1
|
Ma S, Ahn S, Kaareen A, Yang Q, Qiu Z, Chen J, Berman M, Wagener T, Shang C. Features of disposable e-cigarettes and their association with pricing and consumer preference: Evidence from web data of US online stores. Addiction 2025; 120:514-523. [PMID: 39711153 DOI: 10.1111/add.16719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 10/22/2024] [Indexed: 12/24/2024]
Abstract
BACKGROUND AND AIMS Disposable e-cigarettes designed for one-time use are the most popular option among youth users in the United States (US). Product-level data (e.g., sales prices, flavors) of disposables in the online market are lacking. This study aims to identify key characteristics of online disposables and estimate their association with pricing and consumer preferences. DESIGN, SETTING AND CASES Data analysis using detailed features of 2320 unique e-cigarette disposable products scraped from the websites of five US online vape shops. MEASUREMENTS Product size was measured as volume in milliliter (ml) or number of puffs. Sales prices were standardized as price per ml volume and price per puff. Consumer preferences were measured by the total number of reviews for each product, and (when a product was reviewed) by the numeric rating it received, which ranged from 1 to 5 stars. Key product features included battery capacity (mAh), nicotine concentration (mg/ml), explicit marketing claims of nicotine salt and synthetic nicotine products, and product primary flavor (fruit, tobacco, sweet, menthol, alcohol, etc.). FINDINGS Number of consumer reviews (3.92 [range = 0,72]) and numeric ratings (4.51 [1, 5]) were statistically significantly higher for disposables with higher nicotine concentration. While the average unit price of disposables in dollars (13.95 [1.99, 129.99]) sold in online stores was similar to those in brick-and-mortar stores, online products on average had lower price per ml (1.93 [0.07, 20.00]) due to volume discounts. Number of reviews and ratings were statistically significantly higher for fruit and sweet flavors (coefficient = 0.17, p < 0.05), compared with alcohol flavors (coefficient = -0.07, p < 0.05). Compared with products with a battery capacity ≤500 mAh, consumers gave 30% to 78% fewer reviews (p < 0.001) and 4% to 7% lower ratings (p < 0.01) for products with a battery capacity >500 mAh. CONCLUSIONS In US-based online vape shops, disposable e-cigarettes with higher volume sizes are associated with lower prices, suggesting that price discounts for disposables primarily take the form of volume discounts. Consumers appear to prefer disposable e-cigarettes with lower capacity batteries, high nicotine concentrations, no synthetic nicotine, and fruit/sweet flavours.
Collapse
Affiliation(s)
- Shaoying Ma
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Sooa Ahn
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Aadeeba Kaareen
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Qian Yang
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | - Zefeng Qiu
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - Jian Chen
- Department of Computer Science and Engineering, The Ohio State University, Columbus, OH, USA
| | - Micah Berman
- Division of Health Services Management and Policy, College of Public Health, The Ohio State University, Columbus, OH, USA
- Michael E. Moritz College of Law, The Ohio State University, Columbus, OH, USA
| | - Theodore Wagener
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Ce Shang
- Center for Tobacco Research, The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| |
Collapse
|
2
|
Diaz MC, Silver NA, Bertrand A, Schillo BA. Bigger, stronger and cheaper: growth in e-cigarette market driven by disposable devices with more e-liquid, higher nicotine concentration and declining prices. Tob Control 2025; 34:65-70. [PMID: 37536928 PMCID: PMC11877113 DOI: 10.1136/tc-2023-058033] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 07/20/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE Given the evolving changes in the disposable e-cigarette market, we explore patterns of sales in the USA by e-liquid volume capacity, nicotine strength and real sales-weighted average prices by both e-cigarette unit and volume of e-liquid. METHODOLOGY We used NielsenIQ retail scanner data from January 2017 to September 2022 to examine changes over time for average product volume capacity in millilitres, nicotine strength (%) and both sales-weighted average price per disposable unit and per millilitre of e-liquid for each 4-week period. RESULTS Among disposable e-cigarettes sold between January 2017 and September 2022, average volume capacity increased 518% from 1.1 mL to 5.7 mL and average nicotine strength increased 294% from 1.7% to 5%. Sales-weighted average price per disposable unit and millilitres of e-liquid both remained relatively constant until January 2020. From January 2020 through September 2022, average unit prices increased 165.7% from US$8.49 to US$14.07, while the average price of 1 mL of e-liquid decreased 69.2% from US$7.96 to US$2.45. CONCLUSIONS The current regulatory regime around e-cigarettes has resulted in disposable e-cigarette manufacturers providing consumers with bigger, cheaper disposable e-cigarettes that come in increasingly higher nicotine strengths. Tobacco policy recommendations such as restricting e-liquid capacity and minimum price laws as well as regulations on product characteristics that affect nicotine emissions and delivery such as nicotine strength, nicotine output, device power, and puff duration should be considered in regulating the e-cigarette market.
Collapse
Affiliation(s)
- Megan C Diaz
- Schroeder Institute, Truth Initiative, Washington, DC, USA
| | | | | | | |
Collapse
|
3
|
Cho A, Lim C, Sun T, Chan G, Gartner C. The effect of tobacco tax increase on price-minimizing tobacco purchasing behaviours: A systematic review and meta-analysis. Addiction 2024; 119:1923-1936. [PMID: 39009013 DOI: 10.1111/add.16618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/09/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND AND AIMS Tobacco product excise taxes are a cost-effective method for reducing tobacco consumption, but industry pricing and marketing strategies encourage consumers to engage in price-minimizing behaviours (PMBs). We investigated the relationship between tobacco tax increases and PMBs, measuring whether PMBs intensify following tax increases, whether low-income consumers with higher nicotine dependence are more likely to engage in PMBs and whether PMBs are negatively related to smoking cessation. METHOD This was a systematic review with meta-analysis of cross-sectional and longitudinal studies from seven databases up to March 2023, using studies that reported any product- and purchasing-related smoking behaviours post-tobacco tax increase in a general representative population. Sixty-eight studies were quality-assessed using the Newcastle-Ottawa scale. All studies were narratively synthesized, with five studies involving 13 068-26 575 participants providing data for pooled analyses on PMBs [purchasing lower-priced brands, roll-your-own (RYO) tobacco and cartons] pre- and post-tax increases using a random effects meta-analytical model. RESULTS Fifty-seven studies reported on legal PMBs, and 17 studies reported illicit cigarette purchasing. Meta-analysis showed that consecutive tax increases were positively associated with purchasing RYO [odds ratio (OR) = 1.60, 95% confidence interval (CI) = 1.04-2.46], especially in higher tobacco taxing environments, with substantial heterogeneity (I2 = 96%). Lower income and higher nicotine dependence were associated with purchasing lower-priced brands and RYO, whereas higher income and nicotine dependence were associated with purchasing cartons, large-sized packs and cross-border sales. Less evidence associated illicit tobacco purchases with tax increases or PMBs with smoking cessation. CONCLUSIONS Tobacco purchasers' PMBs vary widely by state, country and time-period within countries. Both legal and illegal PMBs, potentially influenced by industry pricing tactics, may exacerbate health inequalities and dilute the public health benefits of tobacco tax increases.
Collapse
Affiliation(s)
- Ara Cho
- Faculty of Medicine, School of Public Health, The University of Queensland, Herston, Queensland, Australia
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Carmen Lim
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia
- The National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Tianze Sun
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia
- The National Centre for Youth Substance Use Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Gary Chan
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia
- The National Centre for Youth Substance Use Research, 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, Herston, Queensland, Australia
| |
Collapse
|
4
|
Ma H, Golden SD. Impact of New York City Cigarette Floor Price Policy on Reducing Smoking Disparities. Nicotine Tob Res 2024; 26:1504-1511. [PMID: 38795013 DOI: 10.1093/ntr/ntae122] [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: 07/24/2023] [Revised: 04/09/2024] [Accepted: 05/15/2024] [Indexed: 05/27/2024]
Abstract
INTRODUCTION In 2017, New York City (NYC) passed a minimum floor price law (MFPL) to raise the minimum price of a pack of cigarettes to $13.00. Evaluation of the MFPL in NYC is limited and has yet to examine its potential as a proequity policy. AIMS AND METHODS Data (n = 20 241; prepolicy n = 15 037, postpolicy n = 5204) were obtained from the New York State Adult Tobacco Survey, a quarterly repeated cross-sectional survey. Using the Difference-in-Differences approach, we compared changes in reported cigarette prices, cigarette consumption, and smoking status among NYC residents before and after policy implementation to changes in the same outcomes among residents in the rest of the state (ROS) over the same period. RESULTS For some smokers, cigarette price increased in NYC for the postpolicy period; moreover, prices increased more in NYC than in ROS. NYC smokers who reported higher income, more education, or White or "Other" race, reported a bigger price increase than their ROS counterparts. Cigarette consumption decreased more in the postpolicy period for people in the ROS, in general and among certain groups. Everyday smoking status decreased similarly in both NYC and ROS, whereas someday smoking status decreased primarily in the ROS during the analysis period. CONCLUSIONS Cigarette prices in NYC increased after the 2017 MFPL; these increases were greater than those occurring elsewhere in the state, suggesting the policy might be a factor in the change. However, the increases were concentrated among relatively higher-priced purchases, and groups with lower smoking prevalence. Changes in smoking status and cigarette consumption did not correspond to study hypotheses. IMPLICATIONS This study provides an empirical analysis of a real-world policy in tobacco control. It examines the potential of the MFPL in NYC as a proequity policy. Findings extend the current MFPL literature and suggest that they may be able to raise cigarette prices for some purchases, but also may have a limited impact on smoking behaviors.
Collapse
Affiliation(s)
- Haijing Ma
- Department of Communication, English, Creative Writing and Publishing, College of Liberal Arts and Social Sciences, University of Houston-Victoria, Victoria, TX, USA
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
5
|
Elliott AM, Kong AY, McGuirt J, Prentice-Dunn H, Gougler-Reeves KM, Little MA, Ribisl KM. Comparison of Tobacco Product Prices at Fort Liberty Army Installation and Surrounding Community Areas, 2021. Nicotine Tob Res 2024; 26:1586-1590. [PMID: 38747193 PMCID: PMC11494477 DOI: 10.1093/ntr/ntae116] [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: 11/29/2023] [Revised: 05/05/2024] [Accepted: 05/10/2024] [Indexed: 10/23/2024]
Abstract
INTRODUCTION High rates of tobacco use persist in the U.S. military, with 18.4% of service members smoking cigarettes in 2018. The Department of Defense's (DoD) 2017 policy required that tobacco retailers on military installations set tobacco product prices equal to the most common community price, including tax, but there is limited evidence confirming whether local retailers are adhering to this policy. We examined tobacco product pricing in tobacco retailers on- and off-post at the largest U.S. Army installation, Fort Liberty, and Cumberland County, North Carolina. AIMS AND METHODS Between June and August 2021, we collected data on tobacco product availability, price, and promotions from retailers on Fort Liberty (n = 14) and a random sample of off-post retailers within 10 miles of installation gates (n = 52). We calculated the mode, mean, and median price of each product, plus the difference in these prices at on- and off-post retailers. We used Welch's t-test to test differences in mean prices between on- versus off-post retailers. RESULTS The mode, mean, and median prices of cigarette packs and cartons were lower on-post than off-post (eg, $0.51-$0.55 cheaper for Marlboro cigarette packs on-post). However, the mode, mean, and median prices of smokeless tobacco products and little cigars were higher on-post than off-post (eg, $0.82-$0.89 more costly for Swisher Sweets 2-packs on-post). CONCLUSIONS Results highlight the need for continued enforcement to ensure compliance with the 2017 DoD policy. Comprehensive policy action to reduce tobacco price disparities on- and off-post is critical to reducing high rates of tobacco use among service members. IMPLICATIONS Despite the implementation of the 2017 DoD pricing policy, some tobacco products remain cheaper at tobacco retailers on-post compared to off-post retailers. Our results highlight the need for greater routine surveillance to increase implementation of the policy-particularly for cigarettes-to reduce high rates of tobacco use among service members.
Collapse
Affiliation(s)
- Alison M Elliott
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Center for Cancer Prevention & Control Research, University of California Fielding School of Public Health, Los Angeles, CA, USA
| | - Amanda Y Kong
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family & Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Jared McGuirt
- Department of Nutrition, University of North Carolina Greensboro, Greensboro, NC, USA
| | - Hannah Prentice-Dunn
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Melissa A Little
- Department of Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA, USA
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
6
|
Pravosud V, Holmes LM, Lempert LK, Ling PM. Impacts of Tax and Flavor Tobacco Policies on San Francisco Bay Area Tobacco Prices. EVALUATION REVIEW 2023; 47:763-785. [PMID: 36943027 PMCID: PMC10542911 DOI: 10.1177/0193841x231164908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
California Proposition 56 increased the state tobacco tax by $2 per cigarette pack effective April 1, 2017. Between 2015-2020 San Francisco (SF) and some cities in Alameda County enacted local flavored tobacco sales restrictions. SF also increased its Cigarette Litter Abatement Fee, from $0.20/pack in 2015 to $1.00 in 2020. Compare the change in tobacco prices before (2015) and after (2019/20) the implementation of a $2 increase in tobacco excise tax and local flavored tobacco policies in SF and Alameda Counties. Descriptive study of the pre-to-post policy analysis design. We drew a proportional random sample of retailers (N=463) in SF and Alameda Counties, by city. Using multivariable, single- and multiple-level linear regressions, we compared inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and by flavor policy, accounting for socio-demographics. Change in inflation-adjusted average tobacco prices in 2015 vs. 2019/20 by county and flavor policy, accounting for socio-demographics. Between 2015-2019/20, the increase in cigarette prices was higher than the $2 tax increase, and higher in SF than Alameda County (+$4.6 vs +$2.5). SF retailers stopped selling Newport menthol cigarettes and Blu brand menthol e-cigarettes in 2019/20. Adjusted average cigarette prices increased significantly more in SF and Alameda County cities with comprehensive or partial flavor policies versus cities without flavor policies (by $3.23 and $2.11). Local flavor policies affected menthol product availability and may have had positive spillover effects and indirectly increased pack prices.
Collapse
Affiliation(s)
- Vira Pravosud
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Louisa M. Holmes
- The Pennsylvania State University, Departments of Geography and Demography, University Park, PA, USA
| | - Lauren K. Lempert
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
| | - Pamela M. Ling
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, CA, USA
- Division of General Internal Medicine, Department of Medicine, School of Medicine, University of California San Francisco, San Francisco, CA, USA
| |
Collapse
|
7
|
Mills SD, Golden SD, O'Leary MC, Logan P, Hassmiller Lich K. Using systems science to advance health equity in tobacco control: a causal loop diagram of smoking. Tob Control 2023; 32:287-295. [PMID: 34535509 PMCID: PMC9466654 DOI: 10.1136/tobaccocontrol-2021-056695] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 08/11/2021] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Develop and use a causal loop diagram (CLD) of smoking among racial/ethnic minority and lower-income groups to anticipate the intended and unintended effects of tobacco control policies. METHODS We developed a CLD to elucidate connections between individual, environmental and structural causes of racial/ethnic and socioeconomic disparities in smoking. The CLD was informed by a review of conceptual and empirical models of smoking, fundamental cause and social stress theories and 19 qualitative interviews with tobacco control stakeholders. The CLD was then used to examine the potential impacts of three tobacco control policies. RESULTS The CLD includes 24 constructs encompassing individual (eg, risk perceptions), environmental (eg, marketing) and structural (eg, systemic racism) factors associated with smoking. Evaluations of tobacco control policies using the CLD identified potential unintended consequences that may maintain smoking disparities. For example, the intent of a smoke-free policy for public housing is to reduce smoking among residents. Our CLD suggests that the policy may reduce smoking among residents by reducing smoking among family/friends, which subsequently reduces pro-smoking norms and perceptions of tobacco use as low risk. On the other hand, some residents who smoke may violate the policy. Policy violations may result in financial strain and/or housing instability, which increases stress and reduces feelings of control, thus having the unintended consequence of increasing smoking. CONCLUSIONS The CLD may be used to support stakeholder engagement in action planning and to identify non-traditional partners and approaches for tobacco control.
Collapse
Affiliation(s)
- Sarah D Mills
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Meghan C O'Leary
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Paige Logan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Kristen Hassmiller Lich
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| |
Collapse
|
8
|
Argefa TG, Carnegie T, Kassa SA, Kitonyo-Devotsu R, Mdege ND. Tobacco advertising, promotion, and sponsorship (TAPS) in Ethiopia: a scoping review and narrative synthesis. JOURNAL OF GLOBAL HEALTH REPORTS 2023. [DOI: 10.29392/001c.57372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
Background Tobacco advertising, promotion and sponsorship (TAPS) has been shown to increase tobacco use in both adults and young people. In Ethiopia, TAPS is recognised as a top priority for the government, and all tobacco advertising, promotion, and sponsorship forms are prohibited. There is recognition that there are gaps in the evidence needed to inform policy and practice on TAPS, but the extent and nature of these gaps have not been explored. This review was aimed at understanding the extent and nature of the evidence gaps on TAPS in Ethiopia and identifying primary research priorities to inform future research direction. Methods Systematic searches were conducted in February 2022 in the following research databases: Medline, EMBASE, and PsycInfo. Two reviewers independently screened the study reports for eligibility and extracted data from the eligible studies. The extracted data was collated and summarised descriptively and policy, practice, and research recommendations were drawn. Research topics on TAPS in Ethiopia that stakeholders perceived to be priorities for primary research were identified through a consultation workshop. Results 579 research reports were identified, and only six studies were included in the scoping review. The included studies explored the following topics: the use of tobacco imagery in movies/films (two studies); the association between mass media exposure or home internet access and tobacco use (two studies), watching of televised football and tobacco smoking in adolescents (one study), exposure to point-of-sale advertising of tobacco products and daily occurrence of smoking or second-hand smoke exposure in the home among women (one study), and exposure to anti-smoking messages through mass media and disparities in risk perceptions across socio-economic and urban-rural subgroups (one study). None of the included studies investigated tobacco-related sponsorship. The top research priority topics identified by stakeholders in Ethiopia were: 1) barriers and facilitators to TAPS policy implementation, enforcement, and compliance monitoring; and 2) developing and testing effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring. Conclusions There is a need for research evidence to inform policy and practice on TAPS in Ethiopia, particularly on barriers and facilitators to TAPS policy implementation, enforcement, compliance monitoring, and effective, low-cost, and scalable strategies for TAPS enforcement and compliance monitoring.
Collapse
Affiliation(s)
- Terefe G. Argefa
- ICAP at Columbia University Mailman School of Public Health, Addis Ababa, Ethiopia
- Development Gateway: an IREX Venture, Washington, DC, United States
| | - Tyryn Carnegie
- Development Gateway: an IREX Venture, Washington, DC, United States
| | - Selam A. Kassa
- Development Gateway: an IREX Venture, Washington, DC, United States
| | | | - Noreen D. Mdege
- Development Gateway: an IREX Venture, Washington, DC, United States
- Department of Health Sciences, University of York, York, United Kingdom
- Centre for Research in Health and Development, Amos Drive, York, United Kingdom
| |
Collapse
|
9
|
Nayak R, Kamath A, Li J, Kulkarni MM, Kamath VG, Kumar P, Naik A, Parrott S, Mdege ND. The association between the retail price of manufactured cigarettes and bidis on current smoking status in India. Tob Induc Dis 2022; 20:43. [PMID: 35600725 PMCID: PMC9074849 DOI: 10.18332/tid/146904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 01/27/2022] [Accepted: 02/23/2022] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION In India, the retail prices of bidis and cigarettes varied between the two Global Adult Tobacco Surveys (GATS) conducted in 2009-2010 and 2016-2017. The relationship between the retail price of smoked tobacco products and their use is unclear for India. Our study thus aimed to use available datasets to investigate the association between the retail price and current smoking status of bidis and cigarettes in India. METHODS Current smoking status data for bidis and cigarettes were obtained from the two GATS rounds. The average state-level retail prices of bidis and cigarettes were obtained from India's Consumer Price Index- Industrial Workers database. Descriptive statistics were used to describe current smoking status patterns. Generalized Linear Mixed Models were used to investigate the association between the retail prices and current smoking status of bidis and cigarettes. RESULTS For cigarettes, an increase in the average retail price by one Indian Rupee was associated with a reduction in the odds of being a current smoker of 7% (OR=0.925; 95% CI: 0.918-0.932, p<0.001). For bidis, the association between the retail price and current smoking status was not statistically significant (OR=1.01; 95% CI: 1.00-1.02, p=0.082). CONCLUSIONS Current increases in the retail prices of tobacco products in India seem to have an impact on the use of cigarettes but not bidis. This highlights the need for tobacco product tax increases that result in sufficient retail prices increase to make all tobacco products less affordable and reduce their use.
Collapse
Affiliation(s)
- Radhika Nayak
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Asha Kamath
- Department of Data Science, Prasanna School of Public Health, Manipal Academy of Higher Education, Manipal, India
| | - Jinshuo Li
- Department of Health Sciences, University of York, York, United Kingdom
| | - Muralidhar M. Kulkarni
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Veena G. Kamath
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Praveen Kumar
- Department of Commerce, Manipal Academy of Higher Education, Manipal, India
| | - Ashwath Naik
- Department of Community Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
| | - Steve Parrott
- Department of Health Sciences, University of York, York, United Kingdom
| | - Noreen D. Mdege
- Department of Health Sciences, University of York, York, United Kingdom
| |
Collapse
|
10
|
Choi K, Kreuger K, McNeel TS, Osgood N. Point-of-sale cigarette pricing strategies and young adult smokers' intention to purchase cigarettes: an online experiment. Tob Control 2022; 31:473-478. [PMID: 33632805 PMCID: PMC8385012 DOI: 10.1136/tobaccocontrol-2020-056004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/21/2020] [Accepted: 10/26/2020] [Indexed: 11/04/2022]
Abstract
BACKGROUND Point-of-sale tobacco marketing has been shown to be related to tobacco use behaviours; however, specific influences of cigarette price discounts, price tiers and pack/carton availability on cigarette purchasing intention are less understood by the tobacco control community. METHODS We conducted discrete choice experiments among an online sample of US young adult smokers (aged 18-30 years; n=1823). Participants were presented scenarios depicting their presence at a tobacco retail outlet with varying availability of cigarette price discounts, price tiers and pack/carton. At each scenario, participants were asked whether they would purchase cigarettes. Generalised linear regression models were used to examine the associations between of cigarette price discounts, price tiers and pack/carton with intention to purchase cigarettes overall and stratified by educational attainment. RESULTS Participants chose to purchase cigarettes in 70.9% of the scenarios. Offering price discounts were associated with higher odds of choosing to purchase cigarettes. Reducing the number of cigarette price tiers available in the store was associated with lower odds of choosing to purchase cigarettes. Stratified analysis showed that offering discounts on high-tier cigarette packs increased odds of choosing to purchase cigarettes among young adult smokers with at least some college education, while offering discounts on medium-tier cigarette packs increased odds of choosing to purchase cigarettes among those with some college education or less (eg, with a 10% discount, adjusted odds ratio [AOR]some college=1.62, 95% confidence interval [CI] 1.21 to 2.16; AOR≤high school=1.44, 95% CI 1.08 to 1.93). CONCLUSIONS Availability of cigarette price discounts, price tiers and pack/carton could potentially influence cigarette purchasing behaviours among young adult smokers. Regulating these marketing strategies may, therefore, reduce education-related smoking disparities.
Collapse
Affiliation(s)
- Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, Maryland, USA
| | - Kurt Kreuger
- Center for the Study of Complex Systems, University of Michigan, Ann Arbor, Michigan, USA
| | | | - Nathaniel Osgood
- Department of Community Health & Epidemiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
- Department of Computer Science, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| |
Collapse
|
11
|
Silver N, Rahman B, Folger S, Bertrand A, Khatib B, Gbenro M, Schillo B. A content analysis of promotional features in US direct-mail from ads across tobacco products from 2018-2020. Nicotine Tob Res 2022; 24:1627-1634. [PMID: 35417549 PMCID: PMC9759106 DOI: 10.1093/ntr/ntac095] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Direct-mail advertising is a crucial channel through which tobacco companies deliver price incentives that lower the barrier to tobacco use while promoting tobacco products via thematic appeals not legally permitted on other marketing channels. We examine the prevalence of price incentives and ad characteristics used in tobacco product ads mailed directly to US consumers. METHODS We analyzed the content of direct-mail tobacco advertisements (N= 1047) in circulation between January 2018 and December 2020 as captured by Mintel Comperemedia Direct. These ads were coded for product type, manufacturer/brand type, model characteristics, price incentives, and themes known to appeal to vulnerable subgroups. RESULTS Ads across all tobacco products included price incentives (96%) and contained themes that appealed to rural white (40%) and black audiences (15%). Themes known to appeal to youth and young adults were present in 40% of ads across all products, including 78% of ads promoting electronic nicotine delivery systems (ENDS). Moreover, among the ENDS ads featuring youth appealing themes (51%), also featured young models. DISCUSSION Expanding on previous research which focused on combustible and smokeless tobacco products, this analysis examines direct-mail ads across the full range of tobacco products. Our findings highlight the need for regulations to address 1) the high prevalence of price incentives which undermine the effectiveness of excise taxes on tobacco use, and 2) ad themes and characteristics that appeal to groups vulnerable to tobacco use, both of which have the potential to further exacerbate tobacco related health disparities. IMPLICATIONS This study reinforces the importance of examining direct-mail as the dominant medium for tobacco advertising, particularly by including coupons and discount codes that reduce product price and thus circumventing the effect of tobacco-related tax legislation.Direct-mail encourages continued product loyalty and use and engages new consumers using price incentives and advertising strategies likely to appeal to price-sensitive consumers and other vulnerable populations.Substantial use of youth-appealing elements in ENDS ads contradict the tobacco industry's mandate to not appeal to youth, warranting highlighting the gaps in current regulations that allows them to continue appealing to this population.
Collapse
Affiliation(s)
- Nathan Silver
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | - Basmah Rahman
- Evidence Synthesis Program, U.S. Department of Veteran Affairs, Washington, DC USA
| | - Shanell Folger
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | | | - Bushraa Khatib
- Truth Initiative Schroeder Institute, Washington, DC, USA
| | | | | |
Collapse
|
12
|
Grummon AH, Golden SD. Sugar-Sweetened Beverage Pricing Policies: Simulation of Minimum Price Laws and Taxes in New York City. Am J Prev Med 2022; 62:e159-e168. [PMID: 34782187 DOI: 10.1016/j.amepre.2021.08.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/01/2022]
Abstract
INTRODUCTION Minimum price laws, which set a price below which a product cannot be sold, are a promising but understudied strategy for reducing the consumption of sugar-sweetened beverages. New York City has implemented a minimum price law for tobacco products and could consider this policy for sugar-sweetened beverages. This study projects the impacts of a sugar-sweetened beverage minimum price law among New York City adults, with effects of a sugar-sweetened beverage excise tax examined for comparison. METHODS In 2020-2021, a microsimulation model of dietary behaviors and body weight was developed using population-based survey data, research on responsiveness to and avoidance of price increases, and a validated weight change model. Analyses applied the model to simulate the impacts of implementing a minimum price law (8 or 10 cents/ounce price floors) or an excise tax (1 or 2 cents/ounce tax rates) on diet and body weight among New York City adults for more than 5 years. Sensitivity analyses varied assumptions about price responsiveness, caloric compensation, and avoidance. RESULTS A sugar-sweetened beverage minimum price law with an 8 cents/ounce floor would reduce average sugar-sweetened beverage intake by 16.5 calories/day (95% uncertainty interval= -17.2, -15.8) and obesity prevalence by 0.86 percentage points (95% uncertainty interval= -1.03, -0.69). Benefits were similar for a minimum price law with a 10 cents/ounce floor and for 1 and 2 cents/ounce taxes (range of obesity reductions: -0.84 to -1.24 percentage points). Benefits persisted in sensitivity analyses and were larger for Black and Hispanic than for White and Asian adults and for adults with lower than for those with higher income. CONCLUSIONS Excise taxes and minimum price laws for sugar-sweetened beverages could both reduce New York City adults' sugar-sweetened beverage consumption and obesity prevalence and narrow sociodemographic disparities in obesity.
Collapse
Affiliation(s)
- Anna H Grummon
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Cambridge, Massachusetts; Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
| | - Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, UNC School of Medicine, University of North Carolina Chapel Hill, Chapel Hill, North Carolina
| |
Collapse
|
13
|
Scollo M, Branston JR. Where to next for countries with high tobacco taxes? The potential for greater control of tobacco pricing through licensing regulation. Tob Control 2022; 31:235-240. [PMID: 35241594 DOI: 10.1136/tobaccocontrol-2021-056554] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 10/29/2021] [Indexed: 11/04/2022]
Abstract
Optimising the taxation of tobacco products should be among the highest priorities for health and hence economic policy in every country. The WHO Technical Manual on Tobacco Tax Policy and Administration released in April 2021 provides invaluable advice, including 26 best practice recommendations on policy design, administrative efficiency and addressing industry tactics to circumvent tobacco tax increases. Introducing and increasing tobacco taxes is the most important tobacco control measure for any jurisdiction. The effects of simple tax structures, high tax levels, and frequent above-inflation increases in specific excise duties can be enhanced through strict controls on packaging (including pack size), product design, and discounting. However, even with such measures, tobacco companies can continue to undermine the effectiveness of tax policy by offering some products in their ranges at very low prices, as well as gradually and selectively increasing the prices of some but not all products after tax increases. This paper is aimed at policymakers in countries that have already adopted best practice tax policy. It explores the idea of wholesale price capping combined with retail licensing to address the problems of brand proliferation, dispersion of prices, cushioning and strategic under/overshifting of tax increases, thereby radically and sustainably increasing the effectiveness of tobacco tax policy while also raising additional tax revenue for governments by reducing industry profitability.
Collapse
Affiliation(s)
- Michelle Scollo
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | | |
Collapse
|
14
|
Kong AY, Golden SD, Ribisl KM, Krukowski RA, Vandegrift SM, Little MA. Cheaper tobacco product prices at US Air Force Bases compared with surrounding community areas, 2019. Tob Control 2021; 31:e169-e174. [PMID: 34907089 DOI: 10.1136/tobaccocontrol-2021-056984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 11/17/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION In March 2017, the US Department of Defense (DoD) implemented a policy requiring all military stores to set tobacco prices equal to 'prevailing prices' in the 'local community' adjusted for state and local taxes. We compared tobacco product prices in a sample of retailers located on five Air Force Bases (AFBs) in Texas and Mississippi with those sold in nearby off-base stores. METHODS We constructed a list of on-base and off-base tobacco retailers. Off-base retailers included stores that were located within a 1.5-mile road network service area from main AFB gates. Between July and September 2019, a trained auditor visited 23 on-base and 50 off-base retailers to confirm tobacco product sales, and documented the price of cigarettes and Copenhagen smokeless tobacco. For each area, the median price for each product, as well as the difference in median prices by on-base versus off-base status, was calculated. RESULTS The median price of cigarettes and smokeless products was cheaper at on-base retailers. All products were cheaper at on-base stores in Fort Sam Houston and Lackland AFB. Similarly, all products were cheaper in on-base stores at Keesler AFB, with the exception of Marlboro Red packs ($0.22 more), and at Sheppard AFB with the exception of cheapest cigarette cartons ($6.26 more). CONCLUSION Despite the implementation of the new DoD policy, tobacco products are cheaper in on-base retailers compared with off-base retailers. Refining of the definitions used and improved compliance with the new DoD policy are needed.
Collapse
Affiliation(s)
- Amanda Y Kong
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Family & Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Shelley D Golden
- Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Kurt M Ribisl
- Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA.,Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rebecca A Krukowski
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sara M Vandegrift
- Health Behavior, University of North Carolina at Chapel Hill Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Melissa A Little
- Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| |
Collapse
|
15
|
Kong AY, King BA. Boosting the Tobacco Control Vaccine: recognizing the role of the retail environment in addressing tobacco use and disparities. Tob Control 2021; 30:e162-e168. [PMID: 32967986 PMCID: PMC9377406 DOI: 10.1136/tobaccocontrol-2020-055722] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 07/22/2020] [Accepted: 07/28/2020] [Indexed: 01/18/2023]
Abstract
Much of the progress in reducing cigarette smoking and tobacco-related morbidity and mortality among youth and adults is attributable to population-level strategies previously described in the context of the Tobacco Control Vaccine. The retail environment is used heavily by the tobacco industry to promote and advertise its products, and variations in exposure to and characteristics of the retail environment exist across demographic groups. It is therefore also an essential environment for further reducing smoking, as well as ameliorating racial, ethnic and socioeconomic tobacco-related disparities. This commentary provides an overview of the importance of incorporating strategies focused on the tobacco retailer environment (availability; pricing and promotion; advertising and display; age of sale; and retail licensure) as part of a comprehensive approach to tobacco prevention and control. To reach tobacco endgame targets, such innovative strategies are a complement to, but not a replacement for, long-standing evidence-based components of the Tobacco Control Vaccine.
Collapse
Affiliation(s)
- Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Brian A King
- Office on Smoking and Health, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
16
|
Arena R, Myers J, Kaminsky LA, Williams M, Sabbahi A, Popovic D, Axtell R, Faghy MA, Hills AP, Olivares Olivares SL, Lopez M, Pronk NP, Laddu D, Babu AS, Josephson R, Whitsel LP, Severin R, Christle JW, Dourado VZ, Niebauer J, Savage P, Austford LD, Lavie CJ. Current Activities Centered on Healthy Living and Recommendations for the Future: A Position Statement from the HL-PIVOT Network. Curr Probl Cardiol 2021; 46:100823. [PMID: 33789171 PMCID: PMC9587486 DOI: 10.1016/j.cpcardiol.2021.100823] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 02/22/2021] [Indexed: 12/15/2022]
Abstract
We continue to increase our cognizance and recognition of the importance of healthy living (HL) behaviors and HL medicine (HLM) to prevent and treat chronic disease. The continually unfolding events precipitated by the coronavirus disease 2019 (COVID-19) pandemic have further highlighted the importance of HL behaviors, as indicated by the characteristics of those who have been hospitalized and died from this viral infection. There has already been recognition that leading a healthy lifestyle, prior to the COVID-19 pandemic, may have a substantial protective effect in those who become infected with the virus. Now more than ever, HL behaviors and HLM are essential and must be promoted with a renewed vigor across the globe. In response to the rapidly evolving world since the beginning of the COVID-19 pandemic, and the clear need to change lifestyle behaviors to promote human resilience and quality of life, the HL for Pandemic Event Protection (HL-PIVOT) network was established. The 4 major areas of focus for the network are: (1) knowledge discovery and dissemination; (2) education; (3) policy; (4) implementation. This HL-PIVOT network position statement provides a current synopsis of the major focus areas of the network, including leading research in the field of HL behaviors and HLM, examples of best practices in education, policy, and implementation, and recommendations for the future.
Collapse
Key Words
- aca, affordable care act
- bmi, body mass index
- copd, chronic obstructive pulmonary disease
- covid-19, coronavirus disease 2019
- crf, cardiorespiratory fitness
- hcps, healthcare professionals
- hl, healthy living
- hlm, healthy living medicine
- hl-pivot, healthy living for pandemic event protection
- mets, metabolic equivalents
- pa, physical activity
- pafit, physical activity and fitness
- sars-cov-2, severe acute respiratory syndrome coronavirus 2
- us, united states
- vo2, oxygen consumption
- who, world health organization
Collapse
Affiliation(s)
- Ross Arena
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL.
| | - Jonathan Myers
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; VA Palo Alto Health Care System and Stanford University, Palo Alto, CA
| | - Leonard A Kaminsky
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Ball State University, Muncie, IN
| | - Mark Williams
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Creighton University, Omaha, NE
| | - Ahmad Sabbahi
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL
| | - Dejana Popovic
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Clinic for Cardiology, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia
| | - Robert Axtell
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Southern Connecticut State University, New Haven, CT
| | - Mark A Faghy
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Human Research Centre, University of Derby, Derby, United Kingdom
| | - Andrew P Hills
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; School of Health Sciences, University of Tasmania, Tasmania, Australia
| | - Silvia Lizett Olivares Olivares
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Mildred Lopez
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Nicolaas P Pronk
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; HealthPartners Institute, Bloomington, Minnesota, and Harvard TH Chan School of Public Health, Boston, MA
| | - Deepika Laddu
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL
| | - Abraham Samuel Babu
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Department of Physiotherapy, Manipal College of Health Professions, Manipal Academy of Higher Education, Manipal, India
| | - Richard Josephson
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Case Western Reserve University and University Hospitals of Cleveland, Cleveland, OH
| | - Laurie P Whitsel
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL
| | - Rich Severin
- Department of Physical Therapy, College of Applied Science, University of Illinois at Chicago, Chicago, IL; Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL
| | - Jeffrey W Christle
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Stanford University, Stanford, CA
| | - Victor Zuniga Dourado
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Federal University of São Paulo, Santos, São Paulo, Brazil
| | - Josef Niebauer
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Institute of Sports Medicine, Prevention and Rehabilitation, Paracelsus Medical University and Ludwig Boltzmann Institute for Digital Health and Prevention, Salzburg, Austria
| | - Patrick Savage
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; University of Vermont Medical Center, Cardiac Rehabilitation Program, South Burlington, VT
| | - Leslie D Austford
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; TotalCardiology Research Network, and TotalCardiologyTM, Calgary, Alberta, Canada
| | - Carl J Lavie
- Healthy Living for Pandemic Event Protection (HL - PIVOT) Network, Chicago, IL; Department of Cardiovascular Diseases, John Ochsner Heart and Vascular Institute, Ochsner Clinical School-University of Queensland School of Medicine, New Orleans, LA
| |
Collapse
|
17
|
Boettiger DC, White JS. Effects of a minimum floor Price law on cigarette use in Oakland, California: A static microsimulation model. Prev Med 2021; 145:106444. [PMID: 33529637 DOI: 10.1016/j.ypmed.2021.106444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/25/2021] [Accepted: 01/27/2021] [Indexed: 11/17/2022]
Abstract
Tobacco minimum floor price laws (MFPLs) are a non-tax price policy that set a price below which tobacco products cannot be sold, thereby raising prices. Despite their growing interest among policy makers, little is known about the effects of local MFPLs on smoking prevalence or smoking intensity. We aimed to project the impact of a local tobacco MFPL on cigarette smoking prevalence and cigarette smoking intensity in Oakland, California, including detailed analysis of several important subpopulations. We used data collected between April 2017 and December 2019 from the California Behavioral Risk Factor Surveillance System and the National Youth Tobacco Survey to construct a static microsimulation model representative of Oakland. We projected the impact of MFPLs ranging from $8.00 to $13.00 per pack. All analyses were conducted between 2019 and 2020. With the introduction of an MFPL and assuming 15% policy evasion, mean price paid per pack was projected to increase by $1.05 to $4.69, cigarette smoking prevalence was projected to drop by 0.3% to 0.8%, and smoking intensity was projected to drop by 0.7% to 2.0% among continuing smokers. Total number of cigarettes smoked per month was projected to drop by 246,000 to 734,000 cigarettes, a 3.0% to 9.0% reduction from the current level (8.2 million cigarettes). The greatest reductions in cigarette smoking prevalence were among those aged 12 to 24-years-old, of non-Hispanic black or other race/ethnicity, and living below the federal poverty level. An MFPL in Oakland may substantially reduce cigarette use and target several important subpopulations.
Collapse
Affiliation(s)
- David C Boettiger
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA; Kirby Institute, University of New South Wales, Sydney, Australia.
| | - Justin S White
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, USA
| |
Collapse
|
18
|
Critchlow N, Moodie C, Best C, Stead M. Anticipated responses to a hypothetical minimum price for cigarettes and roll-your-own tobacco: an online cross-sectional survey with cigarette smokers and ex-smokers in the UK. BMJ Open 2021; 11:e042724. [PMID: 33753438 PMCID: PMC7986940 DOI: 10.1136/bmjopen-2020-042724] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 12/30/2020] [Accepted: 03/05/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES As tobacco companies can circumvent tax increases, a minimum retail price per-cigarette/per-gram of roll-your-own tobacco presents an additional mechanism for governments to reduce smoking. We examined (1) anticipated responses to a hypothetical minimum price-per-cigarette/per-gram among smokers in the UK; (2) what demographic and smoker characteristics are associated with anticipated responses; and (3) whether minimum pricing may help ex-smokers stay quit. DESIGN Cross-sectional survey (May-July 2019). SETTING UK. PARTICIPANTS Adult cigarette smokers (n=2412) and ex-smokers (n=700). MAIN OUTCOME MEASUREMENTS Anticipated responses to a hypothetical minimum price of £10.00 for 20 cigarettes (£0.50 per-cigarette) and £13.50 for 30 grams of roll-your-own tobacco (£0.45 per-gram); approximately £0.10 per-cigarette/per-gram increases on the cheapest prices in leading UK supermarkets (January 2019). Smokers were presented with ten options (eg, 'Try to quit') and asked which they would do (Yes/No) and then which they would most likely do. Ex-smokers were asked to what extent the minimum prices would help them stay quit (A lot vs Lesser agreement). RESULTS Among smokers, 55.6% said they would most likely smoke the same amount, 10.7% they would smoke less, 9.5% they would try to quit and 5.8% they would use e-cigarettes more often. Anticipated reactions were associated with demography and smoker characteristics, for example, C2DE (lower social grade) smokers were less likely than ABC1 (higher social grade) smokers to say they would smoke the same as they do now (ORAdj=0.74, 95% CI 0.62 to 0.88). Among ex-smokers, 38.5% said the minimum prices would help them stay quit 'A lot', more so among C2DE than ABC1 participants (ORAdj=1.80, 95% CI 1.30 to 2.49). CONCLUSIONS In response to a hypothetical minimum price for cigarettes and roll-your-own tobacco, approximately a fifth of smokers in the UK indicated they would smoke less or quit and almost two-fifths of ex-smokers indicated the prices would help them stay quit.
Collapse
Affiliation(s)
- Nathan Critchlow
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Crawford Moodie
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Catherine Best
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| | - Martine Stead
- Institute for Social Marketing and Health, University of Stirling, Stirling, UK
| |
Collapse
|
19
|
Khanal GN, Khatri RB. Burden, prevention and control of tobacco consumption in Nepal: a narrative review of existing evidence. Int Health 2021; 13:110-121. [PMID: 32914846 PMCID: PMC7902273 DOI: 10.1093/inthealth/ihaa055] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Revised: 06/02/2020] [Accepted: 08/09/2020] [Indexed: 11/23/2022] Open
Abstract
Tobacco consumption is one of the major public health problems in the world. Annually, 27 100 premature deaths are attributed to tobacco-related diseases in Nepal. Despite enacting different policies and strategies, the prevalence of tobacco consumption is still high. This study aims to synthesize prevalence, factors associated with its consumption and the policy initiatives for prevention and control in Nepal. This review includes peer-reviewed studies retrieved from two databases (PubMed and EMBASE) and published from 2000 to 2018, and policy initiatives on tobacco prevention and regulations in Nepal. A total of 32 studies and 5 policy documents were reviewed. Findings suggest that tobacco consumption was higher among men, illiterates, older people, people living in rural and mountainous areas and those who initiated smoking as adolescents. Peer pressure and parental/family smoking were major contributing factors for tobacco initiation. Policy analysis showed that low excise tax, weak monitoring mechanisms, poor compliance to bans on the advertisement and promotion of tobacco, smoke-free zones and insufficient programs on tobacco cessation were the major factors behind weak implementation of tobacco-control policies. Hence, targeted and high-risk group tobacco-cessation interventions, increasing taxation and strict policy implementation are crucial for effective tobacco prevention and control in Nepal.
Collapse
Affiliation(s)
| | - Resham Bahadur Khatri
- Center for Research and Development, Surkhet, Nepal.,School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
20
|
Lee JGL, Cristello JV, Buckton CH, Carey RN, Trucco EM, Schenk PM, Ikegwuonu T, Hilton S, Golden SD, Conway DI. Message framing to inform cancer prevention pricing interventions in the UK and USA: a factorial experiment, 2019. BMJ Open 2021; 11:e041324. [PMID: 33495253 PMCID: PMC7839858 DOI: 10.1136/bmjopen-2020-041324] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/10/2020] [Accepted: 12/18/2020] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To advance understanding of how message framing can be used to maximise public support across different pricing policies for alcohol, tobacco and sugary drinks/foods that prevent consumption of cancer-causing products. DESIGN We designed a 3×4×3 randomised factorial experiment to test responses to messages with three pricing policies, four message frames and three products. SETTING Online survey panel (Qualtrics) in 2019. PARTICIPANTS Adults (N=1850) from the UK and USA. INTERVENTIONS Participants randomly viewed one of 36 separate messages that varied by pricing policy (increasing taxes, getting rid of price discounts, getting rid of low-cost products), four frames and product (alcohol, tobacco, sugary drinks/foods). PRIMARY AND SECONDARY OUTCOME MEASURES We assessed the relationship between the message characteristics and four dependent variables. Three were related to policy support: (1) increasing taxes on the product mentioned in the message, (2) getting rid of price discounts and special offers on the product mentioned in the message and (3) getting rid of low-cost versions of the product mentioned in the message. One was related to reactance, a psychological response to having one's freedom limited. RESULTS We found no effect for pricing policy in the message. Frames regarding children and reducing cancer risk moderated some outcomes, showing promise for real-world use. We found differences in support by product and reactance with greatest support and least reactance for tobacco policies, less support and more reactance for alcohol policies, and the least support and most reactance for sugary drinks/foods policies. CONCLUSIONS Cancer prevention efforts using policy interventions can be informed by the message framing literature. Our results offer insights for cancer prevention advocacy efforts across the UK and USA and highlight that tax versus non-tax approaches to increasing the cost of cancer-causing products result in similar responses from consumers.
Collapse
Affiliation(s)
- Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, North Carolina, USA
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
| | - Julie V Cristello
- Department of Psychology, Florida International University, Miami, Florida, USA
| | - Christina H Buckton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Rachel N Carey
- Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Elisa M Trucco
- Department of Psychology and Center for Children and Families, Florida International University, Miami, Florida, USA
- Department of Psychiatry, University of Michigan, Ann Arbor, Michigan, USA
| | - Paulina M Schenk
- Department of Clinical, Educational & Health Psychology, University College London, London, UK
| | - Theresa Ikegwuonu
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Shona Hilton
- MRC/CSO Social and Public Health Sciences Unit, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Shelley D Golden
- Cancer Prevention and Control, University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina, USA
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - David I Conway
- School of Medicine, Dentistry, and Nursing, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| |
Collapse
|
21
|
Apollonio DE, Glantz S. Tobacco manufacturer lobbying to undercut minimum price laws: an analysis of internal industry documents. Tob Control 2020; 29:e10-e17. [PMID: 31969381 PMCID: PMC7374022 DOI: 10.1136/tobaccocontrol-2019-055354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/19/2019] [Accepted: 12/11/2019] [Indexed: 11/03/2022]
Abstract
BACKGROUND Increasing the price of tobacco products has the potential to reduce tobacco consumption. As other forms of promotion have been increasingly restricted over time, tobacco manufacturers have relied more on trade discounts. Minimum price laws that prevented the use of manufacturer promotions were once common; however in most US jurisdictions these discounts are now legally protected. METHODS We collected tobacco industry documents, state legislation and court cases between 1987 and 2016 to review tobacco manufacturer strategies to change minimum price laws in the USA. RESULTS Beginning in 2000, tobacco manufacturers lobbied to amend minimum price legislation after state regulators indicated that manufacturer promotions were illegal under existing laws. Companies viewed changing these laws as critical to maintaining tobacco sales, and after the initiation of an industry lobbying campaign, at least 20 states changed the way they calculated tobacco prices. CONCLUSIONS Modifying existing minimum price laws so that manufacturer discounts are no longer protected, and implementing new minimum price policies with comparable scope, would likely increase prices and reduce tobacco use.
Collapse
Affiliation(s)
- Dorie E Apollonio
- Department of Clinical Pharmacy, University of California San Francisco, San Francisco, California, USA
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| |
Collapse
|
22
|
Guindon GE, Fatima T, Abbat B, Bhons P, Garasia S. Area-level differences in the prices of tobacco and electronic nicotine delivery systems - A systematic review. Health Place 2020; 65:102395. [PMID: 32858241 DOI: 10.1016/j.healthplace.2020.102395] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/30/2020] [Accepted: 07/09/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To examine associations between area-level characteristics (socioeconomic status, racial or ethnic characteristics, age, and any other characteristics that may be associated with vulnerability) and the prices of tobacco products and electronic nicotine delivery systems (ENDS). DATA SOURCES We searched MEDLINE, EconLit and Scopus, unpublished and grey literature, hand-searched four specialty journals, examined references of relevant studies, and contacted key informants. STUDY SELECTION We considered all studies that quantitatively examined area-level variations in the prices of tobacco products and ENDS. We included all studies that examined any area-level measures regardless of the geographic location, language or time of publication. At least two reviewers independently screened the articles. We identified 20 studies. DATA EXTRACTION At least two reviewers independently extracted the characteristics, methods, and main results and assessed the quality of each included study. DATA SYNTHESIS Overall, cigarette prices were found to be lower in lower socioeconomic status neighbourhoods, and in neighbourhoods with a higher percentage of youth, and Blacks or African Americans. We identified too few studies that examined price differences for cigarillos, chewing tobacco, roll-your-own, and ENDS to reach any conclusions. CONCLUSIONS Our findings are in keeping with tobacco industry documents that detailed how manufacturers used race, class, and geography to target vulnerable populations and suggest that regulations that can limit industry price manipulation such as minimum, maximum, and uniform prices, and high specific excise taxes should be considered. More frequent and systematic monitoring of tobacco prices and ENDS is warranted.
Collapse
Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada; Department of Economics, McMaster University, Hamilton, ON, Canada.
| | - Tooba Fatima
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Bipandeep Abbat
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Prabhnoor Bhons
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Sophiya Garasia
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence, and Impact (HEI), McMaster University, Hamilton, ON, Canada
| |
Collapse
|
23
|
Boettiger DC, White JS. Cigarette Pack Prices and Sales Following Policy Changes in California, 2011-2018. Am J Public Health 2020; 110:1002-1005. [PMID: 32437272 PMCID: PMC7287537 DOI: 10.2105/ajph.2020.305647] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/29/2020] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the combined effect of California's Tobacco 21 law (enacted June 2016) and $2-per-pack cigarette excise tax increase (enacted April 2017) on cigarette prices and sales, compared with matched comparator states.Methods. We used synthetic control methods to compare cigarette prices and sales after the policies were enacted, relative to what we would have expected without the policy reforms. To estimate the counterfactual, we matched pre-reform covariate and outcome trends between California and control states to construct a "synthetic" California.Results. Compared with the synthetic control in 2018, cigarette prices in California were $1.89 higher ($7.86 vs $5.97; P < .001), and cigarette sales were 16.6% lower (19.9 vs 16.6 packs per capita; P < .001). This reduction in sales equates to 153.9 million fewer packs being sold between 2017 and 2018.Conclusions. California's new cigarette tax was largely passed on to consumers. The new cigarette tax, combined with the Tobacco 21 law, have contributed to a rapid and substantial reduction in cigarette consumption in California.
Collapse
Affiliation(s)
- David C Boettiger
- David C. Boettiger is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, and the Kirby Institute, University of New South Wales, Sydney, Australia. Justin S. White is with the Philip R. Lee Institute for Health Policy Studies and the Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Justin S White
- David C. Boettiger is with the Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, and the Kirby Institute, University of New South Wales, Sydney, Australia. Justin S. White is with the Philip R. Lee Institute for Health Policy Studies and the Department of Epidemiology and Biostatistics, University of California, San Francisco
| |
Collapse
|
24
|
Perry CL, Creamer MR, Chaffee BW, Unger JB, Sutfin EL, Kong G, Shang C, Clendennen SL, Krishnan-Sarin S, Pentz MA. Research on Youth and Young Adult Tobacco Use, 2013-2018, From the Food and Drug Administration-National Institutes of Health Tobacco Centers of Regulatory Science. Nicotine Tob Res 2020; 22:1063-1076. [PMID: 31127298 PMCID: PMC7457341 DOI: 10.1093/ntr/ntz059] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 04/16/2019] [Indexed: 12/21/2022]
Abstract
The Tobacco Regulatory Science Program is a collaborative research effort between the National Institutes of Health (NIH) and the Food and Drug Administration (FDA). In 2013, the NIH funded 14 Tobacco Centers of Regulatory Science (TCORS), which serve as partners in establishing research, training, and professional development programs to guide FDA. Each of the fourteen TCORS, and two other NIH-funded research programs, the Center for the Evaluation of Nicotine in Cigarettes (CENIC) and the Consortium on Methods Evaluating Tobacco (COMET), pursued specific research themes relevant to FDA's priorities. A key mandate for FDA is to reduce tobacco use among young people. This article is a review of the peer-reviewed research, including published and in-press manuscripts, from the TCORS, CENIC, and COMET, which provides specific data or other findings on youth (ages 10-18 years) and/or young adults (ages 18-34 years), from 2013 to 2018. Citations of all TCORS, CENIC, and COMET articles from September 2013 to December 2017 were collected by the TCORS coordinating center, the Center for Evaluation and Coordination of Training and Research. Additional citations up to April 30, 2018 were requested from the principal investigators. A scoring rubric was developed and implemented to assess study type, primary theme, and FDA priority area addressed by each article. The major subareas and findings from each priority area are presented. There were 766 articles in total, with 258 (34%) focusing on youth and/or young adults. Findings relevant to FDA from this review concern impact analysis, toxicity, health effects, addiction, marketing influences, communications, and behavior. IMPLICATIONS The Tobacco Centers of Regulatory Science, CENIC, and COMET have had a high output of scientific articles since 2013. These Centers are unique in that the FDA supports science specifically to guide future regulatory actions. The 258 articles that have focused on youth and/or young adults are providing data for regulatory actions by the FDA related to the key priority areas such as the addictiveness of non-cigarette products, the effects of exposure to electronic cigarette marketing on initiation and cessation, and the impact of flavored products on youth and young adult tobacco use. Future regulations to reduce tobacco use will be guided by the cumulative evidence. These Centers are one innovative mechanism to promote important outcomes to advance tobacco regulatory science.
Collapse
Affiliation(s)
- Cheryl L Perry
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | - MeLisa R Creamer
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Jennifer B Unger
- Keck School of Medicine,University of Southern California, Los Angeles, CA
| | | | | | - Ce Shang
- Oklahoma Tobacco Research Center, Stephenson Cancer Center
- Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, OK
| | - Stephanie L Clendennen
- School of Public Health at Austin, The University of Texas Health Science Center at Houston, Austin, TX
| | | | - Mary Ann Pentz
- Keck School of Medicine,University of Southern California, Los Angeles, CA
| |
Collapse
|
25
|
Fahey MC, Talcott GW, McMurry TL, Klesges RC, Tubman D, Krukowski RA, Little MA. When, How, & Where Tobacco Initiation and Relapse Occur During U.S. Air Force Technical Training. Mil Med 2020; 185:e609-e615. [PMID: 32060547 PMCID: PMC7282443 DOI: 10.1093/milmed/usaa016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 12/09/2019] [Accepted: 01/21/2020] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Military personnel are at high risk for tobacco use, particularly during the first year of military service. Technical Training follows an 8½ week tobacco ban during basic military training and is a vulnerable time for personnel to both reinitiate and initiate tobacco use. Thus, this can be a crucial time to promote tobacco policies and interventions. However, there is limited research examining when, how, and where personnel access tobacco during the first year of service, particularly among users of newer products (eg, electronic cigarettes[e-cigarettes]). Thus, the purpose of the current study is to explore the timing, source, and location of tobacco use during Technical Training across all types of products. Furthermore, this study will examine differences in demographic characteristics and prior tobacco history in relationship to these tobacco behaviors. MATERIALS AND METHODS Participants were U.S. Air Force recruits completing Technical Training (2017-2018). Protocol was approved by the Institutional Review Board at the 59th Medical Wing of the U.S. Air Force. During the first week of Technical Training, Airmen were consented to participate in the study and completed a questionnaire about demographics and tobacco use history. Next, Airmen were randomized to receive one of three tobacco prevention interventions as part of military training. At a 3-month follow-up, during the last week of Technical Training, consented participants completed a questionnaire about current tobacco use. Airmen reported when (ie, first month vs. after), how (ie, "bummed" from another airman, bought on or off base, received from the internet or event), and where (ie, designated smoking areas on base, off base, bar or club, friend's house, cigar lounge, hookah bar, or vape shop) they used tobacco during Technical Training. Descriptive statistics were used to examine these behaviors across all tobacco products. Additionally, Wilcoxon-Mann-Whitney and Kruskal-Wallis tests compared differences in demographic characteristics and baseline tobacco use in relationship to these tobacco behaviors. RESULTS No significant differences were found when comparing prior users and first-time users in relationship to tobacco behaviors during Technical Training; however, significant differences in educational background and age were found in regard to the source and location of tobacco use. Additionally, how and where Airmen first used tobacco during Technical Training differed across products. Cigarettes and smokeless tobacco were equally likely to be bought on or off base and most commonly first used at a designated smoking area on base. However, e-cigarettes, cigarillos/little cigars, and hookah were more likely to be bought off base, and first used at a specialty store (ie, vape shop, hookah bar, or cigar lounge). CONCLUSIONS Tobacco use behaviors during Technical Training differed depending on the type of product. Specifically, new and emerging products were more likely to be bought off base and first used at a specialty store. Thus, military polices regulating on base tobacco pricing might not reduce the growing prevalence of e-cigarettes. Future policies might consider addressing the density of off-base tobacco retailers to reduce the high rates of tobacco use in this population.
Collapse
Affiliation(s)
| | - G Wayne Talcott
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio- Lackland AFB; 1100 Wilford Hall Loop, Bldg 4430; JBSA-Lackland, TX 78236-9908, USA
| | - Timothy L McMurry
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - Robert C Klesges
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - David Tubman
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
| | - Rebecca A Krukowski
- University of Tennessee Health Science Center, Department of Preventive Medicine; 66 N Pauline Street Memphis, TN 38163, USA
| | - Melissa A Little
- University of Virginia School of Medicine; Center for Addiction and Prevention Research; 560 Ray C. Hunt Drive, Charlottesville, VA 22908, USA
- Wilford Hall Ambulatory Surgical Center, Joint Base San Antonio- Lackland AFB; 1100 Wilford Hall Loop, Bldg 4430; JBSA-Lackland, TX 78236-9908, USA
| |
Collapse
|
26
|
Perera SK, Vaikuntam BP, John D, Senanayake B. Designing an Optimum Fiscal Policy for Tobacco to Maximise the Tax Revenue, Social Savings and the Net Monetary Benefits in Sri Lanka. Int J Health Policy Manag 2020; 9:250-256. [PMID: 32613793 PMCID: PMC7382908 DOI: 10.15171/ijhpm.2019.114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 11/09/2019] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Fiscal policy targeting tobacco control is identified as the most effective strategy for rapid control of tobacco use. An optimum fiscal policy to estimate the percentage taxation that will maximise the government tax revenue, social savings and the net monetary benefit has not been empirically designed before in Sri Lanka. METHODS A model was developed using Microsoft Excel 2016, utilizing up-to-date published evidence on the cigarette sales, current fiscal policy, social cost of tobacco use, consumer response and the price elasticity of cigarettes. Univariate estimates on the expected revenue from tobacco tax, average annual social savings and the net monetary benefit were predicted for different levels of tobacco taxation. A deterministic sensitivity analysis was performed covering all possibilities. The percentage taxation maximizing the government tax revenue and the net monetary benefit were identified. RESULTS It was estimated that a further 30% tax increase from the 2019 baseline will generate approximately LKR 3544 million per year of additional tax revenue for the government while saving LKR 28 069 million per annum as social savings. A fiscal elevation of 50% will produce identical annual tax revenue to that of 2018, while securing a social saving of more than LKR 47 600 million per annum. The maximum net monetary benefit is achievable at an overnight tax increase of 90% from the baseline, however with a short-term compromise in tax revenue. CONCLUSION The well-defined thresholds take tobacco taxation advocacy in Sri Lanka a step forward and will assist the government in taking an informed decision on its fiscal policy for cigarettes.
Collapse
Affiliation(s)
| | - Bharat Phani Vaikuntam
- University of New South Wales, Sydney, NSW, Australia
- University of Sydney, Sydney, NSW, Australia
| | - Denny John
- Campbell Collaboration, New Delhi, India
- National Institute of Medical Statistics, New Delhi, India
| | | |
Collapse
|
27
|
Halas G, Schultz ASH, Rothney J, Wener P, Holmqvist M, Cohen B, Kosowan L, Enns JE, Katz A. A Scoping Review of Foci, Trends, and Gaps in Reviews of Tobacco Control Research. Nicotine Tob Res 2020; 22:599-612. [PMID: 30715468 DOI: 10.1093/ntr/nty269] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/17/2019] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The burden of disease associated with tobacco use has prompted a substantial increase in tobacco-related research, but the breadth of this literature has not been comprehensively examined. This review examines the nature of the research addressing the action areas in World Health Organization's Framework Convention on Tobacco Control (FCTC), the populations targeted and how equity-related concepts are integrated. METHOD A scoping review of published reviews addressing tobacco control within the primary prevention domain. We searched PubMed, Scopus, Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Educational Resources Information Centre, and PsycInfo from 2004 to 2018. RESULTS The scoping review of reviews offered a "birds-eye-view" of the tobacco control literature. Within the 681 reviews meeting inclusion criteria, there was a strong focus on smoking cessation targeting individuals; less attention has been given to product regulation, packaging, and labeling or sales to minors. Equity-related concepts were addressed in 167/681 (24.5%); few were focused on addressing inequity through structural and systemic root causes. CONCLUSION This analysis of foci, trends, and gaps in the research pursuant to the FCTC illustrated the particular action areas and populations most frequently addressed in tobacco control research. Further research is needed to address: (1) underlying social influences, (2) particular action areas and with specific populations, and (3) sustained tobacco use through the influence of novel marketing and product innovations by tobacco industry. IMPLICATIONS This scoping review of the breadth of tobacco control research reviews enables a better understanding of which action areas and target populations have been addressed in the research. Our findings alongside recommendations from other reviews suggest prioritizing further research to support policymaking and considering the role of the tobacco industry in circumventing tobacco control efforts. The large amount of research targeting individual cessation would suggest there is a need to move beyond a focus on individual choice and decontextualized behaviors. Also, given the majority of reviews that simply recognize or describe disparity, further research that integrates equity and targets various forms of social exclusion and discrimination is needed and may benefit from working in collaboration with communities where programs can be tailored to need and context.
Collapse
Affiliation(s)
- Gayle Halas
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Annette S H Schultz
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Janet Rothney
- Neil John Maclean Health Sciences Library, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Wener
- Department of Occupational Therapy, College of Rehabilitation Sciences, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Maxine Holmqvist
- Department of Clinical Health Psychology, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Benita Cohen
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Leanne Kosowan
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Jennifer E Enns
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| | - Alan Katz
- Department of Family Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
- Department of Community Health Sciences, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, MB, Canada
| |
Collapse
|
28
|
Wang TW, Falvey K, Gammon DG, Loomis BR, Kuiper NM, Rogers T, King BA. Sales Trends in Price-Discounted Cigarettes, Large Cigars, Little Cigars, and Cigarillos-United States, 2011-2016. Nicotine Tob Res 2019; 20:1401-1406. [PMID: 29253226 DOI: 10.1093/ntr/ntx249] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 11/21/2017] [Indexed: 11/14/2022]
Abstract
Introduction Tobacco manufacturers continue to implement a range of pricing strategies to increase the affordability and consumption of tobacco products. To demonstrate the extent of retail- and brand-level price discounts at the point of sale, this study assessed national sales trends in price-discounted cigarettes, large cigars, little cigars, and cigarillos. Methods Retail scanner data for tobacco product sales were obtained for convenience stores (C-store) and all-other-outlets-combined (AOC) from September 25, 2011, to January 9, 2016. The proportion of price-discounted sales, average nondiscounted unit price, and average discounted unit price were examined by product category and brand. JoinPoint regression was used to assess average monthly percentage change. Results Overall, price-discounted sales accounted for 11.3% of cigarette, 3.4% of large cigar, 4.1% of little cigar, and 3.9% of cigarillo sales. The average difference between nondiscounted and discounted prices was 25.5% (C-store) and 36.7% (AOC) for cigarettes; 11.0% (C-store) and 11.2% (AOC) for large cigars; 19.2% (C-store) and 9.6% (AOC) for little cigars; and 5.3% (C-store) and 14.7% (AOC) for cigarillos. Furthermore, price-discounted sales of top-selling tobacco brands comprised up to 36% of cigarette, 7.4% of large cigar, 7.7% of little cigar, and 4.2% of cigarillo unit sales. Conclusions These findings highlight the use of price discounts by tobacco manufacturers to reduce the cost of cigarettes, large cigars, little cigars, and cigarillos to consumers. These sales patterns underscore the importance of sustained efforts to implement evidence-based strategies to increase prices and reduce availability and consumption of combustible tobacco in the United States. Implications This study highlights the prevalence and provides a baseline of price-discounted cigarettes, large cigars, little cigars, and cigarillos. Surveillance of tobacco sales data, including state-level trends and additional product types, is critical for informing approaches to reduce tobacco consumption. These approaches include countering tobacco product price-discounting practices and raising and maintaining a high sales price for all tobacco products. The implementation of evidence-based population-level interventions, together with local, state, and federal regulation of tobacco products, could prevent tobacco initiation, increase tobacco cessation, and reduce overall tobacco use among US youth and adults.
Collapse
Affiliation(s)
- Teresa W Wang
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.,Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Kyle Falvey
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Doris G Gammon
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Brett R Loomis
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Nicole M Kuiper
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Todd Rogers
- Center for Health Policy Science and Tobacco Research, RTI International, Research Triangle Park, North Carolina, USA
| | - Brian A King
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| |
Collapse
|
29
|
Kuipers MA, Partos T, McNeill A, Beard E, Gilmore AB, West R, Brown J. Smokers' strategies across social grades to minimise the cost of smoking in a period with annual tax increases: evidence from a national survey in England. BMJ Open 2019; 9:e026320. [PMID: 31243031 PMCID: PMC6597620 DOI: 10.1136/bmjopen-2018-026320] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 04/15/2019] [Accepted: 06/11/2019] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess associations between smokers' strategies to minimise how much their smoking costs and cost of smoking among smokers across three social grades during a period of annual tax increases in England. DESIGN Repeat cross-sectional. SETTING England, May 2012-December 2016. PARTICIPANTS 16 967 adult smokers in 56 monthly surveys with nationally representative samples. MEASURES AND ANALYSIS Weighted generalised additive models assessed associations between four cost-minimising strategies (factory-made and roll-your-own (RYO) cigarette consumption levels, illicit and cross-border purchases) and cost of smoking (£/week). We adjusted for inflation rate, age, gender and secular and seasonal trends. RESULTS Cost of smoking did not increase above the rate of inflation. Factory-made cigarette consumption decreased, while proportion of RYO and, to a much lesser extent, illicit and cross-border purchases increased. These trends were only evident in lowest social grade. Cost of smoking was 12.99% lower with consumption of 10 fewer factory-made cigarettes (95% CI -13.18 to -12.80) and 5.86% lower with consumption of 10 fewer RYO cigarettes (95% CI -5.66 to -6.06). Consumption levels accounted for 60% of variance in cost. Cross-border and illicit tobacco purchases were associated with 9.64% (95% CI -12.94 to -6.33) and 9.47% (95% CI -12.74 to -6.20) lower costs, respectively, but due to low prevalence, accounted for only 0.2% of variation. Associations were similar across social grades, although weaker for illicit and cross-border purchases and stronger for consumption in higher social grades compared with lower social grades. CONCLUSION During a period of annual tax increases, the weekly cost of smoking did not increase above inflation. Cost-minimising strategies increased, especially among more disadvantaged smokers. Reducing cigarette consumption and switching to RYO tobacco explained a large part of cost variation, while use of illicit and cross-border purchasing played only a minor role.
Collapse
Affiliation(s)
- Mirte Ag Kuipers
- Department of Public Health, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, Netherlands
- Department of Behavioural Science and Health, University College London, London, UK
| | - Timea Partos
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Ann McNeill
- Department of Addictions, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Beard
- Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Robert West
- Department of Behavioural Science and Health, University College London, London, UK
| | - Jamie Brown
- Department of Behavioural Science and Health, University College London, London, UK
- Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| |
Collapse
|
30
|
Bhatnagar A, Whitsel LP, Blaha MJ, Huffman MD, Krishan-Sarin S, Maa J, Rigotti N, Robertson RM, Warner JJ. New and Emerging Tobacco Products and the Nicotine Endgame: The Role of Robust Regulation and Comprehensive Tobacco Control and Prevention: A Presidential Advisory From the American Heart Association. Circulation 2019; 139:e937-e958. [DOI: 10.1161/cir.0000000000000669] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The advent of new tobacco products such as electronic cigarettes and the dramatic rise in their use, especially by adolescents and young adults, are significant public health concerns. Electronic cigarettes have become the most popular tobacco products for youth and adolescents in the United States and are attracting youth to new avenues for nicotine addiction. Although these products may have benefit by helping some smokers quit or to move to a less harmful product, the long-term health effects of these products and the net public health effect associated with their use remain unclear and widely debated. There is increasing concern that the use of newer tobacco products may catalyze transition to the use of other tobacco products or recreational drugs, particularly in young adults. Therefore, there is urgent need for robust US Food and Drug Administration regulation of all tobacco products to avoid the significant economic and population health consequences of continued tobacco use. Although the American Heart Association acknowledges that the ultimate endgame would be an end to all tobacco and nicotine addiction in the United States, it supports first minimizing the use of all combustible tobacco products while ensuring that other products do not addict the next generation of youth and adolescents. The endgame strategy needs to be coordinated with the long-standing, evidence-based tobacco control strategies that have significantly reduced tobacco use and initiation in the United States.
Collapse
|
31
|
Myers AE, Knocke K, Leeman J. Tapping Into Multiple Data "Springs" to Strengthen Policy Streams: A Guide to the Types of Data Needed to Formulate Local Retail Tobacco Control Policy. Prev Chronic Dis 2019; 16:E43. [PMID: 30950786 PMCID: PMC6466950 DOI: 10.5888/pcd16.180282] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In 2015, the tobacco industry spent $8.24 billion to market tobacco products in convenience stores, supermarkets, pharmacies, and other retail or point-of-sale settings. Community tobacco control partnerships have numerous evidence-based policies (eg, tobacco retailer licensing and compliance, tobacco-free–school buffer zones, eliminating price discounts) to counter point-of-sale tobacco marketing. However, deciding which point-of-sale policies to implement — and when and in what order to implement them — is challenging. The objective of this article was to describe tools and other resources that local-level tobacco use prevention and control leaders can use to assemble the data they need to formulate point-of-sale tobacco policies that fit the needs of their communities, have potential for public health impact, and are feasible in the local policy environment. We were guided by Kingdon’s theory of policy change, which contends that windows of policy opportunity open when 3 streams align: a clear problem, a solution to the problem, and the political will to work for change. Community partnerships can draw on 7 data “springs” to activate Kingdon’s streams: 1) epidemiologic and surveillance data, 2) macro retail environment data, 3) micro retail environment data, 4) the current policy context, 5) local legal feasibility of policy options, 6) the potential for public health impact, and 7) political will.
Collapse
Affiliation(s)
- Allison E Myers
- Counter Tools, Inc, Carrboro, North Carolina.,Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina
| | - Kathleen Knocke
- Department of Health Policy and Management, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina.,1101 McGavran-Greenberg, Campus Box 7411, Chapel Hill, NC 27599.
| | - Jennifer Leeman
- School of Nursing, University of North Carolina, Chapel Hill, North Carolina
| |
Collapse
|
32
|
Nargis N, Zheng R, Xu SS, Fong GT, Feng G, Jiang Y, Wang Y, Hu X. Cigarette Affordability in China, 2006⁻2015: Findings from International Tobacco Control China Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071205. [PMID: 30987255 PMCID: PMC6480272 DOI: 10.3390/ijerph16071205] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/24/2022]
Abstract
China is world’s largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers—50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to the detriment of public health. This study investigated whether the level and growth in cigarette affordability in China was equally shared by smokers from all demographic and socio-economic statuses (SES) and across all price tiers of cigarette brands. The data came from the urban smoker sample (≥18 years) of the International Tobacco Control China Surveys conducted in five waves over 2006–2015. Cigarette affordability was measured by Relative Income Price—percentage of per capita household income needed to purchase 100 cigarette packs of the last purchased brand. Overall and group-specific trends in affordability by age, gender, SES (e.g., income, education, and employment status), and price tiers were analyzed using generalized estimating equations method. Cigarette affordability was higher among older, female, and higher-SES smokers, and for cheaper brands. It increased overall and across all groups over time. The increase was significantly larger among younger and lower-SES smokers, a trend that poses an added challenge to tobacco control and health equity. To reduce cigarette affordability and consumption among these vulnerable groups, a uniform specific excise system should be introduced in place of the existing tiered ad valorem excise. The specific excise should be periodically adjusted to inflation and per capita income growth observed among younger and lower-SES people, who can potentially experience faster income growth than the national average. The excise tax policy can also be complimented with minimum price regulations and restrictions on price promotions.
Collapse
Affiliation(s)
- Nigar Nargis
- American Cancer Society, 555 11th Street NW, Suite 300, Washington, DC 20004, USA.
| | - Rong Zheng
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China.
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada.
| | - Guoze Feng
- Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China.
| | - Yuan Jiang
- Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China.
| | - Yang Wang
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China.
| | - Xiao Hu
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China.
| |
Collapse
|
33
|
Kong AY, Golden SD, Myers AE, Little MA, Klesges R, Talcott W, Vandegrift S, Cassidy D, Ribisl KM. Availability, price and promotions for cigarettes and non-cigarette tobacco products: an observational comparison of US Air Force bases with nearby tobacco retailers, 2016. Tob Control 2019; 28:189-194. [PMID: 29705745 PMCID: PMC6204316 DOI: 10.1136/tobaccocontrol-2018-054266] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 04/09/2018] [Accepted: 04/10/2018] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Active duty military personnel have higher cigarette and smokeless tobacco use rates than civilian populations. Although US Airmen (called Airmen regardless of gender or rank) are required to be tobacco-free during initial training, many resume use once this period ends, perhaps as a result of easy access to cheap tobacco products. METHODS Between July and September 2016, we collected tobacco product, price and promotion information by visiting on-base (n=28) and off-base (n=80) tobacco retailers near the eight technical training bases where approximately 99% of Airmen attend training. We conducted mixed linear effects models to examine on-base versus off-base differences. RESULTS Cigarette packs were 11%-12% cheaper at on-base retailers compared with off-base retailers. Newport Menthol and Marlboro Red cigarette packs were $0.87 and $0.80 lower on-base (p<0.001) while the cheapest pack available was $0.54 lower on-base (p<0.01). Copenhagen smokeless tobacco was also significantly cheaper on-base (B=-0.65, p<0.01). Interior price promotions were more common on-base. CONCLUSIONS Retail stores located on Air Force bases sell cigarettes and smokeless tobacco products at prices well below those in nearby off-base retailers: the vast majority of these retailers feature interior price promotions for these products. Federal policies regulating prices of on-base tobacco sales, if implemented more effectively, have the potential to protect the health of Airmen by helping them remain tobacco-free after technical training.
Collapse
Affiliation(s)
- Amanda Y. Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Shelley D. Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Allison E. Myers
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Counter Tools, Carrboro, NC, USA
| | - Melissa A. Little
- Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Lackland AFB, TX, USA
| | - Robert Klesges
- Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA, USA
| | - Wayne Talcott
- Center for Addiction Prevention Research, Department of Public Health Sciences, University of Virginia Medical School, Charlottesville, VA, USA
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Lackland AFB, TX, USA
| | - Sara Vandegrift
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Daniel Cassidy
- Wilford Hall Ambulatory Surgical Center, Lackland Air Force Base, Lackland AFB, TX, USA
| | - Kurt M. Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| |
Collapse
|
34
|
Callard CD, Collishaw N. Cigarette pricing 1 year after new restrictions on tobacco industry retailer programmes in Quebec, Canada. Tob Control 2019; 28:562-565. [PMID: 30770437 DOI: 10.1136/tobaccocontrol-2018-054516] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Revised: 08/23/2018] [Accepted: 08/29/2018] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Over the past 15 years, tobacco companies operating in Canada abandoned their long-standing unitary price model in favour of price differentiation. Concerns about low cigarette prices were identified by the Quebec government in 2015 when it introduced restrictions on the types of incentives that tobacco manufacturers may offer to retailers. This study sought to explore cigarette prices in Quebec 1 year after these restrictions came into effect. METHODS Details on cigarette trading terms and programmes were obtained from websites maintained by retailer groups. Visits were made to tobacco retailers in four Quebec municipalities in the autumn of 2017. The price displayed for cigarettes was observed and recorded in 273 convenience stores. RESULTS Two forms of price differentiation were observed. The first was price-segmentation between brands, reflected in a difference of $3 or more in the average displayed price between premium and discount brands of each manufacturer (ie, $10.48 vs $7.43 for a package of 20 cigarettes of the most and least expensive brands sold by Philip Morris International). Price localisation was also observed, reflected in a $2 range of prices between retail outlets for the same package of cigarettes. Even among outlets of a given chain of convenience stores, the price of the least expensive brands varied by more than $1 per package. The size of the variance in prices rivals or exceeds the size of tobacco tax increases in Quebec over the past decade. CONCLUSIONS Recent restrictions on tobacco industry incentive programmes for retailers have not ended price differentiation. Tobacco manufacturers' and retailers' pricing policies continue to provide price-sensitive smokers with ways to avoid the impact of tobacco tax increases.
Collapse
Affiliation(s)
- Cynthia D Callard
- Physicians for a Smoke-Free Canada, Ottawa, Ontario, Canada.,Association pour la santé publique du Québec, Montreal, Quebec, Canada
| | - Neil Collishaw
- Physicians for a Smoke-Free Canada, Ottawa, Ontario, Canada
| |
Collapse
|
35
|
Araya D, Paraje G. The impact of prices on alcoholic beverage consumption in Chile. PLoS One 2018; 13:e0205932. [PMID: 30346989 PMCID: PMC6197648 DOI: 10.1371/journal.pone.0205932] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/19/2018] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION AND OBJECTIVE Chile is among the countries with the highest alcohol consumption per capita in Latin America, but little has been done in the way of public policy and policy research to overcome this problem. The objective of the present study is to estimate demand elasticities (own-price, cross-price, expenditure and quality) for three groups of alcoholic beverages in Chile: spirits, wines, and beers. DATA AND METHODS The study uses data from the VII Encuesta de Presupuestos Familiares (Family Budget Survey) 2011-2012 conducted by the National Institute of Statistics. Because of problems with the quality of the measurement units, hot-deck imputation method was used with the alcohol purchases that presented problems. To estimate the demand elasticities, the Almost Ideal Demand System (AIDS) method proposed by Deaton was used. Quality decisions were estimated for each beverage separately using an equation proposed by Deaton in the three-step AIDS. RESULTS The estimated elasticities were more inelastic for spirits (-0.14, P<0.01), followed by wines (-0.77, P<0.01) and beers (-0.93, P<0.01). Spirits reported less sensitivity to changes in the total budget, while wines reported the most sensitivity to changes in the total budget (expenditure elasticity). Wines also reported the most sensitivity related to quality for changes in the total budget (0,20, meaning that a 10% increase in a household's total expenditure increases the "quality" of purchased wines by 2%). CONCLUSIONS Own-price elasticities reported for spirits, wines and beers are consistently negative, and inelastic, in line with international evidence. Although own-price elasticities for spirits is more inelastic than found in most studies, its quality-elasticity is more positive and greater. This could be explained by the greater price dispersion of spirits, as well as spirits (and wine) being consumed more than beers in Chile. This in turn may be because consumers have the option of switching to cheaper, Chilean-produced spirits such as pisco and wines when prices rise. The existence of these relatively broad quality-elasticities points to the need for a change in the alcohol tax structure from the current ad-valorem tax to a specific tax that could reduce price dispersion and curb total consumption.
Collapse
Affiliation(s)
- Daniel Araya
- Universidad Adolfo Ibáñez, Santiago, Chile
- * E-mail:
| | | |
Collapse
|
36
|
Anderson P, Gual A, Rehm J. Reducing the health risks derived from exposure to addictive substances. Curr Opin Psychiatry 2018; 31:333-341. [PMID: 29746421 DOI: 10.1097/yco.0000000000000432] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW To discuss the health risks due to exposure to alcohol, illegal drugs and nicotine and how these risks might be reduced. RECENT FINDINGS In 2016, worldwide, alcohol, illegal drugs and nicotine were responsible for some 10 million deaths. There is evolutionary and biological evidence that humans are predisposed to consuming alcohol, illegal drugs and nicotine - present-day problems are caused by high levels of potency, exposure and drug delivery systems. The two priority substances for action are alcohol and smoked cigarettes; their exposure can be reduced by price increases, setting minimum prices per product, regulating a shift form smoked cigarettes to electronic nicotine delivery devices and, theoretically, reducing the ethanol content of existing beverages. Legalization of cannabis requires a strict regulatory framework. SUMMARY Purposeful policy can reduce the harm done by alcohol, illegal drugs and nicotine. In particular, policy to reduce exposure to alcohol requires considerable strengthening.
Collapse
Affiliation(s)
- Peter Anderson
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK.,Care and Public Health Research Institute, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Antoni Gual
- Addictions Unit, Psychiatry Department, Neurosciences Institute, Hospital Clinic.,Institut d'Investigacions Biomèdiques.,August Pi i Sunyer (IDIBAPS), Barcelona, Catalonia.,Red de Trastornos Adictivos (RTA - RETICS), Instituto de Salud Carlos III, Madrid, Spain
| | - Jürgen Rehm
- Institute for Clinical Psychology and Psychotherapy, TU Dresden, Dresden, Germany.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
37
|
Choi K, Chen JC, Tan AS, Soneji S, Moran MB. Receipt of tobacco direct mail/email discount coupons and trajectories of cigarette smoking behaviours in a nationally representative longitudinal cohort of US adults. Tob Control 2018; 28:tobaccocontrol-2018-054363. [PMID: 29921623 PMCID: PMC6301118 DOI: 10.1136/tobaccocontrol-2018-054363] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2018] [Revised: 05/10/2018] [Accepted: 05/11/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND We assessed whether receipt of coupons-via direct mail or e-mail-was prospectively related to trajectories of smoking behaviours. METHODS Data were from a cohort of US adults (n=26 447) who participated in wave 1 (2013-2014) and wave 2 (2014-2015) of the Population Assessment of Tobacco and Health Study. Participants reported receipt of tobacco direct mail/email coupons in the past 6 months in wave 1 and their smoking status in both waves. Weighted multiple logistic regressions were used to examine demographic correlates of receiving tobacco direct mail/email coupons at wave 1 and to examine the prospective effect of receiving tobacco coupons on trajectories of smoking behaviours. FINDINGS At wave 1, 10.7% of never smokers, 13.9% of experimental smokers, 37.1% of current smokers and 16.5% of former smokers reported receiving tobacco direct mail/email coupons. Lower education and higher poverty adults and non-Hispanic white current smokers were more likely to have received these coupons (p<0.05). Receiving tobacco direct mail/email coupons at wave 1 was associated with increased odds of smoking initiation among never smokers (adjusted odds ratio (AOR)=2.28, 95% CI 1.36 to 3.83), becoming established smokers among experimenters (AOR=1.62, 95% CI 1.29 to 2.04), becoming daily smokers among non-daily smokers (AOR=1.56, 95% CI 1.23 to 1.99) and smoking relapse among former smokers between waves (AOR=1.91, 95% CI 1.39 to 2.65). Receiving these coupons at wave 1 was associated with reduced odds of smoking cessation ≥6 months among current smokers (AOR=0.71, 95% CI 0.58 to 0.88). CONCLUSIONS Tobacco direct mail/email coupons encourage and sustain smoking and disproportionately affect lower socioeconomic populations.
Collapse
Affiliation(s)
- Kelvin Choi
- National Institute on Minority Health and Health Disparities Division of Intramural Research, Bethesda, Maryland, U.S.A
| | - Julia Cen Chen
- National Institute on Minority Health and Health Disparities Division of Intramural Research, Bethesda, Maryland, U.S.A
| | - Andy S.L. Tan
- Dana-Farber Cancer Institute Division of Population Sciences, Boston, Massachusetts, U.S.A
- Harvard T.H. Chan School of Public Health Department of Social and Behavioral Sciences, Boston, Massachusetts, U.S.A
| | - Samir Soneji
- Geisel School of Medicine at Dartmouth The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, New Hampshire, U.S.A
| | - Meghan B. Moran
- Johns Hopkins University Bloomberg School of Public Health Department of Health, Behavior and Society, Baltimore, Maryland, U.S.A
| |
Collapse
|
38
|
Doogan NJ, Wewers ME, Berman M. The impact of a federal cigarette minimum pack price policy on cigarette use in the USA. Tob Control 2018; 27:203-208. [PMID: 28259846 PMCID: PMC5583019 DOI: 10.1136/tobaccocontrol-2016-053457] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Increasing cigarette prices reduce cigarette use. The US Food and Drug Administration has the authority to regulate the sale and promotion-and therefore the price-of tobacco products. OBJECTIVE To examine the potential effect of federal minimum price regulation on the sales of cigarettes in the USA. METHOD We used yearly state-level data from the Tax Burden on Tobacco and other sources to model per capita cigarette sales as a function of price. We used the fitted model to compare the status quo sales with counterfactual scenarios in which a federal minimum price was set. The minimum price scenarios ranged from $0 to $12. RESULTS The estimated price effect in our model was comparable with that found in the literature. Our counterfactual analyses suggested that the impact of a minimum price requirement could range from a minimal effect at the $4 level to a reduction of 5.7 billion packs sold per year and 10 million smokers at the $10 level. CONCLUSION A federal minimum price policy has the potential to greatly benefit tobacco control and public health by uniformly increasing the price of cigarettes and by eliminating many price-reducing strategies currently available to both sellers and consumers.
Collapse
Affiliation(s)
- Nathan J Doogan
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Mary Ellen Wewers
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Micah Berman
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
39
|
Disparities in cigarette tax exposure by race, ethnicity, poverty status and sexual orientation, 2006-2014, USA. Prev Med 2018; 108:137-144. [PMID: 29289642 PMCID: PMC6030689 DOI: 10.1016/j.ypmed.2017.12.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/02/2017] [Accepted: 12/18/2017] [Indexed: 11/20/2022]
Abstract
Cigarette excise taxes are an effective tobacco control strategy but they vary geographically due to differences in state and local taxation. There are also pronounced sociodemographic differences in community composition, suggesting that different population groups might face vastly different cigarette excise tax rates. In this study, we examine how cigarette excise tax rates differ for population groups defined by race, ethnicity, poverty status, and sexual orientation, and how these differences have evolved over time. We constructed annual cigarette tax rates in 109 mutually exclusive jurisdictions within the United States (U.S.) between 2006 and 2014. After merging with Census sociodemographic data, we calculated annual cigarette excise tax exposures for each population group as the average of each place-based tax, weighted by the proportion of the group living there. In 2014, the average U.S. resident was required to pay $2.68 in cigarette taxes, more than 60% of which was due to state and local taxation. On average, Asian/Native Hawaiian and Other Pacific Islander populations faced the highest average tax ($2.95), which was $0.44 more than American Indian populations. Local taxes disproportionately augmented state and federal taxes for non-White populations, same-sex couples, and people living in poverty. Geographic variation in cigarette excise taxes produces sociodemographic variation in cigarette tax exposure. Raising cigarette taxes specifically in those places where groups at risk for tobacco-related disease are more likely to live, or otherwise creating geographically uniform tax levels, could reduce important disparities in cigarette smoking.
Collapse
|
40
|
Luke DA, Sorg AA, Combs T, Robichaux CB, Moreland-Russell S, Ribisl KM, Henriksen L. Tobacco retail policy landscape: a longitudinal survey of US states. Tob Control 2018; 25:i44-i51. [PMID: 27697947 PMCID: PMC5099223 DOI: 10.1136/tobaccocontrol-2016-053075] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Accepted: 06/28/2016] [Indexed: 11/04/2022]
Abstract
Background There are ∼380 000 tobacco retailers in the USA, where the largest tobacco companies spend almost $9 billion a year to promote their products. No systematic survey has been conducted of state-level activities to regulate the retail environment, thus little is known about what policies are being planned, proposed or implemented. Methods This longitudinal study is the first US survey of state tobacco control programmes (TCPs) about retail policy activities. Surveyed in 2012 and 2014, programme managers (n=46) reported activities in multiple domains: e-cigarettes, retailer density and licensing, non-tax price increases, product placement, advertising and promotion, health warnings and other approaches. Policy activities were reported in one of five levels: no formal activity, planning or advocating, policy was proposed, policy was enacted or policy was implemented. Overall and domain-specific activity scores were calculated for each state. Results The average retail policy activity almost doubled between 2012 and 2014. States with the largest increase in scores included: Minnesota, which established a fee-based tobacco retail licensing system and banned self-service for e-cigarettes and all other tobacco products (OTP); Oregon, Kansas and Maine, all of which banned self-service for OTP; and West Virginia, which banned some types of flavoured OTP. Conclusions Retail policy activities in US states increased dramatically in a short time. Given what is known about the impact of the retail environment on tobacco use by youth and adults, state and local TCPs may want diversify policy priorities by implementing retail policies alongside tax and smoke-free air laws.
Collapse
Affiliation(s)
- Douglas A Luke
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Amy A Sorg
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Todd Combs
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Christopher B Robichaux
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Sarah Moreland-Russell
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University in St Louis, St Louis, Missouri, USA
| | - Kurt M Ribisl
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, California, USA
| |
Collapse
|
41
|
Huang J, Chriqui JF, DeLong H, Mirza M, Diaz MC, Chaloupka FJ. Do state minimum markup/price laws work? Evidence from retail scanner data and TUS-CPS. Tob Control 2018; 25:i52-i59. [PMID: 27697948 PMCID: PMC5099228 DOI: 10.1136/tobaccocontrol-2016-053093] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Accepted: 06/23/2016] [Indexed: 11/25/2022]
Abstract
Background Minimum markup/price laws (MPLs) have been proposed as an alternative non-tax pricing strategy to reduce tobacco use and access. However, the empirical evidence on the effectiveness of MPLs in increasing cigarette prices is very limited. This study aims to fill this critical gap by examining the association between MPLs and cigarette prices. Methods State MPLs were compiled from primary legal research databases and were linked to cigarette prices constructed from the Nielsen retail scanner data and the self-reported cigarette prices from the Tobacco Use Supplement to the Current Population Survey. Multivariate regression analyses were conducted to examine the association between MPLs and the major components of MPLs and cigarette prices. Results The presence of MPLs was associated with higher cigarette prices. In addition, cigarette prices were higher, above and beyond the higher prices resulting from MPLs, in states that prohibit below-cost combination sales; do not allow any distributing party to use trade discounts to reduce the base cost of cigarettes; prohibit distributing parties from meeting the price of a competitor, and prohibit distributing below-cost coupons to the consumer. Moreover, states that had total markup rates >24% were associated with significantly higher cigarette prices. Conclusions MPLs are an effective way to increase cigarette prices. The impact of MPLs can be further strengthened by imposing greater markup rates and by prohibiting coupon distribution, competitor price matching, and use of below-cost combination sales and trade discounts.
Collapse
Affiliation(s)
- Jidong Huang
- School of Public Health, Georgia State University, Atlanta, USA
| | - Jamie F Chriqui
- Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hillary DeLong
- School of Public Health, Georgia State University, Atlanta, USA
| | - Maryam Mirza
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Megan C Diaz
- Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Frank J Chaloupka
- School of Public Health, Georgia State University, Atlanta, USA Department of Economics, University of Illinois at Chicago, Chicago, Illinois, USA
| |
Collapse
|
42
|
Golden SD, Farrelly MC, Luke DA, Ribisl KM. Comparing projected impacts of cigarette floor price and excise tax policies on socioeconomic disparities in smoking. Tob Control 2018; 25:i60-i66. [PMID: 27697949 PMCID: PMC5099216 DOI: 10.1136/tobaccocontrol-2016-053230] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/12/2016] [Indexed: 11/24/2022]
Abstract
Background About half of all US states have cigarette minimum price laws (MPLs) that require a per cent mark-up on prices, but research suggests they may not be very effective in raising prices. An alternative type of MPL sets a floor price below which packs cannot be sold, and may be more promising. This new type of MPL policy has only been implemented in 1 city, therefore its benefits relative to excise taxes is difficult to assess. Methods We constructed a set of possible state floor price MPL options, and matched them to possible state excise tax hikes designed to produce similar average price increases. Using self-reported price and cigarette consumption data from 23 521 participants in the 2010–2011 Tobacco Use Supplement of the Current Population Survey, we projected changes in pack prices and cigarette consumption following implementation of each paired MPL and tax option, for lower and higher income groups. Results We project that state MPLs set at the average reported pack price would raise prices by $0.33 and reduce cigarette consumption by about 4%; a tax with a similar average price effect would reduce consumption by 2.3%. MPLs and taxes that raise average prices by more than $2.00 would reduce consumption by 15.9% and 13.5%, respectively. In all models, we project that MPLs will reduce income-based smoking disparities more than their comparable excise taxes. Conclusions Floor price cigarette MPLs set at or above what consumers currently report paying could reduce both tobacco use and socioeconomic disparities in smoking.
Collapse
Affiliation(s)
- Shelley D Golden
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA
| | | | - Douglas A Luke
- Center for Public Health Systems Science, George Warren Brown School of Social Work, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Kurt M Ribisl
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, North Carolina, USA Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| |
Collapse
|
43
|
Henriksen L, Andersen-Rodgers E, Zhang X, Roeseler A, Sun DL, Johnson TO, Schleicher NC. Neighborhood Variation in the Price of Cheap Tobacco Products in California: Results From Healthy Stores for a Healthy Community. Nicotine Tob Res 2017; 19:1330-1337. [PMID: 28444233 PMCID: PMC5896445 DOI: 10.1093/ntr/ntx089] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Accepted: 04/19/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND Retail marketing surveillance research highlights concerns about lower priced cigarettes in neighborhoods with a higher proportion of racial/ethnic minorities but focuses almost exclusively on premium brands. To remedy this gap in the literature, the current study examines neighborhood variation in prices for the cheapest cigarettes and a popular brand of cigarillos in a large statewide sample of licensed tobacco retailers in a low-tax state. METHODS All 61 local health departments in California trained data collectors to conduct observations in a census of eligible licensed tobacco retailers in randomly selected zip codes (n = 7393 stores, completion rate=91%). Data were collected in 2013, when California had a low and stagnant tobacco tax. Two prices were requested: the cheapest cigarette pack regardless of brand and a single, flavored Swisher Sweets cigarillo. Multilevel models (stores clustered in tracts) examined prices (before sales tax) as a function of neighborhood race/ethnicity and proportion of school-age youth (aged 5-17). Models adjusted for store type and median household income. RESULTS Approximately 84% of stores sold cigarettes for less than $5 and a Swisher Sweets cigarillo was available for less than $1 in 74% of stores that sold the brand. The cheapest cigarettes cost even less in neighborhoods with a higher proportion of school-age residents and Asian/Pacific Islanders. CONCLUSIONS Neighborhood disparities in the price of the cheapest combustible tobacco products are a public health threat. Policy changes that make all tobacco products, especially combustible products, less available and more costly may reduce disparities in their use and protect public health. IMPLICATIONS Much of what is known about neighborhood variation in the price of combustible tobacco products focuses on premium brand cigarettes. The current study extends this literature in two ways, by studying prices for the cheapest cigarette pack regardless of brand and a popular brand of flavored cigarillos and by reporting data from the largest statewide sample of licensed tobacco retailers. Significantly lower prices in neighborhoods with a higher proportion of youth and of racial/ethnic groups with higher smoking prevalence are a cause of concern. The study results underscore the need for policies that reduce availability and increase price of combustible tobacco products, particularly in states with low, stagnant tobacco taxes.
Collapse
Affiliation(s)
- Lisa Henriksen
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | | | - Xueying Zhang
- California Tobacco Control Program, California Department of Public Health, Sacramento, CA
| | - April Roeseler
- California Tobacco Control Program, California Department of Public Health, Sacramento, CA
| | - Dennis L Sun
- Department of Statistics, California Polytechnic State University, San Luis Obispo, CA
| | - Trent O Johnson
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| | - Nina C Schleicher
- Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA
| |
Collapse
|
44
|
Lee JG, Golden SD, Ribisl KM. Limited indications of tax stamp discordance and counterfeiting on cigarette packs purchased in tobacco retailers, 97 counties, USA, 2012. Prev Med Rep 2017; 8:148-152. [PMID: 29034149 PMCID: PMC5635242 DOI: 10.1016/j.pmedr.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/19/2017] [Accepted: 09/23/2017] [Indexed: 11/18/2022] Open
Abstract
Increasing the per-unit cost of tobacco products is one of the strongest interventions for tobacco control. In jurisdictions with higher taxes in the U.S., however, cigarette pack litter studies show a substantial proportion of littered packs lack the appropriate tax stamp. More limited but still present counterfeiting also exists. We sought to examine the role of tobacco retailers as a source for untaxed and counterfeit products. Data collectors purchased Newport Green (menthol) or Marlboro Red cigarette packs in a national probability-based sample of tobacco retailers (in 97 counties) from June–October 2012. They made no effort to buy counterfeit or untaxed cigarettes. In this cross-sectional study, we assessed the presence, tax authority, and type (low-tech thermal vs. encrypted) of cigarette pack tax stamps; concordance of tax stamps with where the pack was purchased; and, for Marlboro cigarettes, publicly available visible indicators of counterfeiting. We purchased 2147 packs of which 2033 had tax stamps. Packs missing stamps were in states that do not require them. We found very limited discordance between store location and tax stamp(s) (< 1%). However, a substantial minority of cigarette packs had damaged tax stamps (13%). This occurred entirely with low-tech tax stamps and was not identified with encrypted tax stamps. We found no clear evidence of counterfeit products. Almost all tax stamps matched the location of purchase. Litter studies may be picking up legal tax avoidance instead of illegal tax evasion or, alternatively, purchase of illicit products requires special request by the purchaser. This study purchased 2147 cigarette packs in 97 U.S. counties. No clear indicators of cigarette counterfeiting were found. Virtually all packs had the correct tax stamp affixed. Inspection protocols for illicit cigarettes should consider real-world behaviors.
Collapse
Affiliation(s)
- Joseph G.L. Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 1000 East 5 Street, Greenville, NC 27858, USA
- Corresponding author at: Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 1000 E. 5 St., Mail Stop 529, Greenville, NC 27858, USA.Department of Health Education and PromotionCollege of Health and Human PerformanceEast Carolina University1000 E. 5 St., Mail Stop 529GreenvilleNC27858USA
| | - Shelley D. Golden
- Department of Health Behavior, UNC Gillings School of Global Public Health, 145 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Kurt M. Ribisl
- Department of Health Behavior, UNC Gillings School of Global Public Health, 145 Dauer Drive, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
45
|
Becker CM, Lee JGL, Hudson S, Hoover J, Civils D. A 14-year longitudinal study of the impact of clean indoor air legislation on state smoking prevalence, USA, 1997-2010. Prev Med 2017; 99:63-66. [PMID: 28188797 DOI: 10.1016/j.ypmed.2017.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 01/21/2017] [Accepted: 01/28/2017] [Indexed: 11/17/2022]
Abstract
While clean indoor air legislation at the state level is an evidence-based recommendation, only limited evidence exists regarding the impact of clean indoor air policies on state smoking prevalence. Using state smoking prevalence data from 1997 to 2010, a repeated measures observational analysis assessed the association between clean indoor air policies (i.e., workplace, restaurant, and bar) and state smoking prevalence while controlling for state cigarette taxes and year. The impacts from the number of previous years with any clean indoor air policy, the number of policies in effect during the current year, and the number of policies in effect the previous year were analyzed. Findings indicate a smoking prevalence predicted decrease of 0.13 percentage points (p=0.03) for each additional year one or more clean indoor air policies were in effect, a predicted decrease of 0.12 percentage points (p=0.09) for each policy in effect in the current year, and a predicted decrease of 0.22 percentage points (p=0.01) for each policy in effect in the previous year on the subsequent year. Clean indoor air policies show measurable associations with reductions in smoking prevalence within a year of implementation above and beyond taxes and time trends. Further efforts are needed to diffuse clean indoor air policies across states and provinces that have not yet adopted such policies.
Collapse
Affiliation(s)
- Craig M Becker
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA.
| | - Joseph G L Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| | - Suzanne Hudson
- Department of Biostatistics, College of Allied Health Sciences, East Carolina University, Greenville, NC, USA
| | - Jeanne Hoover
- Joyner Library, East Carolina University, Greenville, NC, USA
| | - Donald Civils
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, Greenville, NC, USA
| |
Collapse
|
46
|
Leeman J, Myers A, Grant JC, Wangen M, Queen TL. Implementation strategies to promote community-engaged efforts to counter tobacco marketing at the point of sale. Transl Behav Med 2017; 7:405-414. [PMID: 28405905 DOI: 10.1007/s13142-017-0489-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
The US tobacco industry spends $8.2 billion annually on marketing at the point of sale (POS), a practice known to increase tobacco use. Evidence-based policy interventions (EBPIs) are available to reduce exposure to POS marketing, and nationwide, states are funding community-based tobacco control partnerships to promote local enactment of these EBPIs. Little is known, however, about what implementation strategies best support community partnerships' success enacting EBPI. Guided by Kingdon's theory of policy change, Counter Tools provides tools, training, and other implementation strategies to support community partnerships' performance of five core policy change processes: document local problem, formulate policy solutions, engage partners, raise awareness of problems and solutions, and persuade decision makers to enact new policy. We assessed Counter Tools' impact at 1 year on (1) partnership coordinators' self-efficacy, (2) partnerships' performance of core policy change processes, (3) community progress toward EBPI enactment, and (4) salient contextual factors. Counter Tools provided implementation strategies to 30 partnerships. Data on self-efficacy were collected using a pre-post survey. Structured interviews assessed performance of core policy change processes. Data also were collected on progress toward EBPI enactment and contextual factors. Analysis included descriptive and bivariate statistics and content analysis. Following 1-year exposure to implementation strategies, coordinators' self-efficacy increased significantly. Partnerships completed the greatest proportion of activities within the "engage partners" and "document local problem" core processes. Communities made only limited progress toward policy enactment. Findings can inform delivery of implementation strategies and tests of their effects on community-level efforts to enact EBPIs.
Collapse
Affiliation(s)
- Jennifer Leeman
- School of Nursing, University of North Carolina at Chapel Hill, CB #7460, Chapel Hill, NC, 27599-7460, USA.
| | | | | | - Mary Wangen
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Tara L Queen
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| |
Collapse
|
47
|
Brock B, Carlson SC, Moilanen M, Schillo BA. Effectiveness of Local Policy Efforts to Increase the Price of Cheap Cigars in Minnesota. Am J Public Health 2016; 107:127-129. [PMID: 27854525 DOI: 10.2105/ajph.2016.303517] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the effect of novel policies designed to increase cheap cigar prices by setting minimum prices at the local level. METHODS Between June 2013 and July 2015, we conducted assessments at tobacco retailers in Minnesota cities of Brooklyn Center (n = 26 in sample; n = 18 assessed before and after policy implementation), Saint Paul (n = 25 in sample; n = 14 assessed pre- and postpolicy), and Maplewood (n = 22 in sample; n = 18 assessed pre- and postpolicy), before and after the adoption of policies setting minimum cigar pricing. RESULTS After policy implementation across all cities (n = 50), significantly fewer retailers sold single cigars (46% vs 80%; P < .01) and 2- or 3-packs (52% vs 74%; P = .01). In Saint Paul and Maplewood, the average price of the cheapest available single cigars increased significantly by $1.17 (P = .03) and $1.27 (P < .01), respectively; the average price of the cheapest 2-pack increased by $2.46 (P = .02) in Saint Paul and by $3.08 (P < .01) in Maplewood. Policy compliance was high in all cities. CONCLUSIONS This study highlights the potential of policies setting minimum cigar prices to decrease cigar availability and increase price through nontax approaches. Results indicate that these policies are successful in cities of various sizes.
Collapse
Affiliation(s)
- Betsy Brock
- Betsy Brock and Samantha C. Carlson are with Association for Nonsmokers-Minnesota, Saint Paul. Molly Moilanen and Barbara A. Schillo are with ClearWay Minnesota, Minneapolis
| | - Samantha C Carlson
- Betsy Brock and Samantha C. Carlson are with Association for Nonsmokers-Minnesota, Saint Paul. Molly Moilanen and Barbara A. Schillo are with ClearWay Minnesota, Minneapolis
| | - Molly Moilanen
- Betsy Brock and Samantha C. Carlson are with Association for Nonsmokers-Minnesota, Saint Paul. Molly Moilanen and Barbara A. Schillo are with ClearWay Minnesota, Minneapolis
| | - Barbara A Schillo
- Betsy Brock and Samantha C. Carlson are with Association for Nonsmokers-Minnesota, Saint Paul. Molly Moilanen and Barbara A. Schillo are with ClearWay Minnesota, Minneapolis
| |
Collapse
|
48
|
Roeseler A, Meaney M, Riordan M, Solomon M, Herndon S, Hallett C. NCI's state and community research initiative: a model for future tobacco control research. Tob Control 2016; 25:i1-i3. [PMID: 27697940 PMCID: PMC5099224 DOI: 10.1136/tobaccocontrol-2016-053350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 08/05/2016] [Indexed: 11/04/2022]
Affiliation(s)
- April Roeseler
- California Tobacco Control Program, California Department of Public Health, Sacramento, California, USA
| | - Mark Meaney
- Tobacco Control Legal Consortium at the Public Health Law Center, St. Paul, Minnesota, USA
| | - Meg Riordan
- Campaign for Tobacco Free Kids, Washington DC, USA
| | | | - Sally Herndon
- Tobacco Prevention and Control Branch, North Carolina Division of Public Health, Raleigh, North Carolina, USA
| | | |
Collapse
|
49
|
Henriksen L, Schleicher NC, Barker DC, Liu Y, Chaloupka FJ. Prices for Tobacco and Nontobacco Products in Pharmacies Versus Other Stores: Results From Retail Marketing Surveillance in California and in the United States. Am J Public Health 2016; 106:1858-64. [PMID: 27552272 DOI: 10.2105/ajph.2016.303306] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To examine disparities in the price of tobacco and nontobacco products in pharmacies compared with other types of stores. METHODS We recorded the prices of Marlboro, Newport, the cheapest cigarettes, and bottled water in a random sample of licensed tobacco retailers (n = 579) in California in 2014. We collected comparable data from retailers (n = 2603) in school enrollment zones for representative samples of US 8th, 10th, and 12th graders in 2012. Ordinary least squares regressions modeled pretax prices as a function of store type and neighborhood demographics. RESULTS In both studies, the cheapest cigarettes cost significantly less in pharmacies than other stores; the average estimated difference was $0.47 to $1.19 less in California. We observed similar patterns for premium-brand cigarettes. Conversely, bottled water cost significantly more in pharmacies than elsewhere. Newport cost less in areas with higher proportions of African Americans; other cigarette prices were related to neighborhood income and age. Neighborhood demographics were not related to water prices. CONCLUSIONS Compared with other stores, pharmacies charged customers less for cigarettes and more for bottled water. State and local policies to promote tobacco-free pharmacies would eliminate an important source of discounted cigarettes.
Collapse
Affiliation(s)
- Lisa Henriksen
- Lisa Henriksen and Nina C. Schleicher are with the Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA. Dianne C. Barker is with Barker Bi-Coastal Health Consultants, Inc, Calabasas, CA. Yawen Liu and Frank J. Chaloupka are with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago
| | - Nina C Schleicher
- Lisa Henriksen and Nina C. Schleicher are with the Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA. Dianne C. Barker is with Barker Bi-Coastal Health Consultants, Inc, Calabasas, CA. Yawen Liu and Frank J. Chaloupka are with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago
| | - Dianne C Barker
- Lisa Henriksen and Nina C. Schleicher are with the Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA. Dianne C. Barker is with Barker Bi-Coastal Health Consultants, Inc, Calabasas, CA. Yawen Liu and Frank J. Chaloupka are with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago
| | - Yawen Liu
- Lisa Henriksen and Nina C. Schleicher are with the Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA. Dianne C. Barker is with Barker Bi-Coastal Health Consultants, Inc, Calabasas, CA. Yawen Liu and Frank J. Chaloupka are with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago
| | - Frank J Chaloupka
- Lisa Henriksen and Nina C. Schleicher are with the Stanford Prevention Research Center, Stanford University School of Medicine, Palo Alto, CA. Dianne C. Barker is with Barker Bi-Coastal Health Consultants, Inc, Calabasas, CA. Yawen Liu and Frank J. Chaloupka are with the Department of Economics and the Institute for Health Research and Policy, University of Illinois, Chicago
| |
Collapse
|
50
|
Golden SD, Kong AY, Ribisl KM. Racial and Ethnic Differences in What Smokers Report Paying for Their Cigarettes. Nicotine Tob Res 2016; 18:1649-55. [PMID: 26874329 DOI: 10.1093/ntr/ntw033] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/05/2016] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Smoking rates and tobacco-related health problems vary by race and ethnicity. We explore whether cigarette prices, a determinant of tobacco use, differ across racial and ethnic groups, and whether consumer behaviors influence these differences. METHODS We used national Tobacco Use Supplement data from 23 299 adult smokers in the United States to calculate average reported cigarette pack prices for six racial and ethnic groups. Using multivariate regression models, we analyzed the independent effect of race and ethnicity on price, and whether these effects changed once indicators of carton purchasing, menthol use, Indian reservation purchase, and state market prices were incorporated. RESULTS American Indians and whites pay similar amounts and report the lowest prices. Blacks, Hispanics, and Asians reported paying $0.42, $0.68, and $0.89 more for a pack of cigarettes than whites. After accounting for differences in consumer behaviors, these gaps shrunk to $0.27, $0.29, and $0.27, respectively, while American Indians paid $0.38 more than whites. Pack buying was associated with $0.99 higher per-pack prices than carton buying, which was most common among whites. Additionally, people who purchased off an Indian reservation reporting paying $1.54 more than those who purchased on reservation. CONCLUSIONS Average reported cigarette prices vary by race and ethnicity, in part due to differences in product use and purchase location. Tobacco price policies, especially those that target low prices for multipack products or on Indian reservations may increase the prices paid by whites and American Indians, who smoke at the highest rates and pay the least per pack. IMPLICATIONS This study examines differences in reported prices paid by different racial and ethnic groups, using recent, national data from the United States. Results indicating that racial and ethnic groups that smoke at the highest rates (American Indians and whites) also pay the least are consistent with evidence that price is a key factor in cigarette use. Additional analysis finds that cigarette purchasing behaviors, especially carton buying and purchasing on Indian reservations, partially account for the documented price differences, and suggest that policies focused on bulk purchases (carton, multipack) and reservation prices have strong tobacco control potential.
Collapse
Affiliation(s)
- Shelley D Golden
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC;
| | - Amanda Y Kong
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Kurt M Ribisl
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| |
Collapse
|