How effective has tobacco tax increase been in the Gambia? A case study of tobacco control

Cigarette Prices and Smoking Experimentation Among Zimbabwean Children: A Survival Analysis of the 2014 Global Youth Tobacco Survey

INTRODUCTION

Zimbabwe has a smoking prevalence of 11.7% among the adult population (15 years and older). Thus, in the absence of effective tobacco control measures, the economic burden of tobacco use will be aggravated, especially considering the increasing tobacco industry activity in the country. Increasing cigarette prices is one possible strategy to reduce tobacco consumption. This study seeks to examine the relationship between cigarette prices and smoking experimentation among children in Zimbabwe, thereby expanding the evidence base for the likely impact of excise taxes on cigarette demand in low- and middle-income countries.

AIMS AND METHODS

A survival analysis using the Zimbabwe 2014 Global Youth Tobacco Survey data.

RESULTS

A 10% increase in the price of cigarettes reduces the probability of experimenting with smoking by 9%. Also, children are more likely to experiment with smoking if they have a smoking brother or father who smokes, or see teachers who smoke. The likelihood of experimenting with smoking is higher among boys than girls and is positively associated with age.

CONCLUSIONS

There is strong evidence that increasing excise taxes can play an effective role in discouraging children from experimenting with cigarette smoking. Considering the relatively low excise tax burden in Zimbabwe, the government should consider substantially increasing the excise tax burden.

IMPLICATIONS

With the number of smokers in low- and middle-income countries expected to increase as the industry intensively expands its market by targeting the youth, increasing excise taxes will play a significant role in preventing children from initiating smoking and help those who are already using tobacco to quit. An increase in the excise tax increases the retail price of tobacco products, making them less affordable, and reduces the demand for them.

Exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among adolescents in Gambia

BACKGROUND

Despite the widespread prevalence of adolescent smoking in Gambia, a West African country, there is limited research exploring the relationships between exposure to pro-tobacco and anti-tobacco media messages and events and smoking behaviour among young people. This study investigates the interplay of these exposures and smoking behaviour among 11-17-year-old adolescents in Gambia.

METHODS

Secondary data analysis was conducted using the 2017 Gambia Global Youth and Tobacco Survey (GYTS), which included a total of 9,127 respondents. Descriptive and inferential analyses, including proportions, Pearson's chi-squared tests, and multivariable logistic regression models, were employed to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI).

RESULTS

The final model revealed significant associations between exposure to anti-tobacco media messages and events and smoking behaviour. Adolescents exposed to anti-tobacco media messages had a 29% increased odds of smoking (aOR 1.29,CI = 1.08,1.53) compared to those unexposed, while exposure to anti-tobacco media events showed a 31% increased odds (aOR 1.31,CI = 1.09,1.59) compared to those unexposed. Exposure to pro-tobacco messages, such as witnessing tobacco use on TV (aOR 1.41, CI = 1.17,1.69) and owning objects with tobacco brand logos (aOR 1.49,CI = 1.19,1.86), was associated with higher odds of smoking. Covariates, including sex, age, and exposure to smoking behaviour by significant others, also demonstrated associations with smoking behaviour. Notably, male respondents showed significantly higher odds of smoking (aOR = 4.01,CI = 3.28,4.89) compared to females. Respondents aged 15 years and older had increased odds of smoking (aOR = 1.47,CI = 1.22,1.76) compared to those below 15 years old. Those whose fathers smoke displayed higher odds of smoking (aOR = 1.35, CI = 1.04,1.76) compared to individuals with non-smoking parents. Additionally, those whose closest friends smoke showed remarkably higher odds of smoking (aOR = 2.87,CI = 2.37, 3.48) compared to those without such influence.

CONCLUSION

This study underscores the significant impact of exposure to both anti-tobacco and pro-tobacco media messages and events on smoking behaviour among adolescents in Gambia. However, pro-tobacco messages had a greater influence on smoking prevalence than anti-tobacco messages and events. Understanding these associations is crucial for devising effective public health interventions aimed at reducing tobacco use in this population.

The global burden of periodontal diseases in 204 countries and territories from 1990 to 2019

AIMS

The aim of this study was to report the incidence, prevalence, and disability-adjusted life-years (DALYs) of periodontal diseases during the period 1990-2019.

METHODS

Data on periodontal diseases were retrieved from the Global Burden of Diseases, Injuries, and Risk Factors study (GBD) 2019. The estimated annual percentage changes were calculated to evaluate the changing trend of age-standardized incidence, prevalence, and DALY rates related to periodontal diseases.

RESULTS

Globally, there were 1,087,367,744.0 cases with 91,518,820.6 new incidence and 7,090,390.3 DALYs of periodontal diseases in 2019, almost twice as many as in 1990. Moreover, the pace of increase in age-standardized incidence, age-standardized prevalence, and age-standardized DALY rates had accelerated during the 1990-2019 time period, with EAPC of 0.29 (95% CI, 0.22 to 0.35), 0.34 (95% CI, 0.26 to 0.43), and 0.35 (95% CI, 0.27 to 0.44) separately. The corresponding age-standardized percentage changes were more pronounced in females, Southeast Asia, and low-middle SDI regions. Western Sub-Saharan Africa was the high-risk area of standardized periodontal diseases burden in 2019, among which Gambia was the country with the heaviest burden.

CONCLUSION

The globally incidence, prevalence, and DALYs of periodontal diseases are substantially increased from 1990 to 2019, which highlights the importance and urgency of periodontal care.

Effect of price on the decision to experiment with cigarette smoking among Gambian children: a survival analysis using the Gambia 2017 Global Youth Tobacco Survey data

OBJECTIVES

To investigate the relationship between cigarette prices and smoking experimentation among children in the Gambia, and thereby expanding the evidence base of the likely impact of excise taxes on cigarette demand in low-income and middle-income countries.

DESIGN

A survival analysis using the Gambia 2017 Global Youth Tobacco Survey data.

SETTING

The Gambia.

PARTICIPANTS

The survey sample was 12 585 youths, aged 12-17 years, but our analysis was restricted to 11 030 respondents with information on smoking status.

PRIMARY AND SECONDARY OUTCOME MEASURES

Our outcome variable was smoking experimentation defined as the first time the respondent smoked (at least part of) a cigarette.

RESULTS

A 1% increase in the price of cigarettes reduces the probability to experiment with smoking by 0.7%. We also found that children are more likely to experiment with smoking if they have at least one smoking parent, friends who smoke and see teachers who smoke. The probability to experiment with cigarette smoking increases with age and is higher among boys than girls.

CONCLUSION

There is strong evidence that increasing excise taxes can play an effective role in discouraging children from experimenting with cigarette smoking. Considering the relatively low excise tax burden in the Gambia, the government should consider substantially increasing the excise tax burden.

Prevalence of and factors associated with tobacco smoking in the Gambia: a national cross-sectional study

OBJECTIVES

To examine the prevalence of and risk factors associated with tobacco smoking in the Gambia.

DESIGN

A nationwide cross-sectional study.

SETTING

The Gambia.

PARTICIPANTS

The study participants were both women and men aged between 15 and 49 years old. We included 16,066 men and women in our final analysis.

DATA ANALYSIS

We analysed data from the Gambia Demographic and Health Survey (DHS), 2019-2020. DHS collected nationally stratified data from local government areas and rural-urban areas. The outcome variable was the prevalence of tobacco smoking. Descriptive analysis, prevalence and logistic regression methods were used to analyse data to identify the potential determinants of tobacco smoking.

RESULTS

The response rate was 93%. The prevalence of current tobacco smoking was 9.92% in the Gambia in 2019-2020, of which, 81% of the consumers smoked tobacco daily. Men (19.3%) smoked tobacco much higher than women (0.65%) (p<0.001). People aged 40-49 years, with lower education, and manual workers were the most prevalent group of smoking in the Gambia (p<0.001).Men were 33 times more likely to smoke tobacco than women. The chance of consuming smoked tobacco increased with the increase of age (adjusted OR (AOR) 9.08, 95% CI 5.08 to 16.22 among adults aged 40-49 years, p<0.001). The strength of association was the highest among primary educated individuals (AOR 5.35, 95% CI 3.35 to 8.54).Manual workers (AOR 2.73) and people from the poorest households (AOR 1.86) were the risk groups for smoking. However, place of residency and region were insignificantly associated with smoking in the Gambia.

CONCLUSIONS

Men, older people, manual workers, individuals with lower education and lower wealth status were the vulnerable groups to tobacco smoking in the Gambia. Government should intensify awareness programmes on the harmful effects of smoking, and introduce proper cessation support services among tobacco smoking users prioritising these risk groups.

Assessment of Tobacco Control Policy Instruments, Status and Effectiveness in Africa: A Systematic Literature Review

Introduction

The tobacco industry has for decades been associated with environmental damage, health-related diseases, human rights violations and corruption issues. The World Health Organisation formulated the Framework Convention on Tobacco Control with the aim of controlling tobacco production and consumption. Most of the countries on the continent of Africa were also the target of the framework given the high importation and use of tobacco products. The main aim of this study was to find out the current status of tobacco control policies and their effectiveness in Africa.

Material and Methods

This study was a systematic literature review that was conducted between the months of August and November 2020 by extracting data from the databases of PubMed, Elsevier Scopus and Web of Science. Only English articles were culled from the retrieved papers. Out of the 910 papers retrieved, only 17 papers from African countries were selected on the quality synthesis after meeting the inclusion criteria.

Results

The results of the study showed that three governance resources were identified of regulatory (64.70%, N=11) which had smoke-free environment, advertisement bans, and cessation programs, economics (29.41%, N=5) which were taxation measures and informative (5.886%, N=1) which were mass media campaigns. Furthermore, Western African countries especially South Africa reported many pronouncements on smoke-free environment and taxation measures. Mass media campaigns proved to be more effective policies as compared to others.

Conclusion

This study recommends that the future research should be done on the effectiveness of mixed policy instruments as compared to single application. Furthermore, the researcher recommends the use of more informative policies in dealing with inelastic behaviours like those related to tobacco due to the addictive nature.

Consumption of legal and illegal cigarettes in the Gambia

BACKGROUND

The prevalence of cigarette smoking in the Gambia is relatively high, compared with most African countries. Little is known about the characteristics of the smokers and their habits, particularly with regard to tobacco tax avoidance and tax evasion.

METHODS

A nationally representative survey of 1211 smokers conducted in November/December 2017 employed a three-stage stratified sampling method and resulted in 1205 complete observations. The sociodemographic characteristics and smoking behaviours were analysed, including smoking intensity and brand preferences. Information on the physical features of cigarette packs that smokers had, observed by enumerators, and self-reported cigarette prices were used to estimate the proportion of illegal cigarettes on the market.

FINDINGS

As in many African countries, most smokers were male, between the ages of 25 and 54 years living primarily in urban areas. The three most popular cigarette brands are Piccadilly, Royal Business and Bond Street, which account for over three-quarters of all cigarette purchases. Price information suggests that about 7.3% of smokers purchased an illicit cigarette at their last purchase. When smoking intensity was taken into account, 8.6% of the total cigarette market was estimated to be illicit. Using an alternative method of evaluating pack's features revealed that only 0.9% of last purchases were illicit.

CONCLUSION

Despite recent excise tobacco tax increases, the use of illicit cigarettes in the Gambia is low and does not represent a significant obstacle to reaching both the public health and fiscal goals of higher tobacco taxes.

Passive Smokers' Support for Stronger Tobacco Control in Indonesia

Secondhand smoke exposure in Indonesia is high, especially compared to other Southeast Asian countries. Passive smoking leads to negative impacts on health and socio-economic well-being. Therefore, increasing the price of cigarettes and, thereby, increasing barriers to access to cigarettes could be an effective way to reduce smoking prevalence and protect people from second-hand smoke. This study aims to assess passive smokers' support for cigarette price increases in Indonesia. We perform a quantitative analysis with a cross-sectional design. The data were obtained through phone-based interviews of 1000 respondents aged 18 and older in Indonesia. Only 596 nonsmokers were included to be further analyzed in this study. This study found that 44.1% respondents have at least one family member who smokes. We considered the respondents' age, gender, education level, employment, and the number of people living in the respondent's household that are exposed to passive smoking. Our results demonstrate that passive smokers support stronger tobacco control such as increasing cigarette prices, regulating smoking behavior using a religious approach (Fatwa), and applying more effective pictorial health warnings.

Prevalence and Predictors of Smoking among Gambian Men: A Cross-Sectional National WHO STEP Survey

Background: Tobacco use is the leading cause of preventable death in the world, with a higher burden in low- and middle-income countries. The aim of this study was to quantify the prevalence and predictors of smoking among Gambian men using nationally representative data. Methods: Data was collected in 2010 from a random, nationally representative sample of 4111 adults aged 25–64 years (78% response rate) using the World Health Organization (WHO) STEPwise cross-sectional survey methods. Our analyses focused on men with valid information on smoking status (n = 1766) because of the low prevalence of smoking among women (1%). Results: The prevalence of current smoking among men was 31.4% (95% CI: 27.2–35.9). The median age of starting smoking was 19 years; 25% started before the age of 18 years and 10% started aged 8–10 years. Rural residence, underweight, and hypertension were significantly associated with smoking. Conclusion: The study reveals a high prevalence of smoking among Gambian men. It is evident that cigarettes are obtained by minors in The Gambia, as a high proportion of current smokers started at a young age. Advice and support to quit smoking should be extended to all smokers regardless of their age and whether or not they have any underlying health conditions.

Exploration of Policy Makers' Views on the Implementation of the Framework Convention on Tobacco Control in the Gambia: A Qualitative Study

BACKGROUND

The World Health Organization's Framework Convention on Tobacco Control (FCTC) is the first international health treaty and has now been ratified by 181 countries. However, there are concerns that in many countries, particularly in sub-Saharan African countries, FCTC legislations and implementation are weak. In this study, we report a qualitative study undertaken to assess policy makers' awareness of the FCTC and national tobacco control policies, and assessed the achievements and challenges to the implementation of the FCTC in the Gambia.

METHODS

The study involved semi-structured one-to-one interviews with 28 members of the National Tobacco Control Committee in the Gambia, which is responsible for formulating tobacco control policies and making recommendations for tobacco control. We used the Framework method and NVivo11 software for data analysis.

RESULTS

Our findings demonstrate that the Gambia has made modest progress in tobacco control before and since ratification of the FCTC, particularly in the areas of policy formulation, bans on tobacco advertising and promotion, smoke-free laws, and tobacco taxation. Although several pieces of tobacco control legislation exist, enforcement and implementation remain a major challenge. We found that policy makers' awareness of polices covered in the FCTC was limited.

CONCLUSION

Our findings highlight several challenges to the FCTC implementation and the need to step up efforts that will help to accomplish the obligations of the FCTC. To achieve the obligations of the FCTC, the Gambia should develop specific public awareness interventions, establish cessation services, mobilize adequate resources for tobacco control and strengthen tobacco surveillance and research.

A decade of cigarette taxation in Bangladesh: lessons learnt for tobacco control

Bangladesh has achieved a high share of tax in the price of cigarettes (greater than the 75% benchmark), but has not achieved the expected health benefits from reduction in cigarette consumption. In this paper we explore why cigarette taxation has not succeeded in reducing cigarette smoking in Bangladesh. Using government records over 2006–2017, we link trends in tax-paid cigarette sales to cigarette excise tax structure and changes in cigarette taxes and prices. We analysed data on smoking prevalence from Bangladesh Global Adult Tobacco Surveys to study consumption of different tobacco products in 2009 and 2017. Drawing on annual reports from tobacco manufacturers and other literature, we examine demand- and supply-side factors in the cigarette market. In addition to a growing affordability of cigarettes, three factors appear to have undermined the effectiveness of tax and price increases in reducing cigarette consumption in Bangladesh. First, the multitiered excise tax structure widened the price differential between brands and incentivized downward substitution by smokers from higher-price to lower-price cigarettes. Second, income growth and shifting preferences of smokers for better quality products encouraged upward substitution from hand-rolled local cigarettes (bidi) to machine-made low-price cigarettes. Third, the tobacco industry’s market expansion and differential pricing strategy changed the relative price to keep low-price cigarettes inexpensive. A high tax share alone may prove inadequate as a barometer of effective tobacco taxation in lower-middle income countries, particularly where the tobacco tax structure is complex, tobacco products prices are relatively low, and the affordability of tobacco products is increasing.

Tobacco tax and price in the developed and developing countries in the World

An ecologic study was conducted on 177 countries which the information of tobacco tax and price and also Human Development Index (HDI) was available in 2014. In this study, the relationship between HDI and four reported indexes by World Health Organization (WHO) was studied. These four indexes included: Tobacco affordability, Taxes as a percent of price of the most sold brand (total tax), Price of a 20 cigarette pack of the most sold brand international dollars at purchasing power parity (Price_ppp) and Price of a 20 cigarette pack of the most sold brand in US$ at official exchange rates (Price_US$). The data of HDI and tobacco were mined from WHO and United Nations Development Programme sites respectively. To study the correlation between HDI and the variables of this study, Pearson correlation coefficient was used and also Linear Regression Analysis was used to study the relationship between HDI and the variables of the study. According to the findings of the linear regression analysis, there was a significant relationship between HDI and total tax (B = 0.81, CI 95%: 0.63–0.99) and tobacco affordability (B = --0.35, CI 95%: --0.42 _ --0.28). There was also a significant relationship between HDI whit price-ppp (B = 9.44, CI 95%: 7.13–11.75) and price-US$ ;(B = 11.97, CI 95%: 9.71–14.23). According to the findings of this study, less developed countries devote less tax on tobacco. Due to the rising trend of the prevalence and also development of non-communicable diseases such as lung cancer in developing countries, policy makers of these countries are required to design stricter policies toward tobacco production and supply as well.