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Background: Tobacco consumption rates in Lebanon are among the highest worldwide. The country ratified the Framework Convention on Tobacco Control in 2005. A law was passed in 2011 which regulates smoking in closed public spaces, bans advertising, and stipulates larger warnings. Despite international evidence confirming that increasing taxation on tobacco products lowers tobacco consumption, no such policy has yet been adopted: a cigarette pack costs on average US$1.50. To date no studies in Lebanon have addressed the welfare and public finance effects of increasing taxes on tobacco products., Methods: Using the 2005 national survey of household living conditions, we estimate an almost ideal demand system to generate price elasticities of demand for tobacco. Using estimated elasticities and a conservative scenario for expected smuggling, we simulate the consumption and tax revenue effects of a change in the price of tobacco under various tax schemes., Results: Increasing taxes on all tobacco products so as to double the price of imported cigarettes would lower their consumption by 7% and consumption of domestically produced cigarettes by over 90%. Young adults (ages 15-30) are more sensitive: consumption would drop by 9% for imported cigarettes and by 100% for domestic cigarettes. Government revenues would increase by approximately 52%., Conclusions: The estimated elasticities indicate that an increase in taxes on all tobacco products would lead to a reduction in consumption and an increase in government revenue. Evidence from Lebanon on the effectiveness of increased taxation may help initiate national debate on the need to raise taxes., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: Many countries have started pursuing tobacco 'endgame' goals of creating a 'tobacco-free' country by a certain date. Researchers have presented models to attain this goal, including shifting the supply of tobacco to a monopoly-oriented endgame model (MOEM), wherein a state-owned entity controls the supply and distribution of tobacco products. Although not designed to end tobacco use, the Regie in Lebanon exhibits some of the key features identified in MOEM and hence can serve as a practical example from which to draw lessons.Methods: We comprehensively review previous literature exploring tobacco endgame proposals featuring a MOEM. We distil these propositions into core themes shared between them to guide a deductive analysis of the operations and actions of the Regie to investigate how it aligns (or does not) with the features of the MOEM.Results: Analysing the endgame proposals featuring MOEM, we generated two main themes: the governance of the organisation; and its operational remit. In line with these themes, the investigation of the Regie led to several reflections on the endgame literature itself, including that it: (i) does not seem to fully appreciate the extent to which the MOEM could end up acting like Transnational Tobacco Companies (TTC); (ii) has only vaguely addressed the implications of political context; and (iii) does not address tobacco growing despite it being an important element of the supply chain.Conclusion: The implementation of tobacco endgame strategies of any type is now closer than ever. Using the Regie as a practical example allows us to effectively revisit both the potential and the pitfalls of endgame strategies aiming to introduce some form of monopoly and requires a focus on: (i) establishing appropriate governance structures for the organisation; and (ii) adjusting the financial incentives to supress any motivation for the organisation to expand its tobacco market. [ABSTRACT FROM AUTHOR]

Objectives: This study measures sociodemographic disparities in perceived effectiveness of pictorial health warnings on cigarette packs. Methods: A cross-sectional study in 2011 tested 20 pictorial warnings among 1517 adults across Lebanon. Participants evaluated the effectiveness of the current text-only warning, and 2 pictorial warnings. Health warnings were thematically grouped. Logistic regression models evaluated associations between the perceived effectiveness of themes and sociodemographic characteristics. Results: Perceived effectiveness of the current warning was 15.0% (95% CI 13.2%-16.9%). All pictorial warnings were perceived to be more effective than the current warning, including those about the long-term consequences of smoking (78.1%, 95% CI 74.9%-81.3%) and second-hand smoke (79.2%, 95% CI 74.3%-84.2%). Men had lower odds of perceiving warnings about dependence and second-hand smoke as being effective (AOR 0.30, 95% 0.14-0.65; AOR 0.22, 95% CI 0.10-0.50, respectively). Older respondents had lower odds of perceiving warnings about reproductive health, but higher odds of perceiving warnings about cessation, as effective (AOR 0.35, 95% CI 0.14-0.88; AOR 3.30 95% CI 1.26-8.64, respectively). Other sociodemographic disparities are described. Conclusions: Pictorial warnings are perceived to be more effective than text-only warnings in Lebanon, and should be implemented considering sociodemographic disparities. [ABSTRACT FROM AUTHOR]