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Cho A, Scollo M, Chan G, Driezen P, Hyland A, Shang C, Gartner CE. Tobacco purchasing in Australia during regular tax increases: findings from the International Tobacco Control Policy Evaluation Project. Tob Control 2023:tc-2023-058130. [PMID: 37652676 PMCID: PMC10902190 DOI: 10.1136/tc-2023-058130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/17/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE We examined Australian tobacco purchasing trends, the average self-reported price paid within each purchase type and the association between type of tobacco product purchased and participant characteristics, including quit intentions, between 2007 and 2020. METHODS We analysed data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007-2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (nsample=5452, nobservations=11 534). The main outcome measures were type of tobacco products purchased: RYO, carton, pack or pouch size and brand segment. Logistic regression, fit using generalised estimating equations, was estimated the association between the outcome and participant characteristics. RESULTS The reported price-minimising purchasing patterns increased from 2007 to 2020: any RYO (23.8-43.9%), large-sized pack (2007: 24.0% to 2016: 34.3%); shifting from large-sized to small-sized packs (2020: 37.7%), and economy brand (2007: 37.2% to 2020: 59.3%); shifting from large (2007: 55.8%) to small economy packs (2014: 15.3% to 2020: 48.1%). Individuals with a lower income, a higher nicotine dependence level and no quit intention were more likely to purchase RYO and large-sized packs. CONCLUSION RYO, large-sized packs and products with a low upfront cost (eg, small RYO pouches and small-sized economy brand packs) may appeal to people on low incomes. Australia's diverse tobacco pack and pouch sizes allow the tobacco industry to influence tobacco purchases. Standardising pack and pouch sizes may reduce some price-related marketing and especially benefit people who have a low income, are highly addicted and have no quit intention.
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Affiliation(s)
- Ara Cho
- Faculty of Medicine, The University of Queensland School of Public Health, Herston, Queensland, Australia
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland School of Public Health, Herston, Queensland, Australia
| | - Michelle Scollo
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Gary Chan
- Centre for Youth Substance Abuse Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Andrew Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA
| | - Ce Shang
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Coral E Gartner
- The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, The University of Queensland School of Public Health, Herston, Queensland, Australia
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Jensen JK, Stoddard GJ, Delnevo CD, Merten JW, Azagba S. Longitudinal analysis of cigar use patterns among US youth and adults, 2013-2019. BMC Public Health 2023; 23:1580. [PMID: 37596633 PMCID: PMC10439534 DOI: 10.1186/s12889-023-16253-y] [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: 03/16/2023] [Accepted: 07/06/2023] [Indexed: 08/20/2023] Open
Abstract
BACKGROUND Cigars are available in a range of pack quantities, which contrasts regulations requiring cigarettes to be sold in packs of 20 or greater. Smaller packages may be associated with increases in initiation while larger packs may lead consumers to smoke more. The purpose of this study was to inform pack quantity regulations by examining whether usual cigar pack quantity purchased was associated with use, initiation, and discontinuation among youth and adults for four cigar types: premium cigars, large cigars, cigarillos, and filtered cigars. METHODS We analyzed waves 1-5 (2013-2019) of the adult and waves 2-5 (2014-2019) of the youth Population Assessment of Tobacco and Health (PATH) Study. Samples included those responding to the item on pack quantity and providing data at all waves (adults: premium cigars [N = 536], large cigars [N = 1,272], cigarillos [N = 3,504], filtered cigars [N = 1,281]; youth: premium cigars [N = 55], large cigars [N = 217], cigarillos [N = 1514], filtered cigars [N = 266]). Generalized estimating equation models examined the population-averaged effects of pack quantity on cigar use, initiation, and discontinuation. RESULTS Adult pack quantity was positively associated with the days used per month for premium cigars (b: 0.23, 95% CI: 0.11, 0.34), large cigars (b: 0.17, 95% CI: 0.08, 0.25), cigarillos (b: 0.12, 95% CI: 0.003, 0.24), and filtered cigars (b: 0.07, 95% CI: 0.04, 0.10), and positively associated with amount smoked per day for all cigar types. Youth pack quantity was positively associated with days used per month for premium cigars (b: 0.88, 95% CI: 0.33, 1.43), large cigars (b: 0.79, 95% CI: 0.43, 1.15), and cigarillos (b: 0.17, 95% CI: 0.01, 0.34). Adult initiation was associated with pack quantity for filtered cigars (b: -2.22, 95% CI: -4.29, -0.13), as those who initiated purchased smaller pack quantities compared to those who did not initiate that wave. Pack quantity was not associated with discontinuation for adults or youth. CONCLUSIONS Cigar use increased as usual pack quantity purchased increased across cigar types for youth and adults. Small increases in pack quantity (e.g., one additional cigar) are likely to result in consuming less than one additional day per month, though larger increases (e.g., 10 additional cigars per pack) may result in greater use.
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Affiliation(s)
- Jessica King Jensen
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, New Brunswick, NJ, 08901, USA.
- Family Medicine & Community Health, Rutgers Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, 303 George St, New Brunswick, NJ, 08901, USA.
| | - Gregory J Stoddard
- Department of Internal Medicine, University of Utah, 30 N 1900 E, Salt Lake City, UT, 84132, USA
| | - Cristine D Delnevo
- Rutgers Institute for Nicotine & Tobacco Studies, Rutgers Biomedical and Health Sciences, 303 George Street, New Brunswick, NJ, 08901, USA
| | - Julie W Merten
- Brooks College of Health, University of North Florida, 1 UNF Dr Building 39, Jacksonville, FL, 32224, USA
| | - Sunday Azagba
- Ross and Carol Nese College of Nursing, Penn State University, Nursing Sciences Building, University Park, PA, 16802, USA
- Social Science Research Institute, Penn State University, 114 Building, Henderson Drive, University Park, PA, 16802, USA
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Lee I, Blackwell AKM, Hobson A, Wiggers D, Hammond D, De‐loyde K, Pilling MA, Hollands GJ, Munafò MR, Marteau TM. Cigarette pack size and consumption: a randomized cross-over trial. Addiction 2023; 118:489-499. [PMID: 36326156 PMCID: PMC10100265 DOI: 10.1111/add.16062] [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: 04/21/2022] [Accepted: 09/21/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND AND AIMS Smoking fewer cigarettes per day may increase the chances of stopping smoking. Capping the number of cigarettes per pack is a promising policy option, but the causal impact of such a change is unknown. This study aimed to test the hypothesis that lowering cigarette pack sizes from 25 to 20 reduces the number of cigarettes smoked. DESIGN This randomized controlled cross-over trial had two 14-day intervention periods with an intervening 7-day period of usual behaviour. Participants purchased their own cigarettes. They were instructed to smoke their usual brand from either one of two sizes of pack in each of two 14-day intervention periods: (a) 25 cigarettes and (b) 20 cigarettes. Participants were randomized to the order in which they smoked from the two pack sizes (a-b; b-a). SETTING Canada. PARTICIPANTS Participants were adult smokers who smoked from pack sizes of 25, recruited between July 2020 and June 2021. Of 252 randomized, 240 (95%) completed the study and 236 (94%) provided sufficient data for the primary analysis. MEASUREMENTS Cigarettes smoked per participant per day. FINDINGS Participants smoked fewer cigarettes per day from packs of 20 cigarettes [n = 234, mean = 15.7 standard deviation (SD) = 7.1] than from packs of 25 (n = 235, mean = 16.9, SD = 7.1). After adjusting for pre-specified covariates (baseline consumption and heaviness of smoking), modelling estimated that participants smoked 1.3 fewer cigarettes per day [95% confidence interval (CI) = -1.7 to -0.9], equivalent to 7.6% fewer (95% CI = -10.1 to -5.2%) from packs of 20 cigarettes. CONCLUSIONS Smoking from packs of 20 compared with 25 cigarettes reduced the number of cigarettes smoked per day.
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Affiliation(s)
- Ilse Lee
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
| | | | - Alice Hobson
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
- Nuffield Department of Primary Care Health SciencesUniversity of OxfordOxfordUK
| | - Danielle Wiggers
- School of Public Health Sciences, Faculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - David Hammond
- School of Public Health Sciences, Faculty of HealthUniversity of WaterlooWaterlooOntarioCanada
| | - Katie De‐loyde
- School of Psychological ScienceUniversity of Bristol, 12a Priory RoadBristolUK
| | - Mark A. Pilling
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
| | - Gareth J. Hollands
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
- EPPI Centre, UCL Social Research InstituteUniversity College LondonLondonUK
| | - Marcus R. Munafò
- School of Psychological ScienceUniversity of Bristol, 12a Priory RoadBristolUK
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Mat Rifin H, Jane Ling MY, Robert Lourdes TG, Saminathan TA, Rodzlan Hasani WS, Ab Majid NL, Hamid HAA, Riyadzi MR, Ahmad A, Mohd Yusoff MF, Muhamad NA. Small/Kiddie Cigarette Packaging Size and Its Impact on Smoking: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:12051. [PMID: 36231349 PMCID: PMC9566128 DOI: 10.3390/ijerph191912051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2022] [Revised: 08/23/2022] [Accepted: 09/02/2022] [Indexed: 06/16/2023]
Abstract
Background: Small cigarette pack sizes contain less than 20 cigarette sticks in a pack. Smaller packs may suggest lower costs, increasing affordability among lower-income users, especially the younger generation, which could lead to tobacco-related diseases and economic costs, including human capital lost results from tobacco-attributable morbidity and mortality. This concern has caused many countries to ban the sale of single cigarette sticks or kiddie packs. However, small cigarette pack sizes were proposed recently to be reintroduced by the tobacco industry with an excuse to prevent consumers from buying illicit cigarettes. This would demean efforts in combating tobacco consumption based on the existing tobacco control policies to prevent minors from purchasing cigarettes. Given the competing influences of affordability and availability of tobacco on consumption and the dearth of evidence-based review on the impact of pack size on smoking, this systematic review was conducted to identify the link between kiddie packs and smoking specifically on the initiation of smoking, urge/tendency to buy cigarettes among the general population and attempt to reduce cigarette consumption and prevalence of smoking using kiddie packs among current smokers. Methods: We include all studies except for reviews, guidelines, conference papers, commentaries, editorials, or opinion pieces. A database search was conducted in PubMed, EMBASE, CENTRAL, Web of Science and Scopus on 27 November 2021. The results were presented in the form of narrative synthesis under four groups: initiation of smoking; urge/tendency to buy cigarettes; the prevalence of smoking, and attempt to reduce cigarette consumption. The literature search identified 1601 articles, of which 21 articles had met the inclusion criteria. The methodological quality of all included articles was determined using a validated 16-item quality assessment tool (QATSDD). The average quality score for all papers was 34.8%. Discussion: Given the diverse study settings of the articles and despite the challenges of the methodological quality of some articles, this review provides some evidence that kiddie packs may increase the urge/tendency to buy cigarettes and mixed evidence on the attempt to reduce cigarette consumption. This review also found some evidence that kiddie pack purchasing among teenage smokers was higher compared to adults. However, we are uncertain about the link between kiddie packs and smoking initiation. Nevertheless, since most studies were of low quality, further high-quality studies are needed to conclude about the impact of kiddie packs on smoking to assist the policymakers and stakeholders in formulating new policies and strengthening existing strategies related to the kiddie packs.
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Affiliation(s)
- Halizah Mat Rifin
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Miaw Yn Jane Ling
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Tania Gayle Robert Lourdes
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Thamil Arasu Saminathan
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Wan Shakira Rodzlan Hasani
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Nur Liana Ab Majid
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Hamizatul Akmal Abd Hamid
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Mohd Ruhaizie Riyadzi
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | - Ahzairin Ahmad
- Institute for Public Health, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
| | | | - Nor Asiah Muhamad
- Sector for Evidence-Based Healthcare, National Institutes of Health, Ministry of Health, Shah Alam 40170, Malaysia
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Association of preferred flavorings and device type with box or pack purchase behavior of electronic nicotine delivery systems in the United States. J Public Health Policy 2022; 43:65-76. [PMID: 34997209 DOI: 10.1057/s41271-021-00326-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/30/2021] [Indexed: 11/21/2022]
Abstract
This study examined the associations of preferred flavorings and device type of ENDS with box or pack purchase behavior. We analyzed current adult ENDS users in the United States who reported purchase of their own ENDS. Logistic regression revealed an increased likelihood of box/pack purchase behavior among users of menthol or mint-flavored ENDS, disposable, pod-based devices, and those who purchase ENDS from the Internet. A moderation analysis showed that the magnitude of the association between menthol or mint-flavored ENDS use and box/pack purchase was stronger among disposable and pod-based device users compared to tank or mods (customizable devices) users. In a subsequent stratified analysis menthol or mint flavor users were more likely than non-flavor users to engage in box/pack purchase among disposable and pod-based device users, but not among tank or mods users. Regulating flavors and maximum unit sale quantities of ENDS by device could thwart ENDS box/pack purchase behavior.
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Impact of Little Cigars and Cigarillos Packaging Features on Product Preference. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111443. [PMID: 34769959 PMCID: PMC8583443 DOI: 10.3390/ijerph182111443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/24/2021] [Accepted: 10/26/2021] [Indexed: 11/22/2022]
Abstract
Background: We conducted a discrete choice experiment (DCE) among young adult cigarette smokers in the period July–August 2018 to examine their preference for cigarillos in response to various packaging-related attributes, including flavor, flavor description, quality descriptors, pack size, and prices. Methods: A convenience sample of 566 US young adult cigarette smokers aged 18–34, among whom 296 were current little cigar and cigarillo (LCC) smokers, were recruited using Facebook ads and invited to participate in an online (Qualtrics) tobacco survey containing DCE and tobacco use questions. In the experiment, participants chose among two cigarillo products or “neither” (opt-out). Results: We analyzed preferences for LCCs using multinomial, nested, random parameter logit models. Results showed that young adult cigarette smokers preferred grape over menthol, tobacco/regular, and wine flavors; “color only” and “color and text” flavor depictions over text only; “smooth” and “sweet” quality descriptors over “satisfying”; and larger pack sizes and lower prices. Conclusions: Regulating packaging-related features will impact LCC choices among US young adult smokers. FDA regulation over these packaging-related features may impact LCC use among young adult smokers.
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King JL, Bilic A, Merten JW. Reasons for Pack Size Purchase among US Adults Who Purchase Cigars. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157790. [PMID: 34360081 PMCID: PMC8345579 DOI: 10.3390/ijerph18157790] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 07/09/2021] [Accepted: 07/20/2021] [Indexed: 11/16/2022]
Abstract
With municipalities across the US establishing minimum cigar pack size regulations, it is critical to understand what drives pack size preference. The purpose of this exploratory study was to identify reasons for cigar pack size purchase. We used Amazon’s Mechanical Turk to survey adults who had purchased cigars and reported past 30 day use. Participants responded to an open-ended item asking their reasons for purchasing their usual pack size. Responses were double-coded and categorized. Of 152 respondents, 61 used traditional cigars, 85 used cigarillos, and 36 used filtered cigars. Across all cigar types, most participants (73.7%) purchased boxes rather than singles; 5–9-packs were the most popular pack size category (19.7%), followed by 20+-packs (18.4%). We identified 16 reasons for pack size purchase across seven categories: price, consumption, social aspect, convenience, product characteristics, availability, and general preferences. Reasons varied according to whether the consumer purchased larger or smaller pack sizes. In this exploratory study to identify reasons for cigar pack size purchases, findings were consistent with those identified through tobacco industry documents and in the cigarette literature. Future research should examine the prevalence of these reasons, including as a function of demographic and use characteristics, to help inform the understanding of potential minimum cigar pack regulations.
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Affiliation(s)
- Jessica L. King
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, UT 84112, USA;
- Correspondence:
| | - Anna Bilic
- Department of Health & Kinesiology, University of Utah, 250 S 1850 E, Salt Lake City, UT 84112, USA;
| | - Julie W. Merten
- Department of Public Health, Brooks College of Health, University of North Florida, 1 S UNF Dr Building 39, Jacksonville, FL 32224, USA;
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Cigarette pack size and consumption: an adaptive randomised controlled trial. BMC Public Health 2021; 21:1420. [PMID: 34275444 PMCID: PMC8286601 DOI: 10.1186/s12889-021-11413-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 06/29/2021] [Indexed: 11/10/2022] Open
Abstract
Background Observational evidence suggests that cigarette pack size – the number of cigarettes in a single pack – is associated with consumption but experimental evidence of a causal relationship is lacking. The tobacco industry is introducing increasingly large packs, in the absence of maximum cigarette pack size regulation. In Australia, the minimum pack size is 20 but packs of up to 50 cigarettes are available. We aimed to estimate the impact on smoking of reducing cigarette pack sizes from ≥25 to 20 cigarettes per pack. Method A two-stage adaptive parallel group RCT in which Australian smokers who usually purchase packs containing ≥25 cigarettes were randomised to use only packs containing either 20 (intervention) or their usual packs (control) for four weeks. The primary outcome, the average number of cigarettes smoked per day, was measured through collecting all finished cigarette packs, labelled with the number of cigarettes participants smoked. An interim sample size re-estimation was used to evaluate the possibility of detecting a meaningful difference in the primary outcome. Results The interim analysis, conducted when 124 participants had been randomised, suggested 1122 additional participants needed to be randomised for sufficient power to detect a meaningful effect. This exceeded pre-specified criteria for feasible recruitment, and data collection was terminated accordingly. Analysis of complete data (n = 79) indicated that the mean cigarettes smoked per day was 15.9 (SD = 8.5) in the intervention arm and 16.8 (SD = 6.7) among controls (difference − 0.9: 95%CI = − 4.3, 2.6). Conclusion It remains unclear whether reducing cigarette pack sizes from ≥25 to 20 cigarettes reduces cigarette consumption. Importantly, the results of this study provide no evidence that capping cigarette pack sizes would be ineffective at reducing smoking. The limitations identified in this study can inform a more efficient RCT, which is urgently required to address the dearth of experimental evidence on the impact of large cigarette pack sizes on smoking. Trial registration 10.1186/ISRCTN34202533 Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-11413-4.
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Davydenko M, Kolbuszewska M, Peetz J. A meta-analysis of financial self-control strategies: Comparing empirical findings with online media and lay person perspectives on what helps individuals curb spending and start saving. PLoS One 2021; 16:e0253938. [PMID: 34237109 PMCID: PMC8266115 DOI: 10.1371/journal.pone.0253938] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 06/15/2021] [Indexed: 11/19/2022] Open
Abstract
Self-control can be assisted by using self-control strategies rather than relying solely on willpower to resist tempting situations and to make more goal-consistent decisions. To understand how self-control strategies can aid financial goals, we conducted a meta-analysis (Study 1) to aggregate the latest research on self-control strategies in the financial domain and to estimate their overall effectiveness for saving and spending outcomes. Across 29 studies and 12 different self-control strategies, strategies reduced spending and increased saving significantly with a medium effect size (d = 0.57). Proactive and reactive strategies were equally effective. We next examined whether these strategies studied in the academic literature were present in a media sample of websites (N = 104 websites with 852 strategies) and in individuals' personal experiences (N = 939 participants who listed 830 strategies). About half the strategies identified in the meta-analysis were present in the media sample and about half were listed by lay participants as strategies they personally use. In sum, this paper provides a comprehensive overview of the self-control strategies that have been studied in the empirical literature to date and of the strategies promoted in the media and used in daily life, identifying gaps between these perspectives.
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van Schalkwyk MCI, McKee M, Been JV, Millett C, Filippidis FT. Size matters: An analysis of cigarette pack sizes across 23 European Union countries using Euromonitor data, 2006 to 2017. PLoS One 2020; 15:e0237513. [PMID: 32790798 PMCID: PMC7425903 DOI: 10.1371/journal.pone.0237513] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 07/28/2020] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION The tobacco industry (TI) has used small cigarette pack sizes to encourage brand-switching and consumption, and to mitigate the impacts of tobacco tax increases. Since 2016, the European Union (EU) Tobacco Products Directive (TPD) specifies a minimum pack size of 20 cigarettes. We examined cigarette pack sizes in the EU and whether pack size composition differed between cheap and expensive price segments, as well as the impact of the revised TPD. METHODS We conducted a longitudinal analysis of pricing data from 23 EU countries between 2006-2017. We examined pack sizes over time to assess the impact of the TPD, differences in pack size composition between cheap and expensive price segments, and compared gaps in median prices between products using actual and 'expected' prices (price if all packs contained 20 sticks). RESULTS Cigarette pack sizes changed over time, across the EU. The distribution of pack sizes varied between price segments, with small pack sizes especially frequent in the cheap segment of the cigarette market, but this varied over time and across countries. Packs of <20 cigarettes almost disappeared from the data samples after implementation of the TPD. CONCLUSION Implementation of the TPD appears to have virtually eliminated packs with <20 cigarettes, restricting their use by the TI. Our analysis suggests pack sizes have been used differentially across the EU. Country-level analyses on the industry's use of pack sizes, consumer responses, and evaluations of restricting certain pack sizes are needed to confirm our findings and strengthen policy.
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Affiliation(s)
- May C. I. van Schalkwyk
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- * E-mail:
| | - Martin McKee
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Jasper V. Been
- Department of Paediatrics, Division of Neonatology, Erasmus MC – Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Department of Public Health, Erasmus MC – Sophia Children’s Hospital, University Medical Centre Rotterdam, Rotterdam, Netherlands
- Usher Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Christopher Millett
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Public Health Policy Evaluation Unit, School of Public Health, Imperial College London, London, United Kingdom
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Association between purchasing behaviors and cigar use: A longitudinal analysis of Waves 1-3 of the Population Assessment of Tobacco and Health (PATH) Study. PLoS One 2020; 15:e0235496. [PMID: 32598379 PMCID: PMC7323953 DOI: 10.1371/journal.pone.0235496] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 06/16/2020] [Indexed: 11/24/2022] Open
Abstract
Introduction Over 120 US jurisdictions have implemented policies mandating minimum cigar pack quantities, yet little empirical research exists on the relationship between pack quantity and use. We examined whether cigar use was associated with purchasing cigars by the box/pack or as singles, purchase quantity, and price paid per cigar. Methods Data are from Waves 1–3 (2013–2016) of the Population Assessment of Tobacco and Health (PATH) Study, analyzed in 2019. The sample included adults who reported current use of any type of cigars (cigarillos [N = 3,051], traditional cigars [N = 2,586], and filtered cigars [N = 1,295], including with marijuana) at Wave 1. For each cigar type, a generalized estimating equation model was used to examine the population-averaged effects of purchasing behavior on cigar use. Results Cigar users of each type who purchased by the box or pack smoked more per day than users who purchased singles (cigarillos: β = 1.02, p<0.0001; traditional cigars: β = 1.40, p<0.0001; filtered cigars: β = 2.55, p<0.01). Cigar users who purchased larger quantities smoked more per day (cigarillos: β = 0.16, p<0.0001; traditional cigars: β = 0.04, p<0.0001; filtered cigars: β = 0.24, p<0.0001). Higher price per cigar was significantly associated with smoking fewer traditional cigars (β = -0.12, p<0.01) and filtered cigars (β = -0.86, p = 0.02), but not cigarillos (β = 0.08, p = 0.62). Conclusions Smaller pack quantities and higher price per cigar were associated with smoking fewer cigars per day. Given the authority of the Food and Drug Administration and local jurisdictions over cigar pack quantity, this study provides data pertinent to potential minimum and maximum package quantity regulations and policies.
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Blackwell AKM, Lee I, Scollo M, Wakefield M, Munafò MR, Marteau TM. Should cigarette pack sizes be capped? Addiction 2020; 115:802-809. [PMID: 31376200 PMCID: PMC7187431 DOI: 10.1111/add.14770] [Citation(s) in RCA: 59] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 05/14/2019] [Accepted: 07/30/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Very few countries regulate maximum cigarette pack size. Larger, non-standard sizes are increasingly being introduced by the tobacco industry. Larger portion sizes increase food consumption; larger cigarette packs may similarly increase tobacco consumption. Here we consider the evidence for legislation to cap cigarette pack size to reduce tobacco-related harm. AIMS AND ANALYSIS We first describe the regulations regarding minimum and maximum pack sizes in the 12 countries that have adopted plain packaging legislation and describe the range of sizes available. We then discuss evidence for two key assumptions that would support capping pack size. First, regarding the causal nature of the relationship between pack size and tobacco consumption, observational evidence suggests that people smoke fewer cigarettes when using smaller packs. Secondly, regarding the causal nature of the relationship between reducing consumption and successful cessation, reductions in number of cigarettes smoked per day are associated with increased cessation attempts and subsequent abstinence. However, more experimental evidence is needed to infer the causal nature of these associations among general populations of smokers. CONCLUSION Cigarette pack size is positively associated with consumption and consumption is negatively associated with cessation. Based on limited evidence of the causal nature of these associations, we hypothesize that government regulations to cap cigarette pack sizes would positively contribute to reducing smoking prevalence.
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Affiliation(s)
- Anna K. M. Blackwell
- UK Centre for Tobacco and Alcohol StudiesSchool of Psychological Science, University of BristolBristolUK
| | - Ilse Lee
- Behaviour and Health Research UnitUniversity of CambridgeCambridgeUK
| | - Michelle Scollo
- Centre for Behavioural Research in CancerMelbourneVicAustralia
| | | | - Marcus R. Munafò
- UK Centre for Tobacco and Alcohol StudiesSchool of Psychological Science, University of BristolBristolUK
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Blackwell AKM, Lee I, Scollo M, Wakefield M, Munafò MR, Marteau TM. Size matters but when, why and for whom? Addiction 2020; 115:815-816. [PMID: 32056316 DOI: 10.1111/add.14976] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Accepted: 01/20/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Anna K M Blackwell
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Ilse Lee
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
| | - Michelle Scollo
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne,, VIC, Australia
| | - Melanie Wakefield
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne,, VIC, Australia
| | - Marcus R Munafò
- Tobacco and Alcohol Research Group, School of Psychological Science, University of Bristol, Bristol, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, University of Cambridge, Cambridge, UK
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Willemsen M, Steenhuis I. We do not yet understand the psychological mechanisms explaining how cigarette pack size affects smoking, let alone smoking cessation. Addiction 2020; 115:810-811. [PMID: 31833109 DOI: 10.1111/add.14843] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 09/26/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Marc Willemsen
- Department of Health Promotion, Maastricht University, the Netherlands.,Netherlands Expertise Center for tobacco Control, Trimbos Institute, the Netherlands
| | - Ingrid Steenhuis
- Department of Health Sciences, Faculty of Sciences, Vrije Universiteit Amsterdam, Amsterdam and Public Health Research Institute, the Netherlands
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Persoskie A, O’Brien EK, Donaldson EA, Pearson J, Choi K, Kaufman A, Stanton CA, Delnevo CD. Cigar package quantity and smoking behavior. BMC Public Health 2019; 19:868. [PMID: 31269935 PMCID: PMC6609412 DOI: 10.1186/s12889-019-7205-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 06/19/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Several jurisdictions in the US and abroad limit the minimum number of cigars that can be sold per package. Research has not evaluated whether small packages might result in cigar use initiation, or whether adding cigars to packages might result in purchasers smoking more cigars. METHODS Using nationally representative US adult data from Waves 1 and 2 of the Population Assessment of Tobacco and Health (PATH) Study, we assessed links between cigar package quantity (number of cigars in the package a person usually buys) and (1) price, and (2) cigar and cigarette use over time, for three cigar types: filtered cigars, cigarillos, and large cigars. RESULTS Smaller quantity packages (i.e., packages with fewer cigars) were cheaper per-pack than larger quantity packages but more expensive per-stick for all three cigar types. For filtered cigars, past-year starters tended to buy smaller quantity packages compared to longer-term users (geometric mean = 6.31 vs. 11.75, respectively; b = -.18, 95%CI: -.32, -.04). Also, those who bought smaller quantity packages of filtered cigars tended to smoke fewer cigars over time compared to those who bought larger quantity packages (b = 1.16, 95%CI: 0.45, 1.87). Neither of these associations was observed for cigarillos or large cigars. We also found little evidence that buying larger quantity packages predicted continuing to use cigars or using cigarettes. CONCLUSIONS Although we found consistent associations between package quantity and price, we found few associations between package quantity and changes in cigar smoking behaviors over time, particularly for cigarillos and large cigars. Key limitations include our adult-only analyses and inability to determine the package quantity that cigar users initiated with. Future studies could examine whether package quantity plays a causal role in filtered cigar use initiation or consumption rates.
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Affiliation(s)
- Alexander Persoskie
- Office of Science, US Food and Drug Administration (FDA) Center for Tobacco Products, Building 71, Room G335, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA
| | - Erin Keely O’Brien
- Office of Science, US Food and Drug Administration (FDA) Center for Tobacco Products, Building 71, Room G335, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA
| | - Elisabeth A. Donaldson
- Office of Science, US Food and Drug Administration (FDA) Center for Tobacco Products, Building 71, Room G335, 10903 New Hampshire Avenue, Silver Spring, MD 20993 USA
| | - Jennifer Pearson
- Division of Social and Behavioral Health/Health Administration and Policy, School of Community Health Services, University of Nevada, Reno, NV USA
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD USA
| | - Kelvin Choi
- Division of Intramural Research, National Institute on Minority Health and Health Disparities, Bethesda, MD USA
| | - Annette Kaufman
- Tobacco Control Research Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD USA
| | | | - Cristine D. Delnevo
- Rutgers School of Public Health, Center for Tobacco Studies, New Brunswick, NJ USA
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Breton MO, Britton J, Huang Y, Bogdanovica I. Cigarette brand diversity and price changes during the implementation of plain packaging in the United Kingdom. Addiction 2018; 113:1883-1894. [PMID: 29808595 PMCID: PMC6175013 DOI: 10.1111/add.14282] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/05/2018] [Accepted: 05/23/2018] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIM Plain packaging of cigarettes appeared in the United Kingdom in July 2016 and was ubiquitous by May 2017. The change coincided with another legislative change, raising the minimum pack size from 10 to 20 cigarettes. Laws imposing plain packaging on cigarette packs remove another promotional route from tobacco companies, but the effect of such laws on brand diversity, pricing and sales volume is unknown. This study aimed to (1) describe and quantify changes in brand diversity, price segmentation and sales volumes and (2) estimate the association between the introduction of plain cigarette packaging and cigarette pricing in the United Kingdom. DESIGN We used a natural experiment design to assess the impact of plain packaging legislation on brand diversity and cigarette prices. The data comprised a sample of 76% of sales of cigarettes in the UK between March 2013 and June 2017. SETTING United Kingdom. MEASUREMENTS Cigarette prices, number of brands and products and volumes of sales. FINDINGS During the period analysed, there was a slight decrease in the number of cigarette brands. There was also an initial increase observed in the number of cigarette products, due mainly to an increase in the number of products in packs of fewer than 20 cigarettes sold before July 2016, which was then followed by a rapid decrease in the number of products that coincided with the implementation of the new legislation. Cigarette sales volumes during this period did not deviate from the preceding secular trend, but prices rose substantially. Regression results showed that price per cigarette, regardless of pack size, was 5.0 [95% confidence interval (CI) = 4.8-5.3] pence higher in plain than in fully branded packs. For packs of 20 cigarettes, price increases were greater in the lower price quintiles, ranging from 2.6 (95% CI = 2.4-2.7) GBP in the lowest to 0.3 (95% CI = 0.3-0.4) GBP per pack in the highest quintile. CONCLUSIONS The implementation of standardized packaging legislation in the United Kingdom, which included minimum pack sizes of 20, was associated with significant increases overall in the price of manufactured cigarettes, but no clear deviation in the ongoing downward trend in total volume of cigarette sales.
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Affiliation(s)
- Magdalena Opazo Breton
- University of Nottingham UK Centre for Tobacco and Alcohol StudiesDivision of Epidemiology and Public HealthNottinghamUK
| | - John Britton
- University of Nottingham UK Centre for Tobacco and Alcohol StudiesDivision of Epidemiology and Public HealthNottinghamUK
| | - Yue Huang
- University of Nottingham UK Centre for Tobacco and Alcohol StudiesDivision of Epidemiology and Public HealthNottinghamUK
| | - Ilze Bogdanovica
- University of Nottingham UK Centre for Tobacco and Alcohol StudiesDivision of Epidemiology and Public HealthNottinghamUK
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17
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Persoskie A, Donaldson EA, Ryant C. How tobacco companies have used package quantity for consumer targeting. Tob Control 2018; 28:tobaccocontrol-2017-053993. [PMID: 29853560 DOI: 10.1136/tobaccocontrol-2017-053993] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 04/16/2018] [Accepted: 04/26/2018] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Package quantity refers to the number of cigarettes or amount of other tobacco product in a package. Many countries restrict minimum cigarette package quantities to avoid low-cost packs that may lower barriers to youth smoking. METHODS We reviewed Truth Tobacco Industry Documents to understand tobacco companies' rationales for introducing new package quantities, including companies' expectations and research regarding how package quantity may influence consumer behaviour. A snowball sampling method (phase 1), a static search string (phase 2) and a follow-up snowball search (phase 3) identified 216 documents, mostly from the 1980s and 1990s, concerning cigarettes (200), roll-your-own tobacco (9), smokeless tobacco (6) and 'smokeless cigarettes' (1). RESULTS Companies introduced small and large packages to motivate brand-switching and continued use among current users when faced with low market share or threats such as tax-induced price increases or competitors' use of price promotions. Companies developed and evaluated package quantities for specific brands and consumer segments. Large packages offered value-for-money and matched long-term, heavy users' consumption rates. Small packages were cheaper, matched consumption rates of newer and lighter users, and increased products' novelty, ease of carrying and perceived freshness. Some users also preferred small packages as a way to try to limit consumption or quit. CONCLUSION Industry documents speculated about many potential effects of package quantity on appeal and use, depending on brand and consumer segment. The search was non-exhaustive, and we could not assess the quality of much of the research or other information on which the documents relied.
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Affiliation(s)
| | | | - Chase Ryant
- Office of Science, FDA Center for Tobacco Products, Silver Spring, MD, USA
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18
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Doogan NJ, Cooper S, Quisenberry AJ, Brasky TM, Browning CR, Klein EG, Hinton A, Nagaraja HN, Xi W, Wewers ME. The role of travel distance and price promotions in tobacco product purchase quantity. Health Place 2018; 51:151-157. [PMID: 29625358 PMCID: PMC5964010 DOI: 10.1016/j.healthplace.2018.03.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/03/2018] [Accepted: 03/28/2018] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Rural Americans are particularly vulnerable to tobacco price reducing promotions are known to be directed to and used by vulnerable populations. Tobacco purchasing decisions, such as unit quantity purchased, may vary by rurality, by price promotion use, and possibly by the interaction between the two. Purchase decisions are likely to affect tobacco use behavior. Therefore, explanation of variation in tobacco purchase quantity by factors associated with rural vulnerability and factors that fall under the regulatory scope of the Tobacco Control Act (TCA) of 2009 could be of value to regulatory proposals intended to equitably benefit public health. METHODS Our sample included 54 combustible tobacco users (298 purchase events) and 27 smokeless tobacco users (112 purchase events), who were asked to report all tobacco purchases on a smartphone application. We used an ecological momentary assessment methodology to collect data about tobacco users' purchasing patterns, including products, quantity purchased, and use of price promotions. A parent cohort study provided relevant data for home-outlet distance calculation and covariates. Our analysis examined associations between our outcome-purchase quantity per purchase event-and distance from participant's home to the nearest outlet, whether a price reducing promotion was used, and the interaction of these two factors. RESULTS Combustible users showed an increased cigarette pack purchase quantity if they lived further from an outlet and used a price promotion (i.e., an interaction effect; RR = 1.70, 95% CI [1.11, 2.62]). Smokeless users purchased more units of snuff when they used price promotions (RR = 1.81, 95% CI [1.02, 3.20]). CONCLUSIONS Regulatory action that imposes restrictions on the availability or use of price promotions could alter the purchasing behavior of rural Americans in such a way that makes it easier to reduce tobacco use or quit. Such action would also restrict flexibility in the price of tobacco products, which is known as a powerful tobacco control lever.
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Affiliation(s)
- Nathan J Doogan
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States.
| | - Sarah Cooper
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States
| | - Amanda J Quisenberry
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States
| | - Theodore M Brasky
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States; The Ohio State University College of Medicine, 370W. 9th Ave., Columbus, OH 43210, United States
| | - Christopher R Browning
- The Ohio State University Department of Sociology, Townshend Hall, 1885 Neil Ave. Mall, Columbus, OH 43210, United States
| | - Elizabeth G Klein
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States
| | - Alice Hinton
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States
| | - Haikady N Nagaraja
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States
| | - Wenna Xi
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States
| | - Mary Ellen Wewers
- The Ohio State University College of Public Health, Cunz Hall, 1841 Neil Ave., Columbus, OH 43210, United States
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Hiscock R, Branston JR, McNeill A, Hitchman SC, Partos TR, Gilmore AB. Tobacco industry strategies undermine government tax policy: evidence from commercial data. Tob Control 2017; 27:tobaccocontrol-2017-053891. [PMID: 28993519 PMCID: PMC6109235 DOI: 10.1136/tobaccocontrol-2017-053891] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 09/12/2017] [Accepted: 09/14/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE Taxation equitably reduces smoking, the leading cause of health inequalities. The tobacco industry (TI) can, however, undermine the public health gains realised from tobacco taxation through its pricing strategies. This study aims to examine contemporary TI pricing strategies in the UK and implications for tobacco tax policy. DESIGN Review of commercial literature and longitudinal analysis of tobacco sales and price data. SETTING A high-income country with comprehensive tobacco control policies and high tobacco taxes (UK). PARTICIPANTS 2009 to 2015 Nielsen Scantrak electronic point of sale systems data. MAIN OUTCOME MEASURES Tobacco segmentation; monthly prices, sales volumes of and net revenue from roll-your-own (RYO) and factory-made (FM) cigarettes by segment; use of price-marking and pack sizes. RESULTS The literature review and sales data concurred that both RYO and FM cigarettes were segmented by price. Despite regular tax increases, average real prices for the cheapest FM and RYO segments remained steady from 2013 while volumes grew. Low prices were maintained through reductions in the size of packs and price-marking. Each year, at the point the budget is implemented, the TI drops its revenue by up to 18 pence per pack, absorbing the tax increases (undershifting). Undershifting is most marked for the cheapest segments. CONCLUSIONS The TI currently uses a variety of strategies to keep tobacco cheap. The implementation of standardised packaging will prevent small pack sizes and price-marking but further changes in tax policy are needed to minimise the TI's attempts to prevent sudden price increases.
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Affiliation(s)
- Rosemary Hiscock
- Department for Health, University of Bath, Bath, UK
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
| | | | - Ann McNeill
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Sara C Hitchman
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Timea R Partos
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, UK
| | - Anna B Gilmore
- Department for Health, University of Bath, Bath, UK
- UK Centre for Tobacco & Alcohol Studies, University of Nottingham, Nottingham, UK
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20
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DeAtley T, Bianco E, Welding K, Cohen JE. Compliance with Uruguay's single presentation requirement. Tob Control 2017; 27:220-224. [PMID: 28416710 PMCID: PMC5870447 DOI: 10.1136/tobaccocontrol-2016-053402] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 01/16/2017] [Accepted: 02/17/2017] [Indexed: 11/21/2022]
Abstract
Introduction Tobacco companies vary pack colours, designs, descriptors, flavours and brand names on cigarette packs to target a multitude of consumers. These different brand variants can falsely imply that some brand variants are less harmful than others. Uruguay is the only country that requires cigarette companies to adhere to a single presentation (one brand variant) per brand family. Methods An existing, systematic pack purchasing protocol was adapted for data collection. Neighbourhoods in Montevideo were categorised into five strata by percentage of poor households. Five neighbourhoods within each stratum were selected based on geographical variation. In each neighbourhood, a ‘starting hub’ was identified and a systematic walking protocol was implemented to purchase unique packs at four key vendor types. Results Unique packs were purchased in 9 out of 25 neighbourhoods. Fifty-six unique packs were purchased, representing 30 brands. Of these, 51 packs were legal, representing 26 brands. The majority of the legal brands (n=16; 62%) were compliant with the requirement. The remaining packs were non-compliant due to differences in colour, design element, brand name, crest and descriptors. Although not prohibited by the single presentation requirement, 16 legal brands had more than one stick count (10, 11, 14 or 20 sticks), and packs from four brands had more than one packaging type (hard, soft or tin). Conclusion Overall, compliance with Uruguay’s single presentation requirement was good. In addition to the current restrictions, future single presentation requirements could expand to include packs in more than one stick count and packaging type.
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Affiliation(s)
- Teresa DeAtley
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.,Department of International Research, Campaign for Tobacco Free Kids, Washington DC, USA
| | - Eduardo Bianco
- Department Latin America and the Caribbean, Tobacco Epidemic Research Center of Uruguay, Framework Alliance for Tobacco Control, Montevideo, Uruguay
| | - Kevin Welding
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
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Liber AC, Drope JM, Stoklosa M. Combustible cigarettes cost less to use than e-cigarettes: global evidence and tax policy implications. Tob Control 2016; 26:158-163. [DOI: 10.1136/tobaccocontrol-2015-052874] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/28/2016] [Indexed: 11/04/2022]
Abstract
BackgroundSome scholars suggest that price differences between combustible cigarettes and e-cigarettes could be effective in moving current combustible smokers to e-cigarettes, which could reduce tobacco-related death and disease. Currently, in most jurisdictions, e-cigarettes are not subject to the same excise taxes as combustible cigarettes, potentially providing the category with a price advantage over combustible cigarettes. This paper tests whether e-cigarettes tax advantage has translated into a price advantage.MethodsIn a sample of 45 countries, the price of combustible cigarettes, disposable e-cigarettes and rechargeable cigarettes were compared.ResultsComparable units of combustible cigarettes cost less than disposable e-cigarettes in almost every country in the sample. While the e-liquids consumed in rechargeable e-cigarettes might cost less per comparable unit than combustible cigarettes, the initial cost to purchase a rechargeable e-cigarette presents a significant cost barrier to switching from smoking to vaping.DiscussionExisting prices of e-cigarettes are generally much higher than of combustible cigarettes. If policymakers wish to tax e-cigarettes less than combustibles, forceful policy action—almost certainly through excise taxation—must raise the price of combustible cigarettes beyond the price of using e-cigarettes.
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