Standardised cigarettes: the next step for tobacco policy?

What measures are needed to achieve a tobacco endgame target? A Singapore-based simulation study

BACKGROUND

An increasing number of countries are pursuing a tobacco 'endgame'. We sought to determine the combination of measures it would take to achieve a tobacco endgame in the city-state of Singapore.

METHODS

Using an open-cohort microsimulation model, we estimated the impact of existing measures (quit programmes, tobacco taxes, flavours ban) and more novel measures (very low nicotine cap, tobacco-free generation, raising the minimum legal age to 25 years), and combinations thereof, on smoking prevalence in Singapore over a 50-year horizon. We used Markov Chain Monte Carlo to estimate transition probabilities between the states of never smoker, current smoker and former smoker, updating each individual's state across each year with prior distributions derived from national survey data.

RESULTS

Without new measures, smoking prevalence is expected to rebound from 12.2% (2020) to 14.8% (2070). The only scenarios to achieve a tobacco endgame target within a decade are those combining a very low nicotine cap with a flavours ban. A nicotine cap or tobacco-free generation alone also achieve endgame targets, but after 20 and 39 years, respectively. Taxes, quit programmes, a flavours ban and minimum legal age increase do augment the impact of other measures, but even when combined are insufficient to achieve a tobacco endgame target within 50 years.

CONCLUSION

In Singapore, achieving a tobacco endgame within a decade requires a very low nicotine cap coupled with a tobacco flavours ban, although this target can also be achieved in the long term (within 50 years) with a tobacco-free generation.

Perceptions of health warnings on cigarette sticks among the adult population in Al-Madinah, Saudi Arabia: A cross-sectional survey

INTRODUCTION

Health warnings on cigarette sticks are emerging as a tool to control tobacco consumption; hence, understanding how they are perceived is valuable in determining their effectiveness. Our study aimed to evaluate the perception of health-related messages and warnings on individual cigarette sticks. It also aimed to evaluate the perceptions of the effectiveness of cigarette packaging warnings and the acceptance level for the inclusion of health warnings on cigarette sticks.

METHODS

This cross-sectional survey was conducted on 285 individuals in Al-Madinah, Saudi Arabia. The survey was distributed online using a non-probability convenience sampling technique. The chi-squared test and logistic regression analysis were used to determine the association of sociodemographic characteristics and smoking-related variables with participants' perceptions of health warnings on cigarette sticks and packaging. The responses were also assessed qualitatively using conceptual content analysis.

RESULTS

In all, 18.6% of participants perceived that the package warnings were either 'quite effective' or 'very effective' in prompting smokers to quit. For health warnings on cigarette sticks, 28.1% of participants perceived that the theme of statistics on mortality was either 'quite effective' or 'very effective' in prompting smokers to quit, compared to 35.0 % for the theme of social and financial consequences. Respondents who had secondary education and lower were almost two times more likely to support the inclusion of health warnings than those who had a university education and higher (OR=1.9; 95% CI: 1.02-3.7, p=0.042). Most of the comments were positive for the inclusion of health warnings on cigarette sticks.

CONCLUSIONS

Most participants perceived that package warnings were ineffective, but warnings on cigarette sticks were effective methods of dissuasion of cigarette use. Smokers were almost twice as likely to perceive as effective supportive messages to quit than non-smokers. The majority of participants 'agreed' or 'strongly agreed' to the inclusion of health warnings on cigarette sticks.

Dissuasive cigarettes as a tobacco control measure: a scoping review

OBJECTIVE

The aim was to identify and review the research literature on dissuasive cigarettes, including key concepts, types, sources of evidence and research gaps.

DATA SOURCES

PubMed, Scopus and Web of Science databases were searched up to January 2023 with no language or date restrictions. All study designs were included. Reference lists of the identified studies were manually searched. Studies on tobacco products other than cigarettes or on external cigarette packaging alone were excluded.

STUDY SELECTION

Two reviewers screened titles and abstracts independently using eligibility criteria. The full text of the selected articles was subsequently screened independently by two reviewers to confirm eligibility.

DATA EXTRACTION

Two reviewers independently extracted data from all studies using data abstraction forms. Results were reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist.

DATA SYNTHESIS

We identified 24 original studies, 3 review articles and 4 commentary articles. Research on dissuasive cigarettes was reported from Australia, New Zealand, Europe and North America. We presented results in four themes: the concept of dissuasive cigarettes; approaches and types; potential benefits, barriers and concerns; and current research gaps.

CONCLUSIONS

Dissuasive cigarettes represent a promising strategy that could be used in tobacco control. Parallel implementation with plain packaging would be feasible and synergistic.