Tobacco Taxes in the Southeastern US States: Views from Former Legislators

Message framing to inform cancer prevention pricing interventions in the UK and USA: a factorial experiment, 2019

OBJECTIVES

To advance understanding of how message framing can be used to maximise public support across different pricing policies for alcohol, tobacco and sugary drinks/foods that prevent consumption of cancer-causing products.

DESIGN

We designed a 3×4×3 randomised factorial experiment to test responses to messages with three pricing policies, four message frames and three products.

SETTING

Online survey panel (Qualtrics) in 2019.

PARTICIPANTS

Adults (N=1850) from the UK and USA.

INTERVENTIONS

Participants randomly viewed one of 36 separate messages that varied by pricing policy (increasing taxes, getting rid of price discounts, getting rid of low-cost products), four frames and product (alcohol, tobacco, sugary drinks/foods).

PRIMARY AND SECONDARY OUTCOME MEASURES

We assessed the relationship between the message characteristics and four dependent variables. Three were related to policy support: (1) increasing taxes on the product mentioned in the message, (2) getting rid of price discounts and special offers on the product mentioned in the message and (3) getting rid of low-cost versions of the product mentioned in the message. One was related to reactance, a psychological response to having one's freedom limited.

RESULTS

We found no effect for pricing policy in the message. Frames regarding children and reducing cancer risk moderated some outcomes, showing promise for real-world use. We found differences in support by product and reactance with greatest support and least reactance for tobacco policies, less support and more reactance for alcohol policies, and the least support and most reactance for sugary drinks/foods policies.

CONCLUSIONS

Cancer prevention efforts using policy interventions can be informed by the message framing literature. Our results offer insights for cancer prevention advocacy efforts across the UK and USA and highlight that tax versus non-tax approaches to increasing the cost of cancer-causing products result in similar responses from consumers.

The impact and relevance of tobacco control research in low-and middle-income countries globally and to the US

International and cross-cultural research is critical for understanding multilevel influences on health, health behaviors, and disease. A particularly relevant area of need for such research is tobacco control. The tobacco epidemic is one of the biggest public health threats globally, killing over 7 million people a year. Research critical to addressing this public health problem has leveraged variability in tobacco use, history, product market, and policies across different countries, settings, and populations, particularly in low- and middle-income countries (LMICs) where the tobacco burden is increasing. These efforts are needed in order to advance the science and inform practice and policy in various settings, including the US. Several funding agencies provide support for international research focused on tobacco control in LMICs because of the importance and implications of such research. This paper provides some concrete examples of how such research has advanced our knowledge-base and informed practice and policy globally, particularly in high-income countries including the US. Some prominent themes emphasized in this manuscript include: the development of knowledge regarding the diverse tobacco products on the market; better understanding of tobacco use and its impact among different populations; generating knowledge about the impacts including unintended consequences of tobacco control policy interventions; and better understanding tobacco industry strategies and informing advocacy efforts. In summary, international tobacco control research, particularly in LMICs, is critical in effectively and efficiently building the evidence base to advance tobacco control research, policy, and practice globally, including the US, with the ultimate goal of curbing the tobacco epidemic.

Reactions to smoke-free public policies and smoke-free home policies in the Republic of Georgia: results from a 2014 national survey

OBJECTIVES

We examined receptivity to public smoke-free policies and smoke-free home status among adults in the Republic of Georgia.

METHODS

In Spring 2014, we conducted a national household survey of 1163 adults.

RESULTS

Our sample was on average 42.4 years old, 51.1 % male, and 43.2 % urban. Current smoking prevalence was 54.2 % in men and 6.5 % in women. Notably, 42.2 % reported daily secondhand smoke exposure (SHSe). Past week SHSe was 29.9 % in indoor public places and 33.0 % in outdoor public places. The majority reported no opposition to public smoke-free policies. Correlates of greater receptivity to public policies included being older, female, and a nonsmoker. Past week SHSe in homes was 54.2 %; 38.8 % reported daily SHSe at home. Only 14.3 % reported complete smoke-free home policies; 39.0 % had partial policies. The only correlate of allowing smoking in the home was being a smoker. Among smokers, correlates of allowing smoking in the home were being male and lower confidence in quitting.

CONCLUSIONS

SHSe is prevalent in various settings in Georgia, requiring efforts to promote support for public smoke-free policies and implementation of personal policies.

Reactions to Cigarette Taxes and Related Messaging: Is the South Different?

OBJECTIVES

Given the lag in tobacco control policies in the southeastern US, we examined differences in reactions to tobacco taxes and related messaging among Southeasterners vs. non-Southeasterners.

METHODS

In 2013, a cross-sectional online survey using quota-based sampling was conducted assessing tobacco use, attitudes/knowledge regarding tobacco taxation, and reactions to related messaging (health, youth prevention, economic impact, individual rights/responsibility, morality/religion, hospitality).

RESULTS

Of 2501 participants, 36.7% were past 30-day smokers; 26.7% were Southeasterners. Compared to others, Southeasterners more likely believed that their state was in the bottom 20 states in tobacco taxes (p < .001) and less likely reported that their taxes were too high (p < .001). Regression analysis indicated that correlates of opposition to increased taxes included being older, having less education, being an infrequent church-attender, and being a current smoker (p's < .001); being a Southeasterner was not associated. Compared to others, Southeasterners were more likely to find pro-tobacco tax messages related to prevention and hospitality as more persuasive (p < .05) and anti-tobacco tax messaging related to the unfairness of tobacco taxes to smokers (p = .050) less persuasive.

CONCLUSIONS

Given that Southeasterners are receptive to increased taxation, other factors must contribute to lagging policy and must be addressed.