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Jiang J, Zheng Z. A Critical Review of E-Cigarette Regulation in China: Challenges and Prospects for Youth Prevention and Tobacco Control. Nicotine Tob Res 2024; 26:126-134. [PMID: 37718628 DOI: 10.1093/ntr/ntad180] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 08/16/2023] [Accepted: 09/15/2023] [Indexed: 09/19/2023]
Abstract
INTRODUCTION The increasing popularity of electronic cigarettes (e-cigarettes) has led to the emergence of public health concerns, particularly among the youth. As a major producer and exporter of e-cigarettes, China has faced public health challenges in regulating the unregulated e-cigarette industry. AIMS AND METHODS This study aims to evaluate the regulatory development of e-cigarettes in China. We searched and obtained national policy documents related to e-cigarettes and subnational smoke-free laws from LexisNexis on August 2, 2023, which were enacted between January 1, 2023 and July 31, 2023. We used 99 policy documents for the final analysis, specifically 68 national policy documents on e-cigarettes and 31 subnational smoke-free laws. We chronologically reviewed these policy documents in full text and summarized them on the basis of their content and the requirements of the World Health Organization Framework Convention on Tobacco Control (WHO FCTC). RESULTS Chinese policymakers established the current regulatory framework for e-cigarettes by amending, enacting, and enforcing laws and regulations. E-cigarettes are categorized as tobacco products, and the State Tobacco Monopoly Administration regulates the e-cigarette industry. The Chinese authorities prioritize youth prevention in strengthening the regulation on e-cigarettes. China adopts various tobacco control measures for e-cigarettes and cigarettes. CONCLUSIONS China gained certain degrees of progress on tobacco control by regulating e-cigarettes and adopting measures required by the WHO FCTC. However, tobacco monopoly hinders the full realization of tobacco control goals, which necessitates the National Health Commission to assume its responsibility for the complete implementation of the WHO FCTC. IMPLICATIONS This study presents a critical review of the development of e-cigarette regulation in China by reviewing relevant policy documents and analyzing tobacco control measures. It recognizes the degrees of progress of tobacco control measures and highlights tobacco monopoly as a significant hindrance of the full implementation of the WHO FCTC. Furthermore, empirical studies are required on the enforcement of tobacco control measures in China.
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Affiliation(s)
- Jiayi Jiang
- Law School, Central South University, Changsha, China
| | - Zexing Zheng
- Law School, Central South University, Changsha, China
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2
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Lee K, Egbe CO, Bianco E, Arora M. The 20th anniversary of the WHO Framework Convention on Tobacco Control: hard won progress amid evolving challenges. Lancet 2023; 402:592-594. [PMID: 37263281 DOI: 10.1016/s0140-6736(23)01080-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 05/22/2023] [Indexed: 06/03/2023]
Affiliation(s)
- Kelley Lee
- Pacific Institute on Pathogens, Pandemics and Society, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
| | - Catherine O Egbe
- Alcohol, Tobacco and Other Drug Research Unit, South African Medical Research Council, Pretoria, South Africa; Department of Public Health, Sefako Makgatho Health Sciences University, Pretoria, South Africa
| | - Eduardo Bianco
- The Ulrich and Frank Foundation for International Health, Philadelphia, PA, USA; Centro de Investigación para la Epidemia del Tabaquismo, Montevideo, Uruguay
| | - Monika Arora
- Public Health Foundation of India, New Delhi, India
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Rajani NB, Hoelscher J, Laverty AA, Filippidis FT. A multi-country analysis of transnational tobacco companies' market share. Tob Induc Dis 2023; 21:03. [PMID: 36721861 PMCID: PMC9853956 DOI: 10.18332/tid/157090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Revised: 12/02/2022] [Accepted: 12/05/2022] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION The international tobacco market is dominated by five transnational tobacco companies (TTCs) which continue to interfere with measures to reduce tobacco consumption. The aim of this study is to better understand the current international tobacco industry market structure by providing an overview of the market share of these five companies globally. METHODS A longitudinal multi-country study design was used to understand market share trends across 90 different countries from 2011 to 2020. Descriptive analyses were conducted based on market share and market size data obtained from Euromonitor Passport. Market share (%), maximal market share (%) and cumulative market share (%) were calculated. Maps and boxplots are used to present the descriptive analyses. Median cumulative TTC market share and interquartile ranges for each year were calculated and stratified by country income level. RESULTS The average maximal market share of one company in a country was 50% (IQR: 40.0-63.5) in 2020 compared to 51.5% in 2011 (IQR: 41.3-69.0). One of the five TTCs had the highest market share in 77 out of the 90 countries. Philip Morris International was the main market player in 38 countries, followed by British American Tobacco (24), Japan Tobacco International (8), Imperial Brands (6), and lastly China National Tobacco Corporation was only dominant in China. The percentage of cigarettes manufactured by one of the five TTCs remained relatively stable between 2011 (86.4%) and 2020 (85.2%). Average cumulative TTC market shares increased between 2011 and 2020 in both low- and middle-, and high-income countries. CONCLUSIONS The international tobacco market is concentrated with a small number of large players, and this has not changed substantially between 2011 and 2020. The impact of this on the ability of the tobacco industry to resist policy changes is unknown but presents a cause for concern.
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Affiliation(s)
- Nikita B. Rajani
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Jule Hoelscher
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Anthony A. Laverty
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
| | - Filippos T. Filippidis
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, United Kingdom
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Zheng C, Feng Z, Pearce J. A Cross-sectional Analysis of Socio-spatial Patterning of Tobacco Retail in Shanghai, China. Nicotine Tob Res 2022; 24:2018-2025. [PMID: 35777980 PMCID: PMC9653074 DOI: 10.1093/ntr/ntac155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 04/19/2022] [Accepted: 06/28/2022] [Indexed: 01/03/2023]
Abstract
INTRODUCTION International evidence from high-income countries demonstrates that the availability of tobacco tends to be greater in more urban and more deprived neighborhoods. However, little is known about the socio-spatial disparities in other settings, including megacities in China. This study investigated the patterning of tobacco retailers across Shanghai by types of tobacco retailers, including the relationship with levels of urbanity and neighborhood deprivation. AIMS AND METHODS Tobacco retailer data (n = 19 413) was extracted from a web-scraped Points-of-Interest database. For all communities (n = 5432) across Shanghai, neighborhood tobacco retail availability was calculated using population-weighted kernel density estimation and grouped by quintiles of neighborhood deprivation and a 3-level urban classification. Associations were analyzed using the Kruskal-Wallis tests and epsilon squared. RESULTS Across Shanghai, tobacco retail availability decreased from more urbanized areas to less urbanized areas. There was a statistical difference (p < .001) in the availability of tobacco retail across quintiles of deprivation, with the highest availability in the less deprived neighborhoods, and the lowest availability in the most deprived neighborhoods. However, this trend was reversed in the urban center, where retail availability was greatest in the most deprived areas. Convenience stores were the most common type of tobacco retailer across the city, while tobacco-only outlets were most strongly associated with levels of neighborhood deprivation. CONCLUSIONS The results show an association between tobacco retail availability and neighborhood deprivation, which varied with levels of urbanity and types of tobacco retailers. These findings provide supportive evidence for further interventions that target reducing inequalities in exposure to tobacco retail. IMPLICATIONS This is the first study to examine the relationship between tobacco retail availability and neighborhood deprivation in the context of Chinese megacities. Using data from Shanghai, China, we found a significant non-linear association between tobacco retail availability and neighborhood deprivation across the city. It is plausible that the socio-spatial disparities in tobacco retail availability at the neighborhood level may be a key factor explaining differences in smoking behaviors between sociodemographic groups. The findings emphasize the need for greater efforts in regulating neighborhood-level tobacco retailing in China.
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Affiliation(s)
- Chunyu Zheng
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
| | - Zhiqiang Feng
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
- Scottish Centre for Administrative Data Research, University of Edinburgh, Edinburgh, UK
| | - Jamie Pearce
- Centre for Research on Environment, Society and Health, School of GeoSciences, University of Edinburgh, Edinburgh, UK
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Su Z, McDonnell D, Cheshmehzangi A, Ahmad J, Šegalo S, da Veiga CP. A call to ban the sale of tobacco products. Front Public Health 2022; 10:904971. [PMID: 36438262 PMCID: PMC9684640 DOI: 10.3389/fpubh.2022.904971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 07/26/2022] [Indexed: 11/12/2022] Open
Abstract
Tobacco is both toxic and addictive. Mounting evidence shows that tobacco use has a detrimental impact on almost every aspect of human health, causing or worsening deadly public health crises from the cancer epidemic to the COVID-19 pandemic. However, while tobacco use is a threat to both personal and public health, it continues to surge across the world, especially in China and other low- and middle-income countries. To this end, this article argues in favor of using a ban on the sale of all tobacco products as a practical solution to the global tobacco use epidemic. It is our hope that insights provided by our work will inspire swift policy actions in countries such as China and beyond to curb the tide of rising tobacco consumption, so that populations around the world could be better shielded from the pervasive and long-lasting damage that tobacco products cause or compound.
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Affiliation(s)
- Zhaohui Su
- School of Public Health, Southeast University, Nanjing, China,*Correspondence: Zhaohui Su
| | - Dean McDonnell
- Department of Humanities, Institute of Technology Carlow, Carlow, Ireland
| | - Ali Cheshmehzangi
- Faculty of Science and Engineering, University of Nottingham Ningbo China, Ningbo, China,Network for Education and Research on Peace and Sustainability, Hiroshima University, Hiroshima, Japan
| | | | - Sabina Šegalo
- Faculty of Health Studies, University of Sarajevo, Sarajevo, Bosnia and Herzegovina
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Yach D. Accelerating an end to smoking: a call to action on the eve of the FCTC’s COP9. DRUGS AND ALCOHOL TODAY 2020. [DOI: 10.1108/dat-02-2020-0012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The World Health Organization Framework Convention on Tobacco Control (WHO FCTC) is the first treaty negotiated under the auspices of the WHO. This study aims to describe progress toward the framework’s goals, setbacks and strategies to update its articles to optimize outcomes.
Design/methodology/approach
A review of relevant literature, including papers in this special issue, forms the basis for identifying steps necessary to amplify the impact of the FCTC.
Findings
The WHO suggests that there are 1.3 billion users of tobacco globally. The expected deaths associated with tobacco use could be dramatically reduced by hundreds of millions between now and 2060 through measures that improve cessation and harm reduction support among adults. Additional steps needed to achieve the goals of the FCTC include developing new initiatives to address areas of profound neglect (for example, women); investing in global research and innovation; addressing the needs of vulnerable populations; and establishing a mechanism to fund priority actions required by low- and middle-income countries, including support for alternative livelihoods for smallholder farmers.
Practical implications
In November 2020, the WHO FCTC Parties will host their next Conference of the Parties (COP9) in the Netherlands. This paper aims to contribute to the needed policy decisions related to this meeting. Since acceptance of this article, the WHO FCTC team announced that doe to the COVID-19 pandemic COP9 has been rescheduled till November 2021.
Originality/value
There exists a need to prioritize the goals of tobacco control and offer clear strategies for its execution. This paper fills this niche via a thorough and up-to-date analysis of how to amend and enforce the FCTC.
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Ali R, Zhang Z, Bux Soomro M, Gogan ICW, Soomro HR. Tobacco control via quick response code and mobile health technologies: Empirical-evidence of the health belief model theory. HUMAN SYSTEMS MANAGEMENT 2020. [DOI: 10.3233/hsm-190629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Rahib Ali
- School of Management Science and Economy, Harbin Institute of Technology, Heilongjiang, China
| | - Ziqiong Zhang
- School of Management Science and Economy, Harbin Institute of Technology, Heilongjiang, China
| | - Muhammad Bux Soomro
- Computer Science Department, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Larkana Campus, Pakistan
| | | | - Habib Rehman Soomro
- Management Sciences Department, Shaheed Zulfikar Ali Bhutto Institute of Science and Technology, Larkana Campus, Pakistan
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"All Weather Friends": How China Transformed Zimbabwe's Tobacco Sector. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17030723. [PMID: 31979132 PMCID: PMC7037974 DOI: 10.3390/ijerph17030723] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/16/2020] [Accepted: 01/19/2020] [Indexed: 01/13/2023]
Abstract
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.
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Mlinarić M, Schreuders M, Graen L, Lessenich S. Transnational tobacco companies and the mechanism of externalization: A realist synthesis. Health Place 2019; 61:102240. [PMID: 31734138 DOI: 10.1016/j.healthplace.2019.102240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Revised: 10/16/2019] [Accepted: 11/01/2019] [Indexed: 11/24/2022]
Abstract
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.
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Affiliation(s)
- Martin Mlinarić
- Institute of Medical Sociology, Medical Faculty - Martin Luther University Halle-Wittenberg, Germany.
| | - Michael Schreuders
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, Netherlands
| | | | - Stephan Lessenich
- Political Sociology of Inequalities, Institute of Sociology, Ludwig Maximilians University Munich, Germany
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Fang J, Yang G, Wan X. 'Pro-tobacco propaganda': a case study of tobacco industry-sponsored elementary schools in China. Tob Control 2019; 29:447-451. [PMID: 31302606 PMCID: PMC7361027 DOI: 10.1136/tobaccocontrol-2018-054646] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 05/14/2019] [Accepted: 05/17/2019] [Indexed: 11/05/2022]
Abstract
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.
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Affiliation(s)
- Jennifer Fang
- Faculty of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Gonghuan Yang
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
| | - Xia Wan
- Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences and School of Basic Medicine, Peking Union Medical College, Beijing, China
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Murphy F, Crossley G. Smoking cessation: state owned tobacco companies in China and Japan are at odds with their countries' commitments. BMJ 2019; 365:l2328. [PMID: 31217186 DOI: 10.1136/bmj.l2328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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12
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Xu S, Gravely S, Meng G, Elton-Marshall T, O’Connor RJ, Quah AC, Feng G, Jiang Y, Hu GJ, Fong GT. Impact of China National Tobacco Company's 'Premiumization' Strategy: longitudinal findings from the ITC China Surveys (2006-2015). Tob Control 2019; 28:s68-s76. [PMID: 30158207 PMCID: PMC6445774 DOI: 10.1136/tobaccocontrol-2017-054193] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/18/2018] [Accepted: 07/23/2018] [Indexed: 11/03/2022]
Abstract
BACKGROUND In 2009, the China National Tobacco Company (CNTC) began their Premiumization Strategy, designed to encourage smokers to trade up to more expensive brands, mainly by promoting the concept that higher class cigarettes are better quality and less harmful. This study is the first evaluation of the strategy's impact on: (1) prevalence of premium brand cigarettes (PBC), mid-priced brand cigarettes (MBC) and discount brand cigarettes (DBC) over 9 years, from 3 years pre-strategy (2006) to 6 years post-strategy (2015); and (2) changes in reasons for choosing PBCs, MBCs and DBCs. METHODS A representative cohort of adult Chinese smokers (n=9047) in seven cities who participated in five waves of the International Tobacco Control (ITC) China Survey: pre-implementation (Wave 1 (2006; n=3452), Wave 2 (2007-2008; n=3586)); mid-implementation (Wave 3 (2009; n=4172)); and post-implementation (Wave 4 (2011-2012; n=4070), Wave 5 (2013-2015; n=2775)). Generalised estimating equations were conducted to examine changes in prevalence of PBCs, MBCs and DBCs, and reasons for brand choice from pre-implementation to post-implementation. RESULTS From pre-implementation to post-implementation, there was an increase in prevalence of PBCs (5.4% to 23.2%, p<0.001) and MBCs (40.0% to 50.4%, p<0.001), and a decrease in DBCs (54.6% to 26.5%, p<0.001). There was an increase in smokers who chose their current brand because they believed it to be less harmful, both for MBC smokers (+13.0%, p=0.001) and PBC smokers (+9.0%, p=0.06). There was an increase for smokers in all brand classes for choosing their current brand because they were 'higher in quality' and because of affordable price, but the greatest increase was among PBC smokers (+18.6%, p<0.001 and +34.9%, p<0.001, respectively). CONCLUSIONS Our findings demonstrate that the rising trend in Chinese smokers' choice of 'less harmful', 'higher quality' and 'affordable' cigarettes, particularly PBCs, is likely due to CNTC's aggressive marketing strategies. Strong tobacco control policies that prohibit CNTC's marketing activities are critical in order to dispel erroneous beliefs that sustain continued smoking in China, where the global tobacco epidemic is exerting its greatest toll.
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Affiliation(s)
- Steve Xu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Shannon Gravely
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Gang Meng
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Tara Elton-Marshall
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, London, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Tobacco Research Unit, Toronto, Ontario, Canada
| | | | - Anne C.K. Quah
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Guoze Feng
- Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Yuan Jiang
- Chinese Center for Disease Control and Prevention (China CDC), Beijing, China
| | - Grace J. Hu
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Drehmer JE. Sex differences in the association between countries' smoking prevalence and happiness ratings. Public Health 2018; 160:41-48. [PMID: 29729531 DOI: 10.1016/j.puhe.2018.03.027] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 03/03/2018] [Accepted: 03/21/2018] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To examine the cross-sectional relationship between measures of countries' happiness and countries' prevalence of tobacco smoking. Since smoking prevalence differs widely based on sex in some countries and is similar in other countries, it was examined if there was a sex difference in the relationship between smoking prevalence and country-specific happiness ratings. STUDY DESIGN Ecological study design. METHODS Countries' age-standardized prevalence estimates of smoking any tobacco product among persons aged 15 years and older (%) for 2015 were obtained from the World Health Organization (WHO) Global Health Observatory. Country-specific scores from the World Happiness Report 2016 Update Ranking of Happiness (2013-15) and the 2015 Gallup Positive Experience Index were matched and correlated to 2015 WHO estimates of tobacco smoking prevalence for males and females. The difference between male and female age-standardized smoking prevalence estimates in each country was calculated by subtracting female prevalence from male prevalence and was then correlated to countries' World Happiness Report scores. The analyses did not control for potential confounders. RESULTS The association between male age-standardized smoking prevalence estimates and countries' World Happiness Report scores was inversely correlated [r(104) = -0.22, P = 0.03], whereas the association between female age-standardized smoking prevalence estimates and countries' World Happiness Report scores was positively correlated [r(104) = 0.48, P = 0.00]. An inverse correlation was found between the difference in male and female smoking prevalence estimates and countries' World Happiness Report scores [r(104) = -0.50, P = 0.00]. The association between countries' male age-standardized smoking prevalence estimates and the Positive Experience Index scores was inversely correlated [r(99) = -0.37, P = 0.00], whereas the female age-standardized smoking prevalence estimates in countries were not significantly associated with Positive Experience Index scores [r(99) = -0.03, P = 0.75]. CONCLUSION There are distinct sex differences between the amounts of happiness measured in countries and male and female smoking rates. Greater inequality in age-standardized smoking prevalence estimates between males and females is associated with lower amounts of happiness as measured by the World Happiness Report. These findings can be applied to population-based strategies aimed at reducing national smoking rates in men and women.
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Affiliation(s)
- J E Drehmer
- Tobacco Research and Treatment Center, Massachusetts General Hospital, Boston, MA, United States; Division of General Academic Pediatrics, Massachusetts General Hospital for Children, Boston, MA, United States.
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Eckhardt J, Fang J, Lee K. The Taiwan Tobacco and Liquor Corporation: To 'join the ranks of global companies'. Glob Public Health 2017; 12:335-350. [PMID: 28139964 PMCID: PMC5553428 DOI: 10.1080/17441692.2016.1273366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Until the late 1990s, the Taiwan Tobacco and Liquor Corporation (TTL) focused almost exclusively on serving the domestic market as a highly protected monopoly. This paper describes how the company has adopted a more outward looking strategy since 2000, with ambitions to become a regional, and eventually global, business by 2021. Drawing on company documents and industry sources, the paper argues that this shift in strategy was a direct reaction to the decline in domestic market share following liberalisation of the Taiwanese tobacco market and adoption of tougher domestic tobacco control measures. Market opening occurred as a result of pressure from the U.S. Trade Representative in the 1980s, as well as World Trade Organization membership in 2002. It is argued that TTL’s efforts to globalise operations have been limited by bureaucratic company management and structures, and ongoing political tension between Taiwan and China. However, the relative success of TTL’s alcohol branch, and potential détente as the Taiwanese government reaches out to improve relations with China, may provide TTL with new opportunities to achieve its goal of becoming a regional player with global ambitions. This article is part of the special issue ‘The Emergence of Asian Tobacco Companies: Implications for Global Health Governance.’
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Affiliation(s)
- Jappe Eckhardt
- a Department of Politics , University of York , York , UK
| | - Jennifer Fang
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
| | - Kelley Lee
- b Faculty of Health Sciences , Simon Fraser University , Burnaby , British Columbia , Canada
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Lee K, Eckhardt J. Looming threat of Asian tobacco companies to global health. Lancet 2017; 389:1958-1960. [PMID: 28534742 PMCID: PMC5694664 DOI: 10.1016/s0140-6736(17)31223-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Kelley Lee
- Tier 1 Canada Research Chair in Global Health Governance, Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada,
| | - Jappe Eckhardt
- Lecturer in International Relations, Department of Politics, University of York, York, UK,
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Lee K, Eckhardt J. The globalisation strategies of five Asian tobacco companies: a comparative analysis and implications for global health governance. Glob Public Health 2017; 12:367-379. [PMID: 28139967 PMCID: PMC5553434 DOI: 10.1080/17441692.2016.1273370] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 11/21/2016] [Indexed: 11/05/2022]
Abstract
The global tobacco industry, from the 1960s to mid 1990s, saw consolidation and eventual domination by a small number of transnational tobacco companies (TTC). This paper draws together comparative analysis of five case studies in the special issue on 'The Emergence of Asian Tobacco Companies: Implications for Global Health Governance.' The cases suggest that tobacco industry globalisation is undergoing a new phase, beginning in the late 1990s, with the adoption of global business strategies by five Asian companies. The strategies were prompted foremost by external factors, notably market liberalisation, competition from TTCs and declining domestic markets. State protection and promotion enabled the industries in Japan, South Korea and China to rationalise their operations ahead of foreign market expansion. The TTM and TTL will likely remain domestic or perhaps regional companies, JTI and KT&G have achieved TTC status, and the CNTC is poised to dwarf all existing companies. This global expansion of Asian tobacco companies will increase competition which, in turn, will intensify marketing, exert downward price pressures along the global value chain, and encourage product innovation. Global tobacco control requires fuller understanding of these emerging changes and the regulatory challenges posed by ongoing globalisation.
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Affiliation(s)
- Kelley Lee
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - Jappe Eckhardt
- Department of Politics, University of York, Heslington, York, UK
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Lee K, Eckhardt J. The globalisation strategies of five Asian tobacco companies: An analytical framework. Glob Public Health 2016; 12:269-280. [PMID: 27884083 PMCID: PMC5553427 DOI: 10.1080/17441692.2016.1251604] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
With 30% of the world’s smokers, two million deaths annually from tobacco use, and rising levels of tobacco consumption, the Asian region is recognised as central to the future of global tobacco control. There is less understanding, however, of how Asian tobacco companies with regional and global aspirations are contributing to the global burden of tobacco-related disease and death. This introductory article sets out the background and rationale for this special issue on ‘The Emergence of Asian Tobacco Companies: Implications for Global Health Governance’. The article discusses the core questions to be addressed and presents an analytical framework for assessing the globalisation strategies of Asian tobacco firms. The article also discusses the selection of the five case studies, namely as independent companies in Asia which have demonstrated concerted ambitions to be a major player in the world market.
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Affiliation(s)
- Kelley Lee
- a Faculty of Health Sciences , Simon Fraser University , Burnaby , BC , Canada
| | - Jappe Eckhardt
- b Department of Politics , University of York , York , UK
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