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Introduction: Previous evidence suggests the tobacco industry uses media to disseminate misleading narratives relating to illicit tobacco trade (ITT) as part of efforts to influence policy outcomes. Such evidence is largely high-income countries (HIC) focused, resulting in a literature gap for low- and middle-income countries (LMICs). Pakistan and its annual budget cycle are used as a case study for addressing this gap., Aims and Methods: Electronic English-language articles from newspapers in Pakistan (328) were sourced from LexisNexis and a sub-sample of Urdu-language electronic articles (12) were identified through internet searches. The articles were published between 2015 and 2020 and included claims/estimates relating to ITT, which were coded to identify cited data sources. Changes in media coverage before and after Pakistan's annual budget announcements were explored via Wilcoxon signed rank and Poisson regression tests., Results: Of the 357 claims/estimates analyzed, 66 (20%) were industry-funded. The most prevalent sources were national government bodies (36.6%) and tobacco companies or their representatives (15.1%). Wilcoxon signed-rank and Poisson regression tests on the frequency of English-language articles both created a p-value of < .05 for the frequency of relevant articles between the months of April and May, compared to the other months, indicating statistical significance., Conclusions: There was a statistically significant increase in the number of English-language articles featuring claims/estimates relating to Pakistan's ITT in the months leading up to the annual budget each year. The government should consider measures to improve transparency standards within media coverage and promote factcheck journalism to safeguard against industry tactics to manipulate public discourses., Implications: This paper is, to the best of our knowledge, the largest exploration of the use of data sourced from the tobacco industry within a country's media that has been undertaken to date, utilizing a team of seven coders across the United Kingdom and Pakistan. Our findings reveal weaknesses within media coverage of ITT in Pakistan, both in English and Urdu language publications. We encourage the government to consider new standards to enhance transparency and promote factcheck journalism within media coverage in the country., (© The Author(s) 2024. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco.)

Background: In November 2021, the Tobacconomics team published the second edition of the Cigarette Tax Scorecard which evaluates cigarette taxation in each country based on four components-cigarette price, affordability change, tax share and tax structure. This study examines the relationship between the overall cigarette tax score and tobacco excise tax revenue between 2014 and 2018., Methods: Using cigarette tax scores from the Tobacconomics Cigarette Tax Scorecard and tobacco excise tax revenue information from WHO, this analysis is based on ordinary least squares estimations to assess the association between the overall cigarette tax scores and tobacco excise tax revenues per capita controlling for countries' tobacco control environment, sociodemographic characteristics and country and year fixed effects., Results: A 1-point higher overall cigarette tax score is associated with higher tobacco excise tax revenue per capita of $11.98 (in constant 2018 purchasing power parity international dollars). For low and middle-income countries and lower performing countries at baseline, a 1-point higher overall cigarette tax score is associated with higher tobacco excise tax revenue per capita of $11.32 and $6.92, respectively. If all countries had increased their scores to '5', the tobacco excise tax revenue per capita would have increased by 22.51%., Conclusions: Higher overall cigarette tax scores are associated with higher tobacco excise tax revenue per capita. Countries aiming to reach higher cigarette tax scores would be able to reduce tobacco use and increase their tobacco tax revenue, which can be allocated to development priorities., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: The production of addictive commodities is subject to a range of commercial determinants. There has nevertheless been a gap in understanding how investments into addictive commodities may function as commercial determinants. Institutional investors can yield important financial power with their investment decisions. Many investors apply responsible investment (RI) policies to address environmental, social, and governance concerns. Negative screening is used to exclude certain sectors or companies from investment portfolios, mainly for ethical concerns. Negative screening also affects investment into tobacco and other addictive industries. This article investigates RI policies toward addictive industries among institutional investors that are signatories of the Tobacco-Free Finance Pledge (TFFP; N  = 161). The TFFP is an initiative created in 2021 to de-normalize tobacco-related investments., Methods: The mixed-method study uses descriptive statistics to quantify the extent and scope of exclusion policies as well as institutional and geographical profiles of investors, and a qualitative analysis of the justifications for these exclusion policies., Results: Some TFFP signatories apply negative screening to other addictive industries (gambling: 35%; alcohol: 24%; cannabis 12% of signatories). There are important differences in the applied exclusion thresholds, with only 47% of TFFP signatories applying a zero-tolerance policy to tobacco. Thresholds are higher for other addictive industries. Signatories also differ in terms of their geographical and investor profiles. Justifications pertaining to compliance with international standards and reputational risks were the most common., Conclusion: Addictive industries, such as tobacco, alcohol, gambling, and recreational cannabis, are increasingly excluded by investors. However, different understandings of RI influence how sector exclusions are implemented. Divesting from tobacco and other addictive industries is a crucial step toward a public health approach that prioritizes population health over financial profits. Prominent institutional investors are influential opinion leaders who can change the behavior of other investors and de-normalize controversial industries and reduce or prevent harm., Competing Interests: Author RS was employed by company KPMG. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2024 Berret, Marionneau, Sievänen and Nikkinen.)

Objectives: The illicit cigarette trade endangers public health because it increases access to cheaper tobacco products, hence fueling the tobacco epidemic and undermining tobacco control policies. The objective of this study was to evaluate the execution of an illicit cigarette eradication program under the jurisdiction of the local government in Indonesia. We sought to provide insights into the effectiveness of current policies and their impact on the illicit cigarette trade in line with the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) protocol to eliminate illicit trade in tobacco products., Methods: We conducted semistructured interviews with key policy-makers and semistructured FGDs with consumers and small- to medium-scale cigarette manufacturers at the district level. We indentified Pasuruan and Kudus as the districts or cities with the highest proportion of DBH CHT, and Jepara and Malang as a district with a highest illicit cigarette incident. We used reflective thematic analysis to identify the important opportunities and challenges facing illicit cigarette eradication programs in the three districts., Results: We identified four opportunities and four challenges related to illicit cigarette eradication program implementation under the local government. The opportunities for illicit cigarette eradication lie in strong central government regulatory and multisectoral authority support, consumer awareness, and local governments' commitment to tobacco supply chain control. The key challenges facing illicit cigarette eradication include ineffective public dissemination programs, rapidly changing regulatory designs, consumers' preferences for illicit products, and a lack of industrial involvement in tobacco supply chain control programs., Conclusion: In addition to significant budget allocation and increasing consumer awareness, local programs to eradicate illicit cigarette production require considerable evaluation to rethink the program's design and external stakeholders' engagement within the local government's scope.

Introduction: VLN King menthol and non-menthol are the first combustible cigarettes to receive US Food and Drug Administration (FDA) authorisation as modified risk tobacco products. Focusing on the first retail test market, this study characterised VLN advertising, product placement, discounts and price., Methods: All Chicago-area Circle K stores (n=133) were telephoned to assess whether they sold VLN. Single-pack price of non-menthol was obtained in 57 of 100 stores that sold VLN. In fall 2022, trained data collectors visited those 57 stores to assess VLN product placement, advertising, discounts and prices. Paired t-tests compared observed VLN price with telephone price and to price of other cigarette brands., Results: Nearly all stores (91.1%) displayed exterior advertisements for VLN, and 41.1% displayed interior advertising, with 8.9% of stores advertising VLN in the power wall but never in the header row. VLN cigarettes were displayed in the power wall exclusively and among high-nicotine cigarettes. Some VLN marketing claims were not FDA-authorised. VLN advertised a sweepstakes offer and rewards programme. Most stores (85.7%) offered VLN discounts. VLN was priced like a premium brand (mean=$10.90, SD=$1.53), and prices obtained by telephone did not differ from observed prices several months later., Conclusions: Retail marketing strategies for VLN mimic those for high-nicotine cigarettes. Deviations from FDA-authorised marketing claims were evident. Surveillance in future test markets is recommended to assess compliance with marketing claims and examine relative price and discount offers. Of interest is how premium-priced, low-nicotine cigarettes stand to compete in a market dominated by cheaper high-nicotine cigarettes., Competing Interests: Competing interests: JJP has provided consultation to pharmaceutical and technology companies that make medications and other treatments for quitting smoking and has served as an expert witness in lawsuits against the tobacco companies., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: None declared.

Introduction: Tobacco is one of the world's largest preventable causes of premature death, accounting for more than 8 million deaths and costing the global economy US$1.4 trillion each year. Smoking is a global problem with 1.3 billion people using tobacco worldwide, who will face harmful effects on health and on people's current and future financial situations and quality of life.This article aims to be the first study to generate evidence on the effects of smoking on household expenditure and the number of people living under the poverty threshold by studying the crowding out and impoverishing effect in Mexico., Methods: Through econometric methods and maximising a household utility function we estimate the crowding out and impoverishing effect of tobacco consumption in México based on household's income and spending survey from 2020., Results: Spending on tobacco crowds out household spending on other goods and services. In Mexico, spending on tobacco results in decreased spending on essential goods and services, like education and healthcare, and increased spending on harmful goods such as alcoholic beverages. These effects are common across all income levels but are more pronounced in low-income households. When spending on tobacco increases, for example, following regular price increases made by the tobacco industry, the crowding out effect is exacerbated.In addition, smoking has an impoverishing effect on the population. This is because some families find that their remaining income level falls below the poverty line after deducting money spent on tobacco (a concept known as secondary poverty). In Mexico, 909 132 people are left with a disposable income level below the extreme poverty line because of expenditure on tobacco and smoking-related diseases., Conclusions: Smoking affects individual health and the finances of households in Mexico, particularly those of low-income people. By increasing tobacco taxes, those who quit smoking increase their quality of life and well-being. However, those who continue to smoke and increase their tobacco spending are affected by a shift in their spending on other goods and services.The increase in tobacco taxes must be accompanied by public policies that help reduce tobacco consumption and compensate the crowding out on goods and services relevant to the development of households., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Background: A significant tobacco tax increase has long been advocated to reduce Indonesia's high smoking prevalence. However, implementing such a policy remains challenging due to the tobacco industry's argument that it would negatively impact the economy., Objective: This study aims to provide a comprehensive estimate of the net impact of tobacco taxation on Indonesia's economy., Method: The impact of the tax hike on the economy is simulated through a change in cigarette demand and reallocation of household's budget and allocation government spending from additional tobacco tax revenue. Input-output analysis is employed to estimate the net effect of the tobacco tax rise on the total economic output, income and employment in Indonesia., Finding: Increasing the tobacco tax would generate a net positive impact on the economy as it would increase economic output, household income and employment. The positive impact is mainly driven by government spending from additional revenue from increased tobacco taxes. Spending tax revenue using the current structure of government spending has the potential to generate the optimal economic effect. Increasing tobacco tax by 45% from the 2019 tax level would increase economic output, household income and employment by Rp84.2 trillion, Rp24.1 trillion and 400.3 thousand jobs, respectively., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Competing Interests: Competing interests: The Investigative Desk is a group of investigative journalists funded through donations, grants, scholarships, and fees. Sponsors do not play a role in or have substantive influence on the research or publications. The Investigative Desk is collaborating with the Tobacco Control Research Group (TRCG) of the University of Bath on tax avoidance research. The University of Bath has also provided some financial support for that research. As the TRCG reports on its web pages, this research group receives funding from a variety of sources, including the National Institute for Health Research and Bloomberg Philanthropies. The collaboration with TRCG did not concern the present investigation.

Data from the Australian Taxation Office and Australian Border Force show notable recent increases in illicit tobacco seizures across Australia. The illicit tobacco market results in substantial losses in tax revenue, funds organised crime, and perpetuates tobacco use, threatening to undermine Australia's ability to achieve its national commercial tobacco endgame goal of 5 % or less smoking prevalence by 2030. This commentary discusses recent trends in Australia's illicit tobacco trade, reasons why this is of concern, potential drivers of Australians' illicit tobacco use, and policy measures that could be implemented to mitigate increasing illicit tobacco trade such as implementing a track and trace system, increased investment in the Australian Border Force to enhance detection of illicit tobacco shipments at Australia's borders, and encouraging public tip-offs of illicit tobacco sales., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.)

Background: Tobacco companies and their associated businesses know that placement - where one can see and purchase their products - is critical to their success. Placement is one of the four fundamental Ps of marketing along with product, price and promotion. Placement includes identifying retail locations in important places such as in shopping districts, within neighborhoods, near schools, at beaches, and in parks. In Southeast Asia, counteracting tobacco company placement strategies that result in market penetration is essential to advancing the endgame, namely ending tobacco use. However, in Southeast Asia research on the placement of tobacco products has been limited., Objectives: We undertook to analyze how Philip Morris International (PMI) through its subsidiary Philip Morris Asia Inc. (PMAI), from the time the company entered Thailand's market once it was forced open in 1990, developed its successful product placement strategies and tactics., Methods: We examined over 4,000 PMI and PMAI internal documents using an historical, iterative and thematic approach. We analyzed the most relevant and illuminating documents, particularly those in which PMAI discussed retailer supply, retailer acceptance and retailer cooperation., Results: Even before foreign tobacco brands were legally allowed to be sold in Thailand, PMAI was already doing customer research in Thailand. In 1989, PMAI conducted a study of potential Thai customers in which 24% of respondents' lack of availability (i.e., product placement) was one of the main reasons for not smoking PMI's products. Based on these findings, PMAI engaged in intensive internal efforts to address the placement barrier to gain share. PMAI placed considerable emphasis on "stimulating retail trade acceptance" by making payments to retailers who met agreed upon and contracted product sales targets. PMAI's initial successes incentivizing Thai retailers by essentially buying prime retail space for placement of their brands, to crowd out local and other foreign brands, became the foundation of what evolved into a sophisticated program to make placement highly lucrative for retailers., Conclusion: PMAI viewed aggressive product placement as essential to success as a new entrant in Thailand, and their product placement strategies contributed substantially to capturing a large share of the market. Therefore, endgame strategies must focus on restricting product placement through surveillance of tobacco industry legal, investment and retailer actions and through stricter tobacco retailer licensing requirements and penalties.

Background: Sale of single cigarettes (also known as singles or loosies) is a key driver for early initiation of smoking and is a leading contributor to the smoking epidemic in India. Sale of singles additionally deter implementation of tobacco control strategies of pictorial health warnings including plain packaging and defeat effective taxation and promote illicit trade. We review India's tobacco control policy responses towards banning singles and other products sold as loose tobacco and identify opportunities for future policy intervention especially in the context of the ongoing COVID-19 pandemic., Methods: Existing national and sub-national policy documents were analyzed for their content since the inception of the tobacco control laws in the country., Results: There are no effective provisions at national level to ban loose tobacco products in India. However, the implementation of multiple legislative and regulatory measures (Acts/circulars/letters/notifications/orders/court judgements) in 16 Indian states and jurisdictions provide sufficient legal framework to substantiate its complete ban pan India. While the majority of state governments have adopted state level measures, Rajasthan had issued specific directive to all the 33 districts banning loose cigarettes and other tobacco products. Himachal Pradesh introduced the most unique and comprehensive legislation, for banning the sale of cigarettes and beedis (Dated November 7, 2016). The most recent notification in the state of Maharashtra (September 24, 2020) is the first to leverage powers using a mix of national and state legislations including the legislation addressing the rapidly emerging challenge of managing COVID-19., Conclusion: A robust national policy which supports strong provision to deter tobacco companies, their distribution network and vendors from selling singles or loose tobacco products is urgently needed. Such policy should be backed by cautionary messaging for consumers as well. Eliminating singles and loose tobacco sale will help in blunting tobacco use prevalence besides curbing spread of infectious diseases like COVID-19 pandemic.

Since their launch globally in 2012, electronic nicotine delivery systems (ENDS) were positioned as a harm reduction strategy and cessation device but it is yet to be proven to have clinical safety or public health benefits. Instead, recent reports suggest that the tobacco industry targeted youth and sponsored research whose evidence was used to mislead policymaking. On August 28, 2018, Ministry of Health & Family Welfare's advisory banned the sale, purchase, and trade of ENDS. A survey was done in two waves. The first survey was done between August 10 and 25 2018 all websites which sold ENDS product were mapped and documented. The survey was repeated (November 30, 2018) were after the restriction to trade on ENDS was proposed by the Department of Customs. The two waves of survey found that no website, whether comprehensive e-commerce portals or dedicated ENDS marketing platforms fully complied with government orders. National and states government enforcement agencies are currently unaware of internet-based sale of ENDS. Although some states have given specific directions to stop the sale and delivery of ENDS within the state through e-commerce, there is limited monitoring and legal compliance by seller. Public health advocates need to stay vigilant and monitor the online sale and point of sale retail of ENDS to ensure strict compliance of national and state regulations.

Background: California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017., Methods: Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011-2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a "synthetic" California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted., Results: The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products., Conclusion: Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco., Competing Interests: The authors have declared that no competing interests exist.

Background: Public health policies and recommendations aim to be informed by the best available evidence. Evidence underpinning e-cigarettes policy recommendations has been necessarily limited due to the novelty of the technology and the lack of long-term epidemiological studies and trials. Some public health bodies have actively encouraged e-cigarette use whilst others have raised concerns over introducing new health risks and renormalising tobacco smoking. Using citation network analysis we investigated the author conflicts of interest and study funding statements within sources of evidence used by public health bodies when making recommendations about e-cigarette policy., Methods: We conducted citation network analysis of public health recommendation documents across four purposively selected diverse jurisdictions: WHO, UK, Australia, and USA. We extracted all citations from 15 public health recommendation documents, with more detailed data collected for influential citations (used in 3+ recommendation documents). We analysed the relationships between the sources of evidence used across jurisdictions using block modelling to determine if similar groups of documents were used across different jurisdictions. We assessed the frequency and nature of conflicts of interest., Results: 1700 unique citations were included across the 15 public health recommendation documents, with zero to 923 citations per document (median = 63, IQR = 7.5-132). The evidence base underpinning public health recommendations did not systematically differ across jurisdictions. Of the 1700 citations included, the majority were journal articles (n = 1179). Across 1081 journal articles published between 1998-2018, 200 declared a conflict of interest, 288 contained no mention of conflicts of interest, and 593 declared none. Conflicts of interest were reported with tobacco (3%; n = 37 journal articles of 1081), e-cigarette (7%; n = 72), and pharmaceutical companies (12%; n = 127), with such conflicts present even in the most recent years. There were 53 influential citations, the most common study type was basic science research without human subjects (e.g. examination of aerosols and e-liquids) (n = 18) followed by systematic review (n = 10); with randomised control trial being least common (n = 4). Network analysis identified clusters of highly-cited articles with a higher prevalence of conflicts of interest., Conclusion: Public health bodies across different jurisdictions drew upon similar sources of evidence, despite articulating different policy approaches to e-cigarettes. The evidence drawn upon, including the most influential evidence, contained substantial conflicts of interest (including relationships with e-cigarette and tobacco industries). Processes to explicitly manage conflicts of interest arising from the underlying evidence base may be required when developing public health recommendations., Competing Interests: The authors have declared that no competing interests exist.

Background: Tobacco growing has been considered a mainstay of Mozambique's economy, but there is a dearth of analysis of the tobacco policy landscape in the country. Methods: Review of government and non-government documents and academic papers addressing Mozambique's tobacco-growing history, the changes in the political economy of tobacco, and health policies addressing tobacco use and prevention of noncommunicable diseases. Results: Despite its tobacco growing and exporting history, the contribution of tobacco to the economy has been in steady decline in the past two decades, including in the areas dedicated to growing. At the same time there has been an increase in multinational control of the tobacco economy. In parallel, Mozambique's commitment to addressing the growing burden of noncommunicable disease and accession to the Framework Convention on Tobacco Control indicate a potential for internal government tensions to balance immediate economic interests with long term health goals. Conclusions: With the decline in tobacco share of the overall economy, Mozambique may be well-positioned to explore alternative, sustainable livelihoods for farmers that grow tobacco, but it must overcome inter-sectoral barriers and advocate for a whole of government approach to address the health and economic impact of tobacco.

Introduction: Tobacco production continues to increase in low- and middle-income countries creating complications for tobacco control efforts. There is the need to understand and address the global tobacco leaf supply as a means of decreasing tobacco consumption and improving farmers livelihoods in line with Article 17 of the WHO Framework Convention on Tobacco Control. This study aims to understand the reasons why farmers grow tobacco and identify factors that influence these reasons., Methods: Primary survey data (N = 1770) collected in Kenya, Malawi, and Zambia in the 2013-2014 farming season. Data analysis uses both descriptive and multinomial logistical regression methods., Results: Majority of farmers started and are currently growing tobacco because they believed it was the only economically viable crop. Compared with Malawi, farmers in Kenya and Zambia have a 0.2 and 0.4 lower probability of growing tobacco, respectively because they perceive it as the only economically viable crop, but a 0.04 and 0.2 higher probability of growing tobacco, respectively because they believe it is highly lucrative. There are district/county differences in the reasons provided with some districts having a majority of the farmers citing the existence of a ready market or incentives from the tobacco industry. Statistically significant factors influencing these reasons are the educational level and age of the household head, land allocated to tobacco and debts., Conclusion: There is the need to address the unique features of each district to increase successful uptake of alternative livelihoods. One consistent finding is that farmers' perceived economic viability contributes to tobacco growing., Implications: This study finds that perceived economic viability of tobacco is the dominant factor in the decisions to grow tobacco by smallholder farmers in Malawi, Kenya, and Zambia. There is the need to more deeply understand what contributes to farmers' perceived viability of a crop. Understanding and addressing these factors may increase the successful uptake of alternative livelihoods to tobacco. Furthermore, this study demonstrates that a one-size fits all alternative livelihood intervention is less likely to be effective as each district has unique features affecting farmers' decisions on growing tobacco., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: A gradual reduction of cigarette nicotine content to nonaddictive levels has been proposed as an endgame strategy to accelerate declines in combustible tobacco smoking. We assessed manufacturer-reported nicotine yield in cigarettes sold in the United States from 2013 to 2016., Methods: We merged machine-measured nicotine yield in cigarette smoke and pack characteristics obtained from reports filed by tobacco manufacturers with the Federal Trade Commission for 2013-2016 with monthly Nielsen data on US cigarette sales. Manufacturer-reported, sales-weighted, average annual nicotine yield was assessed, as were nicotine yield sales trends by quartile: markedly low (0.10-0.60 mg/stick), low (0.61-0.80 mg/stick), moderate (0.81-0.90 mg/stick), and high (0.91-3.00 mg/stick). Trends in overall, menthol, and nonmenthol pack sales, by nicotine yield quartiles over the study period and by year, were determined by using Joinpoint regression., Results: During 2013-2016, average annual sales-weighted nicotine yield for all cigarettes increased from 0.903 mg/stick (95% CI, 0.882-0.925) in 2013 to 0.938 mg/stick (95% CI, 0.915-0.962) in 2016 (P < .05). For menthol cigarettes, yield increased from 0.943 mg/stick in 2013 (95% CI, 0.909-0.977) to 1.037 mg/stick in 2016 (95% CI, 0.993-1.081), increasing 0.2% each month (P < .05). Most pack sales occurred among high (41.5%) and low (30.7%) nicotine yield quartiles. Cigarette sales for the markedly low quartile decreased by an average of 0.4% each month during 2013-2016 (P < .05)., Conclusion: During 2013-2016, manufacturer-reported, sales-weighted nicotine yield in cigarettes increased, most notably for menthol cigarettes. Continued monitoring of nicotine yield and content in cigarettes can inform tobacco control strategies.

Objective: To examine associations between area-level characteristics (socioeconomic status, racial or ethnic characteristics, age, and any other characteristics that may be associated with vulnerability) and the prices of tobacco products and electronic nicotine delivery systems (ENDS)., Data Sources: We searched MEDLINE, EconLit and Scopus, unpublished and grey literature, hand-searched four specialty journals, examined references of relevant studies, and contacted key informants., Study Selection: We considered all studies that quantitatively examined area-level variations in the prices of tobacco products and ENDS. We included all studies that examined any area-level measures regardless of the geographic location, language or time of publication. At least two reviewers independently screened the articles. We identified 20 studies., Data Extraction: At least two reviewers independently extracted the characteristics, methods, and main results and assessed the quality of each included study., Data Synthesis: Overall, cigarette prices were found to be lower in lower socioeconomic status neighbourhoods, and in neighbourhoods with a higher percentage of youth, and Blacks or African Americans. We identified too few studies that examined price differences for cigarillos, chewing tobacco, roll-your-own, and ENDS to reach any conclusions., Conclusions: Our findings are in keeping with tobacco industry documents that detailed how manufacturers used race, class, and geography to target vulnerable populations and suggest that regulations that can limit industry price manipulation such as minimum, maximum, and uniform prices, and high specific excise taxes should be considered. More frequent and systematic monitoring of tobacco prices and ENDS is warranted., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: With a 264 million population and the second highest male smoking prevalence in the world, Indonesia hosted over 60 million smokers in 2018. However, the government still has not ratified the Framework Convention on Tobacco Control. In the meantime, tobacco import increases rapidly in Indonesia. These create a double, public health and economic burden for Indonesia's welfare., Objective: Our study analyzed the trend of tobacco import in five countries: Indonesia, Pakistan, Bangladesh, Zimbabwe, and Mozambique. Also, we analyze the tobacco control policies implemented in these countries and determine some lessons learn for Indonesia., Methods: We conducted quantitative analyses on tobacco production, consumption, export, and import during 1990-2016 in the five countries. Data were analyzed using simple ordinary least square regressions, correcting for time series autocorrelation. We also conducted a desk review on the tobacco control policies implemented in the five countries., Results: While local production decreased by almost 20% during 1990-2016, the proportion of tobacco imports out of domestic production quadrupled from 17 to 65%. Similarly, the ratio of tobacco imports to exports reversed from 0.7 (i.e., exports were higher) to 2.9 (i.e., import were 2.9 times higher than export) in 1990 and 2016, respectively. This condition is quite different from the other four respective countries in the observation where their tobacco export is higher than the import. From the tobacco control point of view, the four other countries have ratified the Framework Convention on Tobacco Control (FCTC)., Conclusion: The situation is unlikely for Indonesia to either reduce tobacco consumption or improve the local tobacco farmer's welfare, considering that the number of imports continued to increase. Emulating from the four countries, Indonesia must ratify the FCTC and implement stricter tobacco control policies to decrease tobacco consumption and import.

The 2012 Philippine Sin Tax Reform Law or Republic Act No. 10351 (RA10351) offers important lessons on tobacco taxation and tobacco control. In a span of five years, it increased the excise tax rate on cigarettes to as high as 1000% for low-priced brands. It is recognized by the international community not only because of the magnitude of the tobacco tax increase that it stipulated but also because of the challenging context within which it was achieved. This article presents the Philippine experience as a case study in pursuing bold reforms in tobacco taxation and tobacco control amidst strong opposition by the tobacco industry. It considers: 1) the key events and factors that led to successful reform of the Philippine tobacco tax system; 2) the impact of higher tobacco taxes on health and the economy; and 3) the emerging challenges in tobacco taxation in the Philippines., .

Background: China is the largest producer and consumer of tobacco products worldwide. While direct marketing and advertisement of tobacco products is restricted, indirect marketing still exists under the guise of sponsorship and corporate social responsibility (CSR). This case study is focused on tobacco industry-sponsored elementary schools in Chinese rural areas., Methods: Field visits were conducted in Yunnan province to interview students, teachers, school principals and parents to understand their perceptions of the tobacco industry and its sponsorship of schools. Interviews with tobacco control activists were conducted in Beijing to discuss national tobacco control efforts targeting tobacco industry sponsorship. Interview data were transcribed and coded, with key themes developed using thematic analysis., Results: While health consequences of smoking are generally known, attitudes towards the tobacco industry and its CSR activities remain positive among the general public. Educators and parents do not perceive any impacts on schoolchildren from exposure to 'pro-tobacco propaganda' created by the industry's CSR activities. Attitudes among tobacco control activists were drastically different, with consensus that CSR activities constitute indirect marketing attempts that should be banned., Conclusion: National tobacco control legislation banning all forms of indirect marketing including CSR is needed in order to protect the health of future generations., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

Objectives. To estimate the combined effect of California's Tobacco 21 law (enacted June 2016) and $2-per-pack cigarette excise tax increase (enacted April 2017) on cigarette prices and sales, compared with matched comparator states. Methods. We used synthetic control methods to compare cigarette prices and sales after the policies were enacted, relative to what we would have expected without the policy reforms. To estimate the counterfactual, we matched pre-reform covariate and outcome trends between California and control states to construct a "synthetic" California. Results. Compared with the synthetic control in 2018, cigarette prices in California were $1.89 higher ($7.86 vs $5.97; P  < .001), and cigarette sales were 16.6% lower (19.9 vs 16.6 packs per capita; P  < .001). This reduction in sales equates to 153.9 million fewer packs being sold between 2017 and 2018. Conclusions. California's new cigarette tax was largely passed on to consumers. The new cigarette tax, combined with the Tobacco 21 law, have contributed to a rapid and substantial reduction in cigarette consumption in California.

Background: Increasing tobacco taxes, and through them, prices, is an effective public health strategy to decrease tobacco use. The tobacco industry has developed multiple promotional strategies to undercut these effects; this study assessed promotions directed to wholesalers and retailers and manufacturer price changes that blunt the effects of tax and price increases., Methods: We reviewed tobacco industry documents and contemporaneous research literature dated 1987 to 2016 to identify the nature, extent, and effectiveness of tobacco industry promotions and price changes used after state-level tobacco tax increases., Results: Tobacco companies have created promotions to reduce the effectiveness of tobacco tax increases by encouraging established users to purchase tobacco in lower-tax jurisdictions and sometimes lowering manufacturer pricing to "undershift" smaller tax increases, so that tobacco prices increased by less than the amount of the tax., Conclusions: Policymakers should address industry efforts to undercut an effective public health intervention through regulating minimum prices, limiting tobacco industry promotions, and by enacting tax increases that are large, immediate, and result in price increases., Implications: Tobacco companies view excise tax increases on tobacco products as a critical business threat. To keep users from quitting or reducing tobacco use in response to tax increases, they have shifted manufacturer pricing and developed specific promotions that encourage customers to shop for lower-taxed products. Health authorities should address tobacco industry efforts to undercut the effects of taxes by regulating prices and promotions and passing large and immediate tax increases., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Background: In June 2019, Beverly Hills, California, became the first American city in the 21st century to pass an ordinance ending the sale of most tobacco products, including cigarettes, and it is unlikely to be the last. Knowledge of previous efforts to ban tobacco sales in the US, both successful and unsuccessful, may help inform tobacco control advocates' approach to future efforts., Methods: We retrieved and analyzed archival tobacco industry documents. We confirmed and supplemented information from the documents with news media coverage and publicly available state and local government materials, such as meeting minutes and staff reports, related to proposed bans., Results: We found 22 proposals to end the sale of cigarettes or tobacco products from 1969-2020 in the US. Proposals came from five states, twelve cities or towns, and one county. Most came from elected officials or boards of health, and were justified on public health grounds. In opposing tobacco sales bans, the tobacco industry employed no tactics or arguments that it did not also employ in campaigns against other tobacco control measures. Public health groups typically opposed sales ban proposals on the grounds that they were not evidence-based. This changed with Beverly Hills' 2019 proposal, with public health organizations supporting this and other California city proposals because of their likely positive health impacts. This support did not always translate into passage of local ordinances, as some city council members expressed reservations about the impact on small businesses., Conclusion: Tobacco control advocates are likely to encounter familiar tobacco industry tactics and arguments against tobacco sales ban proposals, and can rely on past experience and the results of a growing body of retail-related research to counter them. Considering how to overcome concerns about harming retailers will likely be vital if other jurisdictions are to succeed in ending tobacco sales., Competing Interests: I have read the journal's policy and the authors of this manuscript have the following competing interests: PAM: Personal financial interests: Since 2006, I have been a full-time faculty employee of the University of California, San Francisco. My salary is provided by funds from research grants. I have received honoraria from the U.S. Department of Justice (for serving as a tobacco industry documents consultant for United States of America vs. Philip Morris, et al.), and Cancer Research UK (for preparing a report on views of the idea of a tobacco “endgame”). I have participated in tobacco control advocacy. Organizational financial interests: Within the last 5 years I have received grant funding from the California Tobacco-Related Disease Research Program (research funds derived from the state tax on cigarettes), and have worked on projects funded by the National Cancer Institute and California Tobacco Control Program. Interests of related parties: None to declare. REM: Personal financial interests: Since 1997, I have been a full-time faculty employee of the University of California, San Francisco. My salary is provided by funds from the state of California and my research grants. I have received travel/accommodation expenses and consulting fees or honoraria from the U.S. Department of Justice (for serving as a tobacco industry documents consultant for United States of America vs. Philip Morris, et al.), World Health Organization (for serving on the Expert Panel on Tobacco Industry Interference with Tobacco Control), American Legacy Foundation (for serving on an award selection panel), Clearway Minnesota (for serving as a grant proposal reviewer), U.S. Centers for Disease Control (for consulting on a tobacco industry documents research project), NIH (for serving as a grant proposal reviewer) and Cancer Research UK (for preparing a report on views of the idea of a tobacco “endgame”). I own one share each of Philip Morris International, Reynolds American, and Altria stock for research and advocacy purposes and have participated in tobacco control advocacy. I receive an annual honorarium and reimbursement of travel/accommodation expenses from BMJ Publishing Group Ltd (for work as editor-in-chief of Tobacco Control). I have also received travel/accommodation expenses and honoraria for speaking to various public health groups. In addition, I have received funding for reviewing documents as a potential expert witness for plaintiffs’ legal cases involving tobacco industry activities. Organisational financial interests: Within the last 5 years I have received grant funding from the National Cancer Institute, National Institutes of Health, the California Tobacco-Related Disease Research Program (research funds derived from the state tax on cigarettes), and the California Tobacco Control Program. Non-financial interests: I have published or collaborated on research with more than 50 colleagues, postdoctoral fellows and students. I recuse myself from handling or reviewing papers submitted by these colleagues and others from my institution (UCSF). Interests of related parties: None to declare In 2019, both authors provided written informational resources at the request of Beverly Hills city staff and/or representatives and REM provided expert testimony at City Council or Health Commission meetings in Beverly Hills, Manhattan Beach, and Hermosa Beach. We confirm that nothing in those competing interest statements alters our adherence to PLOS ONE policies on sharing data and materials.

Background: Plain packaging and minimum pack size legislation for tobacco products was introduced in the UK in May 2016, with a 1-year sell-off period until May 2017, during which both fully branded and plain packs of various sizes were legally available. This study investigates trends in prices of roll-your-own tobacco (RYO) before, during and after implementation of this legislation, and compares trends with those observed in the cigarette market., Methods: We used Nielsen Scantrack data for the period from March 2013 to June 2018 to describe trends in UK inflation-adjusted prices and volumes of both RYO and cigarettes, and linear regression to estimate changes in prices associated with the introduction of plain packaging and the minimum pack sizes of 30 g RYO and 20 cigarettes., Results: In contrast to a downward trend in cigarette sales volumes, RYO volumes rose throughout the study period. By the time plain packs accounted for 75% or more of sales, the average price of products sold in equivalent pack sizes had increased, relative to average prices in the year before implementation and with adjustment for tax changes, from 34.9 to 38.8 pence per gram for RYO (mean difference 4.26, 95% CI 3.99 to 4.53 pence, 12% increase), and from 38.6 to 41.13 pence for cigarettes (mean difference 2.53, 95% CI 2.24 to 2.83 pence, 7% increase) per cigarette., Conclusions: New legislation resulted in higher prices for RYO and manufactured cigarettes. However, sales volumes of RYO continued to increase throughout the study period, perhaps because RYO remains a less expensive means of smoking tobacco., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

Background: In the UK, a ban on the open display of tobacco products at the point of sale (POS) was phased in between 2012 and 2015. We explored any impact of the ban on youth before, during and after implementation., Methods: A repeat cross-sectional in-home survey with young people aged 11-16 years old in the UK was conducted preban (2011, n=1373), mid-ban (2014, n=1205) and postban (2016, n=1213). The analysis focuses on the never-smokers in the sample (n=2953 in total). Preban, we quantified the associations of noticing cigarettes displayed at POS and cigarette brand awareness with smoking susceptibility. We measured any change in noticing cigarettes displayed at POS, cigarette brand awareness and smoking susceptibility between preban, mid-ban and postban. Postban, we assessed support for a display ban, perceived appeal of cigarettes and perceived acceptability of smoking as a result of closed displays., Results: Preban, noticing cigarettes displayed at POS (adjusted OR [AOR]=1.97, 95% CI 1.30 to 2.98) and higher brand awareness (AOR=1.15, 95% CI 1.03 to 1.29) were positively associated with smoking susceptibility. The mean number of brands recalled declined from 0.97 preban to 0.69 postban (p<0.001). Smoking susceptibility decreased from 28% preban to 23% mid-ban and 18% postban (p for trend <0.001). Postban, 90% of never-smokers supported the display ban and indicated that it made cigarettes seem unappealing (77%) and made smoking seem unacceptable (87%)., Conclusions: Both partial and full implementation of a display ban were followed by a reduction in smoking susceptibility among adolescents, which may be driven by decreases in brand awareness., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published by BMJ.)

The effectiveness of tax increase in reducing tobacco use depends on the extent to which the industry passes on the tax to consumers. Evidence suggests that tobacco industry may absorb or raise the price more than the tax increase depending on the price segment of tobacco products. In this paper, we examined the industry's pricing strategy by price segment of the cigarette market in Bangladesh by observing the deviation between the market retail prices (MRP) of cigarettes faced by consumers and government recommended retail prices (RRP) used as tax base in a four-tiered ad valorem tax structure. The RRPs by brands were collected from government sources. The MRPs by brands were collected by the International Tobacco Control Bangladesh Wave 3 Survey 2011-12 and Wave 4 Survey 2014-15. Applying linear regression to the deviation of MRP from RRP by price tiers, we found MRPs were higher than RRPs for higher-price brands allowing extra profit margin from the high end while lowering the relative price of and expanding demand for cheaper brands. Bangladesh cigarette industry adopted a differential pricing strategy that undermined the intended effect of tax policy change in reducing cigarette consumption and improving public health. This pricing strategy was supported by the tiered excise tax structure which should be replaced with a uniform specific excise system. In the face of growing cigarette affordability, it is crucial that the specific tax be increased routinely by an amount that induces cigarette price increases large enough to make cigarettes less affordable over time., Competing Interests: Declaration of Competing Interest Geoffrey T Fong has served as an expert witness on behalf of governments in litigation involving the tobacco industry., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Competing Interests: Competing interests: None declared.

Background: Standardised packaging for factory made (FM) and roll your own (RYO) tobacco was fully implemented in the UK in May 2017. Around the same time, several changes to the tax system were applied (a Minimum Excise Tax (MET) for FM products and tax increases weighted towards RYO products). The tobacco industry claims that standardised packaging will lower prices (a disincentive for quitting) by commoditising the product, yet had itself taken advantage of the previous tax regime to achieve large profits from premium brands while also keeping some products' prices relatively low. Here we evaluate the impact of standardised packaging, the MET and the RYO focussed tax changes on price and industry profitability., Methods and Findings: Nielsen electronic point of sale (EPOS) data (May 2015 to April 2018) were used to calculate real (inflation adjusted) monthly price per stick overall, by cigarette type (FM and RYO) and by seven market segments. Trend estimation, using additive mixed models, assessed weighted average price (weighted by volume of sales) and tobacco industry net revenue changes. The beginning and end of the data series were compared in terms of: (a) average monthly price growth, (b) average monthly net revenue growth, and (c) undershifting and overshifting patterns after tax changes. FM and RYO real prices changed little over the 3-year period-overall prices rose by about 1p per stick. There was no evidence of commoditisation with prices of all FM segments (but not RYO) rising faster after the implementation of standardised packaging than immediately beforehand. The prices of the cheapest FM brands rose with the implementation of the MET. RYO price increases did not close the gap to FM pricing levels despite RYO focussed tax increases. Tax changes following the implementation of standardised packaging and the MET were more widely and quickly passed on to smokers in the form of higher prices than the tax change pre-implementation. The main limitations are first that because we do not know the exact mechanism by which Nielsen scales up sample data to provide UK estimates, we could only use data for a set three year period during which the same adjustments are made. Second, the tax and standardised packaging events were sometimes too close in time to separate their consequences statistically. Third, tobacco prices may also be affected by external factors such as changes in smokers' disposable income or availability of electronic nicotine delivery systems., Conclusions: There was no long-term lowering of tobacco prices after the implementation of standardised packaging as predicted by the industry. The introduction of the MET was successful in increasing the price of the cheapest FM cigarettes and narrowing the price gap between FM brands. The RYO tax increases were, however, insufficient to narrow the price gap between RYO and FM. Overall, undershifting became less extensive indicating that tobacco industry manipulation of the tax system which had previously kept cheap products available had declined. This suggests that standardised packaging and a MET will likely contribute to further declines in UK tobacco use., Competing Interests: The authors have declared that no competing interests exist.

Electronic nicotine delivery systems (ENDS) have been widely referred to as "safer," "healthier," and more "effective" smoking cessation aids, but little evidence supports such claims. New concerns about pulmonary injuries associated with ENDS suggest reasons for concern about these products' health risks and potential for nicotine addiction. Nevertheless, multinational tobacco companies heavily market ENDS to retain customers with nicotine addiction, and global progress against tobacco use might slow as a result. The tobacco industry has managed to divide the tobacco control community by offering hope of harm reduction without actual evidence of ENDS' effectiveness or long-term safety. Low- and middle-income countries need this evidence to assess ENDS' value in mitigating tobacco use., (© 2020 American Medical Association. All Rights Reserved.)

Recent research documents the globalization strategy of the Chinese tobacco industry since the early 2000s and risks posed to global health. There are limited analyses to date of how this strategy is playing out in specific countries. This paper analyses the expansion of the China National Tobacco Company (CNTC) in Zimbabwe, the largest producer of tobacco leaf globally, since the early 2000s, through document analysis . It applies a political economy framework-identifying material, ideational and institutional forces-to demonstrate how CNTC capitalized on the unique features of China-Africa development cooperation to pursue its expansion goals, which threaten global public health efforts to reduce tobacco supply. In a context of economic crisis, CNTC offered substantial resources to revive Zimbabwe's tobacco industry, promoting a shift to contract farming of its preferred leaf. It benefited from perceptions of state friendship, which it fostered through corporate social responsibility initiatives. Through ties with the Chinese embassy and economic actors, CNTC embedded its interests in development institutions. While contributing to improved foreign exchange earnings and some farmers' livelihoods, CNTC's expansion has increased the dependence on China as a development partner and tobacco as a crop, benefitting its "go global" strategy, while contributing to public health and environmental challenges locally and globally. The expansion of the Chinese tobacco industry interests in Zimbabwe offers lessons for global tobacco control and efforts to support alternatives to tobacco growing., Competing Interests: The authors declare no conflict of interest.

Externalization theory assumes that risks and costs are systematically displaced from high-income countries (HICs) to low- and middle-income countries (LMICs). We review how and why transnational tobacco companies (TTCs) influence the local circumstances of LMICs that trigger externalization mechanisms, leading to tobacco-attributable risk outcomes. Our realist synthesis of scientific evidence and gray literature identifies externalization mechanisms with risk outcomes at the level of health policy, smoking trends, and tobacco production. The results reveal the mediating role of local and global third parties and intermediaries. Externalization mechanisms produce systematic tobacco-attributable inequalities between places located in HICs and those located in LMICs., Competing Interests: Declaration of competing interest The authors declare that they have no competing interests. None of the authors have received funding from the (tobacco) industry., (Copyright © 2019 Elsevier Ltd. All rights reserved.)