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Merkaj E, Zhllima E, Imami D, Gjika I, Guerrero-López CM, Drope J. Impact of cigarette price and tobacco control policies on youth smoking experimentation in Albania. Tob Control 2024; 33:s38-s43. [PMID: 38443163 PMCID: PMC11187397 DOI: 10.1136/tc-2023-058196] [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: 06/06/2023] [Accepted: 02/17/2024] [Indexed: 03/07/2024]
Abstract
BACKGROUND Albania has one of the highest smoking prevalence in Europe especially among the youth. There is a lack of evidence in Albania, as well as in most of Eastern Europe and middle-income countries, regarding the effect of price on smoking experimentation. OBJECTIVE The study aims to assess the effect of price and tobacco control policies on youth smoking experimentation in Albania. METHODS We used microdata from the Global Youth Tobacco Survey in Albania for 2004, 2009, 2015 and 2020. We constructed a pseudo-longitudinal dataset and estimated a split-population model to assess the hazard of smoking experimentation. RESULTS Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females (p<0.001). Being male increases the odds for smoking experimentation by more than 50% as compared with females (p<0.001), whereas females appear to be more price sensitive. Peer and parent smoking are also important determinants for smoking experimentation. Introducing penalties for smokers and legal entities violating smoke-free policies implemented in 2014 is also associated with a lower hazard of smoking experimentation. CONCLUSION Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females. A combination of increasing taxes and strengthening the rule of law to control tobacco use in public spaces, in addition to public awareness campaigns targeting both youth and smoking parents, could help to significantly reduce the probability of smoking experimentation.
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Affiliation(s)
| | - Edvin Zhllima
- Agricultural University of Tirana, Tirana, Albania
- Development Solutions Associates (DSA), Tirana, Albania
| | - Drini Imami
- Agricultural University of Tirana, Tirana, Albania
- Development Solutions Associates (DSA), Tirana, Albania
| | | | | | - Jeffrey Drope
- Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Abebe MG, Alemayehu AM, Munaw MB, Tilahun MM, Alemayehu HB. Prevalence and associated factors of refractive error among adults in South Ethiopia, a community-based cross-sectional study. PLoS One 2024; 19:e0298960. [PMID: 38527026 PMCID: PMC10962790 DOI: 10.1371/journal.pone.0298960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 02/01/2024] [Indexed: 03/27/2024] Open
Abstract
INTRODUCTION The increasing prevalence of refractive error has become a serious health issue that needs serious attention. However, there are few studies regarding the prevalence and associated factors of refractive error at the community level in Ethiopia as well as in the study area. Therefore, providing updated data is crucial to reduce the burdens of refractive error in the community. OBJECTIVE To assess the prevalence and associated factors of refractive error among adults in Hawassa City, South Ethiopia, 2023. METHOD A community-based cross-sectional study was conducted on 951 adults using a multistage sampling technique from May 8 to June 8, 2023, in Hawassa City, South Ethiopia. A pretested, structured questionnaire combined with an ocular examination and a refraction procedure was used to collect data. The collected data from the Kobo Toolbox was exported to a statistical package for social sciences for analysis. Binary and multivariable logistic regression analyses were performed. A P-value of less than 0.05 was considered statistically significant in the multivariable analysis. RESULT A total of 894 study participants were involved in this study with a 94.1% response rate. The prevalence of refractive error was 12.3% (95% CI: 10.2, 14.5%). Regular use of electronic devices (adjusted odds ratio = 3.64, 95% CI: 2.25, 5.91), being diabetic (adjusted odds ratio = 4.02, 95% CI: 2.16, 7.48), positive family history of refractive error (adjusted odds ratio = 2.71, 95% CI 1.59, 4.61) and positive history of cataract surgery (adjusted odds ratio = 5.17, 95% CI 2.19, 12.4) were significantly associated with refractive error. CONCLUSION AND RECOMMENDATION The overall magnitude of refractive error in our study area was high. Regular use of electronic devices, being diabetic, positive family history of refractive error, and a positive history of cataract surgery were associated with refractive error.
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Affiliation(s)
- Marshet Gete Abebe
- Department of Ophthalmology and Optometry, Hawassa University, Comprehensive Specialized Hospital, Hawassa, Ethiopia
| | - Abiy Maru Alemayehu
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Minychil Bantihun Munaw
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Mikias Mered Tilahun
- Department of Optometry, School of Medicine, University of Gondar, Comprehensive Specialized Hospital, Gondar, Ethiopia
| | - Henok Biruk Alemayehu
- Department of Ophthalmology and Optometry, Hawassa University, Comprehensive Specialized Hospital, Hawassa, Ethiopia
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Barker HE, Czaplicki L, Cui Y, Shen R, Nian Q, Xie M, Cohen JE. Exposure to and Appeal of Tobacco Ads and Displays in China: A Qualitative Exploration of Chinese Youth Perceptions. Nicotine Tob Res 2024; 26:427-434. [PMID: 37788378 PMCID: PMC10959156 DOI: 10.1093/ntr/ntad192] [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: 03/18/2023] [Revised: 09/15/2023] [Accepted: 09/29/2023] [Indexed: 10/05/2023]
Abstract
INTRODUCTION Adolescents are uniquely vulnerable to nicotine addiction, and smoking is common among male adolescents in China. Although China implemented a ban on cigarette and e-cigarette advertising in public places, Chinese youth remain exposed to this marketing, which may contribute to future use. AIMS AND METHODS From December 2021 to January 2022, we conducted 20 online focus group discussions with 119 adolescents in 10 Chinese cities to explore sources of tobacco marketing exposure, defined as exposure to cigarette and e-cigarette ads and product displays, and what features made marketing attractive. RESULTS All groups discussed exposure to tobacco ads/displays in public places, including locations near their home or school. Nearly all groups discussed that exposure to online tobacco ads was common, particularly exposure to e-cigarette commercial ads and posts made by classmates or friends selling e-cigarettes. Most groups identified how eye-catching colors, imagery, product packaging, and price promotions featured in e-cigarette ads/displays attracted their attention. CONCLUSIONS Results suggest Chinese adolescents are exposed to cigarette and e-cigarette ads and displays, many of which are placed in youth-friendly locations and contain youth-appealing features. IMPLICATIONS Only a handful of studies have examined the influence of cigarette and e-cigarette advertising on youth in the context of China. Prior research has established the relationship between youth exposure to tobacco marketing and increased susceptibility to future use. Our findings emphasize the importance of effectively enforcing and expanding restrictions on cigarette and e-cigarette marketing in order to protect youth from exposure and future smoking/vaping initiation.
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Affiliation(s)
- Hannah E Barker
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Lauren Czaplicki
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Yuxian Cui
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Rachel Shen
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Qinghua Nian
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
| | - Marn Xie
- Rising Sun Marketing Research and Consulting, Shanghai, People’s Republic of China
| | - Joanna E Cohen
- Institute for Global Tobacco Control, Department of Health, Behavior and Society, Johns Hopkins Bloomberg Schools of Public Health, Baltimore, MD, USA
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He Y, Yang Q, Lu B, Shang C. The Association Between the License Fee Increase and the Density of Tobacco Retailers in California-A Segmented Interrupted Time-Series Analysis by Income and Race/Ethnicity. Nicotine Tob Res 2024; 26:177-184. [PMID: 37702761 DOI: 10.1093/ntr/ntad174] [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: 10/11/2022] [Revised: 08/04/2023] [Accepted: 09/08/2023] [Indexed: 09/14/2023]
Abstract
INTRODUCTION On May 9, 2016, the State of California passed a law to increase the licensing fee for tobacco retailers from a one-time-only fee of $100 to an annual fee of $265, effective on June 9, 2016. This study investigates the association between this fee increase and retailer densities by neighborhood income and race/ethnicity characteristics. METHODS We obtained quarterly data on the number of active tobacco retailer licenses from 2011 to 2020 in every zip code in California from the California Department of Tax and Fee Administration. These data were then linked to zip code-level income, race/ethnicity, and population measures. We used a single-group segmented interrupted time-series analysis to assess the association between the increase in licensing fees and retailer densities by neighborhood income and race/ethnicity. RESULTS After the implementation of the annual licensing fees, the retailer density decreased both immediately and gradually. Specifically, the retailer density dropped by 0.47 in the first quarter following the intervention. Compared to the pre-intervention time trend, the retailer density decreased quarterly by 0.05. Furthermore, the impacts of increasing licensing fees were more pronounced in low-income and the majority Black zip codes. CONCLUSIONS Given that higher smoking prevalence is associated with greater tobacco outlet density, the licensing fee increase could be an effective policy tool to reduce tobacco use among economically disadvantaged and minority Black communities, thereby addressing tobacco-use disparities. IMPLICATIONS This study used the single-group segmented interrupted time-series analysis to assess the association between the licensing fee increase and tobacco retailer densities by neighborhood income and race/ethnicity. We found that this licensing fee increase was associated with reduced retailer densities and the total number of active retailers right after the implementation. We further found that the annual licensing fee policy had a continuous effect in reducing tobacco retailer densities in all zip codes. The impacts of increasing licensing fees were more pronounced in low-income and majority of Black zip codes.
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Affiliation(s)
- Yanyun He
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Bo Lu
- Division of Biostatistics, College of Public Health, The Ohio State University, Columbus, OH, USA
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Wexner Medical Center, Columbus, OH, USA
- Department of Internal Medicine, Medical Oncology Division, The Ohio State University, Columbus, OH, USA
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Paraje GR, Jha P, Savedoff W, Fuchs A. Taxation of tobacco, alcohol, and sugar-sweetened beverages: reviewing the evidence and dispelling the myths. BMJ Glob Health 2023; 8:e011866. [PMID: 37813440 PMCID: PMC10565262 DOI: 10.1136/bmjgh-2023-011866] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 06/05/2023] [Indexed: 10/13/2023] Open
Abstract
The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol, and SSB is price-responsive and that tax changes are quickly passed on to consumers. This suggests that taxes can be highly effective in changing consumption and reducing the burden of diseases associated with consuming these products. Tobacco, alcohol, and SSB industries oppose taxation on similar grounds, mostly on the regressivity of taxes since regressive taxes take a larger percentage of income from low income earners than from middle and high income earners; but also on the effects taxes might have on employment and economic activity; and, in the case of tobacco, the effects taxation has on illicit trade.Contrary to industry arguments, evidence shows that taxation may have short-term negative financial consequences for low-income households. However, medium and long-term financial benefits from reduced healthcare costs, better health, and welfare largely compensate for such consequences. Moreover, taxation does not negatively affect aggregate economic activity or employment, as consumers switch demand to other products that generate employment and may compensate for any employment loss in taxed sectors. Evidence also shows the revenues generated are generally spent on labour-intensive services. In the case of illicit trade in tobacco, evidence shows that illicit trade has not increased globally (rather the opposite) despite increases in tobacco taxes. Profit-maximising smugglers increase illicit cigarette prices along with the increases in licit cigarette prices. This implies that even when increased taxes divert some demand to the illicit market, they push prices up in the illicit market, discouraging consumption.
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Affiliation(s)
- Guillermo R Paraje
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago de Chile, Chile
- Millennium Nucleus for the Evaluation and Analysis of Drug Policies (nDP), Santiago de Chile, Chile
| | - Prabhat Jha
- CGHR, Centre for Global Health Research, St. Michael's Hospital and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | - Alan Fuchs
- World Bank, Washington, District of Columbia, USA
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Tuvdendorj A, Feenstra T, Buskens E. Cost-Effectiveness of Four Tobacco Control Interventions in Mongolia. Nicotine Tob Res 2023; 25:1719-1726. [PMID: 37478493 PMCID: PMC10475601 DOI: 10.1093/ntr/ntad111] [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: 07/29/2022] [Revised: 05/12/2023] [Accepted: 07/15/2023] [Indexed: 07/23/2023]
Abstract
INTRODUCTION The aim of this study is to quantify the cost-effectiveness of four tobacco control interventions: Tobacco taxation, mass media campaigns, school programs, and cessation support, and to illustrate how available evaluation tools can be adapted to the local setting. AIMS AND METHODS We used the dynamic population health modeling-health impact assessment tool to project the future smoking prevalence associated with the interventions and to simulate the resulting smoking-related disease burden over time. Applying the most recent available national Mongolian data as input, the costs and effects of four interventions were compared to a business-as-usual scenario, resulting in costs per life year gained and per disability-adjusted life years (DALYs) averted. RESULTS Three years after implementation, all interventions reduce the prevalence of current smoking, with the strongest reduction observed with the increase in tobacco tax (5.1% points), followed by mass media campaigns (1.6% points), school programs (1.3% points), and cessation support interventions (0.6% points). School programs were a cost-saving tobacco control intervention compared to current practice in Mongolia, while the other programs resulted in additional costs compared to business as usual. Compared to the World Health Organization (WHO) thresholds, all interventions would be considered "very cost-effective" in terms of cost per DALY averted (below US$ 4295 per DALY averted) in Mongolia. CONCLUSIONS Large-scale interventions such as taxation and mass media campaigns result in both cost-effectiveness and important health benefits in relation to intervention costs. Reducing the prevalence of smoking among the male population would be particularly worthwhile in Mongolia. IMPLICATIONS This study shows that in Mongolia school programs were a cost-saving intervention, while the cost-effectiveness ratios were US$ 25 per disability-adjusted life year (DALY) averted for mass media campaigns, US$ 74 for taxation, and US$ 1961 for cessation support interventions. Compared to the WHO thresholds, all interventions would be considered "very cost-effective" in terms of expenses per DALY averted (
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Affiliation(s)
- Ariuntuya Tuvdendorj
- Department of Health Policy, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Talitha Feenstra
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Faculty of Science and Engineering, Groningen Research Institute of Pharmacy, University of Groningen, Groningen, The Netherlands
- Faculty of Science and Engineering, Centre for Nutrition, Prevention, and Health Services, Institute for Public Health and the Environment, Bilthoven, The Netherlands
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Kjeld SG, Jørgensen MB, Aundal M, Bast LS. Price elasticity of demand for cigarettes among youths in high-income countries: a systematic review. Scand J Public Health 2023; 51:35-43. [PMID: 34609239 DOI: 10.1177/14034948211047778] [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] [Indexed: 02/04/2023]
Abstract
Aims: Smoking in youth remains a major public health issue. As increasing tobacco prices is considered one of the most effective prevention strategies, examining youth's responsiveness to price changes on cigarettes will provide crucial knowledge. This study aims systematically to review research examining the price elasticity of demand for cigarettes among youths (<30 years of age) in high-income countries. Methods: Searches were conducted in three databases (Web of Science, Pubmed and Scopus). Inclusion criteria were publications within the past 10 years (2011-2021) written in English and with a population of youths below 30 years of age, concerning price elasticity of demand for cigarettes and from high-income countries. Searches were screened by two independent reviewers and the quality of studies was assessed using a quality assessment tool. Results: Four outcomes related to price elasticity of demand for cigarettes were examined in six studies included in this review; that is, cigarette initiation, consumption, prevalence and cessation. Overall, findings indicate that increasing tobacco prices affect youth tobacco use. The effect was associated with gender and age; young women were more price sensitive concerning smoking initiation, whereas young men were more price sensitive concerning cigarette prevalence and consumption. Moreover, younger age was associated with higher price elasticity. Conclusions: Estimates for price elasticity varied across the included studies. This may be caused by differences in data sources, collection methods used and country of origin. Most included studies were of older date. Therefore, to make reliable predictions of the expected effects of increased tobacco prices, further examinations of up-to-date and locally embedded measures are required.
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Affiliation(s)
- Simone Gad Kjeld
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Maria Aundal
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Denmark
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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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Cruces G, Falcone G, Puig J. Differential price responses for tobacco consumption: implications for tax incidence. Tob Control 2022; 31:s95-s100. [PMID: 35017265 DOI: 10.1136/tobaccocontrol-2021-056846] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 12/11/2021] [Indexed: 01/02/2023]
Abstract
Increasing tobacco taxes is considered the most effective an cost-effective policy to reduce tobacco consumption. However, a common objection to tobacco taxes is that they tend to rely disproportionately on the poorest individuals since less affluent smokers incur proportionately greater expenditures on cigarettes compared with more affluent smokers. Such objections usually assume that all smokers throughout the income distribution react similarly to an increase in tobacco prices. But, if less affluent smokers are more sensitive to price changes (ie, they have a higher demand price elasticity), reductions in tobacco consumption should be higher at the bottom of the income distribution. This paper uses data from Argentina's Household Expenditure Survey to estimate demand price elasticities for tobacco by income and age groups. Results indicate that less affluent smokers present higher demand price elasticities for cigarettes than more affluent ones. A 10% increase in cigarette prices would decrease consumption by 8.5% (4.4%) for the poorest (richest) smokers. In addition, young people are the most elastic group. These differential elasticities have relevant implications in terms of the distributional incidence of increasing tobacco taxes. As less well-off individuals reduce consumption relatively more, they bear a relatively lower tax burden. Thus, tobacco tax increases may not be regressive as is often believed. As a whole, this paper provides policymakers with relevant arguments for policy discussion and the public debate on common objections to increasing tobacco taxes.
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Affiliation(s)
- Guillermo Cruces
- CEDLAS, Centro de Estudios Distributivos, Laborales y Sociales, IIE-FCE, Universidad Nacional de La Plata, La Plata, Argentina
| | - Guillermo Falcone
- CEDLAS, Centro de Estudios Distributivos, Laborales y Sociales, IIE-FCE, Universidad Nacional de La Plata, La Plata, Argentina
| | - Jorge Puig
- CEDLAS, Centro de Estudios Distributivos, Laborales y Sociales, IIE-FCE, Universidad Nacional de La Plata, La Plata, Argentina
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Cizmovic M, Mugosa A, Kovacevic M, Lakovic T. Effectiveness of tax policy changes in Montenegro: smoking behaviour by socio-economic status. Tob Control 2022; 31:s124-s132. [DOI: 10.1136/tobaccocontrol-2021-056876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 02/27/2022] [Indexed: 12/21/2022]
Abstract
BackgroundThe main goal of this study was to examine the responsiveness of smoking prevalence and cigarette consumption to price and income changes by income groups and the effectiveness of tax policy changes to reduce cigarette consumption in Montenegro.Data and methodsA two-part model was applied to estimate smoking participation, smoking intensity price and income elasticity. The first part of the model applies logit regression, while the second uses Deaton’s model to improve the validity and objectivity of conditional (smoking intensity) elasticity results. A generalised linear model (GLM) was applied to verify robustness. The reason for this is that Deaton’s model is commonly used in the analysis of Household Budget Survey (HBS) data, especially when households do not report the market price. Moreover, using this model, it is possible to capture the shading of quality to price change. The analysis used HBS data (2006–2017).ResultsThe estimates indicate that tobacco pricing policies had a much higher impact on smoking prevalence in the low-income group (price elasticity of −0.595) relative to the high-income group (price elasticity of −0.344). The same conclusion could be drawn for the smoking intensity elasticity: the high-income group was the least affected by changes in price (price elasticity of −0.258). At the same time, the most affected was the low-income group, with price elasticity of −0.424. Poorer households spent a larger share of their budget on cigarettes. The simulation results confirm that increases in the specific excise taxes of 58.3% on tobacco would reduce total cigarette consumption by 11.25% while increasing the collection of government revenue by 8.07%.ConclusionSmoking prevalence and consumption are very responsive to price and income changes, with considerable differences in elasticities between income groups. The taxation policy has a positive impact on changing patterns of consumption and public revenues across each income group. Low-income and middle-income households would benefit the most, while on the other hand, the highest revenue collection was generated from the wealthiest group. Our results align with results obtained so far for other low-income and middle-income countries. This paper contributes to the analysis of the smoking prevalence and cigarette consumption responsiveness to price and income changes, which was conducted for the first time in Montenegro.
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Tarasenko Y, Ciobanu A, Fayokun R, Lebedeva E, Commar A, Mauer-Stender K. Electronic cigarette use among adolescents in 17 European study sites: findings from the Global Youth Tobacco Survey. Eur J Public Health 2022; 32:126-132. [PMID: 34694383 PMCID: PMC8807119 DOI: 10.1093/eurpub/ckab180] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND As new findings on public health implications of electronic cigarette (e-cigarette) use emerge, its surveillance remains of utmost importance. This study examined the latest state of e-cigarette use in youth in 17 European study sites (i.e. 16 countries and the Federation of Bosnia and Herzegovina) using the Global Youth Tobacco Survey (GYTS). METHODS This was an observational study. Cross-sectional data on students aged 11-17 years from the latest available GYTS round completed in 17 study sites were used to estimate crude and adjusted prevalence of e-cigarette use by sex and pocket money. Panel GYTS data from five countries were used for the trend analyses. All analyses were weighted to account for the survey design and non-response. RESULTS Compared to 2014, the age-adjusted prevalence of e-cigarette use more than doubled in Georgia and Italy, and nearly doubled in Latvia. Significantly more male than female students aged 11-17 years reported use of e-cigarettes, with little to no confounding by age, grade and pocket money across countries. Youth with medium or higher amount of pocket money was 20-200% more likely to use e-cigarettes than those with fewer to no pocket money in 14 study sites. DISCUSSION As e-cigarette use is becoming widespread throughout the world, there is variation in use among and between countries. Expanded and consistent surveillance of e-cigarette use by all World Health Organization member states is essential to generate data on the extent and correlates of youth e-cigarette use for evidence-based planning and evaluation of the electronic nicotine delivery systems and electronic non-nicotine delivery systems national and global control programmes.
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Affiliation(s)
- Yelena Tarasenko
- Department of Biostatistics, Epidemiology and Environmental Health Sciences, Jiann-Ping Hsu College of Public Health, Georgia Southern University, Statesboro, GA, USA
- Division of Country Health Programmes, Regional Office for Europe, World Health Organization, WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
| | - Angela Ciobanu
- Division of Country Health Programmes, Regional Office for Europe, World Health Organization, WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
| | - Ranti Fayokun
- No Tobacco Unit, Healthier Populations Division, Health Promotion Department, World Health Organisation, Geneva, Switzerland
| | - Elizaveta Lebedeva
- Division of Country Health Programmes, Regional Office for Europe, World Health Organization, WHO European Office for the Prevention and Control of NCDs, Moscow, Russian Federation
| | - Alison Commar
- No Tobacco Unit, Healthier Populations Division, Health Promotion Department, World Health Organisation, Geneva, Switzerland
| | - Kristina Mauer-Stender
- Division of Country Support and Emergencies, Regional Office for Europe, World Health Organization, Copenhagen, Denmark
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Tuvdendorj A, Konings SRA, Purevdorj B, Buskens E, Feenstra TL. Reducing the Burden of Disease Through Tobacco Taxes in Mongolia: A Health Impact Analysis Using a Dynamic Public Health Model. Nicotine Tob Res 2022; 24:233-240. [PMID: 34498055 PMCID: PMC8807155 DOI: 10.1093/ntr/ntab182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Accepted: 09/08/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND/OBJECTIVES Smoking is the leading risk factor for many chronic diseases. The quantitative analysis of potential health gains from reduced smoking is important for establishing priorities in Mongolia's health policy. This study quantifies the effect of tobacco-tax increases on future smoking prevalence and the associated smoking-related burden of disease in Mongolia. METHODS The dynamic model for health impact assessment (DYNAMO-HIA) tool was used. The most recent data were used as input for evaluating tobacco-taxation scenarios. Demographic data were taken from the Mongolian Statistical Information Services. Smoking data came from a representative population-based STEPS survey, and smoking-related disease data were obtained from the health-information database of Mongolia's National Health Center. Simulation was used to evaluate various levels of one-time price increases on tobacco products (25% and 75%) in Mongolia. Conservative interpretation suggests that the population will eventually adjust to the higher tobacco price and return to baseline smoking behaviors. RESULTS Over a three-year period, smoking prevalence would be reduced by 1.2% points, corresponding to almost 40 thousand smokers at the population level for a price increase of 75%, compared to the baseline scenario. Projected health benefits of this scenario suggest that more than 137 thousand quality adjusted of life years would be gained by avoiding smoking-related diseases within a population of three million over a 30-year period. DISCUSSION Prevention through effective tobacco-control policy could yield considerable gains in population health in Mongolia. Compared to current policy, tax increases must be higher to have a significant effect on population health. IMPLICATIONS Tobacco taxation is an effective policy for reducing the harm of tobacco smoking, while benefiting population health in countries where the tobacco epidemic is still in an early stage. Smoking prevalence and smoking behaviors in these countries differ from those in Western countries. Reducing the uptake of smoking among young people could be a particularly worthwhile benefit of tobacco-tax increases.
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Affiliation(s)
- Ariuntuya Tuvdendorj
- Department of Health Policy and Management, School of Public Health, Mongolian National University of Medical Sciences, Ulaanbaatar, Mongolia
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Stefan R A Konings
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Erik Buskens
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Talitha L Feenstra
- University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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Filby S, van Walbeek C. Cigarette prices and smoking among youth in 16 African countries: Evidence from the Global Youth Tobacco Survey. Nicotine Tob Res 2022; 24:1218-1227. [PMID: 35037065 PMCID: PMC9278824 DOI: 10.1093/ntr/ntac017] [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: 07/23/2021] [Revised: 11/10/2021] [Accepted: 01/14/2022] [Indexed: 12/03/2022]
Abstract
Introduction African countries have among the lowest excise taxes in the world. This paper provides new evidence on the association between cigarette prices and youth smoking in 16 African countries. Aims and Methods We use Global Youth Tobacco Survey (GYTS) cross-country data from approximately 67 500 participants. The relationship between prices and youth smoking in Africa is estimated using probit models for smoking participation and generalized linear models for conditional cigarette demand. Each model is estimated using local-brand and foreign-brand cigarette prices. Results Higher prices are associated with lower demand across African countries, for both smoking prevalence and the intensity of cigarette consumption by smokers. The estimated price elasticity of participation is −0.70 [95% CI: −1.28 to −0.12] for local-brand cigarettes and −0.71 [95% CI: −0.98 to −0.44] for foreign-brand cigarettes. The price elasticity of conditional cigarette demand is −0.44 [95% CI: −0.76 to −0.12] for local brands and −0.75 [95% CI: −0.96 to −0.53] for foreign brands. The total price elasticity of demand for youth in our sample is −1.14 for local brands and −1.46 for foreign brands. Conclusions Higher cigarette prices significantly decrease the likelihood of smoking and decrease the intensity of cigarette consumption among African youths. Increases in the excise tax that increase the retail price of cigarettes will play an important role in reducing youth tobacco use on the continent. Governments are encouraged to increase excise taxes in order to improve public health. Implications Evidence on the association between cigarette prices and youth smoking in African countries is limited. The Global Youth Tobacco Survey (GYTS) was first introduced in 1999. In 2012, the Centers for Disease Control and Prevention revised the GYTS questionnaire, which removed some questions and introduced new questions into the survey. To the best of our knowledge, there are no published estimates of the relationship between cigarette prices and demand that have used this more recent individual-level GYTS data for African countries. In conducting this analysis, we add to the limited literature on the association between cigarette prices and youth smoking in Africa.
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Affiliation(s)
- Samantha Filby
- Institutional Research Unit on the Economics of Excisable Products (REEP), School of Economics, University of Cape Town, Cape Town, South Africa
| | - Corne van Walbeek
- Institutional Research Unit on the Economics of Excisable Products (REEP), School of Economics, University of Cape Town, Cape Town, South Africa
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Support of the Implementation of a Whistleblowing System for Smoke-Free Environments: A Mixed Methods Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312401. [PMID: 34886128 PMCID: PMC8656714 DOI: 10.3390/ijerph182312401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 11/26/2022]
Abstract
Enforcement of a smoke-free policy is of vital concern in support of the health of smokers and bystanders. Indonesia has issued a smoke-free law, but implementation and enforcement lie with the regional and municipal governments. In a survey of 225 respondents recruited via schools, knowledge about the health effects of smoking and the smoke-free regulation, as well as attitudes towards and commitment and support of the enforcement of the smoke-free regulation in the Kendari City through an electronic whistleblowing system was examined. Furthermore, the participants were asked about the smoking status and smoking behavior. About half of the respondents were students (teenagers), the other half—their parents. Male respondents were strongly overrepresented (85%). Only 18% of the respondents declared to be smokers, mostly adults and males. Both the smokers and the non-smokers supported the smoke-free law and its enforcement through a whistleblowing system. Representatives of the local government were interviewed and participated in focus group discussions. In general, they also exhibited strong support of an electronic enforcement tool. However, issues of efficiency, costs, and responsibility must still be resolved. Nevertheless, an electronic whistleblowing system has the potential to further the health and livelihoods in a community like the Kendari City.
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Verguet S, Kearns PKA, Rees VW. Questioning the regressivity of tobacco taxes: a distributional accounting impact model of increased tobacco taxation. Tob Control 2021; 30:245-257. [PMID: 32576701 PMCID: PMC8077213 DOI: 10.1136/tobaccocontrol-2019-055315] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 01/09/2023]
Abstract
BACKGROUND Tobacco taxes, as with other 'sin taxes', are generally regarded as a highly cost-effective mechanism to reduce consumption but are often considered by policymakers to be regressive, undermining efforts to fully implement them at levels recommended by the WHO due to concerns of fairness. We aim to demonstrate whether there are circumstances in which the impacts of additional tobacco taxes are not regressive, using a standard income-share accounting definition of tax burden. METHODS AND FINDINGS We apply mathematical modelling and explore the hypothetical distributions in the net change in tobacco taxes and cigarette expenditures by income group, following an increase in tobacco taxation. The hypothetical distribution per income group of additional taxes and cigarette expenditures borne by individuals following tobacco tax hikes was calculated with respect to a selection of parameters including: the change in the retail price of cigarettes, the price elasticity of demand for tobacco, smoking prevalence, cigarette consumption and individual income. We determine the range of hypothetical parameter values for which increased tobacco taxation should not be considered to penalise the poorest income groups when examining marginal cigarette consumption expenditures and using an accounting definition of tax burden. CONCLUSIONS Our findings question the doctrine that tobacco taxes are uniformly regressive from a standard income-share accounting view and point to the importance of the specific features of tax policy to shape a progressive approach to tobacco taxation: tobacco tax increases are less likely to be regressive when accompanied by a broad framework of demand-side measures that enhance the capacity of low-income smokers to quit tobacco use.
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Affiliation(s)
- Stéphane Verguet
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Patrick K A Kearns
- Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Vaughan W Rees
- Center for Global Tobacco Control, Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
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Critchlow N, Moodie C, Best C, Stead M. Anticipated responses to a hypothetical minimum price for cigarettes and roll-your-own tobacco: an online cross-sectional survey with cigarette smokers and ex-smokers in the UK. BMJ Open 2021; 11:e042724. [PMID: 33753438 PMCID: PMC7986940 DOI: 10.1136/bmjopen-2020-042724] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/30/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES As tobacco companies can circumvent tax increases, a minimum retail price per-cigarette/per-gram of roll-your-own tobacco presents an additional mechanism for governments to reduce smoking. We examined (1) anticipated responses to a hypothetical minimum price-per-cigarette/per-gram among smokers in the UK; (2) what demographic and smoker characteristics are associated with anticipated responses; and (3) whether minimum pricing may help ex-smokers stay quit. DESIGN Cross-sectional survey (May-July 2019). SETTING UK. PARTICIPANTS Adult cigarette smokers (n=2412) and ex-smokers (n=700). MAIN OUTCOME MEASUREMENTS Anticipated responses to a hypothetical minimum price of £10.00 for 20 cigarettes (£0.50 per-cigarette) and £13.50 for 30 grams of roll-your-own tobacco (£0.45 per-gram); approximately £0.10 per-cigarette/per-gram increases on the cheapest prices in leading UK supermarkets (January 2019). Smokers were presented with ten options (eg, 'Try to quit') and asked which they would do (Yes/No) and then which they would most likely do. Ex-smokers were asked to what extent the minimum prices would help them stay quit (A lot vs Lesser agreement). RESULTS Among smokers, 55.6% said they would most likely smoke the same amount, 10.7% they would smoke less, 9.5% they would try to quit and 5.8% they would use e-cigarettes more often. Anticipated reactions were associated with demography and smoker characteristics, for example, C2DE (lower social grade) smokers were less likely than ABC1 (higher social grade) smokers to say they would smoke the same as they do now (ORAdj=0.74, 95% CI 0.62 to 0.88). Among ex-smokers, 38.5% said the minimum prices would help them stay quit 'A lot', more so among C2DE than ABC1 participants (ORAdj=1.80, 95% CI 1.30 to 2.49). CONCLUSIONS In response to a hypothetical minimum price for cigarettes and roll-your-own tobacco, approximately a fifth of smokers in the UK indicated they would smoke less or quit and almost two-fifths of ex-smokers indicated the prices would help them stay quit.
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Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Catherine Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Martine Stead
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
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Johannesen CK, Andersen S, Bast LS. Estimating future smoking in Danish youth – effects of three prevention strategies. Scand J Public Health 2020; 49:931-939. [DOI: 10.1177/1403494820942678] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Aims: Preventing smoking and aiding cessation among youth and young adults carries the possibility of reducing future smoking prevalence significantly. This paper estimates the impact on future smoking prevalence of 25 year olds by increasing tobacco prices, securing indoor smoke-free homes and implementing school-based multi-tiered interventions. Methods: Utilizing a multi-state Markov model, a status quo projection of the smoking prevalence from years 2017 to 2030 were compared with projections of the smoking prevalence in 2030 considering the impact of the three prevention strategies. Results: In a status quo projection, 27.0% of Danish 25-year-old females are expected to be smokers in 2030, while 13.2% would be smokers in 2030 were all three prevention strategies in effect from 2019. By itself, increasing tobacco prices by 50% reduced the prevalence of smokers among 25-year-old females to 14.8% in 2030, a relative reduction of 47.5%. For 25-year-old males in 2030 the reductions were similar, with a prevalence of 16.6% when all three prevention strategies were in effect, a relative reduction of 51.5%. Conclusions: Implementing increasing tobacco prices, indoor smoke-free homes and school-based multi-tiered interventions in Denmark is likely to significantly decrease youth smoking prevalence in the future. However, these three strategies will not produce a smoke-free generation without other initiatives.
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Affiliation(s)
| | - Susan Andersen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Lotus Sofie Bast
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
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Chen X, Li H, Lucero-Prisno DE, Abdullah AS, Huang J, Laurence C, Liang X, Ma Z, Mao Z, Ren R, Wu S, Wang N, Wang P, Wang T, Yan H, Zou Y. What is global health? Key concepts and clarification of misperceptions: Report of the 2019 GHRP editorial meeting. Glob Health Res Policy 2020; 5:14. [PMID: 32289081 PMCID: PMC7136700 DOI: 10.1186/s41256-020-00142-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Accepted: 03/09/2020] [Indexed: 11/10/2022] Open
Abstract
The call for "Working Together to Build a Community of Shared Future for Mankind" requires us to improve people's health across the globe, while global health development entails a satisfactory answer to a fundamental question: "What is global health?" To promote research, teaching, policymaking, and practice in global health, we summarize the main points on the definition of global health from the Editorial Board Meeting of Global Health Research and Policy, convened in July 2019 in Wuhan, China. The meeting functioned as a platform for free brainstorming, in-depth discussion, and post-meeting synthesizing. Through the meeting, we have reached a consensus that global health can be considered as a general guiding principle, an organizing framework for thinking and action, a new branch of sciences and specialized discipline in the large family of public health and medicine. The word "global" in global health can be subjective or objective, depending on the context and setting. In addition to dual-, multi-country and global, a project or a study conducted at a local area can be global if it (1) is framed with a global perspective, (2) intends to address an issue with global impact, and/or (3) seeks global solutions to an issue, such as frameworks, strategies, policies, laws, and regulations. In this regard, global health is eventually an extension of "international health" by borrowing related knowledge, theories, technologies and methodologies from public health and medicine. Although global health is a concept that will continue to evolve, our conceptualization through group effort provides, to date, a comprehensive understanding. This report helps to inform individuals in the global health community to advance global health science and practice, and recommend to take advantage of the Belt and Road Initiative proposed by China.
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Affiliation(s)
- Xinguang Chen
- Global Health Institute, Wuhan University, Wuhan, China
- Department of Epidemiology, University of Florida, Florida, USA
| | - Hao Li
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Don Eliseo Lucero-Prisno
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Abu S. Abdullah
- Global Health Research Center, Duke Kunshan University, Kunshan, China
- Duke Global Health Institute, Duke University, Durham, North Carolina USA
| | - Jiayan Huang
- School of Public Health, Fudan University, Shanghai, China
| | | | - Xiaohui Liang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Zhenyu Ma
- School of Public Health, Guangxi Medical University, Guangxi, China
| | - Zongfu Mao
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Ran Ren
- Global Health Research Center, Dalian Medical University, Dalian, China
| | - Shaolong Wu
- School of Public Health, Sun Yat-sen University, Guangzhou, China
| | - Nan Wang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Peigang Wang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Tingting Wang
- Global Health Institute, Wuhan University, Wuhan, China
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Hong Yan
- School of Health Sciences, Wuhan University, Wuhan, China
| | - Yuliang Zou
- School of Health Sciences, Wuhan University, Wuhan, China
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Gjika A, Zhllima E, Rama K, Imami D. Analysis of Tobacco Price Elasticity in Albania Using Household Level Data. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E432. [PMID: 31936433 PMCID: PMC7014105 DOI: 10.3390/ijerph17020432] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/20/2019] [Accepted: 12/24/2019] [Indexed: 12/01/2022]
Abstract
This paper analyzes the determinant factors of tobacco consumption in Albania, which is one of the countries with the highest smoking prevalence in Europe. To empirically estimate the elasticity of cigarettes demand in Albania, the paper uses the Living Standard Measurement Survey (LSMS) applying Deaton's (1988) demand model. This paper estimates an Almost Ideal Demand System (AIDS), which allows disentangling quality choice from exogenous price variations using unit values from cigarette consumption. Following Deaton's model, the results suggest that the demand for tobacco is inelastic, with a price elasticity of -0.57. The price elasticity appears to be within the range of elasticity estimates frequently reported for low- and middle-income countries. The results suggest that total expenditure, household size, male-to-female ratio, and adult ratio are important determinants of tobacco demand in Albania. The increase in the tobacco price, which has been mainly driven by increased excises, has demonstrated a significant impact on reducing tobacco consumption. Consequently, the Albanian government may engage in gradual increases in excise taxes given the inelastic tobacco demand.
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Affiliation(s)
- Aida Gjika
- Faculty of Economics, University of Tirana, Development Solutions Associates and CERGE-EI, 1001 Tirana, Albania;
| | - Edvin Zhllima
- Faculty of Economics and Agribusiness, Agricultural University of Tirana, Development Solutions Associates and CERGE-EI, 1029 Tirana, Albania;
| | - Klodjan Rama
- Faculty of Agriculture and Environment, Agricultural University of Tirana and Development Solutions Associates, 1029 Tirana, Albania;
| | - Drini Imami
- Faculty of Economics and Agribusiness, Agricultural University of Tirana, Development Solutions Associates and CERGE-EI, 1029 Tirana, Albania;
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Dauchy E, Ross H. The effect of price and tax policies on the decision to smoke among men in Kenya. Addiction 2019; 114:1249-1263. [PMID: 30912225 DOI: 10.1111/add.14623] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/16/2018] [Accepted: 03/08/2019] [Indexed: 01/09/2023]
Abstract
AIMS To assess the impact of cigarette prices on male smoking initiation and cessation in Kenya from 1960 to 2014. DESIGN Longitudinal study using individual level data from the 2014 Global Adult Tobacco Survey (GATS) and historical data on cigarette prices. SETTING Kenya. PARTICIPANTS A total of 2079 men, among whom 619 identified as ever-smokers. MEASUREMENTS Self-reported data on the years of smoking initiation and cessation, merged with historical data on cigarette prices. We employed several methodologies to estimate the effect of prices on smoking transitions, including a pooled linear model with propensity score matching (PSM). RESULTS Price increases were negatively associated with smoking initiation, with price elasticity of initiation ranging from -0.03 (-0.066 to -0.000) to -0.14 (-0.216 to -0.0563). The association was two to three times larger for younger male adults compared with the average. Price increases were correlated with increased cessation for younger males, with a price elasticity of 0.08 (0.027-0.141) and for low-income males with a price elasticity of 0.16 (-0.752 to 0.429). CONCLUSIONS Cigarette price increases in Kenya between 1960 and 2014 were negatively associated with males' smoking initiation and positively associated with younger and lower-income males' cessation.
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Affiliation(s)
| | - Hana Ross
- School of Economics, University of Cape Town, South Africa
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21
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Watkins D, Hale J, Hutchinson B, Kataria I, Kontis V, Nugent R. Investing in non-communicable disease risk factor control among adolescents worldwide: a modelling study. BMJ Glob Health 2019; 4:e001335. [PMID: 31139451 PMCID: PMC6509594 DOI: 10.1136/bmjgh-2018-001335] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Revised: 02/12/2019] [Accepted: 02/15/2019] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Exposure to non-communicable disease (NCD) risk factors is increasing among adolescents in most countries due to demographic, economic and epidemiological forces. We sought to analyse the potential health impact and costs of implementing NCD risk reduction interventions among adolescents worldwide. METHODS We identified six interventions targeted at adolescent tobacco smoking, heavy episodic drinking and obesity and supported by effectiveness and cost-effectiveness evidence. Based on a population-level cohort of adolescents in 70 representative countries, we assessed the global mortality consequences of fully implementing these interventions over 2020-2070 using the potential impact fraction approach. We calculated the economic benefits of reduced mortality and estimated the required financial costs, discounting both at 3% annually. We also conducted best-case and worst-case scenario analyses. RESULTS Full implementation of these interventions worldwide could avert nearly 10% of premature deaths among this cohort, translating to about US$400 billion in cumulative economic benefits. Cumulatively, the required costs would be about US$85 billion, suggesting that every US$1 of public money invested would generate US$5 in increased human capital. Tobacco taxes generally conferred the highest economic returns; however, an in-depth analysis of three countries illustrated the potential for different priorities, such as alcohol control, to emerge. CONCLUSION From a life course perspective, implementation of a package of interventions to reduce NCD risk among adolescents worldwide would substantially reduce premature mortality at reasonable costs. Our analysis illustrates the importance of integrating NCD prevention policies into the emerging global agenda for adolescent health and well-being.
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Affiliation(s)
- David Watkins
- Division of General Internal Medicine, University of Washington, Seattle, Washington, USA
| | - Jessica Hale
- Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
| | | | | | - Vasilis Kontis
- School of Public Health, MRC-PHE Centre for Environment and Health, Imperial College London, London, UK
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Pénzes M, Foley KL, Balázs P, Urbán R. Patterns of alternative tobacco product experimentation among ever smoker adolescents. Cent Eur J Public Health 2019; 27:3-9. [PMID: 30927390 DOI: 10.21101/cejph.a5364] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Alternative tobacco product (ATP) use is popular among adolescents in Western countries, however, little is known about factors influencing ATP experimentation in Europe. The aim of this study was to explore factors associated with ATP experimentation, and to identify patterns of ATP experimentation among Hungarian adolescents who had ever tried manufactured cigarette smoking. METHODS Logistic regression analyses were applied to estimate the relationship between individual cigarette smoking experiences, social smoking influences, demographics, and ATP experimentation (roll-your-own (RYO) cigarettes, cigars/cigarillos, waterpipe, traditional pipe and flavoured cigarettes) in a cross-sectional sample of 8th and 11th grade students (N = 1,067, 56.0% of girls) who had ever tried manufactured cigarette smoking in six metropolitan cities of Hungary. Latent class analysis (LCA) was performed to identify patterns of different ATP use. RESULTS Almost 90% of the sample had ever tried ATPs and significantly more commonly older (91.8%) versus younger (79.8%) students. Waterpipe was the most popular product to try followed by flavoured cigarettes, cigars/cigarillos, RYO cigarettes, and pipe. Boys were more likely to report ATP experimentation compared to girls. Younger age of cigarette smoking experimentation, greater frequency of past month cigarette smoking and history of ever daily smoking for 30 days showed strong association with ATP experimentation. Students with one or more smoking friends were more vulnerable to experiment with ATPs. Weekly allowance, school academic achievement and household smoking exposure showed no effect on the experimentation. LCA identified four subgroups of ATP experimenters comprising intense polytobacco experimenters (38.4%), mainly waterpipe experimenters (34.2%), moderate polytobacco experimenters (14.9%), and less interested experimenters (12.5%). CONCLUSION Tobacco prevention programmes targeting adolescents should emphasize the risks of using ATPs in addition to manufactured cigarettes. Accessibility of ATPs should be better regulated and restrictions should be strongly enforced in order to prevent potential harmful consequences of adolescent polytobacco use.
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Affiliation(s)
- Melinda Pénzes
- Institute of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Kristie L Foley
- Department of Implementation Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Péter Balázs
- Institute of Public Health, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Róbert Urbán
- Institute of Psychology, Eotvos Lorand University, Budapest, Hungary
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Critchlow N, Stead M, Moodie C, Angus K, Eadie D, MacKintosh AM. Pricing of tobacco products during, and after, the introduction of standardized packaging: an observational study of retail price data from independent and convenience (small) retailers in the United Kingdom. Addiction 2019; 114:523-533. [PMID: 30554446 PMCID: PMC6491979 DOI: 10.1111/add.14488] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2018] [Revised: 06/28/2018] [Accepted: 10/29/2018] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS Tobacco companies claimed that standardized packaging, phased in/introduced May 2016-May 2017, would reduce prices and increase consumption. We: (1) describe changes in price-per-cigarette and price-per-gram during, and after, the introduction of standardized packaging; (2) describe price changes by cigarette price segment; and (3) analyse price changes by stage of implementation. DESIGN An observational study, using electronic point-of-sale data, monitored price trends in three periods: (1) May-September 2016, start of transition period; (2) October 2016-May 2017, when fully branded and standardized products were sold and duty escalators implemented; and (3) June-October 2017, when standardized packaging was mandatory. SETTING United Kingdom. PARTICIPANTS Small retailers (n = 500) stratified by region and deprivation. Data were monitored for 20 leading fully branded tobacco products [15 factory-made cigarettes (FMC), 5 roll-your-own (RYO)] and their standardized equivalents. MEASUREMENT Price-per-cigarette and price-per-gram, based on monthly average Recommended Retail Price (RRP) and actual sale price, adjusted for inflation using the Consumer Pricing Index (CPIH). Net changes (£GBP, %) were analysed by product type (FMC versus RYO) and FMC price segment (value, mid-price, premium). FINDINGS Between May 2016 and October 2017, the average inflation-adjusted RRP/price-per-cigarette and price-per-gram increased for FMC (all price segments) and RYO. For example, sales price-per-cigarette increased +4.64%, with the largest increases for value (+6.81%), premium (+5.32%) and mid-price FMCs (+3.30%). Net sales price-per-cigarette and price-per-gram increases were largest in period 2, when fully branded and standardized products were sold and duty escalators were implemented (FMC = +4.70%; RYO = +3.75%). There were small decreases in sales price-per-cigarette and price-per-gram once standardized packaging became mandatory (FMC = -1.14%; RYO = -0.88%). CONCLUSION In the United Kingdom, the price of leading roll-your-own and factory-made cigarette brands sold by small retailers increased as standardized packaging was phased in, with increases larger than expected through duty escalation.
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Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of StirlingScotland, UK
| | - Martine Stead
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of StirlingScotland, UK
| | - Crawford Moodie
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of StirlingScotland, UK
- Centre for Tobacco Control Research, Faculty of Health Sciences and SportUniversity of StirlingScotland, UK
| | - Kathryn Angus
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of StirlingScotland, UK
| | - Douglas Eadie
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of StirlingScotland, UK
| | - Anne Marie MacKintosh
- Institute for Social Marketing, and UK Centre for Tobacco and Alcohol Studies, Faculty of Health Sciences and Sport, University of StirlingScotland, UK
- Centre for Tobacco Control Research, Faculty of Health Sciences and SportUniversity of StirlingScotland, UK
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Keller-Hamilton B, Roberts ME, Slater MD, Berman M, Ferketich AK. Adolescent males' responses to blu's fake warnings. Tob Control 2019; 28:e151-e153. [PMID: 30772827 DOI: 10.1136/tobaccocontrol-2018-054805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 01/11/2019] [Accepted: 01/21/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Blu's 'Something Better' advertising campaign ran in popular print magazines in 2017. The campaign included advertisements with fake warnings conveying positive messages, which mimicked the Food and Drug Administration (FDA)'s warning requirements for electronic cigarette (e-cigarette) advertisements that took effect in 2018. We report adolescent males' recall of these fake warnings and how exposure to fake warnings affected recall of other advertisement components, including the actual warning or health risks, brand and product. METHODS Ohio males ages 12-19 years (N = 775; 73.8 % white non-Hispanic) were randomly assigned to view an e-cigarette advertisement with or without a fake warning. Afterward, they were asked what they remembered most about the advertisement. Responses were qualitatively coded. Statistical analyses included survey-weighted descriptive statistics and logistic regression. RESULTS Of participants who viewed an e-cigarette advertisement with a fake warning, 27.0 % reported the fake warning was what they remembered most, and 18.8 % repeated the fake warning message. Participants viewing advertisements with a fake warning had lower odds of recalling the actual warning or health risks (OR = 0.29; 95% CI: 0.11 to 0.77) or brand (OR = 0.43; 95% CI: 0.22 to 0.85), compared with participants viewing other e-cigarette advertisements. CONCLUSIONS Adolescents viewing an advertisement with a fake warning were less likely to recall the advertisement's actual warning or health risks. Although e-cigarette advertisements now carry large FDA-mandated warnings, this tactic could be used for cigarette advertisements that continue to carry small warnings in the USA. Findings underscore the necessity of tobacco advertisement surveillance and study of advertisements' effects on adolescents.
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Affiliation(s)
- Brittney Keller-Hamilton
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Megan E Roberts
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, United States
| | - Michael D Slater
- School of Communication, The Ohio State University, Columbus, Ohio, USA
| | - Micah Berman
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, Ohio, United States.,Moritz College of Law, The Ohio State University, Columbus, Ohio, United States
| | - Amy K Ferketich
- Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, Ohio, USA
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Guindon GE, Paraje GR, Chaloupka FJ. El impacto de los precios e impuestos sobre el consumo de productos de tabaco en América Latina y el Caribe. Am J Public Health 2018. [DOI: 10.2105/ajph.2014.302396s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- G. Emmanuel Guindon
- Centro de Economía de la Salud y Análisis de Políticas y al Departamento de Epidemiología y Bioestadística Clínica, Universidad McMaster, Hamilton (Canadá)
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago (Chile)
- Departamento de Economía y al Instituto de Investigación y Políticas de Salud, Universidad de Illinois, Chicago, y la Oficina Nacional de Investigaciones Económicas de los Estados Unidos, Cambridge, Massachusetts La correspondencia se debe dirigir a G. Emmanuel Guindon: Correo electrónico:
| | - Guillermo R. Paraje
- Centro de Economía de la Salud y Análisis de Políticas y al Departamento de Epidemiología y Bioestadística Clínica, Universidad McMaster, Hamilton (Canadá)
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago (Chile)
- Departamento de Economía y al Instituto de Investigación y Políticas de Salud, Universidad de Illinois, Chicago, y la Oficina Nacional de Investigaciones Económicas de los Estados Unidos, Cambridge, Massachusetts La correspondencia se debe dirigir a G. Emmanuel Guindon: Correo electrónico:
| | - Frank J. Chaloupka
- Centro de Economía de la Salud y Análisis de Políticas y al Departamento de Epidemiología y Bioestadística Clínica, Universidad McMaster, Hamilton (Canadá)
- Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago (Chile)
- Departamento de Economía y al Instituto de Investigación y Políticas de Salud, Universidad de Illinois, Chicago, y la Oficina Nacional de Investigaciones Económicas de los Estados Unidos, Cambridge, Massachusetts La correspondencia se debe dirigir a G. Emmanuel Guindon: Correo electrónico:
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Guindon GE, Paraje GR, Chaloupka FJ. The Impact of Prices and Taxes on the Use of Tobacco Products in Latin America and the Caribbean. Am J Public Health 2018. [DOI: 10.2105/ajph.2014.302396r] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- G. Emmanuel Guindon
- G. Emmanuel Guindon is with the Centre for Health Economics and Policy Analysis and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton. Guillermo R. Paraje is with the Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago, Chile. Frank J. Chaloupka is with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago, and the US National Bureau of Economic Research, Cambridge, MA
| | - Guillermo R. Paraje
- G. Emmanuel Guindon is with the Centre for Health Economics and Policy Analysis and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton. Guillermo R. Paraje is with the Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago, Chile. Frank J. Chaloupka is with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago, and the US National Bureau of Economic Research, Cambridge, MA
| | - Frank J. Chaloupka
- G. Emmanuel Guindon is with the Centre for Health Economics and Policy Analysis and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton. Guillermo R. Paraje is with the Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago, Chile. Frank J. Chaloupka is with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago, and the US National Bureau of Economic Research, Cambridge, MA
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Jarlstrup NS, Juel K, Pisinger CH, Grønbæk M, Holm S, Andersen S. International Approaches to Tobacco Use Cessation Programs and Policy in Adolescents and Young Adults: Denmark. CURRENT ADDICTION REPORTS 2018. [DOI: 10.1007/s40429-018-0187-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Best M, Papies EK. Right Here, Right Now: Situated Interventions to Change Consumer Habits. ACTA ACUST UNITED AC 2017. [DOI: 10.1086/695443] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Hwang JH, Park SW. Is there differential responsiveness to a future cigarette price increase depending on adolescents' source of cigarette access? Medicine (Baltimore) 2017; 96:e7311. [PMID: 28658140 PMCID: PMC5500062 DOI: 10.1097/md.0000000000007311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
We examined whether the responsiveness to an increase in cigarettes price differed by adolescents' cigarette acquisition source. We analyzed data on 6134 youth smokers (grades 7-12) from a cross-sectional survey in Korea with national representativeness. The respondents were classified into one of the following according to their source of cigarette acquisition: commercial-source group, social-source group, and others. Multiple logistic regressions were performed to estimate the effects of an increase in cigarette price on the intention to quit smoking on the basis of the cigarette acquisition source. Of the 6134 youth smokers, 36.0% acquired cigarettes from social sources, compared to the 49.6% who purchased cigarettes directly from commercial sources. In response to a future cigarette price increase, regardless of an individual's smoking level, there was no statistically significant difference in the odds ratio for the intention to stop smoking in association with cigarette acquisition sources. The social-source group had nonsignificant, but consistently positive, odds ratios (1.07-1.30) as compared to that of the commercial-source group. Our findings indicate that the cigarette acquisition source does not affect the responsiveness to an increase in cigarette price. Therefore, a cigarette price policy is a comprehensive strategy to reduce smoking among youth smokers, regardless of their source.
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Rutter L, Britton J, Langley T. Price-Minimizing Behaviors in Response to Increasing Tobacco Price: A Cross-Sectional Study of Students. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2017. [DOI: 10.1080/1067828x.2017.1306472] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Lucy Rutter
- University of Nottingham, Nottingham, United Kingdom
| | - John Britton
- University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, Nottingham, United Kingdom
| | - Tessa Langley
- University of Nottingham, Nottingham, United Kingdom
- UK Centre for Tobacco and Alcohol Studies, Nottingham, United Kingdom
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Kong G, Bold KW, Simon P, Camenga DR, Cavallo DA, Krishnan-Sarin S. Reasons for Cigarillo Initiation and Cigarillo Manipulation Methods among Adolescents. TOB REGUL SCI 2017; 3:S48-S58. [PMID: 29085867 PMCID: PMC5658780 DOI: 10.18001/trs.3.2(suppl1).6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To understand reasons for cigarillo initiation and cigarillo manipulation methods among adolescents. METHODS We conducted surveys in 8 Connecticut high schools to assess reasons for trying a cigarillo and cigarillo manipulation methods. We used multivariable logistic regressions to assess associations with demographics and tobacco use status. RESULTS Among ever cigarillo users (N = 697, 33.6% girls, 16.7 years old [SD = 1.14], 62.1% White), top reasons for trying a cigarillo were curiosity (41.9%), appealing flavors (32.9%), because "friends use it" (25.3%), and low cost (22.4%). Overall, 40.3% of ever cigarillo users added marijuana (to create blunts) and 39.2% did not manipulate the product. Endorsement of these reasons for initiation and manipulation methods differed significantly across sex, age, SES and other tobacco use. CONCLUSIONS Cigarillo regulations should include restricting all appealing flavors, increasing the cost, monitoring the restriction of sales of cigarillos to minors, and decreasing the appeal of cigarillo manipulation.
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Kong G, Cavallo DA, Camenga DR, Morean ME, Krishnan-Sarin S. Preference for gain- or loss-framed electronic cigarette prevention messages. Addict Behav 2016; 62:108-13. [PMID: 27344117 DOI: 10.1016/j.addbeh.2016.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 06/04/2016] [Accepted: 06/10/2016] [Indexed: 01/02/2023]
Abstract
BACKGROUND Effective electronic cigarette (e-cigarette) prevention messages are needed to combat the rising popularity/uptake of e-cigarettes among youth. We examined preferences for e-cigarette prevention messages that either emphasized gains (e.g., You save money by not using e-cigarettes) or losses (e.g., You spend money by using e-cigarettes) among adolescents and young adults. METHODS Using surveys in two middle schools, four high schools, and one college in CT (N=5405), we assessed students' preferences for gain- or loss-framed e-cigarette prevention messages related to four themes: financial cost, health risks, addiction potential, and social labeling as a smoker. We also assessed whether preferences for each message framing theme differed by sex, school level, cigarette-use status, and e-cigarette use-status. We also examined whether preference for message framing differed by cigarette and e-cigarette susceptibility status among never e-cigarette users. RESULTS Overall, loss-framing was preferred for message themes related to health risks, addiction potential, and social labeling as a smoker, whereas gain-framing was preferred for message themes related to financial cost. Logistic regression analyses showed that 1) females preferred loss-framed messages for all themes relative to males, 2) lifetime e-cigarette users preferred loss-framed health risks and social labeling messages relative to never users, and 3) high school students preferred gain-framed social labeling messages relative to college students. The preference for message framing did not differ by cigarette or e-cigarette susceptibility. CONCLUSIONS Preference for message framing differed by themes and individual characteristics. This formative research could inform the construction of persuasive e-cigarette prevention messages.
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Is a Price Increase Policy Enough for Adolescent Smokers?: Factors Affecting the Effectiveness of Increasing Cigarette Prices Among Korean Adolescent Smokers. Nicotine Tob Res 2016; 18:2013-9. [DOI: 10.1093/ntr/ntw122] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2015] [Accepted: 04/21/2016] [Indexed: 12/11/2022]
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Abstract
This technical report serves to provide the evidence base for the American Academy of Pediatrics' policy statements "Clinical Practice Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke" and "Public Policy to Protect Children From Tobacco, Nicotine, and Tobacco Smoke." Tobacco use and involuntary exposure are major preventable causes of morbidity and premature mortality in adults and children. Tobacco dependence almost always starts in childhood or adolescence. Electronic nicotine delivery systems are rapidly gaining popularity among youth, and their significant harms are being documented. In utero tobacco smoke exposure, in addition to increasing the risk of preterm birth, low birth weight, stillbirth, placental abruption, and sudden infant death, has been found to increase the risk of obesity and neurodevelopmental disorders. Actions by pediatricians can help to reduce children's risk of developing tobacco dependence and reduce children's involuntary tobacco smoke exposure. Public policy actions to protect children from tobacco are essential to reduce the toll that the tobacco epidemic takes on our children.
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Nikaj S, Chaloupka F. School personnel smoking, school-level policies, and adolescent smoking in low- and middle-income countries. Tob Control 2015; 25:664-670. [DOI: 10.1136/tobaccocontrol-2015-052531] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 10/09/2015] [Indexed: 11/03/2022]
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Aldrich MC, Hidalgo B, Widome R, Briss P, Brownson RC, Teutsch SM. The role of epidemiology in evidence-based policy making: a case study of tobacco use in youth. Ann Epidemiol 2015; 25:360-5. [PMID: 24875267 PMCID: PMC4211989 DOI: 10.1016/j.annepidem.2014.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2014] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE Sound public health policy is based on relevant and timely information. A brief review of the history of youth tobacco control illustrates the central role of epidemiology to inform policy choices and evaluate their consequences. METHODS A narrative review was conducted. RESULTS Epidemiologic studies have shown that most smokers begin as adolescents or young adults and individuals who reach their mid-20s as nonsmokers are unlikely to ever become smokers. This key recognition made it clear that long-term tobacco control must prevent initiation of smoking among youth. Over time, tobacco use prevention interventions have evolved, increasing in reach and effectiveness as they moved from initially focusing on the individual to an approach that targets both populations and communities. Effective interventions for preventing youth smoking include raising tobacco prices, clean indoor air laws, and intensive mass media campaigns. CONCLUSIONS Great strides have been made in youth tobacco control but 18% of high-school students continue to smoke. It is up to epidemiologists, fellow scientists, practitioners, and advocates to assure that strategies that are known to work are fully implemented and to continue to find more successful solutions that can further lower the incidence of youth smoking initiation and can address new tobacco products and changing contexts.
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Affiliation(s)
- Melinda C. Aldrich
- Department of Thoracic Surgery, Vanderbilt University Medical Center, Nashville, TN
- Division of Epidemiology, Vanderbilt University Medical Center, Nashville, TN
| | - Bertha Hidalgo
- Department of Biostatistics, Section on Statistical Genetics, University of Alabama, Birmingham, AL
| | - Rachel Widome
- Division of Epidemiology and Community Health, University of Minnesota School of Public Health, Minneapolis, MN
| | - Peter Briss
- National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Atlanta, Georgia
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO
- Division of Public Health Sciences and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
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Curti D, Shang C, Ridgeway W, Chaloupka FJ, Fong GT. The use of legal, illegal and roll-your-own cigarettes to increasing tobacco excise taxes and comprehensive tobacco control policies: findings from the ITC Uruguay Survey. Tob Control 2015; 24 Suppl 3:iii17-iii24. [PMID: 25740084 DOI: 10.1136/tobaccocontrol-2014-051890] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2014] [Accepted: 02/05/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Little research has been done to examine whether smokers switch to illegal or roll-your-own (RYO) cigarettes in response to a change in their relative price. OBJECTIVE This paper explores how relative prices between three cigarette forms (manufactured legal, manufactured illegal and RYO cigarettes) are associated with the choice of one form over another after controlling for covariates, including sociodemographic characteristics, smokers' exposure to antismoking messaging, health warning labels and tobacco marketing. METHODS Generalised estimating equations were employed to analyse the association between the price ratio of two different cigarette forms and the usage of one form over the other. FINDINGS A 10% increase in the relative price ratio of legal to RYO cigarettes is associated with a 4.6% increase in the probability of consuming RYO cigarettes over manufactured legal cigarettes (p≤0.05). In addition, more exposure to antismoking messaging is associated with a lower odds of choosing RYO cigarettes over manufactured legal cigarettes (p≤0.05). Non-significant associations exist between the manufactured illegal to legal cigarette price ratios and choosing manufactured illegal cigarettes, suggesting that smokers do not switch to manufactured illegal cigarettes as prices of legal ones increase. However, these non-significant findings may be due to lack of variation in the price ratio measures. To improve the effectiveness of increased taxes and prices in reducing smoking, policymakers need to narrow price variability in the tobacco market. Moreover, increasing antismoking messaging reduces tax avoidance in the form of switching to cheaper RYO cigarettes in Uruguay.
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Affiliation(s)
- Dardo Curti
- Centro de Investigación de la Epidemia del Tabaquismo-CIET, Montevideo, Uruguay
| | - Ce Shang
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - William Ridgeway
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA WHO Collaborating Centre on the Economics of Tobacco and Tobacco Control
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Ontario, Canada
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Guindon GE, Paraje GR, Chaloupka FJ. The impact of prices and taxes on the use of tobacco products in Latin America and the Caribbean. Am J Public Health 2015; 105:e9-19. [PMID: 25602902 PMCID: PMC4330839 DOI: 10.2105/ajph.2014.302396] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2014] [Indexed: 01/08/2023]
Abstract
We examined the impact of tobacco prices or taxes on tobacco use in Latin America and Caribbean countries. We searched MEDLINE, EconLit, LILACS, unpublished literature, 6 specialty journals, and reviewed references. We calculated pooled price elasticities using random-effects models. The 32 studies we examined found that cigarette prices have a negative and statistically significant effect on cigarette consumption. A change in price is associated with a less than proportional change in the quantity of cigarettes demanded. In most Latin American countries, own-price elasticity for cigarettes is likely below -0.5 (pooled elasticities, short-run: -0.31; 95% confidence interval=-0.39, -0.24; long-run: -0.43; 95% CI=-0.51, -0.35). Tax increases effectively reduce cigarette use. Lack of studies using household- or individual-level data limits research's policy relevance.
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Affiliation(s)
- G Emmanuel Guindon
- G. Emmanuel Guindon is with the Centre for Health Economics and Policy Analysis and the Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton. Guillermo R. Paraje is with the Escuela de Negocios, Universidad Adolfo Ibáñez, Santiago, Chile. Frank J. Chaloupka is with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago, and the US National Bureau of Economic Research, Cambridge, MA
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International Tobacco Control. CURRENT ADDICTION REPORTS 2015. [DOI: 10.1007/s40429-015-0047-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Cantrell J, Ganz O, Anesetti-Rothermel A, Harrell P, Kreslake JM, Xiao H, Pearson JL, Vallone D, Kirchner TR. Cigarette price variation around high schools: evidence from Washington DC. Health Place 2015; 31:193-8. [PMID: 25560754 DOI: 10.1016/j.healthplace.2014.12.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2014] [Revised: 11/26/2014] [Accepted: 12/02/2014] [Indexed: 11/16/2022]
Abstract
This study examines lowest cigarette prices in all tobacco retail outlets in Washington D.C. (n=750) in relation to the type and number of high schools nearby, controlling for confounders. The lowest overall and Newport menthol prices were significantly lower at outlets near public non-charter and charter schools compared with outlets near private schools. Given higher smoking prevalence and more price-sensitive youth subgroups in U.S. public schools, exposure to low prices may contribute to tobacco-related health disparities in minority and low-income populations. Tobacco taxes combined with policies to minimize the increasing use of price as a marketing tool are critical.
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Affiliation(s)
- Jennifer Cantrell
- Department of Research and Evaluation, Legacy, Washington, DC, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Ollie Ganz
- Department of Research and Evaluation, Legacy, Washington, DC, USA
| | - Andrew Anesetti-Rothermel
- Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA; Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Paul Harrell
- Moffitt Cancer Center, Department of Health Outcomes and Behavior, Tampa, FL (current affiliation); Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD (affiliation at the time the article was written)
| | - Jennifer M Kreslake
- Department of Research and Evaluation, Legacy, Washington, DC, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Haijun Xiao
- Department of Research and Evaluation, Legacy, Washington, DC, USA
| | - Jennifer L Pearson
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
| | - Donna Vallone
- Department of Research and Evaluation, Legacy, Washington, DC, USA; Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Thomas R Kirchner
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Schroeder Institute for Tobacco Research and Policy Studies, Legacy, Washington, DC, USA
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Kostova D, Tesche J, Perucic AM, Yurekli A, Asma S. Exploring the relationship between cigarette prices and smoking among adults: a cross-country study of low- and middle-income nations. Nicotine Tob Res 2014; 16 Suppl 1:S10-5. [PMID: 24343955 DOI: 10.1093/ntr/ntt170] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Evidence on the relationship between cigarette prices and adult smoking in low- and middle-income countries (LMICs) is relatively limited. This study offers new descriptive evidence on this relationship using data from a set of 13 LMICs. METHODS We use Global Adult Tobacco Survey (GATS) cross-country data from approximately 200,000 participants aged 15 and older. Estimates on the relationship between prices and adult smoking were obtained from logit models of smoking participation and ordinary least squares models of conditional cigarette demand. RESULTS Higher prices were associated with lower demand across countries, in terms of both smoking prevalence and daily number of cigarettes smoked among smokers. Our estimates suggest that the total price elasticity of cigarette demand in LMICs is approximately -0.53. We find that higher socioeconomic status (SES), represented through wealth and education effects is associated with lower chance of smoking overall, but among existing smokers, it may be associated with a larger number of cigarettes smoked. CONCLUSIONS After controlling for a set of individual demographic and country characteristics, cigarette prices retain a significant role in shaping cigarette demand across LMICs. Because higher SES is associated with a reduced chance of smoking overall but also with increased daily consumption among current smokers, optimal tobacco tax policies in LMICs may face an added need to accommodate to shifting SES structures within the populations of these countries.
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