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Nip J, Thornley L, Schwartz R, Cunningham R, Hara M, Clancy L, Evans D, Howell F, Duffy S, Gilljam H, Edwards R. Commercial Tobacco Endgame Goals: Early Experiences From Six Countries. Nicotine Tob Res 2024; 26:1322-1330. [PMID: 38547327 PMCID: PMC11417120 DOI: 10.1093/ntr/ntae069] [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: 08/27/2023] [Revised: 03/15/2024] [Accepted: 03/19/2024] [Indexed: 06/06/2024]
Abstract
INTRODUCTION Tobacco use is a major threat to health globally. A number of countries have adopted "endgame goals" to minimize smoking prevalence. The INSPIRED project aims to describe and compare the experiences of the first six countries to adopt an endgame goal. AIMS AND METHODS Data were collected on the initial experiences of endgame goals in Canada, Finland, Ireland, New Zealand (Aotearoa), Scotland, and Sweden up to 2018. Information was collated on the nature of the endgame goals, associated interventions and strategies, potential enablers and barriers, and perceived advantages and disadvantages. RESULTS The INSPIRED countries had relatively low smoking prevalences and moderate-to-strong smoke-free policies. Their endgame goals aimed for smoking prevalences of 5% or less. Target dates ranged from 2025 to 2035. Except for New Zealand (Aotearoa), all countries had an action plan to support their goal by 2018. However, none of the plans incorporated specific endgame measures. Lack of progress in reducing inequities was a key concern, despite the consideration of equity in all of the country's goals and/or action plans. Experience with endgame goals was generally positive; however, participants thought additional interventions would be required to equitably meet their endgame goal. CONCLUSIONS There was variation in the nature and approach to endgame goals. This suggests that countries should consider adopting endgame goals and strategies to suit their social, cultural, and political contexts. The experiences of the INSPIRED countries suggest that further and more significant interventions will be required for the timely and equitable achievement of endgame goals. IMPLICATIONS By 2018, six countries (Canada, Finland, Ireland, New Zealand (Aotearoa), Scotland, and Sweden) had introduced government-endorsed "endgame goals," to rapidly reduce smoking prevalence to very low levels by a specified date. The nature and implementation of endgame goals were variable. Early experiences with the goals were generally positive, but progress in reducing smoking prevalence was insufficient, particularly for priority groups. This finding suggests more significant interventions ("endgame interventions") and measures to reduce inequities need to be implemented to achieve endgame goals. Variation in the nature and experience of endgame goals demonstrates the importance of designing endgame strategies that suit distinct social, cultural, and political contexts.
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Affiliation(s)
- Janine Nip
- University of Otago, Department of Public Health, Newtown, New Zealand
| | - Louise Thornley
- University of Otago, Department of Public Health, Newtown, New Zealand
| | | | | | | | - Luke Clancy
- Tobacco Free Research Institute Ireland, Dublin, Ireland
| | - David Evans
- Health Service Executive, National Social Inclusion Office, Dublin, Ireland
| | | | | | - Hans Gilljam
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Richard Edwards
- University of Otago, Department of Public Health, Newtown, New Zealand
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Tamil Selvan S, Yeo XX, van der Eijk Y. Which countries are ready for a tobacco endgame? A scoping review and cluster analysis. Lancet Glob Health 2024; 12:e1049-e1058. [PMID: 38762285 DOI: 10.1016/s2214-109x(24)00085-8] [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: 09/20/2023] [Revised: 02/05/2024] [Accepted: 02/16/2024] [Indexed: 05/20/2024]
Abstract
Various countries have set tobacco endgame targets to eliminate tobacco use by a certain year. Tobacco endgames are generally considered more feasible in countries with advanced tobacco control measures and a smoking prevalence of 15% or less. We conducted a scoping review of 563 articles sourced from news, academic literature, and grey literature to examine global tobacco endgame progress, and grouped 153 countries into clusters based on their tobacco policy implementation score and smoking prevalence to systematically identify countries that might be well positioned to succeed in a tobacco endgame. The EU, Pacific Islands, and 18 other individual countries have set tobacco endgame targets, with another seven countries described as well positioned for an endgame. These were mostly high-income countries with higher smoking prevalence. We identified 28 endgame-ready countries with advanced tobacco policies and a low smoking prevalence. Of these, only five were part of tobacco endgame movements; the remaining 23 were all low-income or middle-income countries in Africa, Latin America, or Asia. Therefore, the global tobacco endgame movement should focus more on low-income and middle-income countries with low smoking rates and advanced tobacco policies, particularly in Africa, Latin America, and Asia.
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Affiliation(s)
- Sahaana Tamil Selvan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Xue Xin Yeo
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore.
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Hefler M. Progress, setbacks and changing perception of the possible: reflections on Aotearoa/New Zealand's changed political landscape and tobacco policy plans. Tob Control 2024; 33:141-142. [PMID: 38378208 DOI: 10.1136/tc-2024-058630] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Marita Hefler
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
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Kim H, Park S, Kang H, Kang N, Levy DT, Cho SI. Modeling the future of tobacco control: Using SimSmoke to explore the feasibility of the tobacco endgame in Korea. Tob Induc Dis 2023; 21:147. [PMID: 37954490 PMCID: PMC10632939 DOI: 10.18332/tid/174127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/11/2023] [Accepted: 10/14/2023] [Indexed: 11/14/2023] Open
Abstract
INTRODUCTION We used a simulation model to assess the feasibility of reaching the tobacco endgame target (reducing the smoking prevalence to below 5% by 2050) and explored potential implementation strategies. METHODS The impact of strengthened tobacco-control policies on smoking prevalence was analyzed using Korea SimSmoke, a discrete-time Markov process. We considered the effects of various scenarios from 2023 and predictions were conducted until 2050. To confirm the stability of the results, deterministic and probabilistic sensitivity analyses were carried out by increasing and decreasing parameter estimates. RESULTS The implementation of tobacco-control policies in accordance with the WHO MPOWER (Μonitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco smoking; Warn of the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; Raise taxes on tobacco) measures were insufficient to achieve the tobacco endgame objective of 5% by 2050. The overall predicted smoking prevalence in 2050 is 4.7% if all policies are fully implemented in accordance with the FCTC guidelines together with a complete ban on the sale of cigarettes to people born after 2003 and annual 10% increases in price. Sensitivity analyses using the varying policy effect assumptions demonstrated the robustness of the simulation results. CONCLUSIONS For a substantive reduction in smoking prevalence, it is essential to strongly implement the MPOWER strategy. Beyond this foundational step, the eradication of smoking requires a paradigm shift in the perception of conventional tobacco-control policies, including a tobacco-free generation strategy and radical increases in the price of tobacco products.
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Affiliation(s)
- Hana Kim
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - Susan Park
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Heewon Kang
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
| | - Naeun Kang
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
| | - David T. Levy
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, United States
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea
- Institute of Health and Environment, Seoul National University, Seoul, Republic of Korea
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Huang V, Head A, Hyseni L, O'Flaherty M, Buchan I, Capewell S, Kypridemos C. Identifying best modelling practices for tobacco control policy simulations: a systematic review and a novel quality assessment framework. Tob Control 2023; 32:589-598. [PMID: 35017262 PMCID: PMC10447402 DOI: 10.1136/tobaccocontrol-2021-056825] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/27/2021] [Indexed: 12/28/2022]
Abstract
BACKGROUND Policy simulation models (PSMs) have been used extensively to shape health policies before real-world implementation and evaluate post-implementation impact. This systematic review aimed to examine best practices, identify common pitfalls in tobacco control PSMs and propose a modelling quality assessment framework. METHODS We searched five databases to identify eligible publications from July 2013 to August 2019. We additionally included papers from Feirman et al for studies before July 2013. Tobacco control PSMs that project tobacco use and tobacco-related outcomes from smoking policies were included. We extracted model inputs, structure and outputs data for models used in two or more included papers. Using our proposed quality assessment framework, we scored these models on population representativeness, policy effectiveness evidence, simulated smoking histories, included smoking-related diseases, exposure-outcome lag time, transparency, sensitivity analysis, validation and equity. FINDINGS We found 146 eligible papers and 25 distinct models. Most models used population data from public or administrative registries, and all performed sensitivity analysis. However, smoking behaviour was commonly modelled into crude categories of smoking status. Eight models only presented overall changes in mortality rather than explicitly considering smoking-related diseases. Only four models reported impacts on health inequalities, and none offered the source code. Overall, the higher scored models achieved higher citation rates. CONCLUSIONS While fragments of good practices were widespread across the reviewed PSMs, only a few included a 'critical mass' of the good practices specified in our quality assessment framework. This framework might, therefore, potentially serve as a benchmark and support sharing of good modelling practices.
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Affiliation(s)
- Vincy Huang
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Anna Head
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Martin O'Flaherty
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Iain Buchan
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Simon Capewell
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health, Policy and Systems, University of Liverpool, Liverpool, UK
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Puljević C, Feulner L, Hobbs M, Erku D, Bonevski B, Segan C, Baker A, Hefler M, Cho A, Gartner C. Tobacco endgame and priority populations: a scoping review. Tob Control 2023:tc-2022-057715. [PMID: 36720648 DOI: 10.1136/tc-2022-057715] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/11/2023] [Indexed: 02/02/2023]
Abstract
AIM To summarise the research literature on the impacts or perceptions of policies to end tobacco use at a population level (ie, tobacco endgame policies) among people from eight priority population groups (experiencing mental illness, substance use disorders, HIV, homelessness, unemployment or low incomes, who identify as lesbian, gay, bisexual, transgender, queer or intersex (LGBTQI+) or who have experienced incarceration). METHODS Guided by JBI Scoping Review Methodology, we searched six databases for original research examining the impacts or perceptions of 12 tobacco endgame policies among eight priority populations published since 2000. We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. RESULTS Of the 18 included studies, one described perceptions of five endgame policies among people on low incomes in Aotearoa (New Zealand), and 17 focused on the effectiveness or impacts of a very low nicotine content (VLNC) cigarette standard among people experiencing mental illness (n=14), substance use disorders (n=8), low incomes (n=6), unemployment (n=1) or who identify as LGBTQI+ (n=1) in the USA. These studies provide evidence that VLNC cigarettes can reduce tobacco smoking, cigarette cravings, nicotine withdrawal and nicotine dependence among these populations. CONCLUSIONS Most of the tobacco endgame literature related to these priority populations focuses on VLNC cigarettes. Identified research gaps include the effectiveness of endgame policies for reducing smoking, impacts (both expected and unexpected) and policy perceptions among these priority populations.
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Affiliation(s)
- Cheneal Puljević
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Leah Feulner
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Maria Hobbs
- School of Nursing, Midwifery and Social Work, The University of Queensland, Brisbane, Queensland, Australia
| | - Daniel Erku
- Menzies Health Institute, Centre for Applied Health Economics, Griffith University, Brisbane, Queensland, Australia
| | - Billie Bonevski
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | | | - Amanda Baker
- Hunter Medical Research Institute, The University of Newcastle, Newcastle, New South Wales, Australia
| | - Marita Hefler
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Wellbeing and Preventable Chronic Diseases Division, Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Ara Cho
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral Gartner
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Huesca L, Llamas L, Sobarzo H. Tobacco industry in Mexico: a general equilibrium analysis. Tob Control 2022; 31:s118-s123. [PMID: 35074931 DOI: 10.1136/tobaccocontrol-2021-056864] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 11/29/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Effects of tobacco taxation on employment in Mexico are measured by using an applied general equilibrium model. METHODS The study describes the modelling methodology based on a 2013 social accounting matrix for Mexico, built for analysing the impact of tobacco taxation on employment. Unemployment is treated as an endogenous variable. RESULTS Setting the specific component of the Excise Tax on Production and Services (IEPS) at 1.50 pesos per cigarette would lead to the loss of tobacco-related jobs constituting just 0.1% of all jobs nationally. Revenue from IEPS on tobacco would increase by 49%, while consumption would fall by 26%. This minimal loss of employment can be compensated for if the government invests revenue from IEPS on tobacco in some specific sectors. We show this for the case of the health sector. Far from just reducing cigarette consumption, this tax reform would also create 33 781 jobs with a net gain of 32 285 across different sectors of the economy while only reducing 727 jobs in the tobacco industry in the whole country. CONCLUSION Results suggest the existence of a good margin for increasing tobacco tax beyond the 2020 update of 0.49 pesos per stick. In addition, from a public health point of view, if tobacco tax revenue were allocated as a direct healthcare subsidy this would deliver a double dividend by further discouraging consumption and increasing tobacco tax revenue by almost 50%, with little impact on key macroeconomic variables in Mexico, which could be offset in more dynamic sectors while promoting health, employment and development.
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Affiliation(s)
- Luis Huesca
- Desarrollo Regional, Centro de Investigación en Alimentación y Desarrollo AC, Hermosillo, Sonora, Mexico
| | - Linda Llamas
- Universidad Estatal de Sonora, Hermosillo, Sonora, Mexico
| | - Horacio Sobarzo
- Centro de Estudios Económicos, El Colegio de México AC, Ciudad de Mexico, Delegación Tlalpan, Mexico
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Puljević C, Morphett K, Hefler M, Edwards R, Walker N, Thomas DP, Khan MA, Perusco A, Le Grande M, Cullerton K, Ait Ouakrim D, Carstensen G, Sellars D, Hoek J, Borland R, Bonevski B, Blakely T, Brolan C, Gartner CE. Closing the gaps in tobacco endgame evidence: a scoping review. Tob Control 2022; 31:365-375. [PMID: 35241614 DOI: 10.1136/tobaccocontrol-2021-056579] [Citation(s) in RCA: 30] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/12/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Tobacco endgame policies aim to rapidly and permanently reduce smoking to minimal levels. We reviewed evidence syntheses for: (1) endgame policies, (2) evidence gaps, and (3) future research priorities. DATA SOURCES Guided by JBI scoping review methodology, we searched five databases (PubMed, CINAHL, Scopus, Embase and Web of Science) for evidence syntheses published in English since 1990 on 12 policies, and Google for publications from key national and international organisations. Reference lists of included publications were hand searched. STUDY SELECTION Two reviewers independently screened titles and abstracts. Inclusion criteria were broad to capture policy impacts (including unintended), feasibility, public and stakeholder acceptability and other aspects of policy implementation. DATA EXTRACTION We report the results according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS Eight policies have progressed to evidence synthesis stage (49 publications): mandatory very low nicotine content (VLNC) standard (n=26); product standards to substantially reduce consumer appeal or remove the most toxic products from the market (n=1); moving consumers to reduced risk products (n=8); tobacco-free generation (n=4); ending sales (n=2); sinking lid (n=2); tax increases (n=7); and restrictions on tobacco retailers (n=10). Based on published evidence syntheses, the evidence base was most developed for a VLNC standard, with a wide range of evidence synthesised. CONCLUSIONS VLNC cigarettes have attracted the most attention, in terms of synthesised evidence. Additional focus on policies that reduce the availability of tobacco is warranted given these measures are being implemented in some jurisdictions.
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Affiliation(s)
- Cheneal Puljević
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Health Services Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Kylie Morphett
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Marita Hefler
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Richard Edwards
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Natalie Walker
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Centre for Addiction Research, Faculty of Medicine and Health Sciences, The University of Auckland, Auckland, New Zealand
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | - David P Thomas
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Menzies School of Health Research, Charles Darwin University, Casuarina, Northern Territory, Australia
| | - Md Arifuzzaman Khan
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Andrew Perusco
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Research School of Population Health, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Michael Le Grande
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
| | - Katherine Cullerton
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Driss Ait Ouakrim
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Georgia Carstensen
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - David Sellars
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia
| | - Janet Hoek
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ron Borland
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Psychological Sciences, The University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Billie Bonevski
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- College for Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
| | - Tony Blakely
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Claire Brolan
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
| | - Coral E Gartner
- NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia
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Kim S, Cho SI. Smoking-related behaviour changes among Korean men after the 2015 tobacco price increase: assessing the implications for the tobacco endgame using a reconstructed retrospective cohort study. BMJ Open 2022; 12:e051712. [PMID: 34983761 PMCID: PMC8728404 DOI: 10.1136/bmjopen-2021-051712] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 11/22/2021] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine the effect of Korea's 2015 tax policy, discuss its effectiveness and limitations and present future directions for tax policy in the context of the tobacco endgame. DESIGN A retrospectively reconstructed cohort study. SETTING Korea, August 2014-October 2015. PARTICIPANTS The study examined 41,605 male smokers aged 19 years and older who participated in the 2015 Korea Community Health Survey. MEASURES AND ANALYSIS Binary and multinomial logistic regression was used to assess the impact of the tax policy on smoking-related behaviour. We adjusted for demographic and health-related variables. RESULTS Among 41,605 men who were smokers in 2014, 15,499 (35.85%, weighted) reported being affected by the price increase. Of all smokers, 1,772 (3.96%, weighted) reported quitting smoking because of the tobacco price increase. Others reduced their smoking amount (n=9,714, 22.48%, weighted) or made other changes such as switching brands (n=4,013, 9.41%, weighted). An additional 2,401 smokers (5.72%, weighted) quit smoking for reasons other than the tobacco price increase. Compared with those in the highest quintile of household income, the odds that those in the lowest quintile quit smoking due to the price increase were almost twice as high (OR=1.98, 95% CI 1.54 to 2.54). CONCLUSIONS Korea's 2015 tobacco price increase affected a significant number of smokers within a year, especially in the lowest income group, inducing some to quit or reduce their smoking amount. However, more smokers quit for reasons independent of the price change. Tax policy can effectively reduce smoking, but needs to be combined with other policies for optimal results.
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Affiliation(s)
- Seulgi Kim
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
| | - Sung-Il Cho
- Graduate School of Public Health, Seoul National University, Seoul, South Korea
- Institute of Health and Environment, Seoul National University, Seoul, South Korea
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Blakely T, Moss R, Collins J, Mizdrak A, Singh A, Carvalho N, Wilson N, Geard N, Flaxman A. Proportional multistate lifetable modelling of preventive interventions: concepts, code and worked examples. Int J Epidemiol 2020; 49:1624-1636. [PMID: 33038892 DOI: 10.1093/ije/dyaa132] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/14/2020] [Indexed: 11/12/2022] Open
Abstract
Burden of Disease studies-such as the Global Burden of Disease (GBD) Study-quantify health loss in disability-adjusted life-years. However, these studies stop short of quantifying the future impact of interventions that shift risk factor distributions, allowing for trends and time lags. This methodology paper explains how proportional multistate lifetable (PMSLT) modelling quantifies intervention impacts, using comparisons between three tobacco control case studies [eradication of tobacco, tobacco-free generation i.e. the age at which tobacco can be legally purchased is lifted by 1 year of age for each calendar year) and tobacco tax]. We also illustrate the importance of epidemiological specification of business-as-usual in the comparator arm that the intervention acts on, by demonstrating variations in simulated health gains when incorrectly: (i) assuming no decreasing trend in tobacco prevalence; and (ii) not including time lags from quitting tobacco to changing disease incidence. In conjunction with increasing availability of baseline and forecast demographic and epidemiological data, PMSLT modelling is well suited to future multiple country comparisons to better inform national, regional and global prioritization of preventive interventions. To facilitate use of PMSLT, we introduce a Python-based modelling framework and associated tools that facilitate the construction, calibration and analysis of PMSLT models.
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Affiliation(s)
- Tony Blakely
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Rob Moss
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - James Collins
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
| | - Anja Mizdrak
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Ankur Singh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Natalie Carvalho
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nicholas Geard
- Computing and Information Systems, University of Melbourne, Melbourne, VIC, Australia
| | - Abraham Flaxman
- Institute of Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Petrović-van der Deen FS, Blakely T, Kvizhinadze G, Cleghorn CL, Cobiac LJ, Wilson N. Restricting tobacco sales to only pharmacies combined with cessation advice: a modelling study of the future smoking prevalence, health and cost impacts. Tob Control 2018; 28:643-650. [PMID: 30413563 DOI: 10.1136/tobaccocontrol-2018-054600] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/27/2018] [Accepted: 09/28/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Restricting tobacco sales to pharmacies only, including the provision of cessation advice, has been suggested as a potential measure to hasten progress towards the tobacco endgame. We aimed to quantify the impacts of this hypothetical intervention package on future smoking prevalence, population health and health system costs for a country with an endgame goal: New Zealand (NZ). METHODS We used two peer-reviewed simulation models: 1) a dynamic population forecasting model for smoking prevalence and 2) a closed cohort multi-state life-table model for future health gains and costs by sex, age and ethnicity. Greater costs due to increased travel distances to purchase tobacco were treated as an increase in the price of tobacco. Annual cessation rates were multiplied with the effect size for brief opportunistic cessation advice on sustained smoking abstinence. RESULTS The intervention package was associated with a reduction in future smoking prevalence, such that by 2025 prevalence was 17.3%/6.8% for Māori (Indigenous)/non-Māori compared to 20.5%/8.1% projected under no intervention. The measure was furthermore estimated to accrue 41 700 discounted quality-adjusted life-years (QALYs) (95% uncertainty interval (UI): 33 500 to 51 600) over the remainder of the 2011 NZ population's lives. Of these QALYs gained, 74% were due to the provision of cessation advice over and above the limiting of sales to pharmacies. CONCLUSIONS This work provides modelling-level evidence that the package of restricting tobacco sales to only pharmacies combined with cessation advice in these settings can accelerate progress towards the tobacco endgame, and achieve large population health benefits and cost-savings. :.
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Affiliation(s)
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand.,Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
| | - Christine L Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
| | - Linda J Cobiac
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE 3), University of Otago, Wellington, New Zealand
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12
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Cleghorn CL, Blakely T, Kvizhinadze G, van der Deen FS, Nghiem N, Cobiac LJ, Wilson N. Impact of increasing tobacco taxes on working-age adults: short-term health gain, health equity and cost savings. Tob Control 2018; 27:e167-e170. [PMID: 29146589 DOI: 10.1136/tobaccocontrol-2017-053914] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/03/2022]
Abstract
OBJECTIVE The health gains and cost savings from tobacco tax increase peak many decades into the future. Policy-makers may take a shorter-term perspective and be particularly interested in the health of working-age adults (given their role in economic productivity). Therefore, we estimated the impact of tobacco taxes in this population within a 10-year horizon. METHODS As per previous modelling work, we used a multistate life table model with 16 tobacco-related diseases in parallel, parameterised with rich national data by sex, age and ethnicity. The intervention modelled was 10% annual increases in tobacco tax from 2011 to 2020 in the New Zealand population (n=4.4 million in 2011). The perspective was that of the health system, and the discount rate used was 3%. RESULTS For this 10-year time horizon, the total health gain from the tobacco tax in discounted quality-adjusted life years (QALYs) in the 20-65 year age group (age at QALY accrual) was 180 QALYs or 1.6% of the lifetime QALYs gained in this age group (11 300 QALYs). Nevertheless, for this short time horizon: (1) cost savings in this group amounted to NZ$10.6 million (equivalent to US$7.1 million; 95% uncertainty interval: NZ$6.0 million to NZ$17.7 million); and (2) around two-thirds of the QALY gains for all ages occurred in the 20-65 year age group. Focusing on just the preretirement and postretirement ages, the QALY gains in each of the 60-64 and 65-69 year olds were 11.5% and 10.6%, respectively, of the 268 total QALYs gained for all age groups in 2011-2020. CONCLUSIONS The majority of the health benefit over a 10-year horizon from increasing tobacco taxes is accrued in the working-age population (20-65 years). There remains a need for more work on the associated productivity benefits of such health gains.
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Affiliation(s)
- Christine L Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
| | - Frederieke S van der Deen
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
| | - Linda J Cobiac
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, University of Otago, Wellington, New Zealand
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13
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Li L, Zhang Q, Zhan X. Study on the Influence Factors of Tobacco Market Demand and Efficiency Evaluation. INTERNATIONAL JOURNAL OF INFORMATION SYSTEMS AND SUPPLY CHAIN MANAGEMENT 2018. [DOI: 10.4018/ijisscm.2018010106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
A number of studies have shown that many factors influence the development of the tobacco companies. This article analyzes the market demand of the Chinese tobacco and efficiency evaluation about Yantai Tobacco Company in order to improve customer satisfaction, repeating purchase intention and the company's innovation ability. We collected data through Multi-stage stratified cluster sampling. Through analysis of the data, we find that different social classes have different sensitivities to tobacco price. In the structural equation model, the brand image has a significant impact on the model, based on which we make some suggestions for the enterprise. Furthermore, IAHP method is used to evaluate the importance of the innovative elements in tobacco industry development. We can easily see that technology professionals have a direct impact on the innovation ability, with a significant impact on innovation efficiency.
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Affiliation(s)
- Lei Li
- Tianjin University, Tianjin, China
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14
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Robinson M, Reid G. Population cigarette consumption in Great Britain: novel insights using retail sales data. BMC Public Health 2017; 17:941. [PMID: 29258451 PMCID: PMC5738187 DOI: 10.1186/s12889-017-4950-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Accepted: 11/24/2017] [Indexed: 11/15/2022] Open
Abstract
Background Accurate data to measure population cigarette consumption are vital for surveillance and for evaluating the impact of tobacco control policies. This study uses cigarette retail sales data to provide novel insights into trends and patterns in cigarette consumption in Great Britain. Methods Cigarette sales estimates derived from electronic sales from most large grocery stores and a weighted representative sample of smaller convenience stores were obtained from Nielsen. Data on the number of cigarette sticks sold per calendar month and per week were obtained for Scotland and England/Wales (combined) for the period January 2008 to December 2015. Cigarette consumption per adult smoker per month was calculated using survey-based smoking prevalence estimates and mid-year population estimates. Results Population cigarette consumption in Great Britain declined between 2008 and 2013. Cigarette sales have since stabilised at around 400 cigarettes per adult smoker per month. Cigarettes sold in 14- to 19-packs have substituted a sharp decline in 20-packs and now account for over half of all cigarettes sold in Great Britain. Cigarette consumption has been consistently higher in Scotland than England/Wales. This is due to higher sales of 20-packs in Scotland between 2008 and 2013, which has been substituted by higher sales of 14- to 19-packs in recent years. Conclusions Cigarette retail sales data provide unique insights into levels and patterns of cigarette consumption and should be used for monitoring and evaluating tobacco control policy in Great Britain. Electronic supplementary material The online version of this article (10.1186/s12889-017-4950-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Mark Robinson
- Public Health Science Directorate, NHS Health Scotland, Glasgow, Scotland.
| | - Garth Reid
- Public Health Science Directorate, NHS Health Scotland, Glasgow, Scotland
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15
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Levy DT, Borland R, Lindblom EN, Goniewicz ML, Meza R, Holford TR, Yuan Z, Luo Y, O'Connor RJ, Niaura R, Abrams DB. Potential deaths averted in USA by replacing cigarettes with e-cigarettes. Tob Control 2017; 27:18-25. [PMID: 28970328 PMCID: PMC5801653 DOI: 10.1136/tobaccocontrol-2017-053759] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2017] [Revised: 07/11/2017] [Accepted: 08/05/2017] [Indexed: 12/14/2022]
Abstract
Introduction US tobacco control policies to reduce cigarette use have been effective, but their impact has been relatively slow. This study considers a strategy of switching cigarette smokers to e-cigarette use (‘vaping’) in the USA to accelerate tobacco control progress. Methods A Status Quo Scenario, developed to project smoking rates and health outcomes in the absence of vaping, is compared with Substitution models, whereby cigarette use is largely replaced by vaping over a 10-year period. We test an Optimistic and a Pessimistic Scenario, differing in terms of the relative harms of e-cigarettes compared with cigarettes and the impact on overall initiation, cessation and switching. Projected mortality outcomes by age and sex under the Status Quo and E-Cigarette Substitution Scenarios are compared from 2016 to 2100 to determine public health impacts. Findings Compared with the Status Quo, replacement of cigarette by e-cigarette use over a 10-year period yields 6.6 million fewer premature deaths with 86.7 million fewer life years lost in the Optimistic Scenario. Under the Pessimistic Scenario, 1.6 million premature deaths are averted with 20.8 million fewer life years lost. The largest gains are among younger cohorts, with a 0.5 gain in average life expectancy projected for the age 15 years cohort in 2016. Conclusions The tobacco control community has been divided regarding the role of e-cigarettes in tobacco control. Our projections show that a strategy of replacing cigarette smoking with vaping would yield substantial life year gains, even under pessimistic assumptions regarding cessation, initiation and relative harm.
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Affiliation(s)
- David T Levy
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Ron Borland
- Nigel Gray Distinguished Fellow in Cancer Prevention, VicHealth Centre for Tobacco Control, The Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Eric N Lindblom
- O'Neill Institute for National & Global Health Law, Georgetown University Law Center, Washington, District of Columbia, USA
| | - Maciej L Goniewicz
- Department of Health Behavior, Division of Cancer Prevention and Population Studies, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Rafael Meza
- Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
| | - Theodore R Holford
- Department of Biostatistics, Yale University, New Haven, Connecticut, USA
| | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Yuying Luo
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, District of Columbia, USA
| | - Richard J O'Connor
- Department of Health Behavior, Division of Cancer Prevention and Population Studies, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Raymond Niaura
- Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA
| | - David B Abrams
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA.,Schroeder Institute for Tobacco Research and Policy Studies, Truth Initiative, Washington, District of Columbia, USA
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16
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van der Deen FS, Wilson N, Cleghorn CL, Kvizhinadze G, Cobiac LJ, Nghiem N, Blakely T. Impact of five tobacco endgame strategies on future smoking prevalence, population health and health system costs: two modelling studies to inform the tobacco endgame. Tob Control 2017. [PMID: 28647728 DOI: 10.1136/tobaccocontrol-2016-053585] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE There is growing international interest in advancing 'the tobacco endgame'. We use New Zealand (Smokefree goal for 2025) as a case study to model the impacts on smoking prevalence (SP), health gains (quality-adjusted life-years (QALYs)) and cost savings of (1) 10% annual tobacco tax increases, (2) a tobacco-free generation (TFG), (3) a substantial outlet reduction strategy, (4) a sinking lid on tobacco supply and (5) a combination of 1, 2 and 3. METHODS Two models were used: (1) a dynamic population forecasting model for SP and (2) a closed cohort (population alive in 2011) multistate life table model (including 16 tobacco-related diseases) for health gains and costs. RESULTS All selected tobacco endgame strategies were associated with reductions in SP by 2025, down from 34.7%/14.1% for Māori (indigenous population)/non-Māori in 2011 to 16.0%/6.8% for tax increases; 11.2%/5.6% for the TFG; 17.8%/7.3% for the outlet reduction; 0% for the sinking lid; and 9.3%/4.8% for the combined strategy. Major health gains accrued over the remainder of the 2011 population's lives ranging from 28 900 QALYs (95% Uncertainty Interval (UI)): 16 500 to 48 200; outlet reduction) to 282 000 QALYs (95%UI: 189 000 to 405 000; sinking lid) compared with business-as-usual (3% discounting). The timing of health gain and cost savings greatly differed for the various strategies (with accumulated health gain peaking in 2040 for the sinking lid and 2070 for the TFG). CONCLUSIONS Implementing endgame strategies is needed to achieve tobacco endgame targets and reduce inequalities in smoking. Given such strategies are new, modelling studies provide provisional information on what approaches may be best.
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Affiliation(s)
- Frederieke S van der Deen
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE3), University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE3), University of Otago, Wellington, New Zealand
| | - Christine L Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE3), University of Otago, Wellington, New Zealand
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE3), University of Otago, Wellington, New Zealand
| | - Linda J Cobiac
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE3), University of Otago, Wellington, New Zealand.,Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE3), University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme (BODE3), University of Otago, Wellington, New Zealand.,Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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17
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Scarborough P, Smolina K, Mizdrak A, Cobiac L, Briggs A. Assessing the external validity of model-based estimates of the incidence of heart attack in England: a modelling study. BMC Public Health 2016; 16:1135. [PMID: 27809823 PMCID: PMC5093931 DOI: 10.1186/s12889-016-3782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Accepted: 10/18/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The DisMod II model is designed to estimate epidemiological parameters on diseases where measured data are incomplete and has been used to provide estimates of disease incidence for the Global Burden of Disease study. We assessed the external validity of the DisMod II model by comparing modelled estimates of the incidence of first acute myocardial infarction (AMI) in England in 2010 with estimates derived from a linked dataset of hospital records and death certificates. METHODS Inputs for DisMod II were prevalence rates of ever having had an AMI taken from a population health survey, total mortality rates and AMI mortality rates taken from death certificates. By definition, remission rates were zero. We estimated first AMI incidence in an external dataset from England in 2010 using a linked dataset including all hospital admissions and death certificates since 1998. 95 % confidence intervals were derived around estimates from the external dataset and DisMod II estimates based on sampling variance and reported uncertainty in prevalence estimates respectively. RESULTS Estimates of the incidence rate for the whole population were higher in the DisMod II results than the external dataset (+54 % for men and +26 % for women). Age-specific results showed that the DisMod II results over-estimated incidence for all but the oldest age groups. Confidence intervals for the DisMod II and external dataset estimates did not overlap for most age groups. CONCLUSION By comparison with AMI incidence rates in England, DisMod II did not achieve external validity for age-specific incidence rates, but did provide global estimates of incidence that are of similar magnitude to measured estimates. The model should be used with caution when estimating age-specific incidence rates.
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Affiliation(s)
- Peter Scarborough
- British Heart Foundation Centre for Population Approaches to Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Kate Smolina
- British Columbia Centre for Disease Control, Vancouver, Canada
| | - Anja Mizdrak
- British Heart Foundation Centre for Population Approaches to Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Linda Cobiac
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE3) Programme, University of Otago, Wellington, New Zealand
| | - Adam Briggs
- British Heart Foundation Centre for Population Approaches to Non-Communicable Disease Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, UK
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18
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Pearson AL, Cleghorn CL, van der Deen FS, Cobiac LJ, Kvizhinadze G, Nghiem N, Blakely T, Wilson N. Tobacco retail outlet restrictions: health and cost impacts from multistate life-table modelling in a national population. Tob Control 2016; 26:tobaccocontrol-2015-052846. [PMID: 27660112 DOI: 10.1136/tobaccocontrol-2015-052846] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 08/31/2016] [Indexed: 11/04/2022]
Abstract
BACKGROUND Since there is some evidence that the density and distribution of tobacco retail outlets may influence smoking behaviours, we aimed to estimate the impacts of 4 tobacco outlet reduction interventions in a country with a smoke-free goal: New Zealand (NZ). METHODS A multistate life-table model of 16 tobacco-related diseases, using national data by sex, age and ethnicity, was used to estimate quality-adjusted life years (QALYs) gained and net costs over the remainder of the 2011 NZ population's lifetime. The outlet reduction interventions assumed that increased travel costs can be operationalised as equivalent to price increases in tobacco. RESULTS All 4 modelled interventions led to reductions of >89% of current tobacco outlets after the 10-year phase-in process. The most effective intervention limited sales to half of liquor stores (and nowhere else) at 129 000 QALYs gained over the lifetime of the population (95% UI: 74 100 to 212 000, undiscounted). The per capita QALY gains were up to 5 times greater for Māori (indigenous population) compared to non-Māori. All interventions were cost-saving to the health system, with the largest saving for the liquor store only intervention: US$1.23 billion (95% UI: $0.70 to $2.00 billion, undiscounted). CONCLUSIONS These tobacco outlet reductions reduced smoking prevalence, achieved health gains and saved health system costs. Effects would be larger if outlet reductions have additional spill-over effects (eg, smoking denormalisation). While these interventions were not as effective as tobacco tax increases (using the same model), these and other strategies could be combined to maximise health gain and to maximise cost-savings to the health system.
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Affiliation(s)
- Amber L Pearson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand Department of Geography, Michigan State University, East Lansing, Michigan, USA
| | - Christine L Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand
| | - Frederieke S van der Deen
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand
| | - Linda J Cobiac
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand Nuffield Department of Population Health, British Heart Foundation Centre on Population Approaches to NCD Prevention, University of Oxford, Oxford, UK
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness (BODE) Programme, University of Otago, Wellington, New Zealand
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19
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Edwards R, Tu D, Newcombe R, Holland K, Walton D. Achieving the tobacco endgame: evidence on the hardening hypothesis from repeated cross-sectional studies in New Zealand 2008-2014. Tob Control 2016; 26:399-405. [PMID: 27382047 DOI: 10.1136/tobaccocontrol-2015-052860] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 06/09/2016] [Accepted: 06/16/2016] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The hardening hypothesis proposes that as smoking prevalence declines the proportion of 'hardcore' or 'hardened' smokers will increase. The possible constructs of hardening include reduced motivation to quit, increased levels of addiction, increased levels of disadvantage and reduced quit rates among continuing smokers. Most previous studies have investigated only a single facet of the hypothesis. We used data from a national population monitor to test the hypothesis using measures across all four hardening constructs. METHODS We analysed data from a biennial population-based survey of New Zealand adults (aged 15 years+) from 2008 to 2014. Data were collected through face-to-face computer-assisted personal interviews. RESULTS During a period of reducing smoking prevalence, there were no statistically significant changes in indicators of hardening including the proportion of smokers who were unmotivated to quit, unable to quit despite repeated attempts or receiving state benefits or on a low income. Quit rates did not change significantly over the study period. For 2014 versus 2008, the OR for recent (within last 1-12 months) quitting was 1.14 (95% CI 0.53 to 2.46) and for sustained (within previous 13-24 months) quitting was 1.88 (95% CI 0.78 to 4.54). CONCLUSIONS This study provides evidence that robust tobacco control strategies that result in substantial declines in smoking prevalence are not accompanied by the hypothesised increase in 'hardcore' or 'hardened' smokers who are more addicted and less motivated and able to quit. The findings suggest that there is no need for substantial change in approach to achieve New Zealand's Smokefree 2025 goal on the grounds that the smoker population is becoming increasingly hardened.
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Affiliation(s)
- Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Danny Tu
- Research and Evaluation Unit, Health Promotion Agency, Wellington, New Zealand
| | - Rhiannon Newcombe
- Research and Evaluation Unit, Health Promotion Agency, Wellington, New Zealand
| | - Kate Holland
- Health Promotion Agency, Wellington, New Zealand
| | - Darren Walton
- Psychology Department, University of Canterbury, Christchurch, New Zealand
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20
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Marsh L, Cameron C, Quigg R, Hoek J, Doscher C, McGee R, Sullivan T. The impact of an increase in excise tax on the retail price of tobacco in New Zealand. Tob Control 2016; 25:458-63. [PMID: 26138823 DOI: 10.1136/tobaccocontrol-2015-052259] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 06/16/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND In 2010, the New Zealand (NZ) government introduced an annual 10% tobacco excise tax increase. We examined retailers' adherence to recommended retail prices (RRP), and whether the RRP included the full tax increase. METHODS We collected price data on three British American Tobacco (BAT) factory-made cigarette brands, (premium, mainstream, and budget), and one roll-your-own tobacco brand before and after the 2014 tax increase from a sample of tobacco retailers. We examined price increases in each tobacco brand and compared these with the RRP. The extent to which the excise tax increases had been included in the RRP since 2010 was estimated using data sourced from the Ministry of Health and NZ Customs. FINDINGS The median increase in price from before to after the tax change was only 3% for the budget brand (461 retailers). This contrasted with the median of 8% for the premium brand (448 retailers), and 11% for both mainstream and roll-your-own brands (471 and 464 retailers, respectively). While many retail outlets made changes according to the RRP set by BAT, several did not comply. Our analyses suggest BAT may be undershifting excise tax on the budget brand, and overshifting tax on brands in other price partitions. CONCLUSIONS Tobacco companies do not appear to be increasing the RRPs of budget brands in line with tobacco excise tax increases. The increasing price differential between budget brands, and mainstream and premium brands may undermine cessation and impede realisation of New Zealand's Smokefree 2025 goal.
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Affiliation(s)
- Louise Marsh
- Cancer Society Social and Behavioural Research Unit, University of Otago, Dunedin, New Zealand
| | - Claire Cameron
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
| | - Robin Quigg
- Cancer Society Social and Behavioural Research Unit, University of Otago, Dunedin, New Zealand
| | - Janet Hoek
- Department of Marketing, University of Otago, Dunedin, New Zealand
| | - Crile Doscher
- Faculty of Environment, Society and Design, Lincoln University, Canterbury, New Zealand
| | - Rob McGee
- Cancer Society Social and Behavioural Research Unit, University of Otago, Dunedin, New Zealand
| | - Trudy Sullivan
- Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
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21
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Blakely T, Cobiac LJ, Cleghorn CL, Pearson AL, van der Deen FS, Kvizhinadze G, Nghiem N, McLeod M, Wilson N. Health, Health Inequality, and Cost Impacts of Annual Increases in Tobacco Tax: Multistate Life Table Modeling in New Zealand. PLoS Med 2015; 12:e1001856. [PMID: 26218517 PMCID: PMC4517929 DOI: 10.1371/journal.pmed.1001856] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2015] [Accepted: 06/16/2015] [Indexed: 12/02/2022] Open
Abstract
BACKGROUND Countries are increasingly considering how to reduce or even end tobacco consumption, and raising tobacco taxes is a potential strategy to achieve these goals. We estimated the impacts on health, health inequalities, and health system costs of ongoing tobacco tax increases (10% annually from 2011 to 2031, compared to no tax increases from 2011 ["business as usual," BAU]), in a country (New Zealand) with large ethnic inequalities in smoking-related and noncommunicable disease (NCD) burden. METHODS AND FINDINGS We modeled 16 tobacco-related diseases in parallel, using rich national data by sex, age, and ethnicity, to estimate undiscounted quality-adjusted life-years (QALYs) gained and net health system costs over the remaining life of the 2011 population (n = 4.4 million). A total of 260,000 (95% uncertainty interval [UI]: 155,000-419,000) QALYs were gained among the 2011 cohort exposed to annual tobacco tax increases, compared to BAU, and cost savings were US$2,550 million (95% UI: US$1,480 to US$4,000). QALY gains and cost savings took 50 y to peak, owing to such factors as the price sensitivity of youth and young adult smokers. The QALY gains per capita were 3.7 times greater for Māori (indigenous population) compared to non-Māori because of higher background smoking prevalence and price sensitivity in Māori. Health inequalities measured by differences in 45+ y-old standardized mortality rates between Māori and non-Māori were projected to be 2.31% (95% UI: 1.49% to 3.41%) less in 2041 with ongoing tax rises, compared to BAU. Percentage reductions in inequalities in 2041 were maximal for 45-64-y-old women (3.01%). As with all such modeling, there were limitations pertaining to the model structure and input parameters. CONCLUSIONS Ongoing tobacco tax increases deliver sizeable health gains and health sector cost savings and are likely to reduce health inequalities. However, if policy makers are to achieve more rapid reductions in the NCD burden and health inequalities, they will also need to complement tobacco tax increases with additional tobacco control interventions focused on cessation.
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Affiliation(s)
- Tony Blakely
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Linda J. Cobiac
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
- British Heart Foundation Centre on Population Approaches to NCD Prevention, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Christine L. Cleghorn
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Amber L. Pearson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
- Department of Geography, Michigan State University, East Lansing, Michigan, United States of America
| | - Frederieke S. van der Deen
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Giorgi Kvizhinadze
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Melissa McLeod
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Burden of Disease Epidemiology, Equity and Cost Effectiveness Programme, Department of Public Health, University of Otago, Wellington, New Zealand
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Rimmer M. Price and trade: World No Tobacco Day 2015. Tob Control 2015; 24:e123-4. [PMID: 26025095 DOI: 10.1136/tobaccocontrol-2015-052450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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