Search

After the outbreak of e-cigarette or vaping use-associated lung injury (EVALI) strongly linked to vitamin E acetate found in some tetrahydrocannabinol-containing vaping products in 2019, several states passed emergency bans on the sale of electronic nicotine delivery systems (ENDS) products. We use a fixed-effect panel regression model with an embedded difference-in-differences design to evaluate the unintended effects of state-level ENDS bans. Besides eliminating ENDS sales, our results indicate that a full ENDS ban is associated with a 94.5 percent increase in volume sales of ENDS refills in neighboring counties compared with the pre-ban average. We find similar but weaker spatial spillover impacts of flavor (non-tobacco) ENDS bans. As these flavor bans did not restrict tobacco-flavored ENDS sales, we observe an overall 55.4 percent decline in sales of ENDS refills but more-than-doubled sales of tobacco-flavored ENDS refills in the states subject to the flavor bans. Relative increases in cigarette sales can be observed when states implemented either full or flavor ENDS bans. This study improves our understanding of the unintended consequences of ENDS bans, as our results suggest significant spillover effects from cross-border purchasing behavior, switching across flavors of ENDS, and substitution between ENDS and cigarettes after states implemented such bans. [ABSTRACT FROM AUTHOR]

Smoke-free laws (SFL) are more effective with public support. This study investigated the smoking prevalence, public perceptions of smoking rules, and support for comprehensive SFL among 1047 people who smoke (PWS) and 206 people who do not smoke (PNS) aged ≥18 in the 2020 International Tobacco Control Malaysia Survey. Smoking prevalence was highest in nighttime entertainment venues (85.7%), non-air-conditioned eateries (49.7%), and indoor workplaces (34.6%). Respondents reported that smoking was banned in most indoor workplaces (81.7% PNS, 69.2% PWS), air-conditioned eateries (84.7% PNS, 75.7% PWS), and non-air-conditioned eateries (81.2% PNS, 78.7% PWS), but much less so in nighttime entertainment venues (30.1% PNS, 24.6% PWS). Support for comprehensive SFL in public venues was highest among PNS (≥84.9%) but still substantial among PWS (≥49.9%). PWS under 40, Malay, married, and aware of smoking rules supported SFL more. Robust SFL enforcement is essential in Malaysia to reduce secondhand smoke exposure in public places. [ABSTRACT FROM AUTHOR]

A sound understanding of the potency of tobacco control policies is key to tobacco prevention. This study exploits a Smoothed Instrumental Variables Quantile Regression estimator to gauge the effectiveness of these policies while addressing major methodological and data limitations plaguing the previous literature. Specifically, smoke-free indoor air laws and tobacco control expenditures are examined in a single framework, which has the promise of accounting for potential complementarities thereof. Further, endogeneity of price (a proxy for tax policy) and other tobacco control policies is addressed through a unique set of instruments while allowing for differential impacts across the conditional distribution of cigarette consumption. Finally, our use of the nationally representative individual-level price and consumption data is essential to precise estimation of price elasticities and policy effects. Results indicate that ignoring price and policy endogeneity leads to inconsistent estimates. Further, tobacco control expenditures appear to be effective only for relatively more addicted smokers. Meanwhile, state-level smoke-free indoor laws, whose primary goal is to reduce exposure to second-hand smoke, do not affect cigarette use among smokers. In contrast, tax policy appears to be most potent for less addicted individuals. Therefore, optimal policy responses should combine tobacco control expenditures with sin taxes. [ABSTRACT FROM AUTHOR]

Abstract We propose a compartmental model for investigating smoking dynamics in an Italian region (Tuscany). Calibrating the model on local data from 1993 to 2019, we estimate the probabilities of starting and quitting smoking and the probability of smoking relapse. Then, we forecast the evolution of smoking prevalence until 2043 and assess the impact on mortality in terms of attributable deaths. We introduce elements of novelty with respect to previous studies in this field, including a formal definition of the equations governing the model dynamics and a flexible modelling of smoking probabilities based on cubic regression splines. We estimate model parameters by defining a two-step procedure and quantify the sampling variability via a parametric bootstrap. We propose the implementation of cross-validation on a rolling basis and variance-based Global Sensitivity Analysis to check the robustness of the results and support our findings. Our results suggest a decrease in smoking prevalence among males and stability among females, over the next two decades. We estimate that, in 2023, 18% of deaths among males and 8% among females are due to smoking. We test the use of the model in assessing the impact on smoking prevalence and mortality of different tobacco control policies, including the tobacco-free generation ban recently introduced in New Zealand.

The smoking rate in Thailand has been steadily decreasing for decades alongside the government's tobacco control policies. However, evidence of whether the decrease to date has occurred equally across all population groups is scarce. Therefore, this study aimed to examine the changes in the socioeconomic patterns of smoking among male adults in Thailand from 2001 to 2021. This study employed a pooled cross-sectional design with 296,011 male adults aged 15 years or older from the Health and Welfare Survey 2001 (n = 74,003), 2003 (n = 14,940), 2006 (n = 25,088), 2009 (n = 26,370), 2013 (n = 26,919), 2015 (n = 52,904), and 2021 (n = 75,787). Descriptive analysis and binary logistic regression were used. The results indicated that the smoking rate decreased by approximately 25% from 46.81% in 2001 to 35.01% in 2021. This decrease was significantly greater in high- and low-level socioeconomic groups than in mid-level groups. Specifically, high- and low-income, highand low-educated, older, married and divorced, employed, and urban and rural people exhibited larger decreases in smoking rates than middle-income, middle-educated, middle-aged and younger, single, unemployed, and Bangkok metropolitan people, respectively. Additionally, the smoking rates of low-income groups decreased as cigarette retail prices increased, whereas those of high-income groups decreased regardless of tobacco control policies. The government's price policy and health awareness may have significantly influenced the decrease in smoking rates of the low- and high-level socioeconomic groups, respectively. Therefore, the government should continue its price policy and public relations practices to further decrease smoking rates. [ABSTRACT FROM AUTHOR]

Abstract Background The polluter’s pay principle (PPP) aims to internalise external costs and assign liability to the polluter for the harmful cost of their products to society. Tobacco companies continue to manufacture and sell harmful cigarettes, earning billions in profits each year from these products. Meanwhile, governments and their people are left to ‘clean up’ and deal with the detrimental health consequences. This paper explores with expert stakeholders how the PPP could be implemented within the context of tobacco control in the United Kingdom (UK). Methods Twenty-four semi-structured interviews and two follow-up discussion groups were conducted with UK and international experts on tobacco control, public health, economics, or law from the academic, public, private and third sector. Participants considered the facilitators and barriers to implementing the PPP to tobacco control in the UK. Thematic analysis was employed, aided by NVivo 12, and data were compared to examine the views expressed by the different types of experts. Results Stakeholders favoured the implementation of the PPP in the context of tobacco control and indicated that it could be acceptable and feasible to implement and that it would likely have support from policymakers and the public alike. Stakeholders unanimously agreed that any legislation and administration should be free from tobacco industry influence; however, differences arose concerning who should oversee the implementation. Conclusion The PPP from environmental law was predominantly seen as an approach that could be usefully applied to the tobacco industry. However, there is no one size fits all template, therefore its implementation would need to be adapted to fit the UK context.

Abstract Background Tobacco use and the associated health burden is a cause of concern in India and globally. Despite several tobacco control policies in place, their sub-optimal and variable implementation across Indian states has remained a concern. Studies evaluating the real-world implementation of policies such as Cigarettes and Other Tobacco Products (COTPA) or National Tobacco Control Program (NTCP) in India and its association with reductions in tobacco use are limited. In this paper, we analyse data from a nationally representative survey to examine how policy implementation is associated with the tobacco use prevalence in India. Methods We analysed data from the Global Adult Tobacco Survey (GATS 2016–17) India using multivariable logistic regression. The dependent variables were the use of smoked tobacco, smokeless tobacco, and tobacco in any form. The independent variables were proxies of implementation of the COTPA and the NTCP. We followed a step-wise backward elimination technique to reach the best fit models. Results People exposed to no-smoking signages had lower odds of using tobacco (OR = 0.70, p

Background: The polluter's pay principle (PPP) aims to internalise external costs and assign liability to the polluter for the harmful cost of their products to society. Tobacco companies continue to manufacture and sell harmful cigarettes, earning billions in profits each year from these products. Meanwhile, governments and their people are left to 'clean up' and deal with the detrimental health consequences. This paper explores with expert stakeholders how the PPP could be implemented within the context of tobacco control in the United Kingdom (UK). Methods: Twenty-four semi-structured interviews and two follow-up discussion groups were conducted with UK and international experts on tobacco control, public health, economics, or law from the academic, public, private and third sector. Participants considered the facilitators and barriers to implementing the PPP to tobacco control in the UK. Thematic analysis was employed, aided by NVivo 12, and data were compared to examine the views expressed by the different types of experts. Results: Stakeholders favoured the implementation of the PPP in the context of tobacco control and indicated that it could be acceptable and feasible to implement and that it would likely have support from policymakers and the public alike. Stakeholders unanimously agreed that any legislation and administration should be free from tobacco industry influence; however, differences arose concerning who should oversee the implementation. Conclusion: The PPP from environmental law was predominantly seen as an approach that could be usefully applied to the tobacco industry. However, there is no one size fits all template, therefore its implementation would need to be adapted to fit the UK context. [ABSTRACT FROM AUTHOR]

Background: Tobacco use and the associated health burden is a cause of concern in India and globally. Despite several tobacco control policies in place, their sub-optimal and variable implementation across Indian states has remained a concern. Studies evaluating the real-world implementation of policies such as Cigarettes and Other Tobacco Products (COTPA) or National Tobacco Control Program (NTCP) in India and its association with reductions in tobacco use are limited. In this paper, we analyse data from a nationally representative survey to examine how policy implementation is associated with the tobacco use prevalence in India. Methods: We analysed data from the Global Adult Tobacco Survey (GATS 2016–17) India using multivariable logistic regression. The dependent variables were the use of smoked tobacco, smokeless tobacco, and tobacco in any form. The independent variables were proxies of implementation of the COTPA and the NTCP. We followed a step-wise backward elimination technique to reach the best fit models. Results: People exposed to no-smoking signages had lower odds of using tobacco (OR = 0.70, p < 0.001). People exposed to second-hand smoke (OR = 1.51, p < 0.001) and tobacco product advertisements (OR = 1.23, p < 0.001) had greater odds of using tobacco. Exposure to tobacco advertisements was associated with higher odds of using smokeless tobacco (OR = 1.23, p < 0.001), and smoked (OR = 1.33, p < 0.001) forms of tobacco. Conclusion: We find significant association between the implementation of tobacco control laws/programs and tobacco use in India. Our findings highlight the potential that policy implementation holds in reducing population-level tobacco use thus drawing attention towards the implementation phase of policies. The findings have implications on prioritising enforcement of specific tobacco control measures such as smokefree laws, modifying COTPA signages to encompass all tobacco products including against smokeless tobacco use and strengthening indirect advertising restrictions. Future research could focus on developing and validating predictors specific to policy implementation to support policy evaluation efforts. [ABSTRACT FROM AUTHOR]

(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic characteristics. (2) Methods: We analyzed data from the Tobacco Use Supplement to the Current Population Survey, 2003-2015, to explore whether multiple measures of smoking restrictions were associated with cessation across population subgroups. We examined area-based measures of exposure to smoke-free laws, as well as self-reported exposure to workplace smoke-free policies. We used age-stratified, fixed effects logistic regression models to assess the impact of each smoke-free measure on 90-day cessation. Effect modification by gender, education, family income, and race/ethnicity was examined using interaction terms. (3) Results: Coverage by workplace smoke-free laws and self-reported workplace smoke-free policies was associated with higher odds of cessation among respondents ages 40-54. Family income modified the association between smoke-free workplace laws and cessation for women ages 25-39 (the change in the probability of cessation associated with coverage was most pronounced among lower-income women). (4) Conclusions: Heterogeneous associations between policies and cessation suggest that smoke-free policies may have important implications for health equity.

We examine the optimal design of policies directed at regulating tobacco consumption through two types of instruments: taxation and anti-smoking mass media campaigns. We find that the main role of taxation is to correct for the population-average internal costs of smoking, while anti-smoking campaigns serve a complementary role. Namely, they add to the social welfare benefits of tobacco regulation as they are relatively more effective than taxation at discouraging smoking by individuals characterized by low degrees of self-control and high smoke-related health [ABSTRACT FROM AUTHOR]

The study aims to assess the implementation of tobacco control policies in Mexico from 2003 through 2017 using the Tobacco Control Scale (TCS). The TCS is a research tool widely used in the European region. It facilitates assessment of tobacco control policy implementation based on six cost-effective interventions: tobacco taxes, smoke-free policies, advertising bans, public spending on the information campaign, health warnings, and smoking cessation treatment, reflecting results in a total score between 0 and 100. From 2003 through 2017, Mexico's total score improved from 24/100 to 55/100, with substantial progress in raising tobacco taxes, 11 subnational smoke-free laws, and with placement on cigarette packs of large health warnings with pictograms. Progress in tobacco control policies implemented in this period corresponds with a decrease in smoking prevalence across Mexico. This tool is useful for monitoring tobacco policy implementation in low- and middle-income countries and be used for advocacy purposes to enforce and improve tobacco control legislation. [ABSTRACT FROM AUTHOR]

BackgroundAlthough tobacco control efforts have contributed to an overall decline in smoking, individuals with substance use disorders (SUDs) continue to smoke at high rates and remain targets of advertising to vulnerable groups, including those with mental health disorders and SUDs.ObjectivesWe examined associations of tobacco advertising exposure and receptivity, anti-tobacco message awareness, and health-risk perception with smoking status and cigarettes-per-day (CPD) in a national sample of SUD treatment patients.MethodsThe patients (N = 1,113) in 24 programs chosen randomly, stratified by program type, from among publicly funded adult treatment programs within the National Drug Abuse Treatment Clinical Trials Network completed surveys of smoking, advertising exposure and receptivity, anti-tobacco message awareness, and perceived health risks.ResultsCurrent smokers (77.9% of the sample) smoked a daily median of 10 cigarettes (IQR = 13). The participants reporting daily advertising exposure were 1.41 times more likely to be smokers (p = 0.019) than others. Those highly receptive to advertising were 2.34 times more likely to be smokers (p < 0.001) than those with low/moderate receptivity. Higher perceived health risk was associated with lower odds of smoking (OR = 0.99, 95% CI: 0.98-0.99, p < 0.001). CPD for smokers highly receptive to advertising was 11.1% (95% CI: 2.8%-20.0%) higher than for smokers with low/moderate advertising receptivity. Anti-tobacco message awareness was not associated with smoking status or CPD.ConclusionThe high rate of smoking among SUD treatment patients is associated with daily exposure and high receptivity to tobacco advertisements and lower perception of health-related smoking risks. Tobacco control efforts should target this vulnerable population.

Introduction The Tobacco Control Scale (TCS) was designed for advocacy purposes but has also been used as a research tool. In the present study, we characterized TCS use, its limitations and strengths, and critically assessed its use as a research instrument. Methods We conducted an extensive search of the biomedical databases PubMed and Web of Science for the keyword ‘tobacco control scale’ in all fields. The search was limited to studies published in the period March 2006 to December 2019. Out of 69 hits, 32 studies met the inclusion criteria. Two reviewers independently extracted information from each publication regarding their general characteristics, publication and research aspects, and the characteristics of the use of the TCS. Results We found that researchers have used the TCS as a tool to monitor tobacco control policies mainly in cross-sectional observational studies with ecological and multilevel designs directed to advocacy and the promotion of further research. Different outcomes, such as smoking prevalence and quit ratios, have been associated with tobacco control policy scores. The main reported limitations of the TCS were a low variance across countries and a failure to express enforcement and to incorporate the most recent legislation. Conclusions The TCS has been commonly used to assess differences in outcomes according to tobacco control policies. However, there are still areas for improvement in its use in research regarding the lack of comparability of TCS scores across time. The lessons that have been learned should be used to adapt and expand the TCS overseas.

Introduction: The Global Adult Tobacco Survey (GATS) India 2016–17 has shown that increased regulations over time impacted tobacco use culture, which opened the doors for further regulation, making it an iterative process. But do the ‘tobacco control policies’ reach till most deprived sections of society? This paper tries to answer this question. Methods: In this paper, the relative reduction in tobacco use prevalence is seen (from 2009 to 10 to 2016–17) across different levels of material deprivation and educational attainment. The relative reduction in prevalence/ use of various forms of smoking and smokeless tobacco products was also studied.Material Deprivation as a new index was computed, where the weightage was given to various variables related to household ownership of various material things as available in data sets of GATS Survey. The recoded variables were then added and further categorised into six levels of material deprivation where Level 1 corresponds to least deprived and Level 6 corresponds to most deprived.The relative reduction in the prevalence of tobacco use was calculated with the formula [(P1-P2)/P1]*100, where P1 is the prevalence of tobacco use (smoking or smokeless) during GATS1 (2009–10), and P2 is the prevalence of tobacco use (smoking or smokeless) during GATS2 (2016–17). Results: It has been shown that the higher the level of material deprivation, the lesser the relative reduction in the prevalence of tobacco use. The relative reduction in tobacco use was more for higher levels of educational attainment. It has been found that relative reduction is more for smoking products as compared to smokeless tobacco (SLT) products. Khaini and Bidis are emerging as popular products, which are least regulated by existing tobacco control policies. Conclusion: The reduction in the prevalence of tobacco use from GATS1 to GATS2 is inequitous across levels of material deprivation and levels of educational attainment by individuals. Also, there is a tendency for product substitution among tobacco users.

Long considered a smoker's paradise, Japan passed its strictest regulations yet on indoor smoking in 2018 with revisions to the Health Promotion Law and a new ordinance in Tokyo. Timed for the Tokyo Olympics, both reforms made smoking regulations stronger and more legalistic despite reflecting distinctive policy paradigms in their particulars. The national regulations curtailed smoking in many public spaces but accommodated smoking in small restaurants and bars. Tokyo's stronger restrictions emphasized public health protection by exempting only eateries with no employees. I argue that fully understanding these contemporaneous reforms requires analyzing insider activists: state actors who participated in the tobacco control movement or had sustained interaction with it during earlier reform waves. Case studies drawing on interviews and movement and government documents illustrate the mechanisms insider activists can access because they straddle multiple fields. This article contributes to scholarship about ideas, policy entrepreneurship, and the blurry line between insiders and outsiders in policymaking. [ABSTRACT FROM AUTHOR]

Abstract Background Smokeless tobacco (SLT) prevalence had been declining in the US prior to 2002 but has since increased. Knowledge about the impact of tobacco control policies on SLT and cigarette use is limited. This study examines the interrelationship between policies, cigarette use, and SLT use by applying the SimSmoke tobacco control policy simulation model. Methods Using data from large-scale Tobacco Use Supplement and information on policies implemented, US SimSmoke was updated and extended to incorporate SLT use. The model distinguishes between exclusive SLT and dual use of SLT and cigarettes, and considers the effect of implementing individual and combined tobacco control policies on smoking and SLT use, and on deaths attributable to their use. After validating against Tobacco Use Supplement (TUS) survey data through 2015, the model was used to estimate the impact of policies implemented between 1993 and 2017. Results SimSmoke reflected trends in exclusive cigarette use from the TUS, but over-estimated the reductions, especially among 18–24 year olds, until 2002 and under-estimated the reductions from 2011 to 2015. By 2015, SimSmoke projections of exclusive SLT and dual use were close to TUS estimates, but under-estimated reductions in both from 1993 to 2002 and failed to estimate the growth in male exclusive SLT use, especially among 18–24 year olds, from 2011 to 2015. SimSmoke projects that policies implemented between 1993 and 2017 reduced exclusive cigarette use by about 35%, dual use by 32.5% and SLT use by 16.5%, yielding a reduction of 7.5 million tobacco-attributable deaths by 2067. The largest reductions were attributed to tax increases. Conclusions Our results indicate that cigarette-oriented policies may be effective in also reducing the use of other tobacco products. However, further information is needed on the effect of tobacco control policies on exclusive and dual SLT use and the role of industry.

INTRODUCTION The Tobacco Control Scale (TCS) was designed for advocacy purposes but has also been used as a research tool. In the present study, we characterized TCS use, its limitations and strengths, and critically assessed its use as a research instrument. METHODS We conducted an extensive search of the biomedical databases PubMed and Web of Science for the keyword 'tobacco control scale' in all fields. The search was limited to studies published in the period March 2006 to December 2019. Out of 69 hits, 32 studies met the inclusion criteria. Two reviewers independently extracted information from each publication regarding their general characteristics, publication and research aspects, and the characteristics of the use of the TCS. RESULTS We found that researchers have used the TCS as a tool to monitor tobacco control policies mainly in cross-sectional observational studies with ecological and multilevel designs directed to advocacy and the promotion of further research. Different outcomes, such as smoking prevalence and quit ratios, have been associated with tobacco control policy scores. The main reported limitations of the TCS were a low variance across countries and a failure to express enforcement and to incorporate the most recent legislation. CONCLUSIONS The TCS has been commonly used to assess differences in outcomes according to tobacco control policies. However, there are still areas for improvement in its use in research regarding the lack of comparability of TCS scores across time. The lessons that have been learned should be used to adapt and expand the TCS overseas. [ABSTRACT FROM AUTHOR]

INTRODUCTION In 2003, the Philippines implemented legislation that prohibited the sale of tobacco products to youth, placed text warning labels on tobacco products, and prohibited tobacco smoking in public places. This study assessed if this legislation was associated with reduced cigarette smoking among youth. METHODS Data came from the 2000-2015 Philippines Global Youth Tobacco Survey (GYTS), a nationally representative, cross-sectional survey of students aged 13- 15 years. GYTS data were used to determine associations between tobacco control legislation and current, past 30-day, current cigarette smoking (CCS). Logistic regression models were adjusted for age, sex, current other tobacco product use (COTPU), and price per cigarette stick (PPCS). RESULTS In the unadjusted model, the 2003 legislation was not associated with CCS (OR=0.77; 95% CI: 0.54-1.10). After adjusting for covariates, it was negatively associated (AOR=0.65; 95% CI: 0.53-0.80). Being 15 years old (OR=1.31; 95% CI: 1.08-1.58), male (OR=2.54; 95% CI: 2.17-2.98), and COTPU (OR=4.12; 95% CI: 3.47-4.91) were positively associated with CCS in unadjusted models. In adjusted models, being 14 years old (AOR=1.29; 95% CI: 1.08-1.53), 15 years old (AOR=1.55; 95% CI: 1.31-1.84), male (AOR=2.49; 95% CI: 2.13-2.91), and COTPU (AOR=3.96; 95% CI: 3.32-4.73), were associated with CCS. PPCS was not associated with CCS in either the unadjusted (OR=1.32; 95% CI: 0.82-2.11) or adjusted (AOR=1.32; 95% CI: 0.79-2.18) models. CONCLUSIONS After adjusting for covariates, the 2003 tobacco control legislation was associated with lower current cigarette smoking, but price per cigarette stick was not. [ABSTRACT FROM AUTHOR]

Introduction This review aims to clarify the status and future directions of comprehensive tobacco control policies for the 2020 Tokyo Olympic Games based on a comparison with seventeen countries that hosted the Olympic Games. Methods Seventeen countries that hosted the Olympic Games from 1988 to 2018 were identified by searching the website of IOC. A comparison of the contents was carried out by six themes (Monitor, Protect, Offer, Warn, Enforcement and Raise) in accordance with the MPOWER package for implementation of the FCTC. The comparison items and data were obtained from Global Health Observatory (GHO) data, Japanese government websites, and the literature. Based on the MPOWER scale, the 17 countries were ranked by total score, and a correlation between smoking prevalence and MPOWER total scores was established. Results The following three results were clarified: 1) Compared to the 17 countries that hosted the Olympic Games, smoking prevalence in Japan at 22.5% is at a moderate level and male smoking prevalence (33.7%) is still higher than other developed countries such as UK (24.7%) and Australia (16.5%); 2) Japanese tobacco control policies were far behind other countries that hosted the Olympic Games, especially in protecting people from tobacco smoke, warning about the dangers of tobacco, anti-tobacco mass media campaigns and enforcing bans on tobacco advertising, promotion, and sponsorship; and 3) The better practice in MPOWER was able to reduce total and male smoking prevalence in the study countries. Conclusions Japanese tobacco control policies are far behind other countries that hosted the Olympic Games. In order to successfully hold the 2020 Tokyo Olympic Games, it will be necessary to strengthen tobacco control policies, based on the FCTC, in the future.

Between 2016 and 2018, tobacco control legislation has undergone several amendments to further restrict tobacco use in Singapore. This study explored the attitudes toward these policy changes and the perceived effectiveness of legislations from the perspectives of young male adults in Singapore. Twenty-nine semi-structured telephone interviews were conducted among young male adults who have completed their National Service in 2017/18 and self-reported as a smoker at pre-enlistment screening. Young male smoker perspectives on Singapore tobacco policies including taxation, smoke-free environment, point-of-sale display ban on tobacco products, graphic health warnings, and raising the minimum legal age of smoking to 21, were evaluated. Participants held the view that cigarette pricing was a highly effective approach to control their smoking behavior because it has a direct impact on tobacco affordability, and they shared that the least effective approaches were point-of-sale display bans and graphic health warnings. Results demonstrate that participants were well aware of tobacco control policies in Singapore, but they did not always fully accept them or understand the rationale behind them. Tobacco control measures should be implemented along with public education to correct misperceptions and increase public support for tobacco control measures in Singapore. [ABSTRACT FROM AUTHOR]

We investigate the effect of tobacco control policies on smoking initiation in eleven European countries. Based on individual data about age of onset of smoking, we use hazard rate models to study smoking initiation. Thus, we are able to take into account observed and unobserved personal characteristics as well as the effect of the introduction of a variety of tobacco control policies including price and and non-price policies, i.e., bans on tobacco advertisements, smoke-free air regulation, health warnings on packages of cigarettes, and treatment programs to help smokers quit smoking. We find that higher tobacco prices have a negative effect on the initiation into smoking for males but not for females. We find no effect of non-price tobacco control policies on smoking initiation. [ABSTRACT FROM AUTHOR]

Background and Aims: The impact of tobacco control on European older adults has not been studied, despite evidence that smoking cessation at old age can bring significant life expectancy gains. Our aim was to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013. Design We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE, aged 50+ years) from four waves from 2004 to 2013. We used logistic regression models with clustered standard errors to determine whether the implementation of tobacco control policies was associated with changes in smoking status. Furthermore, we studied whether these associations varied by socio‐demographic characteristics. Regression coefficients were converted to changes the probability of smoking [marginal effects (ME)]. Measurements Smoking status was the dependent variable, and the Tobacco Control Scale (TCS) was the explanatory variable, overall and by its main policy components (pricing and smoke‐free policies). Covariates included age, sex, education and country and wave fixed‐effects. Findings A 10‐point increase in TCS was associated with a lower probability of smoking by 1.6 percentage points [95% confidence interval (CI) = −3.208, −0.056] for those aged 50–65, but not for older Europeans. Among those with primary school or no education, the associated drop was of 1.5 percentage points (95% CI = –2.751, −0.253). By contrast, no significant relation between TCS and smoking was observed among those with high education. Higher TCS scores for pricing (ME = –0.636, 95% CI = –0.998, −0.275) and smoke‐free policies (ME = –0.243, 95% CI = –0.445, −0.041) were associated with a significantly lower probability of smoking (P = 0.001 and P = 0.018, respectively). Conclusion: Increases in tobacco taxes and smoke‐free policies are significantly related with a reduction in smoking among European older adults, suggesting potential health gains for this rising share of the population. These policies may be more effective among the lowest educated. [ABSTRACT FROM AUTHOR]

Our paper evaluates the extent to which the brain disease model of addiction (BDMA) has contributed to reducing the prevalence of tobacco smoking and tobacco-related harm over the past 20 years. We discuss the ways in which genetic and neuroscience research on nicotine addiction have contributed to our understanding of tobacco smoking. We then examine the extent to which the BDMA has produced more effective treatments to assist smoking cessation. We also assess the degree to which the BDMA has contributed to the tobacco control policies that have produced substantial reductions in tobacco-related morbidity and mortality in the two decades since the model was first proposed by Alan Leshner. We also assess whether the BDMA has reduced the stigmatisation of people who smoke tobacco. • Brain disease model of nicotine addiction, Tobacco control, Nicotine genetics, Nicotine pharmacogenetics, Nicotine vaccines. [ABSTRACT FROM AUTHOR]

Tobacco vendors are critical stakeholders in the tobacco supply chain. This study examined their perception, compliance, and potential economic impact of Nigeria's tobacco control laws related to the retail setting. This was a qualitative study involving in-depth interviews of 24 purposively selected tobacco vendors. The face-to-face interviews were aided by a semi-structured interview guide, audio-recorded, transcribed verbatim, and analyzed using thematic analysis with NVivo version 12. Five themes emerged, encompassing reasons for selling tobacco, awareness, perception, compliance with tobacco sales laws, the potential economic impact of the laws, and law enforcement activities. Vendors commenced tobacco sales due to consumers' demand, profit motives, and advice from close family relatives. They were unaware and non-compliant with most of the retail-related laws. Most participants had positive perceptions about the ban on sales to and by minors, were indifferent about the ban on Tobacco Advertising Promotion and Sponsorships (TAPS) and product display, and had negative perceptions about the ban on sales of single sticks. Most vendors stated quitting tobacco sales would not have a serious economic impact on their business. In conclusion, the vendors demonstrated limited awareness and non-compliance with various retail-oriented tobacco control laws in Nigeria. Addressing these gaps requires targeted educational campaigns and effective law enforcement strategies to enhance vendors' compliance.

We use the Nielsen Consumer Panel to investigate the impact of tobacco control policies on purchases of electronic cigarettes (e-cigarettes), cigarettes, and smoking cessation products. We measure product quantity, product type, nicotine content, and liquid volume of e-cigarettes, and product quantity and nicotine content of cigarettes. Higher cigarette excise taxes decrease both cigarette and e-cigarette purchases, suggesting that cigarettes and e-cigarettes are complements, and higher cigarette excise taxes reduce the aggregate amount of nicotine purchased from cigarettes and e-cigarettes. Cigarette smoke-free air laws decrease cigarette purchases, while e-cigarette smoke-free air laws do not affect cigarette or e-cigarette purchases. [ABSTRACT FROM AUTHOR]

Abstract: Background and aim: As smoking initiation generally occurs in adolescence, smoking prevention is targeted primarily at young adolescents (aged below 16 years). We hypothesize that, with the adoption of increasingly stronger youth access laws, a shift in the age of smoking initiation may have occurred. Design: Repeated cross‐sectional survey. Setting: The Netherlands. Participants: A total of 13 163 respondents born between 1980 and 1995. Measurements: In the 2010–15 National Health Survey we measured retrospectively self‐reported initiation rates per year of age by birth cohort (1980–83, 1984–87, 1988–91, 1992–95). Logistic regression analyses were performed to assess differences between cohorts, per sex and educational level. Findings: Of those who started smoking, 67.2% initiated smoking between 12 and 16 years of age. Contrary to our hypothesis, no shift in initiation towards higher ages was observed. The peak age of initiation was 16 years for all cohorts. Initiation at ages 17–21 was lower in younger birth cohorts than in older birth cohorts [e.g. cohort 1993–95 versus 1980–83: odds ratio (OR) for initiating at 19–21 years = 0.45, 95% confidence interval (CI) = 0.31–0.64]. Trends in age of initiation were similar for males and females. Initiation at ages 15–17 decreased across cohorts for respondents in higher education levels, but not for those in lower education levels. Conclusions: In the Netherlands, the peak age of smoking initiation did not shift throughour subsequent cohorts born between 1980 and 1995, suggesting that young adolescents remain the main target group for smoking initiation prevention policies. [ABSTRACT FROM AUTHOR]

Aims We compared predicted life-time health-care costs for current, never and ex-smokers in Germany under the current set of tobacco control polices. We compared these economic consequences of the current situation with an alternative in which Germany were to implement more comprehensive tobacco control policies consistent with the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) guidelines. Design German EstSmoke, an adapted version of the UK EstSmoke simulation model, applies the Markov modelling approach. Transition probabilities for (re-)currence of smoking-related diseases were calculated from large German disease-specific registries and the German Health Update (GEDA 2010). Estimations of both health-care costs and effect sizes of smoking cessation policies were taken from recent German studies and discounted at 3.5%/year. Setting Germany. Participants German population of prevalent current, never and ex-smokers in 2009. Measurement Life-time cost and outcomes in current, never and ex-smokers. Findings If tobacco control policies are not strengthened, the German smoking population will incur €41.56 billion life-time excess costs compared with never smokers. Implementing tobacco control policies consistent with WHO FCTC guidelines would reduce the difference of life-time costs between current smokers and ex-smokers by at least €1.7 billion. Conclusions Modelling suggests that the life-time healthcare costs of people in Germany who smoke are substantially greater than those of people who have never smoked. However, more comprehensive tobacco control policies could reduce health-care expenditures for current smokers by at least 4%. [ABSTRACT FROM AUTHOR]

Objective To assess the correlation between tobacco control policies— particularly smoking bans in work and public places—and the prevalence of preterm births and low birth weight in the European countries. Methods This is an ecological study and the unit of analysis set at the country level. Tobacco control data in Europe were obtained for the years 2010 and 2013 as measured by the Tobacco Control Scale (TCS), which reflects the level of implementation of tobacco control policies. Prevalence data for preterm births and low birth weight were obtained from two sources: the European Perinatal Health Report (EPHR), which provides data for 2010, and the Eurostat data, which includes the years 2013 and 2014. We analyzed the correlation between the TCS score and the prevalence of preterm birth and low birth weight in the European countries by means of Spearman (rsp) rank-correlation coefficients and their 95% confidence intervals (95%CI). Results The 2010 TCS was negatively correlated with the prevalence of preterm births before week 37 (rsp = −0.51; 95% CI: −0.77, −0.15; p = 0.006) and week 32 (rsp = −0.42; 95%CI: −0.73, −0.01; p = 0.030) and with the prevalence of the low birth weight (< 2500 g, (rsp = −0.42; 95% CI: −0.66, −0.09; p = 0.028) in European countries in 2010. We found a statistically significant inverse correlation between the level of restrictions on smoking in public places and the prevalence of low birth weight (< 2500 g rsp: −0.54; 95%CI: −0.72, −0.10; p = 0.017). Conclusion The level of smoke-free legislation in European countries correlates with lower preterm birth prevalence rates at the ecological level. Given the important negative effects of premature births for the public health system, these data support greater implementation of smoke-free policies and tend to support the implementation of tobacco control policies, but more research is needed. [ABSTRACT FROM AUTHOR]

Objective To describe the voluntary adoption of smoke-free homes and social attitudes in Spain towards banning smoking in vehicles in which children are present. Methods Cross-sectional study of a representative sample of the adult Spanish population age range, 18–75 years (n=1036). The field work was conducted via a computer-assisted telephone survey in March and April 2016. Survey respondents answered questions about smoking rules at home and attitudes towards a smoking ban in cars with or without children. Home smoking rules were defined as complete (smoking not allowed anywhere in the house), partial (smoking allowed in some areas inside the house) or absent (smoking allowed everywhere). Results Most (83.0%) of the surveyed population had some type of smoking restriction in place at home (45.6% complete and 37.5% partial). There were significant differences between groups according to age group (the highest prevalence was 86.1% from 66 to 75 years and the lowest prevalence was 77.8% from 46 to 65 years) and smoking status (the highest prevalence was 89.4% in people who had never been smokers and the lowest prevalence was 75.0% in current smokers) with regards to the prevalence of smoke-free homes (p<0.05), with partial bans more prevalent in smoking households (49.0%). Most (61.6%) of the population favored banning smoking in cars, and 90.1% supported a ban in cars carrying minors. Attitudes towards smoking regulation in cars (with or without children) varied significantly by age group (the highest prevalence was 81.9% from 66 to 75 years and the lowest prevalence was 54.5% from 18 to 45 years) and smoking status (the highest prevalence was 71.4% in people who had never been smokers and the lowest prevalence was 46.0% in current smokers). However, no significant differences were found with regard to attitudes towards smoking regulation in cars carrying children, regardless of sex, age, social class, or smoking status. Conclusion Approximately half of the adult population in Spain have implemented a complete smoke-free rule at home. More than 9 out of 10 adults favor regulating smoking in cars in the presence of minors. These findings support the expansion of smoke-free regulations to include private vehicles, particularly when minors are in the car. [ABSTRACT FROM AUTHOR]

We examined the effect of tobacco control policies in Mexico on smoking prevalence and smoking-related deaths using the MexicoSimSmokemodel. The model is based on the previously developedSimSmokesimulation model of tobacco control policy, and uses population size, smoking rates and tobacco control policy data for Mexico. It assesses, individually, and in combination, the effect of six tobacco control policies on smoking prevalence and smoking-related deaths. Policies included: cigarette excise taxes, smoke-free laws, anti-smoking public education campaigns, marketing restrictions, access to tobacco cessation treatments and enforcement against tobacco sales youth. The model estimates that, if Mexico were to adopt strong tobacco control policies compared to current policy levels, smoking prevalence could be reduced by 30% in the next decade and by 50% by 2053; an additional 470,000 smoking-related premature deaths could be averted over the next 40 years. The greatest impact on smoking and smoking-related deaths would be achieved by raising excise taxes on cigarettes from 55% to at least 70% of the retail price, followed by strong youth access enforcement and access to cessation treatments. Implementing tobacco control policies in Mexico could reduce smoking prevalence by 50%, and prevent 470,000 smoking-related deaths by 2053. [ABSTRACT FROM AUTHOR]

There is little research on public support for banning the sale and purchase of combustible cigarettes even though a ban is an essential step towards achieving the endgame for tobacco products. We report the first studies designed to (a) examine predictors of support for a ban (Study 1), and (b) test interventions to increase such support (Studies 2–4). In Study 1, current, former, and never smokers (N = 479) were randomized to conditions measuring their willingness to ban the sale of cigarettes vs. an unspecified product. Smokers were randomized to a persuasive communication in Study 2 and a paradoxical thinking intervention in Study 3 (N s = 300 and 302, respectively). In Study 4 (N = 336), we randomized smokers to self-persuasion and issue-framing interventions. Whereas nonsmokers were willing to ban the sale of both cigarettes and equivalent products, current and former smokers exempted cigarettes from a ban. Reactance to prohibition and perceived effectiveness predicted willingness to ban cigarette sales in all three smoking status groups (Study 1). Neither persuasive communication nor paradoxical thinking increased support for banning cigarette sales in Studies 2–3. However, self-persuasion and framing the ban as "protecting Americans from avoidable harm" both led to increased support for banning cigarette sales (Study 4). Reactance and doubt about the effectiveness of banning the sale of cigarettes are key barriers to supporting a ban. Self-persuasion and issue framing may be effective means of mobilizing policy support among smokers. The present research offers new insights relevant to promoting the "Tobacco Endgame" and helps specify directions for future research on public support for health policies. • Unlike smokers, nonsmokers would ban sales of cigarettes and other harmful products. • Beliefs about effectiveness and views of prohibition predicted willingness to ban. • Neither direct persuasion nor paradoxical thinking increased support for a ban. • A self-persuasion intervention promoted support for a ban on cigarette sales. • Framing a ban in terms of "protecting Americans from harm" led to increased support. [ABSTRACT FROM AUTHOR]

Despite the presence of tobacco control policies, Louisiana continues to experience a high smoking burden and elevated smoking-attributable deaths. The SimSmoke model provides projections of these health outcomes in the face of existing and expanded (simulated) tobacco control polices. The SimSmoke model utilizes population data, smoking rates, and various tobacco control policy measures from Louisiana to predict smoking prevalence and smoking-attributable deaths. The model begins in 1993 and estimates are projected through 2054. The model is validated against existing Louisiana smoking prevalence data. The most powerful individual policy measure for reducing smoking prevalence is cigarette excise tax. However, a comprehensive cessation treatment policy is predicted to save the most lives. A combination of tobacco control policies provides the greatest reduction in smoking prevalence and smoking-attributable deaths. The existing Louisiana excise tax ranks as one of the lowest in the country and the legislature is against further increases. Alternative policy measures aimed at lowering prevalence and attributable deaths are: cessation treatments, comprehensive smoke-free policies, and limiting youth access. These three policies have a substantial effect on smoking prevalence and attributable deaths and are likely to encounter more favor in the Louisiana legislature than increasing the state excise tax. [ABSTRACT FROM AUTHOR]

En este trabajo se analiza cómo el aumento de los impuestos afecta a la demanda de productos derivados del tabaco, en especial a la demanda de cigarrillos. El análisis comparado de los estudios revisados demuestra que las subidas en los impuestos sobre el tabaco se traducen en un aumento de los precios de estos productos. La elasticidad precio de la demanda de cigarrillos en países de ingreso medio y bajo resulta el doble que la de los países de ingresos altos, alrededor de -0,4. Además, y como señal de la naturaleza adictiva de este tipo de consumo, esta demanda se presenta más elástica en el largo que en el corto plazo. El efecto de una subida en los impuestos del tabaco es mayor en los jóvenes, más sensibles a los precios que los fumadores adultos. La evidencia empírica para el caso español sitúa la elasticidad precio de la demanda de cigarrillos a corto plazo en un intervalo que oscila entre -0,5 y -0,3, similar a los encontrados en la bibliografía internacional. Estos datos no ofrecen perspectivas optimistas sobre la potencialidad de las medidas fiscales como herramienta de control del tabaquismo, más allá de sus efectos recaudatorios y compensadores de externalidades. Además, si se consideran las posibilidades de sustituciones entre marcas y el margen estratégico de la industria para compensar los efectos de los impuestos, reducir las demandas y alentar el contrabando, el panorama se presenta todavía más pesimista.This paper analyzes the extent to which an increase in tobacco taxes affects the demand for tobacco products, especially for cigarettes. Comparison of the studies reviewed revealed that higher tobacco taxes result in higher tobacco prices. The price-elasticity of cigarette demand in low- and middle-income countries is about double that in high-income countries, about -0.4. Furthermore, because of the addictive nature of tobacco use, demand for tobacco products is more elastic in the long run than in the short run. The effect of higher tobacco taxes is greater on the young, among whom demand is more sensitive to price than among adults. The empirical evidence for Spain estimates the price elasticity of cigarette demand in the short run to be in the range of -0.5 to -0.3, a result which is similar to other studies. These results do not suggest that tax policy is an effective tool for tobacco control, although taxes are useful for their revenue generating potential and for compensating the external costs generated by tobacco consumption. Furthermore, when the possibilities of substitutions among brands and the strategies of the tobacco industry to compensate for the effects of taxes (lowering prices and encouraging cigarette smuggling) are considered, the panorama is even more pessimistic

To achieve equity in protection from poor health outcomes due to tobacco use, tobacco control policies and interventions need to affect socially disadvantaged groups more strongly than advantaged groups. Flavored tobacco bans have been seen as a policy with this potential. However, tobacco control researchers, in close concert with policy advocates, need to consider how to center equity throughout the policy process to achieve equitable outcomes from banning flavored tobacco. In this commentary, we outline the rationale for how and why tobacco control researchers should consider equity throughout the policy process to help fully achieve the potential of flavored tobacco ban policies. These recommendations emerged from a presentation at the Vermont Center on Behavior and Health 2021 Conference. Specifically, we focus on recommendations for tobacco control researchers to center equity including partnering with communities in agenda setting, examining how various policy formulations or exemptions may increase or decrease disparities, determining where flavor policies need to reach and whether policies are equitably reaching all populations disproportionately burdened by flavored tobacco, assessing whether policy implementation/enforcement is carried out equitably to maximize policy benefits, and evaluating policy impact with as much granularity as possible. Considering the entire policy process is central to enhancing equitable outcomes from banning flavored tobacco. Tobacco control researchers can play a key role in ensuring that these policies are viewed through an equity lens to, not just improve population health, but also to reduce harms to those disproportionately burdened by use of flavored products. [ABSTRACT FROM AUTHOR]

This study was designed to determine the prevalence of active smoking and environmental tobacco smoke (ETS) exposure among medical students in Riyadh, Saudi Arabia, and to examine their attitudes and beliefs towards tobacco control programs. The investigation was a cross-sectional study conducted during the first semester of 2013 at King Saud University School of Medicine located in Riyadh, Saudi Arabia. Invited to participate in this study were 1,789 medical students. A descriptive data analysis was performed. A total of 805 medical students completed the questionnaire. The prevalence of experimentation with cigarette smoking was 11.3 %. The estimated prevalence of current smoking among the study participants was 4.7 %. The majority of the students held positive attitudes toward tobacco control and approximately 93.1 % of the students felt that health care professionals should be required to receive training for cessation counseling while only 36.8 % of the students reported having received any training in this area. Over the study's duration 57.7 % of participants reported that ETS exposure was much higher in public places, while 13.9 % reported exposure at home. This investigation revealed that ETS exposure among medical students in Riyadh is at an alarmingly high rate. The data suggests a need for a more robust smoke-free policy and a commitment to greater enforcement in public places. The results of the study also demonstrate a positive attitude among participants for tobacco control. It also indicates a need for cessation counseling and training which could be incorporated into medical school curriculum. [ABSTRACT FROM AUTHOR]

The tobacco sector in Turkey has passed through a market-oriented transformation together with the neo-liberal policies since 1980. Within this period, as an input of cigarette manufacturing, the state control over the conditions of tobacco production and cigarette manufacturing and distribution has been gradually deactivated and left to the decisions of transnational tobacco companies. The restructuring of tobacco sector as a new area of valorization for capital has led to an increase in cigarette consumption. On the other hand, demand-side policies to reduce cigarette consumption that have been implemented since the mid-1990s have been doomed to have a much weaker effect, in an environment of increasing manufacturing and trade. As the case of Turkey illustrates, a real struggle against cigarette consumption has to target manufacturing and thus, the tobacco industry itself. From a public health-perspective, this fact indicates the necessity of establishing public control over manufacturing and trade of tobacco products. [ABSTRACT FROM AUTHOR]