The impact of tobacco tax cuts on smoking initiation among Canadian young adults

Impact of cigarette price and tobacco control policies on youth smoking experimentation in Albania

BACKGROUND

Albania has one of the highest smoking prevalence in Europe especially among the youth. There is a lack of evidence in Albania, as well as in most of Eastern Europe and middle-income countries, regarding the effect of price on smoking experimentation.

OBJECTIVE

The study aims to assess the effect of price and tobacco control policies on youth smoking experimentation in Albania.

METHODS

We used microdata from the Global Youth Tobacco Survey in Albania for 2004, 2009, 2015 and 2020. We constructed a pseudo-longitudinal dataset and estimated a split-population model to assess the hazard of smoking experimentation.

RESULTS

Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females (p<0.001). Being male increases the odds for smoking experimentation by more than 50% as compared with females (p<0.001), whereas females appear to be more price sensitive. Peer and parent smoking are also important determinants for smoking experimentation. Introducing penalties for smokers and legal entities violating smoke-free policies implemented in 2014 is also associated with a lower hazard of smoking experimentation.

CONCLUSION

Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females. A combination of increasing taxes and strengthening the rule of law to control tobacco use in public spaces, in addition to public awareness campaigns targeting both youth and smoking parents, could help to significantly reduce the probability of smoking experimentation.

Price and Income Elasticities of Cigarette Smoking Demand in Bangladesh: Evidence from Urban Adolescents and Young Adults

INTRODUCTION

Understanding the elasticities of cigarette smoking demand among the youth could help improve the effectiveness of tobacco control interventions. The objective of this study is to measure the price and income elasticities of cigarette smoking demand among urban Bangladeshi male adolescents and young adults aged 10-24 years.

METHOD

Using data from a cross-sectional survey conducted in seven urban districts of Bangladesh, we applied probit and ordinary least square (OLS) models to examine the effect of price and income on smoking participation (decision to smoke) and intensity (number of cigarettes smoked).

RESULTS

Our results showed that price was not significantly associated with the decision to smoke, while income was a significant determinant of smoking participation. Both price and income determined the smoking intensity. The positive income elasticity (0.39) indicated that participants with greater access to money were more likely to participate in cigarette smoking and smoked more cigarettes. Negative price elasticity (-0.62) implied that increasing prices could lead to a reduction in smoking intensity among adolescents and young adults in urban Bangladesh.

CONCLUSION

The inelastic price demand for cigarette smoking suggests that there is scope for increasing tax on cigarettes without compromising the tax revenue.

IMPLICATIONS

This is the first study to investigate price and income elasticities among urban adolescents and young adults in Bangladesh. The study found no evidence that increasing the price of cigarettes discourages smoking participation but did show that increasing the price reduces the intensity of smoking among existing smokers. The results also suggest that economic measures such as taxation that increase the price of cigarettes could be a useful policy tool to limit smoking intensity without compromising government tax revenue.

Quantile regression of tobacco tax pass-through in the UK 2013-2019. How have manufacturers passed through tax changes for different tobacco products?

BACKGROUND

The effectiveness of tax increases relies heavily on the tobacco industry passing on such increases to smokers (also referred to as 'pass-through'). Previous research has found heterogeneous levels of tax pass-through across the market segments of tobacco products available to smokers. This study uses retail sales data to assess the extent to which recent tax changes have been passed on to smokers and whether this varies across the price distribution.

METHODS

We use panel data quantile regression analysis on Nielsen commercial data of tobacco price and sales in the UK from January 2013 to March 2019 combined with official UK tax rates and inflation to calculate the rate of tax pass-through for factory made (FM) cigarettes and roll your own (RYO) tobacco.

RESULTS

Following increases in the specific tax payable on tobacco, we find evidence of overshifting across the price distribution for both FM and RYO. The rate of the overshift in tax increased the more expensive the products were. This was consistent for FM and RYO. Additionally, our findings suggest that the introduction of standardised packaging was not followed by changes in how the tobacco industry responded to tax increases.

CONCLUSIONS

Following the repeated introduction of increases in specific tobacco tax as well as standardised packaging, we show that the tobacco industry applies techniques to keep the cheapest tobacco cheaper relative to the more expensive products when passing on tax increases to smokers.

Tobacco Endgame Simulation Modelling: Assessing the Impact of Policy Changes on Smoking Prevalence in 2035

Smoking causes substantial amount of mortality and morbidity. This article presents the findings from simulation models that projected the impact of five potential Tobacco Endgame strategies on smoking prevalence in Ontario by 2035 and expected impact of smoking prevalence “less than 5 by 35” on tax revenue. We used Ontario SimSmoke simulation for modelling the expected impact of four strategies: plain packaging, free cessation services, decreasing the number of tobacco outlets, and increasing tobacco taxes. Separate models were used to project the impact of increasing the minimum age to legally purchase tobacco to 21 years on smoking prevalence and impact of price and tax increase to achieve “less than 5 by 35” on taxation revenue. The combined effect of four strategies in Ontario SimSmoke Model are expected to reduce smoking prevalence by 8.5% in 2035. Increasing tobacco taxes had the greatest independent predicted decrease in smoking prevalence (2.8%) followed by raised minimum age for legal purchase to 21 years (2.4%), decreasing tobacco outlets (1.5%), free cessation services (0.7%), and plain packaging (0.6%). Increasing tobacco excise tax and prices are projected to have minimal impact on taxation revenue, with a decrease from 1.5 billion to 1.2 billion annual tax receipts.

The effects of cigarette price and the amount of pocket money on youth smoking initiation and intensity in Canada

OBJECTIVES

To investigate the price and income elasticities of adolescent smoking initiation and intensity to determine the extent to which increased pocket money leads to greater smoking among youth, and whether higher taxes can mitigate this effect.

METHODS

We used the 2012/2013 Canadian Youth Smoking Survey including students in grades 7-12. The multivariable logistic regression was used to examine the probability of smoking initiation, and a linear regression to examine the smoking intensity determined by province-level prices of cigarettes, pocket money, and a vector of individual characteristics, including age, sex, race, and school-related and psychosocial factors.

RESULTS

Of respondents, 28.8% have tried cigarette smoking. More than 90% of these initiated smoking between age 9 and 17. Male smokers consumed a higher average number of whole cigarettes daily than did females. The price elasticity of smoking initiation and intensity for youth in the full sample were - 1.13 and - 1.02, respectively, which means that a 10% increase in price leads to an 11.3% reduction in initiation and a 10.2% reduction in intensity. The income elasticity of smoking initiation and intensity for youth in the full sample were 0.07 and 0.06, respectively, which means that a 10% increase in income leads to a 0.7% increase in initiation and a 0.6% increase in intensity.

CONCLUSION

Economic measures such as taxation that raise the price of cigarettes may be a useful policy tool to limit smoking initiation and intensity.

Banning tobacco price promotions, smoking-related beliefs and behaviour: findings from the International Tobacco Control Four Country (ITC 4C) Survey

BACKGROUND

Ecological models emphasise multilevel influences on health behaviours. While studies show that exposure to price promotions is associated with smoking behaviour and its antecedents, less is known about whether these associations differ by macro-level factors such as national price promotion policies.

METHODS

Current and former smokers (N=4698) from the International Tobacco Control Policy Evaluation Project four-country cohort were included in weighted multivariate logistic regression models to examine individual-level associations between exposure to price promotions at waves 7 and 8 (conducted in 2008-2009 and 2010-2011) and beliefs (social and injunctive norms, functional value of smoking, misconceptions around smoking and beliefs of tobacco industry and its regulations) and behaviour at wave 8, stratified by whether countries allow (Australia and USA) or ban (Canada and UK) price promotions.

RESULTS

Associations between exposure to price promotions and smoking-related beliefs and behaviour differed by national price promotion policies. In countries that allow price promotions, participants repeatedly exposed to price promotions at waves 7 and 8 were more likely to associate functional values to smoking (ie, calms down when stressed (adjusted OR (AOR) 1.83) and to be current smokers at wave 8 (AOR 1.94). In countries that ban price promotions, participants repeatedly exposed to price promotions were less likely to hold misconceptions around smoking (ie, harsher smoke is more dangerous).

CONCLUSIONS

Differential associations emerged between exposure to price promotions, smoking-related beliefs and behaviour across countries with and without a price promotions ban. Adopting price promotion bans could ameliorate the associations between exposure to price promotions and smoking beliefs and behaviours.

Trends in point-of-sale tobacco marketing around college campuses: Opportunities for enhanced tobacco control efforts

OBJECTIVE

Colleges have implemented policies to limit tobacco use on-campus; however, the off-campus environment is often overlooked in tobacco control efforts. We assessed availability, marketing, and promotion of cigarettes, snus, and traditional smokeless tobacco (SLT) in a sample of communities surrounding 11 college campuses in North Carolina and Virginia.

PARTICIPANTS

Between January-March of 2011, 2012 and 2013, 481 tobacco-selling retailers, including convenience stores, pharmacies and supermarkets, located near campuses were assessed.

METHODS

Trained observers completed annual point-of-sale assessments.

RESULTS

The percentage of stores selling (81.4% to 58.6%; p < .0001) and advertising snus (80.1% to 53.11%; p < .0001) significantly decreased over time. Convenience stores increased promotions of cigarettes (65.4% to 72.8%; p = 0.04) and SLT (3.1% to 23.3%; p = 0.02).

CONCLUSIONS

Off-campus environments have abundant tobacco availability and marketing. Colleges should collaborate with state and local tobacco control advocates to address tobacco promotion near campuses to potentially decrease product appeal and access among young adults.

Levels and trends in cigarette contraband in Canada

Background

There is overwhelming evidence that increases in tobacco taxes reduce tobacco use, save lives and increase government tax revenue. High taxes, however, create an incentive to devise ways to avoid or evade tobacco taxes through contraband tobacco. The associated consequences are significant and call for an accurate measurement of contraband's magnitude. However, its illegal nature makes the levels and trends in contraband intrinsically difficult to measure accurately.

Objective

To examine levels and trends in cigarette contraband in Canada.

Methods

We employed 2 approaches: first, we contrasted estimates of tax-paid cigarettes sales with consumption estimates based on survey data; second, we used data from several individual-level surveys that examined smokers' purchasing and use behaviours. We placed a particular emphasis on the provinces of Québec and Ontario because existing research suggests that cigarette contraband levels are far higher than in any other province.

Results

The estimates presented show a clear upward trend from the early 2000s in cigarette contraband in Québec and Ontario followed by, on the whole, a decreasing trend from about 2007 to 2009. None of the data presented provide support to the narrative that cigarette contraband has been increasing in recent years. Of note are Québec estimates which suggest relatively low levels of cigarette contraband since 2010, at levels no higher than in the early 2000s.

Conclusions

The data presented suggest that policies to tackle cigarette contraband introduced from the mid-2000s to late 2000s, at both federal and provincial levels, may have dampened the demand for contraband cigarettes.

Determinants of regular smoking onset in South Africa using duration analysis

OBJECTIVES

South Africa has achieved significant success with its tobacco control policy. Between 1994 and 2012, the real price of cigarettes increased by 229%, while regular smoking prevalence decreased from about 31% to 18.2%.

METHODS

Cigarette prices and socioeconomic variables are used to examine the determinants of regular smoking onset. We apply duration analysis techniques to the National Income Dynamics Study, a nationally representative survey of South Africa.

RESULTS

We find that an increase in cigarette prices significantly reduces regular smoking initiation among males, but not among females. Regular smoking among parents is positively correlated with smoking initiation among children. Children with more educated parents are less likely to initiate regular smoking than those with less educated parents. Africans initiate later and at lower rates than other race groups.

CONCLUSIONS

As the tobacco epidemic is shifting towards low-income and middle-income countries, there is an increasing urgency to perform studies in these countries to influence policy. Higher cigarette excise taxes, which lead to higher retail prices, reduce smoking prevalence by encouraging smokers to quit and by discouraging young people from starting smoking.

Changes in Cigarette Smoking Behavior Among US Young Workers From 2005 to 2010: The Role of Occupation

INTRODUCTION

Young adult workers (18-24 years) in the United States have been identified as a high-risk group for smoking. This study compares changes in smoking behavior by occupational class among this group between 2005 and 2010.

METHODS

Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. All respondents 18-24 years who reported that they were employed during the two surveys were selected (n = 1880 in 2005; and n = 1531 in 2010). Weighted percentages and 95% confidence interval were reported. Logistic regression analyses were performed to compare smoking behavior between occupational groups (white-collar, blue-collar, and service) and between years (2005-2010), and to examine correlates of smoking, successful quit attempt, and heavy smoking.

RESULTS

Smoking prevalence and daily smoking declined in 2010 in white-collar. Smoking prevalence and intensity decreased while age of smoking initiation increased in blue-collar workers. Young workers were more likely to smoke in 2005 than 2010. Service and blue-collar workers were more likely to smoke than white-collar workers. Older young adults, whites, individuals with a high school/or less education, those without health insurance were more likely to smoke. White workers and individuals with a high school/or less education were more likely to be heavy smokers.

CONCLUSIONS

White-collar workers have benefited the most from tobacco control efforts. Although improvements were seen in smoking behavior among blue-collar workers, smoking prevalence remained the highest in this group. Smoking behavior among service workers did not change. Young service workers and blue-collar are priority populations for workplace tobacco control efforts.

IMPLICATIONS

The current study examines changes in smoking behavior among young adult workers (18-24 years) by occupational class (white-collar, blue-collar, and service workers) between 2005 and 2010. Data were pooled from the Tobacco Supplement in the 2005 and 2010 National Health Interview Survey. Smoking prevalence and daily smoking declined significantly in white-collar workers. No change in smoking behavior was observed among service workers. Positive changes in smoking behavior were observed among blue-collar workers, but smoking prevalence remained the highest in this group. Blue-collar and service workers are priority groups for future workplace tobacco control efforts.

Temporal trends in social disparities in maternal smoking and breastfeeding in Canada, 1992-2008

A steady decrease in maternal smoking during pregnancy and a steady increase in breastfeeding rates have been observed in Canada in the past two decades. However, the extent to which all socioeconomic classes have benefited from this progress is unknown. Therefore, this study was undertaken to determine: (1) whether progress achieved benefited the entire population or was limited to specific strata; and (2) whether disparities among strata decreased, stayed the same, or increased over time. We used data from the National Longitudinal Survey of Children and Youth, which enrolled children aged 0-3 years between 1994 and 2008. Data collected at entry was analyzed in a cross-sectional manner. Between birth years 1992-1996 and 2005-2008, smoking during pregnancy decreased from 11.5 % (95 % CI 10.0-13.0 %) to 5.2 % (95 % CI 4.1-6.3 %) among mothers with a college or university degree and from 43.0 % (95 % CI 38.8-47.2 %) to 38.6 % (95 % CI 32.9-44.2 %) among those with less than secondary education. During the same period, the rate of breastfeeding initiation increased from 83.8 % (95 % CI 81.9-85.6 %) to 91.5 % (95 % CI 90.2-92.8 %) among mothers with a college or university degree and from 63.1 % (95 % CI 58.9-67.4 %) to 74.7 % (95 % CI 69.8-79.7 %) among those with less than secondary education. The risks of smoking and of not breastfeeding remained significantly higher in the least educated category than in the most educated throughout the study period, and these associations remained statistically significant after controlling for maternal age. Gaps between the least and the most educated mothers narrowed for breastfeeding but widened for smoking during pregnancy.

Unemployment and substance use problems among young adults: Does childhood low socioeconomic status exacerbate the effect?

The current study tested whether unemployment predicted young adults' heavy episodic drinking, cigarette smoking, and cannabis use after taking into account individual development in substance use. Furthermore, building on the life course perspective, this study examined whether the link between unemployment and substance use among young adults differed for those who experienced low childhood SES compared to those who did not. Data for the present study came from the Seattle Social Development Project (SSDP), a panel study examining a broad range of developmental outcomes from ages 10 to 33. A life history calendar (LHC) was administered to assess substance use and unemployment status during young adulthood. Covariates included baseline symptoms of psychopathology, baseline substance use, gender, ethnicity, and adult educational attainment. Results suggest that unemployment is associated with young adults' heavy episodic drinking and possibly cigarette use, but not cannabis use. Moreover, for all three substances, the detrimental impact of unemployment on substance use seems to be exacerbated among young adults who spent their childhood and adolescence in a lower SES household. Public health efforts that provide other viable and affordable options to cope with unemployment among young adults from low SES backgrounds are needed to address this disproportionate concentration of adverse impacts of unemployment on behavioral health.

The relation between tobacco taxes and youth and young adult smoking: what happened following the 2009 U.S. federal tax increase on cigarettes?

BACKGROUND

On April 1, 2009, the federal government raised cigarette taxes from $0.39 to $1.01 per pack. This study examines the impact of this increase on a range of smoking behaviors among youth aged 12 to 17 and young adults aged 18 to 25.

METHODS

Data from the 2002-2011 National Survey on Drug Use and Health (NSDUH) were used to estimate the impact of the tax increase on five smoking outcomes: (1) past year smoking initiation, (2) past-month smoking, (3) past year smoking cessation, (4) number of days cigarettes were smoked during the past month, and (5) average number of cigarettes smoked per day. Each model included individual and state-level covariates and other tobacco control policies that coincided with the tax increase. We examined the impact overall and by race and gender.

RESULTS

The odds of smoking initiation decreased for youth after the tax increase (odds ratio (OR)=0.83, p<0.0001). The odds of past-month smoking also decreased (youth: OR=0.83, p<0.0001; young adults: OR=0.92, p<0.0001), but the odds of smoking cessation remained unchanged. Current smokers smoked on fewer days (youth: coefficient=-0.97, p=0.0001; young adults: coefficient=-0.84, p<0.0001) and smoked fewer cigarettes per day after the tax increase (youth: coefficient=-1.02, p=0.0011; young adults: coefficient=-0.92, p<0.0001).

CONCLUSIONS

The 2009 federal cigarette tax increase was associated with a substantial reduction in smoking among youths and young adults. The impact of the tax increase varied across male, female, white and black subpopulations.

The impact of taxation reduction on smoking in youth between 1990 and 1999: results from a reconstructed cohort analysis of the Canadian Community Health Surveys

BACKGROUND

Increases in taxation can contribute to smoking control. In the early 1990's, tobacco smuggling rates in Canada increased dramatically. Governments responded with a substantial reduction in taxes on tobacco products. This study examines the impact of these tax changes on smoking in youth in Canada.

METHODS

Data on smoking from three consecutive cycles of the Canadian Community Health Surveys were combined and analyzed using a reconstructed cohort approach. Age, sex and calendar year specific rates of smoking experimentation and the onset of daily smoking were estimated for youth. Estimates apply to the entire Canadian population.

RESULTS

There was a strong increase in smoking in youth in the years following the reduction in tobacco taxes. The increase was stronger in women. The rates returned to pre-1990 rates by about 2002. The number of excess daily smokers for people born between 1977 and 1985 that can be linked to the taxation reduction is about 190,000.

INTERPRETATION

There is strong evidence that reduction of tobacco taxes to combat smuggling had an adverse impact on smoking rates in youth.

The impact of tobacco prices on smoking onset in Vietnam: duration analyses of retrospective data

The benefits of preventing smoking onset are well known, and even just delaying smoking onset conveys benefits. Tobacco control policies are of critical importance to low-income countries with high smoking rates such as Vietnam where smoking prevalence is greater than 55 % in young men between the ages of 25 and 45. Using a survey of teens and young adults, I conducted duration analyses to explore the impact of tobacco price on smoking onset. The results suggest that tobacco prices in Vietnam have a statistically significant and fairly substantial effect on the onset of smoking. Increases in average tobacco prices, measured by an index of tobacco prices and by the prices of two popular brands, are found to delay smoking onset. Of particular interest is the finding that Vietnamese youth are more sensitive to changes in prices of a popular international brand that has had favourable tax treatment since the late 1990s.

Promotion of healthy eating through public policy: a controlled experiment

BACKGROUND

To induce consumers to purchase healthier foods and beverages, some policymakers have suggested special taxes or labels on unhealthy products. The potential of such policies is unknown.

PURPOSE

In a controlled field experiment, researchers tested whether consumers were more likely to purchase healthy products under such policies.

METHODS

From October to December 2011, researchers opened a store at a large hospital that sold a variety of healthier and less-healthy foods and beverages. Purchases (N=3680) were analyzed under five conditions: a baseline with no special labeling or taxation, a 30% tax, highlighting the phrase "less healthy" on the price tag, and combinations of taxation and labeling. Purchases were analyzed in January-July 2012, at the single-item and transaction levels.

RESULTS

There was no significant difference between the various taxation conditions. Consumers were 11 percentage points more likely to purchase a healthier item under a 30% tax (95% CI=7%, 16%, p<0.001) and 6 percentage points more likely under labeling (95% CI=0%, 12%, p=0.04). By product type, consumers switched away from the purchase of less-healthy food under taxation (9 percentage point decrease, p<0.001) and into healthier beverages (6 percentage point increase, p=0.001); there were no effects for labeling. Conditions were associated with the purchase of 11-14 fewer calories (9%-11% in relative terms) and 2 fewer grams of sugar. Results remained significant controlling for all items purchased in a single transaction.

CONCLUSIONS

Taxation may induce consumers to purchase healthier foods and beverages. However, it is unclear whether the 15%-20% tax rates proposed in public policy discussions would be more effective than labeling products as less healthy.

A history of ashes: an 80 year comparative portrait of smoking initiation in American Indians and Non-Hispanic whites--the Strong Heart Study

The consequences of starting smoking by age 18 are significant. Early smoking initiation is associated with higher tobacco dependence, increased difficulty in smoking cessation and more negative health outcomes. The purpose of this study is to examine how closely smoking initiation in a well-defined population of American Indians (AI) resembles a group of Non-Hispanic white (NHW) populations born over an 80 year period. We obtained data on age of smoking initiation among 7,073 AIs who were members of 13 tribes in Arizona, Oklahoma and North and South Dakota from the 1988 Strong Heart Study (SHS) and the 2001 Strong Heart Family Study (SHFS) and 19,747 NHW participants in the 2003 National Health Interview Survey. The participants were born as early as 1904 and as late as 1985. We classified participants according to birth cohort by decade, sex, and for AIs, according to location. We estimated the cumulative incidence of smoking initiation by age 18 in each sex and birth cohort group in both AIs and NHWs and used Cox regression to estimate hazard ratios for the association of birth cohort, sex and region with the age at smoking initiation. We found that the cumulative incidence of smoking initiation by age 18 was higher in males than females in all SHS regions and in NHWs (p < 0.001). Our results show regional variation of age of initiation significant in the SHS (p < 0.001). Our data showed that not all AIs (in this sample) showed similar trends toward increased earlier smoking. For instance, Oklahoma SHS male participants born in the 1980s initiated smoking before age 18 less often than those born before 1920 by a ratio of 0.7. The results showed significant variation in age of initiation across sex, birth cohort, and location. Our preliminary analyses suggest that AI smoking trends are not uniform across region or gender but are likely shaped by local context. If tobacco prevention and control programs depend in part on addressing the origin of AI smoking it may be helpful to increase the awareness in regional differences.

Contraband tobacco on post-secondary campuses in Ontario, Canada: analysis of discarded cigarette butts

Background

No studies to date have assessed young adults’ use of First Nations/Native tobacco, a common form of contraband tobacco in Canada. This study examined the proportion of First Nations/Native cigarette butts discarded on post-secondary campuses in the province of Ontario, and potential differences between colleges and universities and across geographical regions.

Methods

In 2009, discarded cigarette butts were collected from high-traffic smoking locations at 12 universities and 13 colleges purposively selected to represent a variety of institutions from all 7 health service regions across Ontario. Cigarette butts were identified as First Nations/Native tobacco if they were: known First Nations/Native brands; had names not matching domestic and international legally-manufactured cigarettes; had no visible branding or logos.

Results

Of 36,355 butts collected, 14% (95% CI = 9.75–19.04) were First Nations/Native. Use of this tobacco was apparent on all campuses, accounting for as little as 2% to as much as 39% of cigarette consumption at a particular school. Proportions of First Nations/Native butts were not significantly higher on colleges (M = 17%) than universities (M = 12%), but were significantly higher in the North region.

Conclusions

The presence of cheap First Nations/Native (contraband) tobacco on post-secondary campuses suggests the need for regulation and public education strategies aimed to reduce its use. Strategies should account for regional variations, and convey messages that resonate with young adults. Care must be taken to present fair messages about First Nations/Native tobacco, and avoid positioning regulated tobacco as a healthier option than contraband.

The impact of tobacco prices on smoking onset: a methodological review

The benefits of preventing smoking onset are well known. Existing reviews clearly demonstrate that increasing the prices of tobacco products reduces smoking prevalence and cigarette consumption. However, only a small number of studies included in existing reviews have examined smoking onset (the transition between never smoking and smoking). Moreover, existing reviews provide limited quality assessment of the data and methods utilised. This paper systematically searches for and critically reviews studies that examine the impact of tobacco prices or taxes on smoking onset. Most studies reviewed have important methodological limitations, including recall bias; a general failure to apply diagnostic tests, to discuss the choice of estimators and distributional assumptions and to conduct sensitivity analysis; and a reliance on empirical approaches that are methodologically weak. On the whole, existing studies do not provide strong evidence that tobacco prices or taxes affect smoking onset.

Framing Nicotine Addiction as a "Disease of the Brain": Social and Ethical Consequences

OBJECTIVES

In this article, we seek to better understand how a genomic vision of addiction may influence drug prevention and treatment. Though social influences on substance use and abuse (e.g., peer and family influence, socioeconomic status) are well documented, biomedical intervention is becoming increasingly technoscientific in nature. We wish to elucidate how emphasizing biological influences on substance use may lead to a vision of addiction as a phenomenon isolated within our bodies and neurochemistry, not lived daily within a complex social web of relationships and a particular political economy, including the tobacco industry, which aggressively markets products known to cause harm.

METHODS

We explore the emerging view of addiction as a "disease of the brain" in open-ended interviews with 86 stakeholders from the fields of nicotine research and tobacco control. Interview data were analyzed using standard qualitative techniques.

RESULTS

Most stakeholders hold a medicalized view of addiction. Though environmental variables are understood to be a primary cause of smoking initiation, the speed and strength with which addiction occurs is understood to be a largely biological process. Though stakeholders believe that an increased focus on addiction as a disease of the brain is not likely to lead to widespread unrealistic expectations for cessation therapies, they remain concerned that it may reinforce teenagers' expectations that quitting is not difficult. Finally, stakeholder responses indicate that genetic and neuroscientific research is unlikely to increase or decrease stigmatization, but will be used by interest groups to buttress their existing views of the stigma associated with smoking.

CONCLUSION

We argue that the main potential harms of focusing on biological etiology stem from a concept of addiction that is disassociated from social context. Focusing on genetic testing and brain scans may lead one to overemphasize pharmaceutical "magic bullet cures" and underemphasize, and underfund, more traditional therapies and public health prevention strategies that have proven to be effective. Genetic research on addiction may fundamentally change our conception of deviance and our identities, and may thus transform our susceptibility to substance use into something isolated in our biology, not embedded in a biosocial context.

Smokeless and flavored tobacco products in the U.S.: 2009 Styles survey results

BACKGROUND

A number of noncigarette tobacco products, including some novel products, recently have been marketed by the tobacco industry, which raises concerns from tobacco control authorities.

PURPOSE

This study aimed to assess current popularity of several noncigarette tobacco products in the U.S.

METHODS

In 2009, a total of 10,587 adults completed a consumer mail-in survey (ConsumerStyles). Based on survey results, the weighted percentages of adults who heard and tried snus, dissolvable tobacco products, flavored little cigars, and flavored cigarettes were computed in 2010. A subset of this sample (n=4556) completed the HealthStyles survey, which included items about health perceptions of these products and use in the past 30 days.

RESULTS

The percentage of U.S. adults in the sample who were aware of these products ranged from 10.4% (dissolvable tobacco) to 44.6% (flavored little cigars). One third of adults who had heard of flavored little cigars tried them and 10.1% had used them in the past 30 days; among those who had heard of them, 27.4% tried flavored cigarettes and 12.6% tried snus. In general, young adults, men, and smokers were most likely to have heard of each product. At least one third of adults were uncertain if these products were as harmful as cigarettes (range=37.3% [snus] to 50.3% [dissolvable tobacco]).

CONCLUSIONS

The awareness of these tobacco products in this sample varied. Groups with a higher prevalence of smoking and tobacco use (e.g., men, people with low levels of education) may be a target audience for marketing and promotions. As availability of products change, continued surveillance is warranted in the U.S.

Prevalence and risk indicators of smoking among on-reserve First Nations youth

OBJECTIVE

To determine the current prevalence of smoking among First Nations youth living on reserve within the Saskatoon Tribal Council, and to determine the independent risk indicators associated with smoking among First Nations youth.

METHODS

Students in grades 5 to 8 attending school within the Saskatoon Tribal Council were asked to complete a youth health survey.

RESULTS

Of 271 eligible students, 204 completed the consent protocol and the school survey, yielding a response rate of 75.3%; 26.5% of youth were defined as current smokers. Regression analysis indicated that older age, not having a happy home life, suicide ideation and having three or more friends who smoke cigarettes were independent risk indicators of smoking in First Nations youth.

DISCUSSION

Smoking prevalence among on-reserve First Nations youth is quite high. The identification of four main risk indicators should assist with the design of youth smoking prevention and cessation programs.

Effects of tobacco taxation and pricing on smoking behavior in high risk populations: a knowledge synthesis

Tobacco taxation is an essential component of a comprehensive tobacco control strategy. However, to fully realize the benefits it is vital to understand the impact of increased taxes among high-risk subpopulations. Are they influenced to the same extent as the general population? Do they need additional measures to influence smoking behavior? The objectives of this study were to synthesize the evidence regarding differential effects of taxation and price on smoking in: youth, young adults, persons of low socio-economic status, with dual diagnoses, heavy/long-term smokers, and Aboriginal people. Using a better practices approach, a knowledge synthesis was conducted using a systematic review of the literature and an expert advisory panel. Experts were involved in developing the study plan, discussing findings, developing policy recommendations, and identifying priorities for future research. Most studies found that raising cigarette prices through increased taxes is a highly effective measure for reducing smoking among youth, young adults, and persons of low socioeconomic status. However, there is a striking lack of evidence about the impact of increasing cigarette prices on smoking behavior in heavy/long-term smokers, persons with a dual diagnosis and Aboriginals. Given their high prevalence of smoking, urgent attention is needed to develop effective policies for the six subpopulations reviewed. These findings will be of value to policy-makers and researchers in their efforts to improve the effectiveness of tobacco control measures, especially with subpopulations at most risk. Although specific studies are needed, tobacco taxation is a key policy measure for driving success.

Integrating genetic studies of nicotine addiction into public health practice: stakeholder views on challenges, barriers and opportunities

OBJECTIVE

Will emerging genetic research strengthen tobacco control programs? In this empirical study, we interview stakeholders in tobacco control to illuminate debates about the role of genomics in public health.

METHODS

The authors performed open-ended interviews with 86 stakeholders from 5 areas of tobacco control: basic scientists, clinicians, tobacco prevention specialists, health payers, and pharmaceutical industry employees. Interviews were qualitatively analyzed using standard techniques.

RESULTS

The central tension is between the hope that an expanding genomic knowledge base will improve prevention and smoking cessation therapies and the fear that genetic research might siphon resources away from traditional and proven public health programs. While showing strong support for traditional public health approaches to tobacco control, stakeholders recognize weaknesses, specifically the difficulty of countering the powerful voice of the tobacco industry when mounting public campaigns and the problem of individuals who are resistant to treatment and continue smoking.

CONCLUSIONS

In order for genetic research to be effectively translated into efforts to minimize the harm of smoking-related disease, the views of key stakeholders must be voiced and disagreements reconciled. Effective translation requires honest evaluation of both the strengths and limitations of genetic approaches.

The influence of parents, siblings and peers on pre- and early-teen smoking: a multilevel model

INTRODUCTION AND AIMS

Despite considerable success in tobacco control, many teenagers in Australia and other industrialised countries still smoke tobacco. There is mixed evidence on the relative influence of proximal social networks (parents/siblings/peers) on pre- and early-teen smoking, and no research has examined how these influences compare after accounting for school- and community-level effects.The aim of this study was to compare the relative influences of parents, siblings and peers, after accounting for school- and community-level variation in smoking.

DESIGN AND METHODS

A cross-sectional fixed and random effects model of smoking prevalence was used, with individuals (n = 7314) nested within schools (n = 231) nested within communities (n = 30). Grade 6 and 8 students (modal ages 11 and 13 years) completed an on-line survey. Key variables included parent/sibling/peer use. Controls included alcohol involvement, sensation seeking, pro-social beliefs, laws/norms about substance use and school commitment.

RESULTS

There was significant variation in smoking at both the school and community levels, supporting the need for a multilevel model. Individual-level predictors accounted for much of the variance at higher levels. The strongest effects were for number of friends who smoke, sibling smoking and alcohol involvement. Smaller significant effects were found for parent smoking. At the community level, socioeconomic disadvantage was significant, but community-level variance in pro-social and drug-related laws/norms was not related to smoking.

DISCUSSION AND CONCLUSIONS

Cross-level interactions were generally non-significant. Early teenage smoking was best explained by sibling and peer smoking, and individual risks largely accounted for the substantial variation observed across schools and communities. In terms of future tobacco control, findings point to the utility of targeting families in disadvantaged communities.

Tobacco litter costs and public policy: a framework and methodology for considering the use of fees to offset abatement costs

OBJECTIVES

Growing concern over the costs, environmental impact and safety of tobacco product litter (TPL) has prompted states and cities to undertake a variety of policy initiatives, of which litter abatement fees are part. The present work describes a framework and methodology for calculating TPL costs and abatement fees.

METHODS

Abatement is associated with four categories of costs: (1) mechanical and manual abatement from streets, sidewalks and public places, (2) mechanical and manual abatement from storm water and sewer treatment systems, (3) the costs associated with harm to the ecosystem and harm to industries dependent on clean and healthy ecosystems, and (4) the costs associated with direct harm to human health. The experiences of the City of San Francisco's recently proposed tobacco litter abatement fee serve as a case study.

RESULTS

City and municipal TPL costs are incurred through manual and mechanical clean-up of surfaces and catchment areas. According to some studies, public litter abatement costs to US cities range from US$3 million to US$16 million. TPL typically comprises between 22% and 36% of all visible litter, implying that total public TPL direct abatement costs range from about US$0.5 million to US$6 million for a city the size of San Francisco. The costs of mitigating the negative externalities of TPL in a city the size of San Francisco can be offset by implementing a fee of approximately US$0.20 per pack.

CONCLUSIONS

Tobacco litter abatement costs to cities can be substantial, even when the costs of potential environmental pollution and tourism effects are excluded. One public policy option to address tobacco litter is levying of fees on cigarettes sold. The methodology described here for calculating TPL costs and abatement fees may be useful to state and local authorities who are considering adoption of this policy initiative.

Problems, policies and politics: A comparative case study of contraband tobacco from the 1990s to the present in the Canadian context

Contraband tobacco has been and continues to be a global public health policy concern, with special manifestations in Canada. Over the past 20 years, in two noteworthy instances the Canadian government has battled contraband - in the early 1990s, and for much of the past decade. In the 1990s, when contraband cigarettes flooded the Canadian market, the government rapidly responded, using policy measures such as implementing a tobacco export tax and cutting domestic sales tax. Unfortunately, contraband made a strong comeback in recent years, but this time the government has hesitated to act, owing to a change in the source of the contraband. Using John Kingdon's streams theory to frame our arguments, we suggest that lack of congruence between different policy stakeholder groups' perceptions of the problem, policy solutions, and political feasibility has road-blocked the implementation of anti-contraband policy in the 2000s.

Evaluation of California's in-school tobacco use prevention education (TUPE) activities using a nested school-longitudinal design, 2003-2004 and 2005-2006

BACKGROUND

Current legislative language requires the California Department of Public Health, California Tobacco Control Program, to evaluate the effectiveness of the school-based Tobacco Use Prevention Education (TUPE) programme in California every 2 years. The objective of the study was to measure change and to identify the impact of school-based tobacco use prevention education activities on youth smoking prevalence and attitudes over time, spanning two school year surveys (2003-2004 and 2005-2006).

METHODS

Evaluation focused on school-based tobacco use prevention activities in 57 schools (student sample size, n=16 833) that participated in the in-school administration of the 2003-2004 and 2005-2006 California Student Tobacco Surveys. Hierarchical linear models were used to predict student tobacco use and precursors to tobacco use.

RESULTS

Overall, student tobacco use, intention to smoke, number of friends smoking and perceived smoking prevalence by peers increased as students moved through grades 9 and 10 to grades 11 and 12. TUPE-related activities showed a suggestive association (p=0.06) with reduced rate in student tobacco use between the two surveys after adjusting for other contextual factors such as each school's socioeconomic characteristics.

CONCLUSIONS

TUPE activities appears to be beneficial in reducing tobacco use in California high school students over time. Other contextual factors were important moderating influences on student tobacco use.

Association between tobacco control policies and smoking behaviour among adolescents in 29 European countries

AIMS

To investigate the associations between well-known, cost-effective tobacco control policies at country level and smoking prevalence among 15-year-old adolescents.

DESIGN

Multi-level modelling based on the 2005-06 Health Behaviour in School-aged Children Study, a cross-national study at individual level, and with country-level variables from the Tobacco Control Scale and published country-level databases.

SETTING

Twenty-nine European countries.

PARTICIPANTS

A total of 25 599 boys and 26 509 girls.

MAIN OUTCOME MEASURES

Self-reported regular smoking defined as at least weekly smoking, including daily smoking (dichotomous).

FINDINGS

Interaction effects between gender and smoking policies were identified, therefore boys and girls were analysed separately. Large cross-national differences in smoking prevalence were documented. Intraclass correlations (ICC) of 0.038 (boys) and 0.035 (girls) were found. In the final multi-level model for boys, besides the significance of the individual variables such as family affluence, country-level affluence and the legality of vending machines were related significantly to regular smoking [b(country affluence) = -0.010; b(partial restriction vending machines) = -0.366, P < 0.05]. Price policy was of borderline significance [b(price policy) = -0.026, P = 0.050]. All relationships were in the expected direction. The model fit is not as good for girls; only the legality of vending machines had a borderline significance in the final model [b(total ban vending machines) = -0.372, P = 0.06].

CONCLUSIONS

For boys, some of the currently recommended tobacco control policies may help to reduce smoking prevalence. However, the model is less suitable for girls, indicating gender differences in the potential efficacy of smoking policies. Future research should address this issue.

Prevalence and correlates of purchasing contraband cigarettes on First Nations reserves in Ontario, Canada

AIMS

Non-First Nations people purchasing cigarettes on First Nations reserves do not pay applicable taxes. We estimated prevalence and identified correlates of purchasing contraband cigarettes on reserves; we also quantified the share of contraband purchased on reserves relative to reported total cigarette consumption and the associated financial impact on taxation revenue.

DESIGN

Data from the Ontario Tobacco Survey, a regionally stratified representative population telephone survey that over-samples smokers.

SETTING

Ontario, Canada.

PARTICIPANTS

A total of 1382 adult current smokers.

MEASUREMENTS

Reported status of purchasing cigarettes on reserves and the quantity of cigarettes bought on reserves. The prevalence of purchasing cigarettes on reserves was assessed with descriptive statistics. A two-part model was used to analyse correlates of having recently purchased contraband.

FINDINGS

A total of 25.8% reported recent purchasing and 11.5% reported usual purchasing. Heavy smoking, having no plans to quit and lower education were correlated with recent purchasing. Heavy smoking and not having plans to quit were also correlated with buying more packs of cigarettes on reserves. Contraband purchases on reserves accounted for 14.0% of the reported total cigarette consumption and resulted in an estimated tax loss of $122.2 million.

CONCLUSIONS

There was substantial purchasing of contraband cigarettes on reserves in Ontario, resulting in significant losses in tax revenues. The availability of these cheap cigarettes undermines the effectiveness of tobacco taxation to reduce smoking. Wherever indicated, governments should strengthen their contraband prevention and control measures, as recommended by the Framework Convention on Tobacco Control, to ensure that tobacco taxation achieves its intended health benefits and that tax revenues are protected.

Changes in cigarette use and nicotine dependence in the United States: evidence from the 2001-2002 wave of the national epidemiologic survey of alcoholism and related conditions

OBJECTIVES

We examined the roles of gender and poverty in cigarette use and nicotine dependence among adults in the United States.

METHODS

Our data were drawn from the 2001-2002 National Epidemiological Survey of Alcoholism and Related Conditions, a nationally representative sample of US adults 18 years and older.

RESULTS

The overall rate of cigarette use declined between 1964 and 2002. Nicotine dependence does not appear to have declined overall, and there is evidence that nicotine dependence has increased among women in recent cohorts. The odds of nicotine dependence among cigarette users appear to have increased significantly in recent cohorts.

CONCLUSIONS

Despite recent declines in cigarette use, the prevalence of nicotine dependence has increased among some groups and has remained steady overall, which may be hampering public health initiatives to reduce cigarette use. Efforts to study or curb cigarette use should therefore take nicotine dependence into account.

The effect of retail cigarette pack displays on impulse purchase

AIMS

To assess the extent to which point-of purchase (POP) cigarette displays stimulate impulse purchases.

DESIGN

Telephone-administered population survey.

SETTING

Victoria, Australia.

PARTICIPANTS

A total of 2996 adults, among whom 526 smoked factory-made cigarettes and 67 were recent quitters (quit in the past 12 months).

MEASUREMENTS

Reported cigarette purchase behaviour; perceived effect on smoking of removing cigarettes from view in retail outlets; reported urges to buy cigarettes as a result of seeing the cigarette display.

FINDINGS

When shopping for items other than cigarettes, 25.2% of smokers purchased cigarettes at least sometimes on impulse as a result of seeing the cigarette display. Thirty-eight per cent of smokers who had tried to quit in the past 12 months and 33.9% of recent quitters experienced an urge to buy cigarettes as a result of seeing the retail cigarette display. One in five smokers trying to quit and one in eight recent quitters avoided stores where they usually bought cigarettes in case they might be tempted to purchase them. Many smokers (31.4%) thought the removal of cigarette displays from stores would make it easier for them to quit.

CONCLUSIONS

POP cigarette displays act as cues to smoke, even among those not explicitly intending to buy cigarettes, and those trying to avoid smoking. Effective POP marketing restrictions should encompass cigarette displays.

Trends in the use and abuse of branded and generic extended release oxycodone and fentanyl products in the United States

BACKGROUND

A great deal of previous work on the pharmacoeconomics of alcohol, tobacco and illicit drug abuse indicates that as cost decreases, abuse increases and vice versa. The application of these cost principles to the abuse of prescribed medications is largely unknown. In this paper we assessed whether the introduction of generic products in the U.S. increased the therapeutic use and illicit abuse of extended release oxycodone products and the fentanyl patch.

METHODS

As an index of therapeutic use, we purchased prescription data for each of the ZIP codes in which we had corresponding abuse data. To gather information about prescription drug abuse, we elicited cases with quarterly questionnaires completed by a key informant network.

RESULTS

The introduction of generic extended release (ER) oxycodone and fentanyl patch did not significantly change the total prescriptions written for these products, but markedly altered the composition of sales: branded sales dropped precipitously over a very short time and this was compensated for by a corresponding increase in sales of generics. Surprisingly, the introduction of generic products did not increase the abuse of ER oxycodone or fentanyl products; the branded version was the drug of choice for at least 2 years.

CONCLUSIONS

Our data suggest that drug costs alone do not increase the overall likelihood that a prescription opioid analgesic will be used therapeutically or abused. However, while generics are rapidly endorsed by insurance companies as a prescribed entity, abuse of the branded versions of ER oxycodone and fentanyl remains predominant for some time.

The psychological science of addiction

AIM

To discuss the contributions and future course of the psychological science of addiction.

BACKGROUND

The psychology of addiction includes a tremendous range of scientific activity, from the basic experimental laboratory through increasingly broad relational contexts, including patient-practitioner interactions, families, social networks, institutional settings, economics and culture. Some of the contributions discussed here include applications of behavioral principles, cognitive and behavioral neuroscience and the development and evaluation of addiction treatment. Psychology has at times been guilty of proliferating theories with relatively little pruning, and of overemphasizing intrapersonal explanations for human behavior. However, at its best, defined as the science of the individual in context, psychology is an integrated discipline using diverse methods well-suited to capture the multi-dimensional nature of addictive behavior.

CONCLUSIONS

Psychology has a unique ability to integrate basic experimental and applied clinical science and to apply the knowledge gained from multiple levels of analysis to the pragmatic goal of reducing the prevalence of addiction.

Five in a row--reactions of smokers to tobacco tax increases: population-based cross-sectional studies in Germany 2001-2006

OBJECTIVE

To assess reactions of smokers to five waves of tobacco tax increases in Germany.

DESIGN

A 10-wave cross-sectional study, with assessments before and after the tax increases.

SETTING

General population of Germany.

PARTICIPANTS AND METHODS

10 representative samples from the general population with a total number of 27,608 people aged > or = 14 years, including 8548 smokers (31% of the total sample), were interviewed.

OUTCOME MEASURES

Reflection on smoking behaviour, and smoking behaviour (quitting, reducing, switching to a cheaper brand or no change) before and after tobacco tax increases.

RESULTS

Before the tax increases, one third to more than half of the smokers reflected on their smoking behaviour, 9.7-13.9% intended to quit, 23.4-34.7% intended to reduce smoking and 10.8-16.4% intended to switch to cheaper tobacco products, whereas 36.1-52.1% did not intend any change at all. After the tax increases, one fourth to more than one third reported to have reflected on their smoking behaviour, 4.0-7.9% quit smoking owing to the increase, 11.5-16.6% reduced consumption and 11.0-19.9% switched to cheaper products. Significant associations were found between the height of the price increase and the intentions and reactions of smokers.

CONCLUSIONS

Price increases lead to a substantial reflection on smoking and intended and realised behaviour changes such as reduced consumption and switching to cheaper tobacco products. These effects are more pronounced the more the price rises. Therefore, taxation policy will lead to quitting and reducing smoking. However, complementary measures should also be taken to prevent smokers switching to cheaper tobacco products, which would reduce the effectiveness of taxation policy.