Economic Impact of Tobacco Price Increases Through Taxation: A Community Guide Systematic Review

CONTEXT

Tobacco use is a leading cause of preventable death in the U.S. and around the world. Increasing tobacco price through higher taxes is an effective intervention both to reduce tobacco use in the population and generate government revenues. The goal of this paper is to review evidence on the economic impact of tobacco price increases through taxation with a focus on the likely healthcare cost savings and improvements in employee productivity.

EVIDENCE ACQUISITION

The search covered studies published in English from January 2000 to July 2012 and included evaluations of national, state, and local policies to increase the price of any type of tobacco product by raising taxes in high-income countries. Economic review methods developed for The Guide to Community Preventive Services were used to screen and abstract included studies. Economic impact estimates were standardized to summarize the available evidence. Analyses were conducted in 2012.

EVIDENCE SYNTHESIS

The review included eight modeling studies, with seven providing estimates of the impact on healthcare costs and three providing estimates of the value of productivity gains. Only one study provided an estimate of intervention costs. The economic merit of tobacco product price increases through taxation was determined from the overall body of evidence on per capita annual cost savings from a conservative 20% price increase.

CONCLUSIONS

The evidence indicates that interventions that raise the unit price of tobacco products through taxes generate substantial healthcare cost savings and can generate additional gains from improved productivity in the workplace.

Predictors of delay in the diagnosis and treatment of suspected tuberculosis in HIV co-infected patients in South Africa

SETTING

In South Africa, the majority of tuberculosis (TB) patients are co-infected with the human immunodeficiency virus (HIV), and delays in diagnosis and treatment likely exacerbate morbidity and mortality.

OBJECTIVE

To determine predictors of delays in the diagnosis and treatment of hospitalised suspected pulmonary TB patients co-infected with HIV.

DESIGN

Post-analysis of data collected in a three-centre prospective cohort of in-patients clinically diagnosed with active TB in three hospitals in South Africa between 2006 and 2009 during the first 24 h of admission. Delay was assessed by asking time of first symptoms and any prior health-seeking behaviour for this episode of illness.

RESULTS

Data from a total of 891 participants with a median age of 36 years and a CD4 count of 67 cells/mm(3) were analysed. Median patient, system and total delays were respectively 28, 1 and 28 days. Unemployment, treatment at Tshepong Hospital, alcohol consumption, crowding index, seeking prior treatment, cotrimoxazole treatment and WHO Stage 4 disease predicted prolonged total delay.

CONCLUSION

Patient delay in seeking care for TB in this high HIV prevalence setting is substantial. Factors identified with delay could be used to develop interventions to improve care seeking and earlier diagnosis of TB.

Diffusive growth of polydisperse hard-sphere crystals

Unlike atoms, colloidal particles are not identical, but can only be synthesised within a finite size tolerance. Colloids are therefore polydisperse, i.e., mixtures of infinitely many components with sizes drawn from a continuous distribution. We model the crystallization of hard-sphere colloids (with/without attractions) from an initially amorphous phase. Although the polydisperse hard-sphere phase diagram has been widely studied, it is not straightforwardly applicable to real colloidal crystals, since they are inevitably out of equilibrium. The process by which colloidal crystals form determines the size distribution of the particles that comprise them. Once frozen into the crystal lattice, the particles are caged so that the composition cannot subsequently relax to the equilibrium optimum. We predict that the mean size of colloidal particles incorporated into a crystal is smaller than anticipated by equilibrium calculations. This is because small particles diffuse fastest and therefore arrive at the crystal in disproportionate abundance.

The rapidity of drug dose escalation influences blood pressure response and adverse effects burden in patients with hypertension: the Quinapril Titration Interval Management Evaluation (ATIME) Study. ATIME Research Group

BACKGROUND

Antihypertensive medication doses are typically increased within several weeks after initiation of therapy because of inadequate blood pressure (BP) control and/or adverse effects.

METHODS

We conducted a parallel-group clinical trial with 2935 subjects (53% women, n=1547) aged 21 to 75 years, with Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure VI stages 1 to 2 hypertension, recruited from 365 physician practices in the southeastern United States. Participants were randomized either to a fast (every 2 weeks; n=1727) or slow (every 6 weeks; n=1208) drug titration. Therapy with quinapril, an angiotensin-converting enzyme inhibitor, was initiated at 20 mg once daily. The dose was doubled at the next 2 clinic visits until the BP was lower than 140/90 mm Hg or a dose of 80 mg was reached.

RESULTS

Pretreatment BP averaged 152/95 mm Hg. Patients with stage 2 hypertension reported more symptoms than those with stage 1. The BP averaged 140/86, 137/84, and 134/83 mm Hg in the slow group compared with 141/88, 137/85, and 135/84 mm Hg in the fast group at the 3 respective clinic visits. The BP control rates to lower than 140/90 mm Hg at the 3 clinic visits were (slow, fast, respectively) 41.3%, 35.7% (P<.001); 54.3%, 51.5% (P=.16); and 68%, 62.3% (P=.02). In the fast group, 10.7% of participants experienced adverse events vs 10.8% in the slow group; however, 21.0% of adverse events in the fast group were "serious" vs only 12% in the slow group.

CONCLUSION

Slower dose escalation of the angiotensin-converting enzyme inhibitor quinapril provides higher BP control rates and fewer serious adverse events than more rapid drug dose escalation.

Oral and booklet presentation of MMPI-2

The MMPI-2 was administered twice to college students under two formats: standard booklet administration and oral presentation, with the examiner reading the items to the students and recording their answers. The two types of administration were compared in a series of mixed-factor analyses of variance. No significant differences were found when comparing oral and booklet presentation for either men or women.

A review of sex differences in the epidemiology of tuberculosis

Globally, the prevalence of infection with Mycobacterium tuberculosis is similar in males and females until adolescence, after which it is higher in males. In industrialized countries in the middle of this century (1930s to 1950s), females aged 15 to 34 years had higher tuberculosis notification rates than males of the same age. However, as notification rates in these countries decreased over time, rates in males became higher than those of females for all ages over 15. Present notification rates of both sexes combined in many developing countries are similar to those of industrialized countries in the middle of the century, although the sex and age pattern is similar to that in industrialized countries at present, with men's disease rates exceeding women's after the age of 15. These findings raise the possibility that cases of tuberculosis among women are being under-reported in developing regions. This is supported by the results of a study comparing active and passive case-finding in which women with tuberculosis were under-notified to public health authorities when relying on passive case-finding. In addition, epidemiological evidence from the pre-human immunodeficiency virus (HIV) era shows that young to early-middle-aged women progress from infection to disease with greater frequency than do men. This elevated frequency of progression among women now coincides with a peak in HIV prevalence among women of the same age. National Tuberculosis Programmes must assess possible sex differences that exist in their countries. In addition, information about the risks of tuberculosis in younger women should be incorporated into maternal and child health, and HIV/AIDS programmes. Further research comparing sex differences in tuberculosis rates, preferably using active as well as passive case-finding, would be necessary to determine whether young women are undernotified in developing countries.

The direct effects of enflurane on coronary blood flow, myocardial oxygen consumption, and myocardial segmental shortening in in situ canine hearts

This study evaluated changes in coronary blood flow (CBF), myocardial oxygen consumption (MVo2), and myocardial segmental shortening (SS) during intracoronary administrations of enflurane in in situ canine hearts. The left anterior descending coronary artery (LAD) of 11 anesthetized and mechanically ventilated dogs was perfused at constant perfusion pressure (80 mm Hg) with enflurane-free blood or with blood equilibrated in an extracorporeal oxygenator with enflurane (1.1%, 2.2%, 4.4%). CBF (measured with a Doppler flow transducer) was multiplied by the local arteriovenous (A-V) O2 difference to calculate MVo2. SS was measured with ultrasonic crystals. Myocardial lactate uptake was assessed. Peak CBF responses during enflurane were compared with those during maximum coronary vasodilation with adenosine. Enflurane caused concentration-dependent increases in CBF, and decreases in MVo2 and SS. The greatest increase in CBF during enflurane (4.4%) was similar to that achievable with adenosine. Myocardial lactate uptake was not affected by enflurane. In conclusion, enflurane has a direct coronary vasodilating effect. The potency of this effect is underscored by the ability of enflurane to cause marked increases in CBF, while appreciably reducing myocardial O2 demand. Since the enflurane-induced reduction in myocardial contractility was not due to ischemia, it likely reflected a direct negative inotropic effect. When the direct effects of enflurane are compared with those of equianesthetic concentrations of halothane and isoflurane previously shown in the same model, enflurane has a coronary vasodilating effect similar to that of halothane but less than that of isoflurane, and it has a negative inotropic effect greater than that of both isoflurane and halothane.

Retest reliability of the Wechsler Adult Intelligence Scale-Revised for 18- to 19-year-olds

Retest reliability of the WAIS-R for 18- to 19-yr.-olds was estimated for 44 undergraduates who took the test twice with 2 to 8 weeks between testings. The mean scores on subtests and IQs and the correlations of subtest scores and IQs were similar to the values obtained by Wechsler in 1981 with only two age groups, 25- to 34- and 45- to 54-yr.-old examinees.

Prevalence of head injury among four-year college students: a replication and combined results

In a replication of an earlier study, college students were surveyed to assess the prevalence of diagnosed head injury or prolonged periods of unconsciousness. Results were consistent with previous research and indicated a significant number of college students reported a head injury or a prolonged period of unconsciousness. The major results of the two studies are reported as combined data.

Use of the Draw-A-Person with conduct-disordered children

The Draw-A-Person test was administered to 40 conduct-disordered and 40 nonconduct-disordered children and adolescents. There were 20 boys and 20 girls, ages 10 to 16 years, in each group. Two independent judges rated the drawings for presence or absence of indicators of aggressiveness that should accompany a conduct disorder, but no significant differences were found between groups or sexes.

Effect of visual cues with the WAIS--R Digit Span subtest

The WAIS-R Digit Span subtest was administered to 43 women and 31 men, ages 18 or 19 years, under standard conditions (examiner facing the person) and with the examiner sitting behind the person to eliminate possible visual cues as the examiner read the numbers. Analysis of variance of the total digits recalled indicated no differences between the sexes or between the two methods of presentation.

Women and men authors' portrayal of curiosity in young children's literature

45 women and 20 men authors' portrayal of curiosity in young children's literature (116 instances) was studied using the same stories examined in an earlier analysis. Chi-squared analyses showed no significant difference between the two groups of authors in how they portrayed curiosity.

Head-injury prevalence among community college students

835 community college students were surveyed to establish the prevalence of head injury or illness. Results are compared to prevalence rates among 4-year college students.

Effect of therapist title on perceived competence of a female therapist

A videotaped segment of a female therapist and female client was shown to groups of male and female undergraduates (N = 278) under six conditions. At the bottom of the screen one of the following six captions was presented: Dr. (name) and client, Ms. (name) and client, Mrs. (name) and client, Miss (name) and client, First and last name and client, and no caption. The students rated the therapist on 11 variables related to competence. Females tended to rate the therapist higher, and isolated effects for title were found; however, the magnitude of the differences was so small as to suggest that no important or meaningful differences had occurred.

Statistical versus clinical significance in research with the MMPI

Some of the contradictions in psychological research may be attributable to failure to distinguish statistical from clinical significance. 82 articles in which the MMPI was the research instrument were analyzed to see how often the results reported as significant were in fact large enough to warrant such a conclusion. Articles were classified as to whether or not the clinical interpretations were consistent with the statistical results. Excluding articles in which data were insufficient to reach an independent conclusion, 54.90% of the articles presented conclusions of clinical significance that were not supported by the data, while 45.10% reported clinical results that were supported by the data.

Effects of therapist title on competence as perceived by a psychiatric sample

A study was conducted on how perceptions of a therapist's competence are affected by the therapist's title. Psychiatric inpatients (58 males and 24 females) viewed one of four copies of a videotaped session of the interaction between a male therapist and a male client. One tape described the therapist as "Doctor," one tape described him as "Mister," one by his first name, and one with no name or title. The therapist was rated by the patients on 11 qualities related to competence. Of 11 analyses, 1 title effect was found, and females rated the therapist higher on two qualities. Overall, 9 of the qualities showed no effect for title or for ratings by gender.

Zung Self-Rating Depression Scale scores of psychiatric outpatients by age and sex

This study was designed to estimate the correlations of the Zung Self-rating Depression Scale with age and sex in a psychiatric outpatient sample. 378 male and 671 female clients of 13 to 89 yr. of age completed the scale as part of their admission to an outpatient psychiatric clinic. The scores were classified according to sex and age (in 10-yr. groups). Analysis showed some statistically significant differences according to age and sex, but the magnitude of those differences was small. Comparison of these data with a previously published set of data from a nonpsychiatric sample showed, as would be expected, the psychiatric group scored consistently higher.

Effect of therapist's title on perceived competence

A videotaped segment of a therapist and student/client was shown to groups of male and female undergraduates under four conditions. One group saw the tape with the title "Doctor (the therapist's actual name was used) and Client" superimposed at the bottom. The second group saw the same tape with "Mr. (blank) Client" superimposed, the third group had "Timothy (blank) and Client," while the fourth group had no title at the bottom. The 204 students rated the therapist on 11 variables. Analysis showed no effect for title and no interaction. Men rated the therapist higher on nine of the 11 variables, than did women.

The relationship between color preference and psychiatric disorders

The relationship between color preference and psychiatric disorders was studied in an outpatient psychiatric sample (N = 1,143). The results were studied by gender and by age. The patients' choice of Luscher's eight colors revealed a sex difference, but only minor variations with age. The present data show both consistencies and discrepancies with past data.

Comment on "Religiosity and United States suicide rates, 1972-1978"

This article comments on the Martin article on religiosity and suicide rates in the United States. Specifically, it is pointed out by the present author that Martin's data do not allow him to draw the conclusions that he offered in his article. A correlational study does not allow for cause and effect conclusions, and the use of group data precludes conclusions about individual cases.

Reassessment of inferring personality traits from Bender-Gestalt drawing styles

Fifty patients with closure difficulty on the Bender-Gestalt and 50 patients with edging tendencies on the Bender Gestalt were assessed for possible personality traits associated with those drawing styles. Patients with and without the drawing styles were compared using MMPI data. Patients who drew along the edge of the paper showed no significant difference in MMPI scores when compared to non-edgers. Patients with closure difficulty were significantly higher on Scale O of the MMPI than were the non-closure difficulty patients. The difference was not considered to be interpretatively important.

Reply to "Validity of five MMPI alcoholism scales: a critique and reanalysis"

Replied to Hays and Stacy's critique of an article by Holmes, Dungan and McLaughlin in which the validity of MMPI alcoholism scales was questioned. Hays and Stacy asserted that the original authors misinterpreted the results of the statistical analyses. The present article presents support for the original conclusions and comments on Hays and Stacy's reanalysis.

Relationship between the Luscher Color Test and the MMPI

Administered the short form of the Luscher Color Test and the booklet form of the MMPI to 42 graduate students in a counseling program. For every S a report that described personality was written from the test results, i.e., each S had two reports, one from the Color Test and one from the MMPI. These reports were written independently by two separate examiners. Two independent raters then read the reports on each S and noted the degree of agreement between the two reports. The overall results showed very little agreement between the Color Test and the MMPI. Reasons for the poor rate of agreement are discussed.

Comparison of master's and doctoral level psychologists in recognizing signs of potential suicide

30 doctoral-level and 43 master's-level psychologists completed a multiple-choice examination of factors from the lethality scale. The psychologists were all staff members of community mental health centers who received the examination (and returned it) by mail. The results showed no differences between the psychologists. Master's degree psychologists recognized as many signs as doctoral-level psychologists, and years of experience was shown to be nonsignificant.

Recognition of suicide signs by physicians in different areas of specialization

Although physicians play a major role in dealing with potentially suicidal individuals, little research has been conducted to assess physicians' knowledge of who may or may not present a suicidal risk. The authors in this article present data on the ability of 202 physicians to recognize well established signs of suicide potential. Physicians in 14 areas of medical specialization completed a 13-item, multiple-choice examination of components taken from a suicide potential rating scale. The results revealed that certain groups of physicians predictably scored highest (for example, psychiatrists) but that most physicians were equally knowledgeable about the signs studied.

Memory-for-designs drawing styles of psychiatric patients

Studied the relationship between several Memory-For-Designs drawing styles and personality traits using a sample of psychiatric outpatients. Four MFD drawing styles were studied by comparing the MMPI scores of Ss who did or did not draw constricted figures, draw expanded figures, draw along the edges of the paper, or place the figures on the page in a disorganized manner. Contrary to previous work in this area, the present results showed a relationship between certain drawing styles and scores on the MMPI, i.e., certain drawing styles correlate with personality traits.

Depression and figure size on the Draw-A-Person test

The relationship between figure size on the Draw-A-Person and depression was studied for depressed patients, non-depressed patients, and non-depressed hospital employees (30 males and 30 females in each group). All participants completed a figure drawing and a measure of depression, Beck's Inventory or the MMPI. No differences were found between any of the groups, that is, all groups drew figures of close to the same size. Figure size and depression were not related.

Factors determining gender of the figure in TAT Card 3BM

Earlier work has shown that subjects commonly view the figure on Card 3BM of the TAT as female rather than male. This study supports that finding and presents the specific qualities of the 3BM card that lead to such perception of the 3BM figure.

Validity of five MMPI alcoholism scales

Assessed five alcoholism scales derived from the MMPI for their ability to classify accurately two groups of alcoholics (N = 120) and a group of nonalcoholic psychiatric patients (N = 60) in an inpatient treatment setting. The alcoholic group was divided into those who were self-committed and those who were court-committed. Depending on how the data were treated, only one, or none of the scales was accurate.

Counselor's recognition of factors in lethality of suicide

Counselors' recognition of factors in lethality of suicide was studied using the same scale of factors as was used in Holmes and Howard's study of other professional groups. 15 professors of counselor education, 12 post-secondary counselors, 47 secondary-level counselors, and 20 elementary-level counselors completed an examination of signs of suicide. The data for each of these groups are presented and analyzed and show counselors' recognition to be equal to those of social workers and ministers.

Extreme constriction of figure size as a personality trait indicator on Memory-for-Designs

Data on constriction of figures in the Memory-For-Designs from a previous study were re-analyzed using protocols which exhibited very frequent reduction in size. High constrictors (13 to 15 constricted designs) were compared to moderate constrictors (6 to 8 constricted figures) and to low constrictors (0 to 2 constricted figures). Analysis indicated that high constrictors were significantly different from low constrictors on two 16 PF variables. These differences, however, were not considered to be clinically, i.e., interpretively, significant. Even with extreme constriction, these data are consistent with previous research.

Personality traits of edgers and non-edgers on the Memory-For-Designs Test

Studied four separate samples to examine the relationship between personality traits and edging on the Memory-For-Designs test. In two samples, edgers and non-edgers were compared on their MMPI results; one sample used 16PF data; and one sample used the HSPQ. The results showed that while edging is not common, it is not related to any unique personality traits, when compared to non-edgers.

Use of the Lithium Response Scale with an outpatient psychiatric sample

Two potentially useful MMPI Lithium Response Scales showed low ability to predict antidepressant responses to lithium therapy in an outpatient sample of 20.

An auditory von Restorff effect

In this experiment 60 undergraduates were given a serial learning task to assess the possibility of an auditory von Restorff effect. Fifteen males and 15 females learned a list of nine words presented aurally (recorded) with the same male voice (control groups). Fifteen males and 15 females (experimental groups) learned the same list as the control groups except that the sixth word was spoken by a female voice: i.e., it was isolated. The results of this study parallel the results of studies using visual stimuli. The von Restorff effect was demonstrated with auditory stimuli in that one of the experimental groups (female) learned the list with significantly fewer errors than the comparable control group. No difference was found between the male groups.

The effects of personality traits on Memory-For-Designs performance

Examined 241 Memory-For-Designs protocols for the drawing styles of closure difficulty, figure-size expansion, and figure-size constriction. Chi squares then were employed to compare those data with the personality traits of the Ss. Personality traits were assessed through use of the Sixteen Personality Factor Questionnaire. The major conclusion drawn from the data analysis was that regardless of his or her personality trait, a S will perform like most other Ss in relation to Memory-For-Designs test behavior. The Ss were university students between the ages of 18 and 23, male or female, who were U. S. citizens attending Emporia State University. Initially, Ss were given the Sixteen Personality Factor Questionnaire in groups. Ss who met sample qualifications on the personality test were asked to return for an individual follow-up test with the Memory-For-Design.

Closure difficulty, figure-size expansion, and figure-size constriction on 240 Graham-Kendall Memory-for-Designs records

To determine the frequency of occurrence of closure difficulty, figure-size expansion, and figure-size constriction, 240 university students were administered the Graham-Kendall Memory-For-Designs test. Subjects were volunteers enrolled in undergraduate psychology courses and were between 18 and 23 yr. of age, male or female, and U.S. citizens. The purpose was to define a sampling of drawing styles exhibited in a normal group on this test. Each drawing style, or factor, was treated as an independent variable, and the frequency of occurence of each level (dependent variable) was compared via chi square. It was noted that a significant number of subjects exhibited some degree of closure difficulty with the designs (X2 = 101.72, p less than .01). Figure-size expansion was noted as extremely rare for this sample (X2 = 444.78, p less than .01). Finally, extreme figure-size constriction occurred significantly more often than either moderate or no contriction of the designs (X2 = 62.58, p less than .01).