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Buszkiewicz JH, Xie Y, Cohen A, Vander Woude C, Colston DC, Patrick ME, Elliott MR, Levy DT, Thrasher JF, Fleischer NL. Interaction Between State-Level Cigarette Prices and County-Level Tobacco 21 Coverage on Cigarette Smoking Outcomes Among US Adolescents. J Adolesc Health 2024; 75:508-515. [PMID: 39001755 DOI: 10.1016/j.jadohealth.2024.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2023] [Revised: 05/28/2024] [Accepted: 05/29/2024] [Indexed: 07/15/2024]
Abstract
PURPOSE To examine whether Tobacco 21 (T21) law coverage moderated associations between cigarette prices and adolescent smoking and associated disparities. METHODS We used nationally representative, repeated cross-sectional 2014-2020 Monitoring the Future study data (n = 20,547-96,083) to examine associations between state-level average cigarette price per pack and county-level T21 coverage (100% vs. < 100%) on past 30-day smoking participation, first and daily cigarette smoking initiation, and smoking intentions in US adolescents in eighth, 10th, and 12th grade. We implemented weighted, grade-stratified, modified Poisson regression models to test for interactions between price and T21 coverage for each outcome. We also tested for disparities by sex, race and ethnicity, parental education, and college educational expectations. RESULTS Higher cigarette prices were associated with a lower probability of past 30-day smoking participation among eighth graders in counties with < 100% T21 coverage (average marginal effect = -0.003, 95% confidence interval = -0.006, 0.000) but not among eighth graders in counties with 100% T21 coverage (average marginal effect = 0.001, 95% confidence interval = -0.001, 0.004) (p for interaction = 0.005). There were no associations with other smoking outcomes or grades or evidence of differential associations by sociodemographic factors. DISCUSSION Our findings suggested that higher cigarette prices were associated with lower adolescent smoking among eighth graders living in counties with < 100% T21 coverage. However, no such association was observed in other grades or smoking outcomes. Further investigation is necessary to determine the best combination of policies to reduce adolescent smoking, related sociodemographic disparities, and the use of other tobacco products in areas with fewer tobacco control policies.
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Affiliation(s)
- James H Buszkiewicz
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan.
| | - Yanmei Xie
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Anne Cohen
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Catherine Vander Woude
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - David C Colston
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan; Department of Health Behavior, University of North Carolina, Chapel Hill, North Carolina
| | - Megan E Patrick
- Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - Michael R Elliott
- Department of Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan; Survey Research Center, Institute for Social Research, University of Michigan, Ann Arbor, Michigan
| | - David T Levy
- Department of Oncology, Georgetown Lombardi Comprehensive Cancer Center, Georgetown University, Washington, D.C
| | - James F Thrasher
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina; Department of Tobacco Research, Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Nancy L Fleischer
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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Visscher K, Everaars B, Suijkerbuijk AW, Lambooij M, de Wit GA. Intended changes in smoking behaviour of Dutch young adults after an increase in excise tax: a cross-sectional survey. BMJ Open 2023; 13:e065535. [PMID: 38154901 PMCID: PMC10759063 DOI: 10.1136/bmjopen-2022-065535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/17/2023] [Indexed: 12/30/2023] Open
Abstract
OBJECTIVES Increasing the price of tobacco is one of the most effective measures to reduce the prevalence of smoking. In the Netherlands, the excise tax on tobacco increased by €1.14 in 2020, raising the price of a standard package of cigarettes to €8.00. This study investigates how young adults intend to change their smoking behaviour in the case of hypothetical price increases of a pack of cigarettes, and which background characteristics are associated with intended behaviour change. DESIGN A cross-sectional online survey was carried out between September and November 2020. Smokers indicated how they would react to several hypothetical increases in price. Four behavioural options were investigated: smoking less, quitting smoking, switching to another/cheaper product and buying cheaper cigarettes cross-border. PARTICIPANTS Data were obtained from 776 Dutch smokers between 15 and 25 years. RESULTS At a hypothetical price of €10 per package, most respondents reported an intention to smoke less (67%), followed by switching to another/cheaper product (61%), quitting smoking (49%) and shopping for cigarettes cross-border (47%). Prior quit attempts, agreeing with the increase in excise tax and the intention to quit smoking in the future increased the odds of changing behaviour. Higher self-efficacy decreased the odds of behavioural change. CONCLUSION Many young adults intend to change their smoking behaviour in the event of increased prices. Although intended behaviour can deviate significantly from actual behaviour, an increase in excise tax may result in a significant amount of quit attempts and reduced smoking among young adults.
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Affiliation(s)
- Kirsten Visscher
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Babette Everaars
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Anita Wm Suijkerbuijk
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Mattijs Lambooij
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Erasmus Universiteit Rotterdam Erasmus School of Health Policy and Management, Rotterdam, The Netherlands
| | - G Ardine de Wit
- National Institute for Public Health and the Environment, Bilthoven, The Netherlands
- Department of Health Sciences, VU Amsterdam, Amsterdam, The Netherlands
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Levy DT, Tam J, Jeon J, Holford TR, Fleischer NL, Meza R. Summary and Concluding Remarks: Patterns of Birth Cohort‒Specific Smoking Histories. Am J Prev Med 2023; 64:S72-S79. [PMID: 36935130 PMCID: PMC11193149 DOI: 10.1016/j.amepre.2022.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 12/18/2022] [Accepted: 12/19/2022] [Indexed: 03/21/2023]
Abstract
The Cancer Intervention and Surveillance Modeling Network (CISNET) Lung Working Group age-period-cohort methodology to study smoking patterns can be applied to tackle important issues in tobacco control and public health. This paper summarizes the analyses of smoking patterns in the U.S. by race/ethnicity, educational attainment, and family income and for each of the 50 U.S. states using the CISNET Lung Working Group age-period-cohort approach. We describe how decision makers, policy advocates, and researchers can use the sociodemographic analyses in this supplement to project state smoking trends and develop effective state-level tobacco control strategies. The all-cause mortality RR estimates associated with smoking for U.S. race/ethnicity and education groups are also discussed in the context of research that measures and evaluates health disparities. Finally, the application of the CISNET Lung Working Group age-period-cohort methodology to Brazil is reviewed with a view to how the same types of analyses can be applied to other low- and middle-income countries.
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Affiliation(s)
- David T Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia.
| | - Jamie Tam
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Jihyoun Jeon
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Theodore R Holford
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
| | - Nancy L Fleischer
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan; Department of Integrative Oncology, BC Cancer Research Institute, Vancouver, British Columbia, Canada
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Patrick ME, Parks MJ, Carroll DM, Mitchell C. Feasibility of mailed biomarker data collection among U.S. young adults: Saliva-based cotinine and self-reported nicotine use. Drug Alcohol Depend 2023; 244:109791. [PMID: 36753804 PMCID: PMC9975042 DOI: 10.1016/j.drugalcdep.2023.109791] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/21/2022] [Accepted: 01/28/2023] [Indexed: 02/04/2023]
Abstract
BACKGROUND Nationally representative self-report studies are the standard for data on the prevalence of substance use. Newly emerging biomarker assessments can add objective measurements of exposure. However, biomarker assessment has typically depended on in-person sample collection. The current study examined whether young adults in a national sample would be willing and able to provide a saliva sample via mail, and the correspondence of cotinine in the saliva sample with self-reported vaping and smoking. METHODS Data collection for the Monitoring the Future (MTF) Vaping Supplement was from September to November 2020. Eligible participants (N = 4358) were selected from a nationally-representative sample of US 12th-grade students in MTF in spring 2019. The MTF Vaping Supplement surveyed individuals nationally about one year after the 12th grade MTF survey (in 2020, mean age = 19.6 years; N = 1244). Survey weights accounted for design and attrition. RESULTS Of those surveyed, 66.2% consented to provide a saliva sample and, of those, 73.8% mailed a sample. There were no significant differences in providing a saliva sample across any demographic characteristic, but those who reported nicotine use were less likely to provide a sample. Cotinine cut-off measures of > 3 ng/mL and > 10 ng/mL had good correspondence with self-reported measures. CONCLUSIONS Results support the feasibility of collecting saliva via the mail in a national sample and the validity of data collected in this way. These findings support future research innovations to expand existing survey research protocols to include biomarker data collection in representative samples of young adults.
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Affiliation(s)
- Megan E Patrick
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, USA.
| | - Michael J Parks
- Center for Applied Research and Educational Improvement, University of Minnesota, 1954 Buford Ave., St. Paul, MN 55108, USA; Butler Center for Research, Hazelden Betty Ford Foundation, 15251 Pleasant Valley Rd., Center City, MN 55012, USA
| | - Dana Mowls Carroll
- Division of Environmental Health Sciences, School of Public Health, University of Minnesota, 420 Delaware St. SE, Minneapolis, MN 55455, USA
| | - Colter Mitchell
- Institute for Social Research, University of Michigan, 426 Thompson St., Ann Arbor, MI 48106-1248, USA
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Di X, Liu S, Xie H, Zeng X, Meng Z, Xiao L. Cigarette availability and affordability among Chinese youth smokers: Findings from the 2019 China Youth Tobacco Survey. Tob Induc Dis 2022; 20:89. [PMID: 36330276 PMCID: PMC9580065 DOI: 10.18332/tid/152511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Preventing youth from tobacco use is a priority for tobacco control in China, and the government has taken many measures such as introducing tobacco control in the health education curriculum, banning smoking in school, promoting smoke-free household, and advocacy campaigns. The objective of this study was to understand the availability and affordability of cigarettes for middle school (MS) and high school (HS) students in China. METHODS The data were extracted from the 2019 China National Youth Tobacco Survey, which was a school-based cross-sectional survey with a nationally representative sample of 288192 MS and HS students. The survey employed a randomized multistage stratified cluster sampling design with probability proportional to size sampling method and used an anonymous self-administrated questionnaire to collect data. The availability and affordability of cigarettes were analyzed, and all parameter estimates were weighted to account for the complex sampling design. RESULTS In 2019, an estimated 80.5% of current smokers who were aged <18 years bought cigarettes in the past 30 days. Among them, 83.3% (83.0% of males and 85.2% of females; and 76.5% in MS and 87.6% in HS) had not been refused purchase of cigarettes because they were underage, with 84.1% in urban and 82.9% in rural areas, and 87.3% in central, 83.4% in eastern, and 80.5% in western regions of China. Among current smokers who bought cigarettes in the past 30 days, 77.3% had bought a pack of cigarettes (20 cigarettes) costing >10 RMB and at least 61.4% had more pocket money per week than the cost of a pack of cigarettes. Although 84.2% of current smokers bought cigarettes by the pack, 9.2% of current smokers reported that they bought cigarettes as sticks. CONCLUSIONS Although the youth smoking rate dropped down from 2014 to 2019, the proportion of youth smokers that bought cigarettes was still high in China. Due to the high amount of pocket money, the current cigarette price was not an effective price barrier to prevent youth smoking. Selling cigarettes by the stick worsens the situation. Strengthening the enforcement of the 2021 Law on the Protection of Minors, increasing tobacco taxes and prices, and forbidding the selling of cigarette sticks, might assist the progress in youth tobacco control.
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Affiliation(s)
- Xinbo Di
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Shiwei Liu
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Huiyu Xie
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Xinying Zeng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Zida Meng
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Lin Xiao
- Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
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Liu H, Qi Q, Duan Y, Ma C, Zhou C. Sex and macroeconomic differences and trends in early attempts at cigarette smoking among adolescents: findings from 147 countries. BMC Med 2022; 20:311. [PMID: 36131270 PMCID: PMC9494856 DOI: 10.1186/s12916-022-02512-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 08/03/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most tobacco users initiate smoking during adolescence. Little is known about the global prevalence and trends in early cigarette smoking among adolescents. This study aimed to evaluate the prevalence of early attempts at cigarette smoking and its change trends among young adolescents. METHODS We used data from the Global Youth Tobacco Surveys on adolescents aged 12-16 years, comprising 456,634 participants from 147 countries between 2006 and 2018, to estimate the prevalence of early attempts at cigarette smoking and age distribution at attempt by sex, country income, purchasing power parity (PPP) per capita, and WHO region. We assessed the average annual rate of reduction (AARR) in the prevalence of attempts at cigarette smoking before 12 years of age in 70 countries that had data from three or more surveys completed between 1999 and 2018. RESULTS The average prevalence of early attempts at cigarette smoking was 12.2% (95% CI: 10.9-13.5) for boys and 6.7% (95% CI: 5.8-7.6) for girls, with the highest prevalence of 17.4% for boys and 10.7% for girls in the European region. Along with the growth of the national economy, the prevalence of early attempts at cigarette smoking gradually increased in both sexes. A total of 22.9% and 30% of countries had a negative change in AARR for boys and for girls, respectively. The countries with an upward prevalence were mainly located in the Eastern Mediterranean, Southeast Asia, and African regions. The age distribution at first cigarette smoked did not differ substantially between sexes. Notably, the age at first cigarette smoked of 10.7 years for girls was significantly earlier than that of 11.8 years for boys in low-income countries. Among cigarette-smoking adolescents, the average percentage of girls reporting smoking their first cigarette at an age <12 years was 55.7% in Q1 for PPP quintiles, 46.5% in Q2, 40.3% in Q3, 38.4% in Q4, and 34.6% in Q5, and the corresponding prevalence for boys was 46.0% in Q1, 42.8% in Q2, 42.9% in Q3, 43.5% in Q4, and 41.1% in Q5. CONCLUSIONS The global prevalence of early attempts at cigarette smoking among adolescents was substantial, with differences by sex and macroeconomic situation, and our findings stress that interventions and policies targeting the first smoking experience are required to prevent the initiation of tobacco use among early adolescents, especially girls in low-income countries.
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Affiliation(s)
- Huaqing Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.,School of Public Health, Bengbu Medical College, Bengbu, China
| | - Qi Qi
- School of Public Health, Bengbu Medical College, Bengbu, China
| | - Ying Duan
- School of Public Health, Bengbu Medical College, Bengbu, China
| | - Chuanwei Ma
- Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chengchao Zhou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China. .,NHC Key Lab of Health Economics and Policy Research, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, Shandong, China.
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