Tobacco advertising restrictions, price, income and tobacco consumption in OECD countries, 1960-1986

Tobacco excise tax reform: From the perspective of "tax to control tobacco" policy in China

The consumption of tobacco is harmful to health and has huge social costs. "Tax to control tobacco" is a widely implemented tobacco control measure all over the world. In order to examine the achievements of two tobacco excise tax reforms in China in 2009 and 2015 on controlling tobacco consumption, we first establish an intertemporal consumption model for addictive goods, and then validate the effectiveness of the two tobacco excise tax reforms using a Continuous Difference-in-Differences Model based on the panel data from 294 cities in China from 2007 to 2018. The results show that the tobacco excise tax reform in 2015 considerably reduced tobacco consumption, while the reform in 2009 did not, providing empirical evidence on the importance of "price links to tax" for tobacco control. Additionally, the study discovers that the tax reform has a heterogeneous effect on the age of smokers, the price of cigarettes, and city size.

Follow the money: a closer look at US tobacco industry marketing expenditures

INTRODUCTION

While much of the concern with tobacco industry marketing has focused on direct media advertising, a less explored form of marketing strategy is to discount prices. Price discounting is important because it keeps the purchase price low and can undermine the impact of tax increases.

METHODS

We examine annual US marketing expenditures from 1975 to 2019 by the largest cigarette and smokeless tobacco companies as reported to the Federal Trade Commission. We consider three categories: direct advertising, promotional allowances and price discounting. In addition to considering trends in these expenditures, we examine how price discounting expenditures relate to changes in product prices and excise taxes.

RESULTS

US direct advertising expenditures for cigarettes fell from 80% of total industry marketing expenditures in 1975 to less than 3% in 2019, while falling from 39% in 1985 to 6% in 2019 for smokeless tobacco. Price discounting expenditures for cigarettes became prominent after the Master Settlement Agreement and related tax increases in 2002. By 2019, 87% of cigarette marketing expenditures were for price discounts and 7% for promotional allowances. Smokeless marketing expenditures were similar: 72% for price promotions and 13% for promotional allowances. Price discounting increased with prices and taxes until reaching their currently high levels.

CONCLUSIONS

Between 1975 and 2019, direct advertising dramatically fell while price discounting and promotional expenditures increased. Local, state and federal policies are needed that apply non-tax mechanisms to increase tobacco prices and restrict industry contracts to offset industry marketing strategies. Further study is needed to better understand industry decisions about marketing expenditures.

'As Long as It Comes off as a Cigarette Ad, Not a Civil Rights Message': Gender, Inequality and the Commercial Determinants of Health

Scholarship on the commercial determinants of health (CDoH) has sought to understand the multiple ways corporate policies, practices and products affect population health. At the same time, gender is recognised as a key determinant of health and an important axis of health inequalities. To date, there has been limited attention paid to the ways in which the CDoH engage with and impact on gender inequalities and health. This review seeks to address this gap by examining evidence on the practices and strategies of two industries-tobacco and alcohol-and their interaction with gender, with a particular focus on women. We first describe the practices by which these industries engage with women in their marketing and corporate social responsibility activities, reinforcing problematic gender norms and stereotypes that harm women and girls. We then examine how tobacco and alcohol companies contribute to gender inequalities through a range of strategies intended to protect their market freedoms and privileged position in society. By reinforcing gender inequalities at multiple levels, CDoH undermine the health of women and girls and exacerbate global health inequalities.

Advertising Restrictions and Market Concentration in the Cigarette Industry: A Cross-Country Analysis

There has been a large increase in the adoption of tobacco advertising restrictions worldwide over the last two decades. Much of the literature studies their direct effect on cigarette demand. This paper investigates the indirect effect of advertising restrictions by evaluating the effect of the policies on the degree of concentration in the tobacco market. By using the variation between countries in timing of adoption of advertising restrictions, I estimate difference-in-difference models to examine the effect of an advertising ban on market-concentration, as measured by HHI. I find that advertising bans lead to an increase in market-concentration: HHI increased by 0.06 points for countries that adopted a ban between 2001 and 2017 conditional on trade and socio-economic characteristics, representing a 13% increase with respect to the mean (0.44). The effect is higher in developing countries (0.08 points increase). Further, I find that 'comprehensive' restrictions have a stronger impact on concentration, and 'limited' restrictions have little or no impact. These findings point to an important trade-off for policymakers: on one hand, advertising restrictions are likely to reduce consumption of cigarettes; on the other hand, due to an increase in market-concentration, they may be giving more power to tobacco companies.

Point-of-Sale Tobacco Advertising Remains Prominent in Mumbai, India

OBJECTIVES

In India, a 2003 law ("COPTA") banned tobacco advertising with the exception of "point of sale" and "on-pack" advertising. Given substantial evidence regarding the impact of point of sale advertising (PoS), we analyzed the prevalence of encountering such advertising in Mumbai, India.

METHODS

A survey was conducted of 199 current and recent former tobacco users recruited at the Tata Memorial Hospital (Mumbai). Enrollees were queried regarding their exposure to tobacco advertising in the last 30 days through multiple media sources. Descriptive epidemiologic techniques were used to characterize the data.

RESULTS

Overall, 95% of participants were men and 5% were women (mean age=49 years). All were current tobacco users or quit using all forms of tobacco in the last 60 days. Participants' responses revealed that PoS tobacco advertising had been encountered in the last 30 days for cigarettes (61%), bidis (54%), and smokeless tobacco (59%). Other forms of tobacco advertising were virtually non-existent.

CONCLUSIONS

PoS tobacco advertising remains prominent and highly visible to consumers in Mumbai, India, indicating corporate exploitation of a loophole in the COPTA legislation. Given the observed compliance with the currently imposed bans, revisions of COPTA to include all forms of tobacco promotion and advertising would be impactful.

Youths' Social Sources of Cigarettes: The Limits of Youth-Access Policies

Federal, state, and local policies aimed at reducing youth access to tobacco have been successful at increasing retail compliance, but they have had limited impact on actual youth smoking rates. One of the reasons that retail-based policies have failed to significantly reduce youth smoking rates is attributable in part to youths, substituting social or non-retail sources of cigarettes for retail supply. The widespread availability of cigarettes through social sources, such as borrowing, stealing, or buying cigarettes from parents, older siblings, and peers, and requesting older strangers to purchase them, highlights the difficulty of eliminating all supplies of youth cigarettes. Strategies should be implemented that are developed specifically to reduce access from social sources. More generally, a comprehensive approach to tobacco-control policies that targets the entire population is necessary to curb youth smoking.

Contextual factors, indoor tanning, and tanning dependence in young women

OBJECTIVES

To investigate the association of contextual factors such as cost, tanning accessibility, regulations, or marketing and indoor tanning or tanning dependence.

METHODS

One hundred thirty-nine college-aged female indoor tanners completed a questionnaire between 2009 and 2011.

RESULTS

Higher scores on tanning dependence and assessment in the spring/summer (versus the fall/winter) were associated with more frequent indoor tanning in the last 30 days (ps < .05). More frequent indoor tanning, greater session length, and more trouble paying for tanning were associated with higher scores on tanning dependence (ps < .05).

CONCLUSIONS

Public health research and practice could benefit from attention to such contextual factors as tanning cost and regulations regarding session length.

Geographically varying effects of weather on tobacco consumption: implications for health marketing initiatives

Weather and its fluctuations have been found to influence the consumption of negative hedonic goods. However, such findings are of limited use to health marketers who cannot control the weather, and hence, its effects. The current research utilizes data obtained at the zip-code level to study geographical variations in the effect of weather on tobacco consumption across the entire continental United States. The results allow health marketers to identify areas that will be most responsive to marketing efforts aimed at curtailing negative hedonic consumption and thus implement more effective, region-specific initiatives.

Implications of lessons learned from tobacco control for tanning bed reform

Tanning beds used according to the manufacturer’s instructions expose the user to health risks, including melanoma and other skin cancers. Applying the MPOWER model (monitor, protect, offer alternatives, warn, enforce, and raise taxes), which has been used in tobacco control, to tanning bed reform could reduce the number of people at risk of diseases associated with tanning bed use. Among the tactics available to government are restricting the use of tanning beds by people under age 18 and those with fair skin, increasing the price of tanning bed services through taxation, licensing tanning bed operators, and banning unsupervised tanning bed operations.

Tobacco use by male prisoners under an indoor smoking ban

INTRODUCTION

Most correctional facilities have implemented tobacco restrictions in an effort to reduce costs and improve prisoner health, but little has been done to evaluate the impact of these policy changes. Patterns of tobacco use among prisoners were explored to determine the impact of incarceration in a facility with an indoor smoking ban on tobacco use behaviors.

METHODS

Recently incarcerated male inmates (n = 200) were surveyed about their tobacco use prior to and during incarceration.

RESULTS

Tobacco use was prevalent prior to arrest (77.5%) and increased during incarceration (81.0%). Though the number of cigarette smokers increased during imprisonment, per-capita cigarette consumption declined by 7.1 cigarettes/day (p < .001). Despite widespread tobacco use, most participants recognized that smoking is a cause of lung cancer (96.0%) and heart disease (75.4%) and that it can be addicting (97.5%). Most tobacco users (70.0%) reported a desire to quit, with 63.0% saying they intended to try quitting in the next year.

CONCLUSIONS

Indoor smoking bans do not promote cessation in prisons but may reduce the amount of tobacco consumed. Though smoking is commonplace in prisons, most prisoners recognize the risks involved and wish to quit. This creates an ideal setting for intervention. Evidence-based cessation assistance should be made freely available to all incarcerated smokers.

The impact of tobacco advertising bans on consumption in developing countries

Tobacco advertising bans have become commonplace in developed nations but are less prevalent in developing countries. The importance of advertising bans as part of comprehensive tobacco control strategies has been emphasised by the Framework Convention on Tobacco Control which calls for comprehensive bans on tobacco advertising. The empirical literature suggests that comprehensive advertising bans have played a role in reducing consumption in developed countries but that limited policies have not. This paper extends this analysis to include 30 developing countries and finds that bans do play an important role in reducing tobacco consumption in these countries. It finds that both comprehensive as well as limited policies are effective in reducing consumption although comprehensive bans have a far greater impact than limited ones. Furthermore, it finds that advertising bans may be even more effective in the developing world than they are in the developed world.

Effects of the 2003 advertising/promotion ban in the United Kingdom on awareness of tobacco marketing: findings from the International Tobacco Control (ITC) Four Country Survey

BACKGROUND

In February 2003, a comprehensive ban on tobacco promotion came into effect in the United Kingdom, which prohibited tobacco marketing through print and broadcast media, billboards, the internet, direct mail, product placement, promotions, free gifts, coupons and sponsorships.

OBJECTIVE

To investigate the impact of the UK's comprehensive ban on tobacco promotion on adult smokers' awareness of tobacco marketing in the UK relative to Canada, the United States and Australia.

DESIGN

A total of 6762 adult smokers participated in two waves of a random digit dialled telephone survey across the four countries. Wave 1 was conducted before the UK ban (October-December 2002) and Wave 2 was conducted after the UK ban (May-September 2003).

KEY MEASURES

Awareness of a range of forms of tobacco marketing.

RESULTS

Levels of tobacco promotion awareness declined significantly among smokers in the UK after implementation of the advertising ban. Declines in awareness were greater in those channels regulated by the new law and change in awareness of tobacco promotions was much greater in the UK than the other three countries not affected by the ban. At least in the short term, there was no evidence that the law resulted in greater exposure to tobacco promotions in the few media channels not covered by the law. Notwithstanding the apparent success of the UK advertising ban and the controls in other countries, 9-22% of smokers in the four countries still reported noticing things that promoted smoking "often or very often" at Wave 2.

CONCLUSIONS

The UK policy to ban tobacco advertising and promotion has significantly reduced exposure to pro-tobacco marketing influences. These findings support the effectiveness of comprehensive bans on advertising and promotion, as included in the Framework Convention on Tobacco Control.

The effects of tobacco control policies on smoking rates: a tobacco control scorecard

This article reviews studies of the effect of tobacco control policies on smoking rates with the aim of providing guidance on the importance of different policies. Based on past studies, we estimate the magnitude of effects of major tobacco control policies, how their effects depend on the manner in which the policies are implemented, the relationship between the different policies, and the barriers to implementation. The most successful campaigns have implemented a combination of tobacco control policies. Of those policies, substantial evidence indicates that higher taxes and clean air laws can have a large impact on smoking rates. Evidence also indicates that media campaigns when implemented with other policies are important. Research on greater access to treatment and telephone support hotlines indicates a strong potential to increase quit rates and may be important in affecting heavier smokers. Direct evidence on the effects of advertising bans and health warnings is mixed, but these policies appear to be important in some of the countries that have had success in reducing smoking rates. School education programs and limits on retail sales are not likely to have much impact if implemented alone, but may be more important when combined with other policies.

A general causal model to guide alcohol, tobacco, and illicit drug prevention: assessing the research evidence

The problems associated with the use of alcohol, tobacco, and other drugs (ATOD) extract a significant health, social, and economic toll on American society. While the field of substance abuse prevention has made great strides during the past decade, two major challenges remain. First, the field has been disorganized and fragmented with respect to its research and prevention practices; that is, there are often separate ATOD prevention "specialists." Second, both the prevention researchers who test the efficacy of specific prevention strategies and the practitioners who implement prevention efforts often lack an overall perspective to guide strategy selection. To address these limitations, we present an ATOD causal model that seeks to identify those variables (Domains) that are theoretically salient and empirically connected across alcohol, tobacco, and illicit drugs. For the researcher, the model demonstrates important commonalities, as well as gaps, in the literature. For the practitioner, the model is a means to recognize both the complexity of the community system that produces ATOD problems and the multiple intervention points that are possible within this system. Researchers and practitioners are thus challenged to work synergistically to find effective and cost-effective approaches to change or reduce ATOD use and associated problems.

Computer-assisted health impact assessment for intersectoral health policy

Intersectoral health policy implies negotiations with politicians outside the health sector. Health politicians have a stronger position if they can quantify health impact. In this Dutch case-study we used a computer simulation approach to answer the following questions: Which anti-tobacco intervention has the largest health gain? Will a commuter cycling policy result in any substantial health gain? What is the relative health gain of promoting higher consumption of vegetables and fruit? We concluded that substantial health gain can be achieved if cigarette packet price were to increase by 2 Dutch guilders. A commitment of all general practitioners to implement a smoking cessation intervention will result in a similar health gain. Stimulating commuter cycling could be a promising example of intersectoral health policy. Interventions to promote higher vegetable and fruit consumption will result in a relatively small health gain. Pros and cons of simulation models to support intersectoral health policy are discussed.

Reviews of evidence regarding interventions to reduce tobacco use and exposure to environmental tobacco smoke

This report presents the results of systematic reviews of effectiveness, applicability, other effects, economic evaluations, and barriers to use of selected population-based interventions intended to reduce tobacco use and exposure to environmental tobacco smoke. The related systematic reviews are linked by a common conceptual approach. These reviews form the basis of recommendations by the Task Force on Community Preventive Services (TFCPS) regarding the use of these selected interventions. The TFCPS recommendations are presented on page 67 of this supplement.

The effect of tobacco advertising bans on tobacco consumption

Tobacco advertising is a public health issue if these activities increase smoking. Although public health advocates assert that tobacco advertising does increase smoking, there is significant empirical literature that finds little or no effect of tobacco advertising. In this paper, these prior studies are examined more closely with several important insights emerging from this analysis. This paper also provides new empirical evidence on the effect of tobacco advertising in 22 Organization for Economic Cooperation and Development (OECD) countries. The primary conclusion of this research is that a comprehensive set of tobacco advertising bans can reduce tobacco consumption and that a limited set of advertising bans will have little or no effect.

The effectiveness of policy and health education strategies for reducing adolescent smoking: a review of the evidence

This paper identifies the most effective measures to prevent smoking among adolescents. A review was made of the international literature concerning a ban on tobacco advertising, restrictions on sales to youth, product regulation, price increase of cigarettes and educational strategies. It is concluded that isolated measures produce little effect. Most effect may be expected from a combination of a complete ban on tobacco advertising, increasing prices, restricting tobacco product sales to tobacconists, mass media education aimed at youth and intensifying school education. A less effective measure is limiting the age at which adolescents are allowed to buy cigarettes.

Economic Issues in Cigarette and Alcohol Advertising

The effects of advertising on cigarette and alcohol consumption are controversial, and research on the subject has produced mixed results. An economic theory underlying the general relationship between advertising and consumption can help explain what type of data is needed to study this question. Studies that use national data on annual advertising expenditures measure advertising at a high level with little yearly change and are likely to find no effect on consumption. In contrast, studies that use local-level data measured over the course of a year find wide variation in the level of advertising and are likely to conclude that advertising increases consumption. To mitigate consumption increases, some countries and localities have tested advertising bans or counteradvertising campaigns. Studies of advertising bans show a decrease in consumption to some degree when intervening factors are controlled. Counteradvertising likewise is found to reduce consumption. Policymakers can choose from various combinations of advertising bans, counteradvertising, and advertising taxation to curb consumption.

Smoking among male teenagers in Dhaka, Bangladesh

BACKGROUND

Smoking is now recognized as a major public health problem in the developing world. Despite this, there is a dearth of relevant data on smoking prevalence and on the characteristics and attitudes of smokers: in particular, studies are lacking among teenagers and young adults, the group in which the habit frequently begins. The present study addresses this issue by examining the smoking patterns of a sample of teenagers in Dhaka, Bangladesh, during 1991.

METHODS

The study investigated smoking behavior and attitudes among two groups of male teenagers: the first consisted of 555 students, age 12-20 years, selected from two metropolitan high schools; the second, chosen to provide a broad comparison group from a different socioeconomic stratum, contained 112 males of similar age residing in an urban slum. Data were collected largely by interview supplemented by some direct observation and relevant secondary data.

RESULTS

The results showed that 29% of the students and 68% of the slum dwellers said they were regular smokers. In addition, the slum youths smoked substantially more and had smoked for longer than the students. While the study suggests both groups of smokers had been influenced to take up smoking by the smoking behavior of peers and parents, peers were more important for the students. Advertising may also have been a important influence on students since smokers in this group could better identify tobacco advertisements compared with their nonsmoking peers. No significant association was found between respondents' knowledge of the health risks of smoking and their actual smoking behavior.

CONCLUSIONS

This study demonstrates that in Bangladesh, smoking is very common among middle-class male teenagers and even more prevalent among youths from nearby slums. Clearly, local and national programs that draw on relevant knowledge from other countries, but are appropriate to Bangladesh, need to be developed to tackle a major epidemic.

Tobacco use among young adults in Norway, 1973-95: has the decrease levelled out?

OBJECTIVE

To describe the prevalence of tobacco use among young Norwegian adults, 1973-1995.

DESIGN

Cross sectional personal and telephone surveys.

SETTING

Norway, 1973-1995.

PARTICIPANTS

Population based samples of Norwegians aged 16-74 years.

RESULTS

A trend to a decline in tobacco use among young adult Norwegians during the 1960s and 1970s levelled out during the 1980s. Hence, the total prevalence of smoking in Norway decreased by only two percentage points from 1980 to 1993, as compared to approximately 10 percentage points in many other European countries. An increase in smoking prevalence (and in the use of snuff among males) in the age group 16-19 years has been observed in recent years. Thus smoking prevalence among young males and females in 1995 was comparable to that observed in the early 1980s.

CONCLUSIONS

Trends in tobacco use reflect an underutilization of preventive measures in general, and health education measures in particular. Financial resources appropriated for health education and information were reduced by 90% during the 1980s.

Patterns of smoking in Spain. Results from a regional general population survey

Smoking patterns were examined in 2500 individuals, aged 14-70 years living in Castille and Leon (Spain) in the fall of 1992. Of these, 39.6% were regular smokers, 7.2% were occasional smokers, 14.8% were former smokers, and 30.4% were non-smokers. Sex differences were striking: there was a higher prevalence of regular smokers among males than females, males smoked much more, and were more frequently French-type cigarette smokers. A comparison of the present figures with data from an earlier survey carried out in 1989 suggests that smoking is decreasing in Spain.

Tobacco consumption and chemical analysis of cigarettes in Bahrain

A 10.0% random sample of smokers in Bahrain was identified from a previous national morbidity survey which was completed in February 1983. Tobacco consumption and the average yields of tar, nicotine, and carbon monoxide (CO) of seven brands of cigarettes were examined. The 1982 adult tobacco consumption (2.3 kg) in Bahrain was generally lower than in developed countries. Similarly, cigarette per person consumption (734) was less than 69 other countries out of 130 that had data available. Tar, nicotine, and CO analysis of the five leading brands and two others which were previously popular in Bahrain showed that the average yields were mostly comparable with the same brands in the UK.

Alcohol advertising bans and alcohol abuse: reply

Young reexamines the work first presented in Saffer (1991) on the relationship between alcohol advertising bans and alcohol use. While there are several interesting possibilities for extending Saffer (1991), Young fails to provide any new insights. Most of his paper is devoted to recreating my data and results. He tries to extend my work with three new specifications. Each of these new specifications is flawed. His errors include a inappropriate application of fixed effects models, inappropriate dependent variables, and incorrect serial correlation computations. The results of these errors are a series of inconsistent advertising ban coefficients. He concludes that these inconsistent results are evidence that advertising bans have no effect of alcohol abuse. It might be better to at least provide a series of consistent regression models before coming to any conclusions.

Interaction of public policy advocacy and research in the passage of New Zealand's Smoke-free Environments Act 1990

This paper examines the public policy campaign that led up to the passage of New Zealand's Smoke-free Environment Act 1990, arguably the toughest tobacco control legislation in the world, focusing on the critical interaction between advocacy and research. The paper argues that had it not been for the Toxic Substances Board Report and the publicity it received, it is doubtful that the Smoke-free Environments Act would have been enacted. The tobacco industry catch cry that ad bans don't work, largely fell on deaf ears because of the Toxic Substances Board Report's findings, and the public health advocate's ability to refer to an authoritative Department of Health document.

Health-related behaviors in Korea: smoking, drinking, and perinatal care

The prevalence of major health-related behaviors and the relationship of these factors with selected sociodemographic factors were studied in South Korea. Subjects studied were household heads and their wives from 989 households. Age-standardized prevalences of smoking were 74.8% and 2.9% for men and women respectively, with no urban-rural difference. There was a tendency of younger or less-educated men smoking more heavily. The prevalence of use of alcoholic drinks were 79.8% and 26.0% for men and women respectively. More drinking was associated with a younger age and higher level of education. The mean prevalences of prenatal care, clinic or hospital delivery, and breastfeeding were 75.0%, 62.6%, and 75.2% respectively in the urban area, whereas the corresponding rates were 63.0%, 50.9%, and 81.1% in the rural area. Higher rates in prenatal care and hospital delivery were associated with a younger age and higher educational level, while breastfeeding showed the opposite trend.