fully implemented in eight countries that encompass 80% of the Latin American population. DESIGN Markov probabilistic microsimulation economic model of the natural history, costs and quality of life associated with the main tobacco-related diseases. Model inputs and data on labour productivity, informal caregivers' burden and interventions' effectiveness were obtained through literature review, surveys, civil registrations, vital statistics and hospital databases. Epidemiological and economic data from January to October 2020 were used to populate the model. FINDINGS In these eight countries, smoking is responsible each year for 351 000 deaths, 2.25 million disease events, 12.2 million healthy years of life lost, US$22.8 billion in direct medical costs, US$16.2 billion in lost productivity and US$10.8 billion in caregiver costs. These economic losses represent 1.4% of countries' aggregated gross domestic products. The full implementation and enforcement of the four strategies: taxes, plain packaging, advertising bans and smoke-free environments would avert 271 000, 78 000, 71 000 and 39 000 deaths, respectively, in the next 10 years, and result in US$63.8, US$12.3, US$11.4 and US$5.7 billions in economic gains, respectively, on top of the benefits being achieved today by the current level of implementation of these measures. CONCLUSIONS Smoking represents a substantial burden in Latin America. The full implementation of tobacco control measures could successfully avert deaths and disability, reduce healthcare spending and caregiver and productivity losses, likely resulting in large net economic benefits.
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Affiliation(s)
- Andrés Pichon-Riviere
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- CIESP, CONICET, Buenos Aires, Argentina
| | - Ariel Bardach
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
- CIESP, CONICET, Buenos Aires, Argentina
| | - Federico Rodríguez Cairoli
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Agustín Casarini
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Natalia Espinola
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Lucas Perelli
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Luz Myriam Reynales-Shigematsu
- Departamento de Investigación sobre Tabaco, Centro de Investigación en Salud Poblacional, Instituto Nacional de Salud Pública, Cuernavaca, Morelos, Mexico
| | | | - Marcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | | | - Tatiana Villacres
- Health Economics, Pontificia Universidad Católica del Ecuador, Quito, Pichincha, Ecuador
| | | | | | - César Loza
- Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru
| | | | | | - Federico Augustovski
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Andrea Alcaraz
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
| | - Alfredo Palacios
- Department of Health Technology Assessment and Health Economics, IECS-Institute for Clinical Effectiveness and Health Policy, Buenos Aires, Argentina
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Alcaraz A, Lazo E, Casarini A, Rodriguez-Cairoli F, Augustovski F, Bardach A, Perelli L, Palacios A, Pichon-Riviere A, Espinola N. Exploring gender disparities in the disease and economic tobacco-attributable burden in Latin America. Front Public Health 2024; 11:1321319. [PMID: 38414564 PMCID: PMC10898166 DOI: 10.3389/fpubh.2023.1321319] [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: 10/13/2023] [Accepted: 11/21/2023] [Indexed: 02/29/2024] Open
Abstract
Introduction Tobacco use has significant health consequences in Latin America, and while studies have examined the overall impact, the gender-specific effects have not been thoroughly researched. Understanding these differences is crucial for effective tobacco control policies. The objective of this study was to explore the differences in tobacco-attributable disease and economic burden between men and women in Argentina, Brazil, Chile, Colombia, Costa Rica, Ecuador, Mexico, and Peru. Methods We used a previously validated economic model to quantify the impact of tobacco-related illnesses, including morbidity, mortality, healthcare costs, productivity losses, informal care expenses, and DALYs, by gender and age. We utilized data from national surveys, records, studies, and expert opinions to populate the model. Results In 2020, there were 351,000 smoking-attributable deaths. Men accounted for 69% and women 31%. Ecuador and Mexico had the highest male-to-female death ratio, while Peru and Chile had the smallest disparities. 2.3 million tobacco-related disease events occurred, with 65% in men and 35% in women. Ecuador and Mexico had higher disease rates among men, while Peru had a more balanced ratio. Regarding DALYs, men lost 6.3 million due to tobacco, while women lost 3.3 million, primarily from COPD, cardiovascular disease, and cancer. Brazil and Mexico had the highest DALY losses for both genders. Costa Rica had a lower male-to-female tobacco use prevalence ratio but ranked second in deaths, disease events, and DALYs attributed to tobacco. Colombia had a unique pattern with a male-to-female death ratio of 2.08 but a higher ratio for disease events. The health systems spent $22.8 billion to treat tobacco-attributable diseases, with a male-to-female cost ratio 2.15. Ecuador showed the greatest gender cost difference, while Peru had the lowest. Productivity loss due to tobacco was $16.2 billion, with Ecuador and Mexico exhibiting the highest gender disparities and Peru the lowest. Informal care costs amounted to $10.8 billion, with men incurring higher costs in Ecuador, Costa Rica, and Mexico. Discussion Tobacco causes significant health and economic burdens in Latin America, with gender-based differences. There is a need for gender-disaggregated data to improve tobacco control policies.
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Affiliation(s)
- Andrea Alcaraz
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Elena Lazo
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Agustín Casarini
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Rodriguez-Cairoli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Federico Augustovski
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Ariel Bardach
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Lucas Perelli
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Alfredo Palacios
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Andrés Pichon-Riviere
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET), Buenos Aires, Argentina
| | - Natalia Espinola
- Instituto de Efectividad Clínica y Sanitaria (IECS), Institute for Clinical Efectiveness and Health Policy (IECS), Buenos Aires, Argentina
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Teed JA, Robichaud MO, Duren M, Gouda HN, Kennedy RD. State of the literature discussing smoke-free policies globally: A narrative review. Tob Induc Dis 2024; 22:TID-22-03. [PMID: 38188939 PMCID: PMC10767724 DOI: 10.18332/tid/174781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Revised: 11/02/2023] [Accepted: 11/06/2023] [Indexed: 01/09/2024] Open
Abstract
Despite the success of the Framework Convention on Tobacco Control (FCTC), most jurisdictions in the world do not have policies that create 100% smoke-free environments in indoor workplaces, indoor public places, public transport, or other public places. We conducted a narrative review of articles that discuss smoke-free policies and describe the state of the current literature. A search of peer-reviewed and gray literature, published between 1 January 2004 and 30 April 2022, was conducted using PubMed and EMBASE databases. We classified articles based on the location of the policy discussed (WHO region, World Bank income classification) and the environment that was being made smoke-free. Insights related to policy development and implementation, as well as compliance and enforcement, were also identified. The search identified 4469 unique citations; 134 articles met the criteria for inclusion and underwent data extraction by two independent coders. The sample included articles published in or about jurisdictions in each WHO region, in high- and low- and mediumincome countries, and articles that discussed policies regulating smoke-free indoor workplaces, indoor public places, public transport, outdoor/quasi-outdoor environments, and other (unspecified) public places. Some important insights from the literature related to smoke-free policy implementation included tobacco industry interference, the important role of civil society, and the need for effective communication, education, and leadership. Enforcement officials' awareness and training, stakeholders' attitudes and beliefs, and understanding social norms were identified as relevant determinants of effective smoke-free policies. There continue to be challenges for implementing smoke-free policies in jurisdictions throughout the globe, in high- and low- and middle-income countries. The literature includes insights to support 100% smoke-free policies in each environment that must be made smoke-free as per the FCTC.
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Affiliation(s)
- Jacqueline A. Teed
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Meagan O. Robichaud
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Michelle Duren
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Johns Hopkings University, Baltimore, United States
| | - Hebe N. Gouda
- Tobacco Free Initiative, World Health Organization, Geneva, Switzerland
| | - Ryan David Kennedy
- Institute for Global Tobacco Control, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
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Severini G, Sandoval RC, Sóñora G, Sosa P, Gutkowski P, Severini L, Valdivia V, Sebrié EM. Towards a smoke-free world? South America became the first 100% smoke-free subregion in the Americas. Rev Panam Salud Publica 2022; 46:e103. [PMID: 36211249 PMCID: PMC9534353 DOI: 10.26633/rpsp.2022.103] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 03/14/2022] [Indexed: 11/24/2022] Open
Abstract
Almost 20 years after the launching by the Pan American Health Organization of its “Smoke-Free Americas” initiative in 2001, in December 2020, South America became the first subregion in the Americas to accomplish 100% smoke-free environments in line with Article 8 of the World Health Organization Framework Convention on Tobacco Control (FCTC). Some of these countries adopted legal measures that are more robust than others, including in their laws specific outdoor places in the smoking ban (like Argentina and Uruguay) and/or novel nicotine and tobacco products under their scope (like Ecuador and Paraguay). The 10 countries took different paths to adopt this public health measure, either through executive or legislative measures or a combination of both. A few countries, like Argentina, Brazil, and Venezuela, started at the subnational level and then moved on to the national level, similar to the rest of the countries. For achieving this milestone, an adequate context was crucial: the broad ratification of the FCTC and the relevance given to the human right to health, civil society efforts, commitments made by intergovernmental bodies, media and communication strategies, and the development of scientific evidence. Countries faced obstacles, including the well-known interference of the tobacco industry, which among other strategies used litigation; however, courts and judges upheld comprehensive legal measures on smoke-free environments. The process by which South America achieved this milestone represents a role model for other subregions of the Americas and the world.
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Affiliation(s)
- Gianella Severini
- Campaign for Tobacco-Free Kids, Washington, D.C., United States of America
| | | | - Gustavo Sóñora
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Patricia Sosa
- Campaign for Tobacco-Free Kids, Washington, D.C., United States of America
| | - Patricia Gutkowski
- Campaign for Tobacco-Free Kids, Washington, D.C., United States of America
| | - Luciana Severini
- Pan American Health Organization, Washington, D.C., United States of America
| | - Víctor Valdivia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Ernesto M. Sebrié
- Campaign for Tobacco-Free Kids, Washington, D.C., United States of America
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Seron P, Lanas F. The urgent need of public policies for promoting cardiovascular health in Latin-American women. LANCET REGIONAL HEALTH. AMERICAS 2021; 4:100114. [PMID: 36776711 PMCID: PMC9903792 DOI: 10.1016/j.lana.2021.100114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 10/21/2021] [Accepted: 10/22/2021] [Indexed: 11/17/2022]
Affiliation(s)
- Pamela Seron
- Internal Medicine Department, Medicine Faculty, Universidad de La Frontera
| | - Fernando Lanas
- Internal Medicine Department, Medicine Faculty, Universidad de La Frontera
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Bardach A, Alcaraz A, Roberti J, Ciapponi A, Augustovski F, Pichon-Riviere A. Optimizing Tobacco Advertising Bans in Seven Latin American Countries: Microsimulation Modeling of Health and Financial Impact to Inform Evidence-Based Policy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5078. [PMID: 34064880 PMCID: PMC8151006 DOI: 10.3390/ijerph18105078] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 12/24/2022]
Abstract
INTRODUCTION In Latin America, tobacco smoking prevalence is between 6.4% and 35.2%. Governments have been making efforts to support the regulation of advertising and, in many cases, banning advertising and promotion of tobacco altogether. The objective of this study was to evaluate the potential impact on health and economic outcomes of optimizing a ban on tobacco advertising and sponsorship in Argentina, Bolivia, Brazil, Chile, Colombia, Mexico, and Peru. METHODS We built a probabilistic microsimulation model, considering natural history, direct health system costs, and quality of life impairment associated with main tobacco-related diseases. We followed individuals in hypothetical cohorts and calculated health outcomes on an annual basis to obtain aggregated 10-year population health outcomes (deaths, events, healthy years of life) and costs. To populate the model, we performed a rapid review of literature to calculate intervention effectiveness. RESULTS With current policies, over 10 years, in Argentina, Bolivia, Brazil, Chile, and Colombia a total of 50,000 deaths and 364,000 disease events will be averted, saving $7.2 billion. If the seven countries strengthened their policies and implemented a comprehensive ban with 100% compliance, 98,000 deaths and 648,000 events would be averted over 10 years, saving almost $15 billion in healthcare costs. CONCLUSIONS Optimizing a ban on tobacco advertising and sponsorship would substantially reduce deaths, diseases, and health care costs attributed to smoking. Latin American countries should not delay the full implementation of this strategy.
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Affiliation(s)
- Ariel Bardach
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Andrea Alcaraz
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
| | - Javier Roberti
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Agustín Ciapponi
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Federico Augustovski
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
| | - Andrés Pichon-Riviere
- Department of Health Technology Assessment and Economic Evaluation, Institute for Clinical Effectiveness and Health Policy, Ravignani 2024, Buenos Aires 1414, Argentina; (A.B.); (A.A.); (A.C.); (F.A.); (A.P.-R.)
- CIESP–CONICET, Centre for Research in Epidemiology and Public Health/National Scientific and Technical Research Council, Ravignani 2024, Buenos Aires 1414, Argentina
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Khokhar MA, Siddiqi K. Smoke-Free Policies in the Global South. NICOTINE & TOBACCO RESEARCH : OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON NICOTINE AND TOBACCO 2020; 22:2125-2126. [PMID: 33049050 DOI: 10.1093/ntr/ntaa210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 10/06/2020] [Indexed: 11/14/2022]
Affiliation(s)
- Mariam A Khokhar
- Department of Health Sciences, University of York, Heslington, York, UK
| | - Kamran Siddiqi
- Department of Health Sciences, University of York, Heslington, York, UK
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