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Antinozzi M, Caminada S, Amendola M, Cammalleri V, Dorelli B, Giffi M, Giordano F, Marani A, Pocino RN, Renzi D, Sindoni A, Cattaruzza MS. Perceptions of Tobacco Price Policy among Students from Sapienza University of Rome: Can This Policy Mitigate Smoking Addiction and Its Health Impacts? Healthcare (Basel) 2024; 12:944. [PMID: 38727502 PMCID: PMC11083090 DOI: 10.3390/healthcare12090944] [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: 03/30/2024] [Revised: 04/18/2024] [Accepted: 04/24/2024] [Indexed: 05/13/2024] Open
Abstract
Tobacco use is one of the main risk factors for non-communicable diseases. Avoiding youth initiation and treating addiction are fundamental public health issues to ensure better health. Among tobacco control policies, increasing tobacco price is the single most effective intervention. It reduces tobacco consumption, especially among youths, while representing a government financing source. This study aimed to assess the agreement with the proposal of a one-euro increase in tobacco price earmarked to health issues among students at Sapienza University. Two convenience samples were surveyed, five years apart, on World No Tobacco Days. Smoking habits, agreement with the proposal and reasons for it were collected. Results from the 208 questionnaires (107 in 2014, 101 in 2019) showed 46.6% of agreement with the proposal (53.3% in 2014, 39.2% in 2019, p = 0.044). Main predictive factor for agreement was being a non-smoker (OR = 6.33 p < 0.001), main reason (64.8%) was it could trigger smokers to quit or reduce consumption. Several factors might have influenced this finding, including the introduction of novel tobacco products and their increased advertisement on social media. In 2024, European Union is planning to update the Tobacco Taxation Directive which could greatly contribute to the reduction of non-communicable diseases and premature deaths.
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Affiliation(s)
- Martina Antinozzi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
| | - Susanna Caminada
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
| | | | - Vittoria Cammalleri
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
| | - Barbara Dorelli
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
| | - Monica Giffi
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
| | - Felice Giordano
- National Institute of Health (Istituto Superiore di Sanità), 00162 Roma, Italy;
| | - Alessandra Marani
- Lazzaro Spallanzani National Institute for Infectious Diseases, 00149 Roma, Italy;
| | - Roberta Noemi Pocino
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
| | - Davide Renzi
- District 1, Local Health Unit Roma 1, 00185 Rome, Italy;
| | - Alessandro Sindoni
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
| | - Maria Sofia Cattaruzza
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy; (S.C.); (V.C.); (B.D.); (M.G.); (R.N.P.); (A.S.); (M.S.C.)
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Mojtabai R, Susukida R, Nejat K, Amin-Esmaeili M. Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis. J Public Health Policy 2024; 45:100-113. [PMID: 38155242 DOI: 10.1057/s41271-023-00458-x] [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] [Accepted: 11/20/2023] [Indexed: 12/30/2023]
Abstract
The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.
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Affiliation(s)
- Ramin Mojtabai
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA
| | - Ryoko Susukida
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA
| | | | - Masoumeh Amin-Esmaeili
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Hampton House, 624 North Broadway, Room 797, Baltimore, MD, 21205, USA.
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Stone M, Dimofte C, Strong D, Pulvers K, Crespo NC, Leas EC, Pierce JP. Evaluating US smokers' willingness to pay for different cigarette packaging designs before and after real-world exposure in a randomised trial. Tob Control 2023; 32:689-695. [PMID: 35232793 DOI: 10.1136/tobaccocontrol-2021-057071] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/20/2022] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Removal of tobacco industry branding from cigarette packs may reduce their appeal. Adding graphic warning labels (GWLs) should enhance this effect. We investigate whether willingness to pay for various packaging designs changes after 3 months' use of: (1) US branded packs without GWLs (US), (2) non-branded packs without GWLs (Blank), and (3) rotating non-branded packs with GWLs (gangrene; throat cancer; neonatal baby) covering >75% of pack (GWL). METHODS Californian adult daily smokers not planning to quit (n=287; 56% female; mean age=39.6) completed a discrete choice purchase task before and after 3 months' experience using one of three packaging options. Conjoint analysis and pre-post modelling evaluated the change in importance of pack attributes and willingness to pay for US, Blank or GWL (blindness; teeth; gangrene) pack designs. RESULTS Price determined ~70% of purchase choices, while pack design determined ~22%. Irrespective of intervention arm, US packaging generated appeal valuations compared with Blank packaging, while GWLs consistently provoked strong aversive valuations at baseline and follow-up. Compared with the US pack arm, using GWL packs for 3 months decreased willingness to pay for US packaging (β=-$0.38, 95% CI -0.76 to 0.00). Wear-out effects were detected in the discount needed to willingly purchase the gangrene-GWL pack (β=$0.49, 95% CI 0.16 to 0.82) and Blank pack (β=$0.42, 95% CI 0.09 to 0.74) but not for GWLs (blindness, teeth) not used in trial. CONCLUSION Compared with US branded packs, the negative valuation of non-branded GWL packs attenuates with even 3 months' use but does not generalise to non-used GWLs. This suggests that GWLs should be regularly refreshed. The appeal valuation of industry imagery suggests that the US plan to retain such imagery on packs may ameliorate the effect of GWLs.
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Affiliation(s)
- Matthew Stone
- Psychiatry, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Claudiu Dimofte
- Marketing, San Diego State University, San Diego, California, USA
| | - David Strong
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - Kim Pulvers
- Psychology, California State University San Marcos, San Marcos, California, USA
| | - Noe C Crespo
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Eric C Leas
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
| | - John P Pierce
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California San Diego, La Jolla, California, USA
- Cancer Prevention and Control Program, University of California San Diego Moores Cancer Center, La Jolla, California, USA
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Moxham L, Thomas T, Curtis E, Mackay M, Pratt H, Livingstone K. Nursing students' attitudes, behaviour, and knowledge toward smoking cessation: Results from a descriptive survey at a regional university. NURSE EDUCATION TODAY 2023; 125:105798. [PMID: 36933373 DOI: 10.1016/j.nedt.2023.105798] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 03/01/2023] [Accepted: 03/09/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Smoking is the largest single cause of lifestyle-related preventable morbidity and mortality. Nurses form the largest cohort of health professionals and are strategically placed to implement smoking cessation interventions. However their capacity is underutilised, particularly in rural and remote areas in countries such as Australia where the incidence of smoking in is higher than average and access to healthcare is limited. One strategy to address the underutilisation of nurses in smoking cessation interventions is to include training in the university/college nursing curriculum. To effectively implement this training, it is vital to have an in-depth knowledge of student nurses' attitudes towards smoking including the role of healthcare professionals in smoking cessation, their smoking behaviour and that of their peers, and knowledge regarding smoking cessation techniques and resources. OBJECTIVES Investigate nursing students' attitudes, behaviour, and knowledge towards smoking cessation, determine the impact of demographics and educational experienced on these, and develop recommendations for future research and educational practice. DESIGN Descriptive survey. PARTICIPANTS Non-probability sample of undergraduate nursing students (n = 247) from a regional Australian university. RESULTS Significantly more participants had tried smoking cigarettes than had not (p = 0.026). There were no significant relationships between gender and smoking (p = 0.169) or e-cigarette use (p = 0.200), but a significant relationship was found between age and smoking status where older participants (48-57 years) were more likely to smoke (p < 0.001). Most participants (70 %) were supportive of public health measures to reduce cigarette smoking but felt that they lacked specific knowledge to assist their patients to cease smoking. CONCLUSIONS Within education there needs to be an emphasis on the central role that nurses play in smoking cessation with a greater focus on training nursing students about smoking cessation strategies and resources. There is also a need to ensure that students know it falls within their duty of care to address smoking cessation with patients.
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Affiliation(s)
- Lorna Moxham
- University of Wollongong, 2 Northfields Avenue, Keiraville, Wollongong, NSW 2500, Australia.
| | - Tamsin Thomas
- University of Wollongong, 2 Northfields Avenue, Keiraville, Wollongong, NSW 2500, Australia.
| | - Elizabeth Curtis
- University of Wollongong, 2 Northfields Avenue, Keiraville, Wollongong, NSW 2500, Australia.
| | - Maria Mackay
- University of Wollongong, 2 Northfields Avenue, Keiraville, Wollongong, NSW 2500, Australia.
| | - Helen Pratt
- University of Wollongong, 2 Northfields Avenue, Keiraville, Wollongong, NSW 2500, Australia.
| | - Kimberley Livingstone
- University of Wollongong, 2 Northfields Avenue, Keiraville, Wollongong, NSW 2500, Australia.
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Nargis N. Healthy People Countdown 2030: reaching 5% cigarette smoking prevalence among US adults through state cigarette excise tax increases. Tob Control 2023; 32:388-392. [PMID: 34740954 PMCID: PMC10176409 DOI: 10.1136/tobaccocontrol-2021-056755] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 08/10/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The Healthy People 2030 goal is to reduce US current adult cigarette smoking prevalence to 5% by 2030. The objective of this report is to investigate if this goal is achievable using state cigarette excise tax increases. METHODS State-specific linear trends in smoking prevalence over 2011-2019 were determined using fractional logit regression and compared with the desired linear trends for achieving 5% smoking prevalence by 2030 in individual states and the District of Columbia (DC). The gaps between price-adjusted and desired trends were used in a simulation model for identifying state-specific systematic annual increases in state cigarette excise tax rates based on state-specific price elasticity of smoking prevalence, maintaining the status quo in other non-tax tobacco control measures. RESULTS The price-adjusted trends in smoking prevalence observed over 2011-2019 exceed the desired trends for achieving 5% smoking prevalence target by 2030 in only five states (eg, Washington, Utah, Rhode Island, Massachusetts and Maryland) and the DC. It suggests that majority of states and USA overall will miss the target smoking prevalence at the current rate of reduction in smoking. 45 states would need systematic annual increases in cigarette excise tax rate in a range of $0.02-$1.37 per pack over 2022-2030 to meet the target. CONCLUSIONS The feasibility of reaching the Healthy People 2030 goal would critically depend on the acceleration of progress in tobacco control. Tax increases tailored to the needs of individual states combined with scaled-up non-tax tobacco control policy interventions can help achieve the desired progress.
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Affiliation(s)
- Nigar Nargis
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
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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: 9.0] [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.
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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
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Levy DT, Gartner C, Liber AC, Sánchez-Romero LM, Yuan Z, Li Y, Cummings KM, Borland R. The Australia Smoking and Vaping Model: The Potential Impact of Increasing Access to Nicotine Vaping Products. Nicotine Tob Res 2022; 25:486-497. [PMID: 36073731 PMCID: PMC9910149 DOI: 10.1093/ntr/ntac210] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 08/08/2022] [Accepted: 09/06/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND We model the potential impact of relaxing current nicotine vaping product (NVP) restrictions on public health in Australia. AIMS AND METHODS A Restricted NVP Scenario was first developed to project current smoking and vaping rates, where a U.S. smoking model was calibrated to recent Australian trends. To model less restrictive NVP policies, a Permissive NVP Scenario applied rates of switching from smoking to vaping, initiation into NVP and cigarette use, and cessation from smoking and vaping based on U.S. trends. The model measures vaping risk relative to the excess mortality rate of smoking. The public health impacts are measured as the difference between smoking- and vaping-attributable deaths (SVADs) and life years lost (LYLs) in the Restricted and Permissive NVP Scenarios. Sensitivity analysis is conducted regarding the NVP excess risk and other factors. RESULTS Assuming an NVP excess risk of 5% that of smoking, 104.2 thousand SVADs (7.7% reduction) and 2.05 million LYLs (17.3% reduction) are averted during 2017-2080 in the Permissive NVP Scenario compared to the Restricted NVP Scenario. Assuming 40% NVP excess risk, 70 thousand SVADs and 1.2 million LYLs are averted. The impact is sensitive to the rate at which smokers switch to NVPs and quit smoking, and relatively insensitive to the smoking initiation and NVP initiation and cessation rates. CONCLUSIONS The model suggests the potential for public health gains to be achieved by relaxing NVP access regulations. However, the model would benefit from better information regarding the impact of NVPs on smoking under a relaxation of current restrictions. IMPLICATIONS Australia has implemented a strong array of cigarette-oriented policies, but has restricted access to NVPs. The Smoking and Vaping Model offers a framework for modeling hypothetical policy scenarios. The Australian model shows the potential for public health gains by maintaining cigarette-oriented policies while relaxing the current restrictive NVP policy. Modeling results under a permissive NVP policy are particularly sensitive to the estimated rates of smoking cessation and switching to vaping, which are not well established and will likely depend on past and future cigarette-oriented policies and the specific NVP policies implemented in Australia.
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Affiliation(s)
- David T Levy
- Corresponding Author: David T. Levy PhD, Georgetown University, 3300 Whitehaven St., NW, Suite 4100, Washington, DC, 20007, USA. Telephone: 301-275-2396; fax: 202-687-0305; E-mail:
| | - Coral Gartner
- School of Public Health, Faculty of Medicine, University of Queensland, Queensland, Australia
| | - Alex C Liber
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | | | - Zhe Yuan
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - Yameng Li
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington DC, USA
| | - K Michael Cummings
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, USA
| | - Ron Borland
- Melbourne Centre for Behaviour Change, School of Psychological Sciences, University of Melbourne, Melbourne, Australia
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Australian Perceptions of Warnings on Cigarette Sticks. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-021-00605-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Zhang G, Zhan J, Fu H. Trends in Smoking Prevalence and Intensity between 2010 and 2018: Implications for Tobacco Control in China. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:670. [PMID: 35055491 PMCID: PMC8776183 DOI: 10.3390/ijerph19020670] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 01/04/2022] [Accepted: 01/06/2022] [Indexed: 12/10/2022]
Abstract
BACKGROUND China is the world's largest producer and consumer of cigarettes. Since 2010, the Chinese government has implemented many policies to combat the tobacco epidemic, yet little is known about their overall impacts. This study aims to investigate the trends in smoking prevalence and intensity between 2010 and 2018. METHODS We use five waves of data from China Family Panel Studies (CFPS), a nationally representative survey, to examine the trends in smoking prevalence and intensity. We use the chi-square test and t-test to examine differences across waves. Binary logistic regressions and linear regressions are applied to examine the association between smoking behaviors and risk factors. RESULTS The current smoking prevalence dropped from 30.30% in 2010 (90% CI 29.47-31.31) to 28.69% (90% CI 27.69-29.69) in 2018. As for smoking intensity, the average daily cigarettes consumption decreased steadily from 16.96 cigarettes (90% CI 16.55-17.36) in 2010 to 15.12 cigarettes (90% CI 15.07-15.94) in 2018. Smoking risk factors for men included marriage status, education level, employment status, alcohol consumption, and physical activities. The smoking risk was higher for women with a lower education level, lower household income, unemployment status, and alcohol consumption behavior. CONCLUSIONS Our study shows declined trends in both smoking prevalence and intensity between 2010 and 2018, suggesting some positive progress in tobacco control in China. Nonetheless, to achieve the goal of reducing smoking prevalence among people aged 15 and above to less than 20% by 2030, the Chinese government needs to take stronger anti-tobacco measures.
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Affiliation(s)
- Guoting Zhang
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing 100191, China;
| | - Jiajia Zhan
- Department of Economics and Public Policy, Business School, Imperial College London, London SW7 2AZ, UK;
| | - Hongqiao Fu
- Department of Health Policy and Management, School of Public Health, Peking University Health Science Center, Beijing 100191, China;
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Laverty AA, Li CR, Chang KCM, Millett C, Filippidis FT. Cigarette taxation and price differentials in 195 countries during 2014-2018. Tob Control 2021; 32:359-365. [PMID: 34667104 DOI: 10.1136/tobaccocontrol-2021-056682] [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: 03/30/2021] [Accepted: 09/27/2021] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Raising tobacco prices via increased taxation may be undermined by tobacco industry tactics to keep budget cigarettes on the market. Price differentials between budget and premium cigarettes allow smokers to trade down in the face of average price rises thus attenuating health benefits. This study examines global trends of price differentials and associations with taxation. METHODS Ecological analysis of country-level panel data of 195 countries' price differentials was performed and compared against total, specific excise, ad valorem and other taxation. Price differentials were expressed as the difference between budget cigarette and premium pack prices (as % of premium pack prices). Two-level linear regression models with repeated measurements (2014, 2016 and 2018) nested within each country assessed the association between country-level taxation structures and price differentials, adjusted for year, geographical region and income group. RESULTS Worldwide, median price differential between budget and premium 20-cigarette packs was 49.4% (IQR 25.9%-70.0%) in 2014 and 44.4% (IQR 22.5%-69.4%) in 2018 with significant regional variation. The largest price differentials in 2018 were in Africa, with the lowest in Europe. Total taxation was negatively associated with price differentials (-1.5%, 95% CI -2.5% to -0.4% per +10% total taxation) as was specific excise taxation (-2.5%, 95% CI -3.7% to -1.2% per +10% specific excise tax). We found no statistically significant association between ad valorem taxation and price differentials. CONCLUSION Total levels of taxation and specific excise taxes were associated with smaller price differentials. Implementing high specific excise taxes may reduce price differentials and improve health outcomes.
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Affiliation(s)
| | | | - Kiara C-M Chang
- Public Health Policy Evaluation Unit, Imperial College London, London, UK
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Hiscock R, Augustin NH, Branston JR, Gilmore AB. Longitudinal evaluation of the impact of standardised packaging and minimum excise tax on tobacco sales and industry revenue in the UK. Tob Control 2021; 30:515-522. [PMID: 32719111 PMCID: PMC8394752 DOI: 10.1136/tobaccocontrol-2019-055387] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 04/29/2020] [Accepted: 05/01/2020] [Indexed: 12/03/2022]
Abstract
BACKGROUND Standardised packaging for factory-made cigarettes (FM) and roll-your-own tobacco (RYO), and a minimum excise tax (MET) were fully implemented in the UK in May 2017 following a 12-month transition period. This paper is the first to examine effects on tobacco sales volumes and company revenues. METHODS Analysis of UK commercial supermarket and convenience store electronic point of sale data on tobacco sales. FM and RYO products' data (May 2015-April 2018) yielded 107 572 monthly observations. Expected values from additive mixed modelling were used to calculate trends in: (1) volumes of tobacco sold overall, by cigarette type (FM and RYO) and by seven market segments; and (2) company net revenues. A 10-month period (June 2015-March 2016) before the transition to standardised packs was compared with a 10-month period after the introduction of the MET and full implementation of standardised packs (June 2017-March 2018). RESULTS Postimplementation, the average monthly decline in stick sales was 6.4 million (95% CI 0.1 million to 12.7 million) sticks faster than prelegislation, almost doubling the speed of decline. Sales of cheap FM brands, previously increasing, plateaued after implementation. Company monthly net revenues declined from a stable £231 million (95% CI £228 million to £234 million), prelegislation, to £198 million (95% CI £191 million to £206 million) in April 2018. CONCLUSIONS The concurrent introduction of standardised packaging and MET in the UK was associated with significant decline in sales and in tobacco industry revenues, and the end of the previous growth in cheap cigarette brands that appeal to young and price conscious smokers.
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Affiliation(s)
- Rosemary Hiscock
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
| | - Nicole H Augustin
- Department of Mathematical Sciences, University of Bath, Bath, Somerset, UK
- School of Mathematics, University of Edinburgh, Edinburgh, UK
| | - J Robert Branston
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
- School of Management, University of Bath, Bath, UK
| | - Anna B Gilmore
- Tobacco Control Research Group, Department for Health, University of Bath, Bath, UK
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Affiliation(s)
- Janet Hoek
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Richard Edwards
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - George W Thomson
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Andrew Waa
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Nick Wilson
- Department of Public Health, University of Otago, Wellington, New Zealand
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Wamamili B, Lawler S, Wallace-Bell M, Gartner C, Sellars D, Grace RC, Courtney R, Coope P. Cigarette smoking and e-cigarette use among university students in Queensland, Australia and New Zealand: results of two cross-sectional surveys. BMJ Open 2021; 11:e041705. [PMID: 33563621 PMCID: PMC7875298 DOI: 10.1136/bmjopen-2020-041705] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 12/07/2020] [Accepted: 12/22/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Examine the patterns of cigarette smoking and e-cigarette use (vaping), the perceived harm of e-cigarettes compared with tobacco cigarettes, and associations between smoking and vaping with student characteristics. DESIGN Cross-sectional studies. SETTING The University of Queensland (UQ), Australia and eight New Zealand (NZ) universities. PARTICIPANTS Students at UQ: 4957 (70.8% aged <25 years, 63.0% women) and NZ: 1854 (82.5% aged <25 years, 60.1% women). METHODS Χ2 tests compared smoking by age and gender, and vaping by age, gender and smoking status. Two-sided p<0.05 was considered significant and 95% CIs reported where appropriate. Multinomial logistic regression examined associations between smoking and vaping (exclusive smoking, exclusive vaping, dual use and non-use) with age, gender and student type (domestic vs international). RESULTS Smoking (UQ vs NZ, 95% CI): ever 45.2% (43.8% to 46.6%) vs 50.0% (47.7% to 52.3%), current 8.9% (8.1% to 9.7%) vs 10.4% (9.1% to 11.9%) and daily 5.2% (4.6% to 5.8%) vs 5.6% (4.6% to 6.7%), and not smoking in indoor 98.3% vs 87.7% or outdoor smoke-free spaces 83.8% vs 65.3%.Vaping (UQ vs NZ, 95% CI): ever 20.9% (19.8% to 22.1%) vs 37.6% (35.4% to 39.9%), current 1.8% (1.5% to 2.2%) vs 6.5% (5.4% to 7.7%) and daily 0.7% (0.5% to 1.0%) vs 2.5% (1.9% to 3.4%), and not vaping in indoor 91.4% vs 79.6% or outdoor smoke-free spaces 84.4% vs 71.3%. Of respondents, 71.7% (70.3% to 73.2%) vs 75.3% (72.9% to 77.6%) perceived e-cigarettes as less harmful than tobacco cigarettes.Men were more likely than women to smoke and vape, and to believe that e-cigarettes are less harmful. Regression models containing all predictors for smoking and vaping were significant and the effect of gender was significant for dual use, exclusive smoking and exclusive vaping (all p<0.01). Men had higher odds for smoking, vaping or dual use. CONCLUSIONS Results suggest significant differences in patterns of smoking and vaping of university students in Australia and NZ, and a strong influence of gender on smoking and vaping.
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Affiliation(s)
- Ben Wamamili
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Sheleigh Lawler
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Mark Wallace-Bell
- School of Health Sciences, University of Canterbury, Christchurch, New Zealand
| | - Coral Gartner
- School of Public Health, University of Queensland, Brisbane, Queensland, Australia
- Queensland Alliance for Environmental Health Sciences, Brisbane, Queensland, Australia
| | - David Sellars
- College of Public Health, Medical and Veterinary Sciences, James Cook University, Townsville, Queensland, Australia
| | - Randolph C Grace
- School of Psychology, Speech and Hearing, University of Canterbury, Christchurch, New Zealand
| | - Ryan Courtney
- National Drug and Alcohol Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Pat Coope
- College of Education, Health and Human Development, University of Canterbury, Christchurch, New Zealand
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Johnson SE, Mitrou F, Lawrence D, Zubrick SR, Wolstencroft K, Ennals P, Hall C, McNaught E. Feasibility of a Consumer Centred Tobacco Management intervention in Community Mental Health Services in Australia. Community Ment Health J 2020; 56:1354-1365. [PMID: 32036516 DOI: 10.1007/s10597-020-00573-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 02/01/2020] [Indexed: 11/29/2022]
Abstract
This study tested a new program for helping smokers with severe mental illness to reduce their tobacco use, together with determining the feasibility of such research in community mental health settings in Australia. Five Neami National sites trialled a Consumer Centred Tobacco Management program called Kick the Habit (n = 34). The intervention included two weeks of free Nicotine Replacement Therapy (patches only) but participants also used a variety of self-funded delivery types in addition or as an alternative to the subsidised nicotine patch. At the 3-month follow-up, Kick the Habit participants had reduced their number of daily cigarettes, dependency levels and average weekly expenditure on tobacco. Although a larger study is required, Kick the Habit represents a promising intervention for tobacco management in community mental health services. The challenges and lessons learnt for scaling up to a larger trial and integration into business-as-usual practice across multiple sites are discussed.
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Affiliation(s)
- Sarah E Johnson
- Telethon Kids Institute, The University of Western Australia, Perth, Australia.
- Telethon Kids Institute, Northern Entrance, Perth Children's Hospital, 15 Hospital Avenue, Nedlands, WA, 6009, Australia.
| | - Francis Mitrou
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | - David Lawrence
- Graduate School of Education, The University of Western Australia, Perth, Australia
| | - Stephen R Zubrick
- Telethon Kids Institute, The University of Western Australia, Perth, Australia
- Centre for Child Health Research, The University of Western Australia, Perth, Australia
| | | | | | - Cristal Hall
- Neami National (Head Office), Melbourne, Australia
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15
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Berney CR. Response to Re: Why it is wrong to 'enforce' smoking cessation. ANZ J Surg 2020; 90:1215. [PMID: 32592301 DOI: 10.1111/ans.15954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 04/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Christophe R Berney
- Department of General Surgery, Bankstown-Lidcombe Hospital, Sydney, New South Wales, Australia
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16
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Marijuana Promotion Online: an Investigation of Dispensary Practices. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2020; 20:280-290. [PMID: 29629505 DOI: 10.1007/s11121-018-0889-2] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Marijuana product advertising will become more common, as the use of medical and/or recreational marijuana becomes increasingly legal in the USA. In this study, we investigate the marketing tactics being used on marijuana dispensary websites in the USA that could influence substance use behaviors. One hundred dispensary websites were randomly selected from 10 states that allowed the legal use of medical or recreational marijuana and had at least 10 operational dispensaries. Three dispensaries were excluded due to non-functioning websites, leaving a sample of 97 dispensaries. Content analysis was conducted on these dispensaries' websites, with the primary areas of focus including website age verification, marijuana effects, warnings, and promotional tactics. Among the 97 dispensaries, 75% did not include age verification. Roughly 30% offered online ordering and 21% offered delivery services. Sixty-seven percent made health claims pertaining to medical conditions that could be treated by their marijuana products, with moderate or conclusive evidence to support their claims. Less than half of the dispensaries (45%) advised consumers of possible side effects, and only 18% included warnings about contraindications. Nearly half (44%) offered reduced prices or coupons, 19% offered "buy one get one free" offers, and 16% provided giveaways or free samples. Our findings indicate that marijuana dispensary websites are easily accessible to youth. In addition, only a small amount of the websites advised consumers about possible side effects or contraindications. This study suggests the need for surveillance of marijuana commercialization and online advertising especially in the context of state policy reforms.
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Blakely T, Gartner C. Tobacco taxes have mixed effects on socioeconomic disparities. Lancet Public Health 2019; 4:e595-e596. [PMID: 31759896 DOI: 10.1016/s2468-2667(19)30223-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 10/22/2019] [Indexed: 12/20/2022]
Affiliation(s)
- Tony Blakely
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010, Australia.
| | - Coral Gartner
- School of Public Health and Queensland Alliance for Environmental Health Sciences, University of Queensland, Brisbane, QLD, Australia
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18
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Yong HH, Borland R, Cummings KM, Gravely S, Thrasher JF, McNeill A, Hitchman S, Greenhalgh E, Thompson ME, Fong GT. Reasons for regular vaping and for its discontinuation among smokers and recent ex-smokers: findings from the 2016 ITC Four Country Smoking and Vaping Survey. Addiction 2019; 114 Suppl 1:35-48. [PMID: 30821861 PMCID: PMC6717696 DOI: 10.1111/add.14593] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AIMS To examine current and ex-smokers' reasons for continuing or discontinuing regular use of nicotine vaping products (NVPs). DESIGN AND PARTICIPANTS Cross-sectional study of 2722 current daily/weekly, and 921 ex-daily/weekly, adult vapers who were either current or ex-cigarette smokers when surveyed. SETTING 2016 ITC Four Country Smoking and Vaping wave 1 (4CV1) surveys conducted in the United States (n = 1159), England (n = 1269), Canada (n = 964) and Australia (n = 251). MEASUREMENTS Current vapers were asked about the following reasons for regular NVP use: less harmful to others, social acceptance, enjoyment, use in smoke-free areas, affordability and managing smoking behaviour. Ex-vapers were asked about the following reasons for discontinuing regular NVP use: addiction concerns, affordability, negative experiences, perceived social unacceptability, safety concerns, product dissatisfaction, inconvenience, unhelpfulness for quitting, unhelpfulness for managing cravings and not needed for smoking relapse prevention. Possible correlates of NVP use and discontinuation, including smoking status, smoking/vaping frequency, quit duration (ex-smokers only), country, age and type of NVP device used, were examined using multivariate logistic regression models. FINDINGS For current smokers, the top three reasons for current regular NVP use were: helpful for cutting down smoking (85.6%), less harmful to others (77.9%) and helpful for quitting smoking (77.4%). The top three reasons for discontinuing vaping were: not being satisfying (77.9%), unhelpfulness for cravings (63.2%), and unhelpfulness for quitting smoking (52.4%). For ex-smokers, the top three reasons for current vaping were: enjoyment (90.6%), less harmful to others (90%) and affordability (89.5%); and for discontinuing were: not needed to stay quit (77.3%), not being satisfying (49.5%) and safety concerns (44%). Reported reasons varied by user characteristics, including age, country and NVP device type. CONCLUSIONS Regular use of nicotine vaping products is mainly motivated by its perceived benefits, especially for reducing or quitting smoking, whereas its discontinuation is motivated by perceived lack of such benefits, with some variation by user characteristics.
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Affiliation(s)
- Hua-Hie Yong
- Deakin University, Geelong, Australia,Cancer Council Victoria, Melbourne, Australia
| | - Ron Borland
- Cancer Council Victoria, Melbourne, Australia
| | | | | | | | | | | | | | | | - Geoffrey T. Fong
- University of Waterloo, Waterloo, Canada,Ontario Institute for Cancer Research, Toronto, Canada
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19
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Do health warnings on cigarette sticks dissuade smokers and non-smokers? A focus group and interview study of Australian university students. Psychol Res Behav Manag 2019; 12:361-373. [PMID: 31191057 PMCID: PMC6526189 DOI: 10.2147/prbm.s193754] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 02/13/2019] [Indexed: 11/30/2022] Open
Abstract
Introduction: Young adults are a vulnerable population for experimentation with tobacco, which can lead to lifelong addiction. In an effort to ensure reductions in tobacco use through improved health promotion materials, we explored young adults' perceptions of current Australian packaging warnings, and novel health warnings on individual cigarette sticks. Methods: Focus groups and interviews were conducted with smoking and non-smoking first-year undergraduate university students at a regional Australian university. Semi-structured questions were used to gather participant perceptions. Sixteen students participated across three focus groups, and eleven students participated in the phone interviews. Data were analyzed using thematic analysis in NVivo. Results: Six emergent themes were identified. Current cigarette packaging warnings were seen as ineffective, being disregarded by current smokers (theme 1), and seen as irrelevant by young adult smokers and non-smokers (theme 2). Several cigarette stick warnings were perceived as engaging and effective, due to the novelty of the cigarette stick as a medium (theme 3), and the proximal nature of the warnings used (theme 4). The warning depicting the financial consequences of smoking was considered the most effective, followed by the impact of smoking on personal appearance, and the "minutes of life lost" warning. Social media (theme 5), and the use of more supportive messages to assist smokers (theme 6) were considered the best next steps as tobacco control interventions. Conclusions: Supplementing packaging warnings which were seen as minimally effective in this study, using cigarette stick warnings and social media may lead to further reductions in tobacco use. New and relatable warnings such as the financial consequences of smoking and impact on personal appearance may be the most effective in dissuading young adults from smoking, particularly within the university environment.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, QLD, Australia
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20
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Smoker perceptions of health warnings on cigarette packaging and cigarette sticks: A four-country study. Tob Induc Dis 2019; 17:23. [PMID: 31582934 PMCID: PMC6751965 DOI: 10.18332/tid/104753] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2018] [Revised: 02/28/2019] [Accepted: 02/28/2019] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Innovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarette-stick warnings across four countries. METHODS An online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis. RESULTS Participants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75–4.25, p<0.001 and OR=2.85, 95% CI: 2.29–3.55, p<0.001, respectively) and cited as strong messages to reduce smoking. Half of the participants either ‘agreed’ or ‘strongly agreed’ to the use of cigarette-stick warnings. CONCLUSIONS The findings of this study suggest that cigarette packaging warnings may experience a loss of effectiveness over time, eventually resulting in minimal impact on smoker behaviour. Health and non-health focused warnings and messages on individual cigarette sticks represent a novel and potentially effective method for reducing tobacco use. This would complement tobacco control interventions currently employed, resulting in public health benefits.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Australia
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21
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Examining quit attempts and successful quitting after recent cigarette tax increases. Prev Med 2019; 118:226-231. [PMID: 30408448 DOI: 10.1016/j.ypmed.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Revised: 09/15/2018] [Accepted: 11/04/2018] [Indexed: 11/20/2022]
Abstract
As cigarette smoking rates decline, an important policy question is whether increasing cigarette taxes will continue to encourage smoking cessation. We tested this question following recent tobacco tax increases. Data were from the Minnesota Adult Tobacco Survey, a serial cross-sectional telephone survey conducted statewide, and was limited to past-year cigarette smokers in 2010 (n = 1029) and 2014 (n = 1382). Weighted estimates were calculated of the prevalence of past year smokers, smokers who attempted to quit smoking, and those who successfully quit by demographics, tobacco use, use of evidence-based cessation assistance to quit, and smoker perceptions of the tax increases. Among past year smokers, almost 60% reported a quit attempt in both years, 12.8% successfully quit in 2010 and 15.6% in 2014. Although older age, daily smoking, mean cigarettes per day, and more days of e-cigarette use, were associated with quit attempts in unadjusted models, only the perceived tax increase effect (AOR = 8.9; 95% CI 6.3-12.5) and low nicotine dependence (AOR = 1.9, 95% CI 1.3-2.7) were associated with making a quit attempt in adjusted models. Successful 12-month quits were predicted by college education (AOR = 3.2, 95% CI 1.3-7.8), the use of cessation support (AOR = 2.1, 95% CI 1.3-3.6), and reporting the tax increase helped maintain a quit (AOR = 12.3, 95% CI 7.5-20.1). These findings suggest that a large tax increase is effective in promoting quitting even in the presence of strong tobacco control measures such as indoor smoking bans and other smoking restrictions, mass media campaigns, and universal access to cessation support.
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22
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Sweeney R, Moodie M, Baker AL, Borland R, Castle D, Segan C, Turner A, Attia J, Kelly PJ, Brophy L, Bonevski B, Williams JM, Baird D, White SL, McCarter K. Protocol for an Economic Evaluation of the Quitlink Randomized Controlled Trial for Accessible Smoking Cessation Support for People With Severe Mental Illness. Front Psychiatry 2019; 10:618. [PMID: 31551827 PMCID: PMC6735263 DOI: 10.3389/fpsyt.2019.00618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Accepted: 08/01/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction: Smoking is a major cause of disease burden and reduced quality of life for people with severe mental illness (SMI). It places significant resource pressure on health systems and financial stress on smokers with SMI (SSMI). Telephone-based smoking cessation interventions have been shown to be cost effective in general populations. However, evidence suggests that SSMI are less likely to be referred to quitlines, and little is known about the effectiveness and cost effectiveness of such interventions that specifically target SSMI. The Quitlink randomized controlled trial for accessible smoking cessation support for SSMI aims to bridge this gap. This paper describes the protocol for evaluating the cost effectiveness of Quitlink. Methods: Quitlink will be implemented in the Australian setting, utilizing the existing mental health peer workforce to link SSMI to a tailored quitline service. The effectiveness of Quitlink will be evaluated in a clustered randomized controlled trial. A cost-effectiveness evaluation will be conducted alongside the Quitlink clustered randomized controlled trial (RCT) with incremental cost-effectiveness ratios (ICERs) calculated for the cost (AUD) per successful quit and quality adjusted life year (QALY) gained at 8 months compared with usual care from both health care system and limited societal perspectives. Financial implications for study participants will also be investigated. A modeled cost-effectiveness analysis will also be conducted to estimate future costs and benefits associated with any treatment effect observed during the trial. Results will be extrapolated to estimate the cost effectiveness of rolling out Quitlink nationally. Sensitivity analyses will be undertaken to assess the impact on results from plausible variations in all modeled variables. Discussion: SSMI require additional support to quit. Quitlink utilizes existing peer worker and quitline workforces and tailors quitline support specifically to provide that increased cessation support. Given Quitlink engages these existing skilled workforces, it is hypothesized that, if found to be effective, it will also be found to be both cost effective and scalable. This protocol describes the economic evaluation of Quitlink that will assess these hypotheses. Ethics and dissemination: Full ethics clearances have been received for the methods described below from the University of Newcastle (Australia) Human Research Ethics Committee (H-2018-0192) and St Vincent's Hospital, Melbourne (HREC/18/SVHM/154). The trial has been registered with the Australian and New Zealand Clinical Trials Registry (ACTRN12619000244101). Participant consent is sought both to participate in the study and to have the study data linked to routine health administrative data on publicly subsidized health service and pharmaceutical use, specifically the Medicare Benefits and Pharmaceutical Benefits Schemes (MBS/PBS). Trial findings (including economic evaluation) will be published in peer reviewed journals and presented at international conferences. Collected data and analyses will be made available in accordance with journal policies and study ethics approvals. Results will be presented to relevant government authorities with an interest in cost effectiveness of these types of interventions.
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Affiliation(s)
- Rohan Sweeney
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Marj Moodie
- Deakin Health Economics, Centre for Population Health Research, Deakin University, Geelong, VIC, Australia
| | - Amanda L Baker
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Ron Borland
- The Cancer Council Victoria, Melbourne, VIC, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, VIC, Australian
| | - David Castle
- Department of Psychiatry, University of Melbourne, Melbourne, VIC, Australia.,Department of Psychiatry, St Vincent's Hospital Melbourne, Fitzroy, VIC, Australia
| | - Catherine Segan
- The Cancer Council Victoria, Melbourne, VIC, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Alyna Turner
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, VIC, Australia.,Barwon Health, Geelong, VIC, Australia
| | - John Attia
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Peter J Kelly
- Illawarra Institute for Mental Health, School of Psychology, University of Wollongong, Wollongong, NSW, Australia
| | - Lisa Brophy
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia.,Mind Australia, Melbourne, VIC, Australia
| | - Billie Bonevski
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Jill M Williams
- Division of Addiction Psychiatry, Rutgers Robert Wood Johnson Medical School and Rutgers Cancer Institute of New Jersey, New Brunswick, NJ, United States
| | - Donita Baird
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
| | - Sarah L White
- The Cancer Council Victoria, Melbourne, VIC, Australia
| | - Kristen McCarter
- Faculty of Health and Medicine, University of Newcastle, Newcastle, NSW, Australia
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian School Student Perceptions of Effective Anti-tobacco Health Warnings. Front Public Health 2018; 6:297. [PMID: 30386764 PMCID: PMC6199459 DOI: 10.3389/fpubh.2018.00297] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Accepted: 09/28/2018] [Indexed: 11/26/2022] Open
Abstract
Background: Recent research posits that anti-tobacco health warnings on cigarette packaging may gradually lose their effectiveness in dissuading adolescents from tobacco products several years after implementation. Health warnings on individual cigarette sticks represent a novel warning medium, and may further educate adolescents on the dangers associated with smoking, and reduce tobacco experimentation amongst this vulnerable population. Methods: In an online survey of school students in Queensland, Australia, participants were requested to rate (on five-point Likert scales) and comment on the perceived effectiveness of current cigarette packaging warnings, and 12 text warnings on cigarette sticks, in preventing non-smokers from smoking, and encouraging current smokers to quit. The warnings were divided into four themes to establish the most effective types of anti-tobacco messages: mortality statistics, health condition consequences, social and financial consequences, and supportive messages. These themes were based on current anti-tobacco interventions within Australia, and the rising cost of tobacco products, and designed to align with the Health Belief Model. Results: Participants (N = 150; Age = 15-18) from five schools completed the survey, and generally viewed current packaging warnings as gross and disgusting, and rating them as somewhat effective in preventing non-smokers from smoking. Current warnings were however considered less effective in prompting current smokers to quit with participants describing them as being un-relatable to teenagers, and smokers as having become desensitized to the warnings used. One theme of cigarette-stick warning (mortality statistics) was rated as significantly more effective (p < 0.001) than current cigarette packaging, with an odds ratio (OR) of 2.77 (95% confidence interval [CI]: 1.67-4.62). Overall, warnings were considered to be 4.71 times (95%CI: 2.72-6.43, p < 0.001) more effective on non-smokers than on smokers. Over three-quarters of participants supported using health warnings on individual cigarette sticks. Conclusions: Current cigarette packaging warnings have retained some effectiveness in dissuading adolescents from smoking, though novel and thought-provoking text-only warnings on cigarette sticks may serve as an additional intervention in reducing tobacco use. Further research requires identification of the most effective warnings, and the perceptions of a more diverse participant base.
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Parnell A, Box E, Biagioni N, Bonevski B, Coffin J, Slevin T, Anwar-McHenry J, Pettigrew S. Attitudinal and behavioural responses to increasing tobacco control regulation among high smoking prevalence groups: A qualitative study. Drug Alcohol Rev 2018; 38:92-100. [DOI: 10.1111/dar.12869] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/01/2018] [Accepted: 09/19/2018] [Indexed: 11/29/2022]
Affiliation(s)
| | | | | | - Billie Bonevski
- School of Medicine and Public Health; University of Newcastle; Newcastle Australia
| | - Juli Coffin
- Broome Campus; University of Notre Dame; Broome Australia
| | - Terry Slevin
- School of Psychology; Curtin University; Perth Australia
- Cancer Council WA; Perth Australia
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Abstract
OBJECTIVE To quantify changes in tobacco tax rates and cigarette affordability after countries ratified the WHO Framework Convention on Tobacco Control (FCTC) using with the WHO MPOWER standards. METHODS We used logistic regression to assess the association of FCTC ratification with adoption of at least 50% and 75% (high) of retail price tobacco tax rates for the most sold brands in countries, accounting for years since ratification and other covariates. We also compared cigarette affordability in 2014 with 1999. RESULTS By 2014, 44% of high-income countries had taxes above 75% of retail value compared with 18% in 1998/1999. In 15 years, 69 countries increased the tobacco tax rate, 33 decreased it and one had the same tax rate. FCTC ratification was not associated with implementing high tobacco taxes. More fragile countries in terms of security, political, economic and social development were less likely to have at least 50% and 75% tobacco tax rates in 2014 compared with 1999. The higher the cigarette prices in 1999 the less likely the countries were to have at least 75% tobacco tax rates in 2014. However, cigarettes were less affordable in 2014 than in 1999 in countries that had ratified FCTC earlier. CONCLUSIONS Despite widespread FCTC ratification, implementing higher tobacco taxes remains incomplete. Guidelines for FCTC Article 6 implementation should assign definite targets for tobacco taxes and for implementation of a tax escalator that gradually increases taxes to match rising income levels. Fragile countries are less likely to have high tobacco taxes and less affordable cigarettes. The tobacco control community should intensify efforts to help fragile countries improve performance in FCTC implementation both through strengthening their administrative and technical capacity and through supporting basic functions of government.
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Affiliation(s)
- Heikki Hiilamo
- VID Specialized University, Oslo, Norway
- Social and public policy, Department of Social Research, University of Helsinki, Helsinki, Finland
| | - Stanton Glantz
- Center for Tobacco Control Research and Education, Philip R. Lee Institute for Health Policy Studies, Helen Diller Family Comprehensive Cancer Center, Department of Medicine, University of California, San Francisco, San Francisco, California, USA
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Drovandi A, Teague PA, Glass B, Malau-Aduli B. Australian community pharmacist experiences with smoking cessation and opinions of health warnings on individual cigarette sticks. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2018; 27:121-130. [PMID: 30019785 DOI: 10.1111/ijpp.12470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Accepted: 06/14/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVES We aimed to identify the experiences of Australian community pharmacists with smokers and their associated perceptions of effective health warnings on individual cigarette sticks. METHODS A mixed-methods online survey was distributed to Australian pharmacists through pharmacy-specific social media pages, and the Pharmaceutical Society of Australia, followed by semi-structured face-to-face interviews with pharmacists in Townsville, Australia, who were purposively sampled. The interviews continued until data saturation was achieved. Participants described their experiences with smokers, perceptions and effectiveness ratings of current cigarette packaging warnings, and 12 text warnings (divided into four themes) on individual cigarette sticks, and their general opinions on effective anti-tobacco health warnings. KEY FINDINGS Seventy pharmacists participated in the survey and 17 pharmacists in the interviews. Both groups of pharmacists cited smoking-related personal or close-contact illness, pressure by family members or physicians and the financial costs of smoking as being the main drivers for quit attempts. Most interviewed pharmacists interact with smokers several times per week. Cigarette stick warnings describing mortality consequences (especially the 'minutes of life lost' warning) and the financial consequences of tobacco use were rated as significantly more effective than current packaging warnings (odds ratio [OR] = 2.23; 95% confidence interval [CI]: 1.12-4.12, P = 0.02, and 1.97; 95%CI: 1.01-3.84, P = 0.04, respectively). CONCLUSIONS Pharmacists have considerable experience assisting smokers with quitting and based on these experiences believe that novel and tangible health warnings on cigarette sticks may be an effective future measure to combat tobacco use. Further research on the opinions of a more diverse range of health professionals and the general community will generate more robust findings regarding this method of intervention.
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Affiliation(s)
- Aaron Drovandi
- College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
| | - Peta-Ann Teague
- College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
| | - Beverley Glass
- College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
| | - Bunmi Malau-Aduli
- College of Medicine and Dentistry, James Cook University, Townsville, Qld, Australia
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