1
|
Apollonio DE, Dutra LM, Glantz SA. Associations between smoking trajectories, smoke-free laws and cigarette taxes in a longitudinal sample of youth and young adults. PLoS One 2021; 16:e0246321. [PMID: 33571218 PMCID: PMC7877665 DOI: 10.1371/journal.pone.0246321] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Accepted: 01/17/2021] [Indexed: 01/25/2023] Open
Abstract
Cigarette smoking patterns vary within the population, with some individuals remaining never smokers, some remaining occasional users, and others progressing to daily use or quitting. There is little research on how population-level tobacco control policy interventions affect individuals within different smoking trajectories. We identified associations between tobacco control policy interventions and changes across different smoking trajectories among adolescents and young adults. Using 15 annual waves of data drawn from the National Longitudinal Survey of Youth 1997 (NLSY97), we applied a group-based trajectory model to identify associations between days smoked per month, comprehensive smoke-free laws, cigarette tax rates, and known socio-demographic risk factors for membership in different smoking trajectories. Comprehensive smoke-free laws were associated with reduced risk of initiation and reductions in days smoked per month for all trajectories other than occasional users. Higher tax rates were associated with reduced risk of initiation and days smoked for all trajectories other than established users. Overall, population-based tobacco control policies, particularly comprehensive smoke-free laws, were associated with reduced smoking. Tobacco taxes primarily reduced risk of initiation and use among never smokers, experimenters, and quitters, consistent with previous research suggesting that tobacco manufacturers lower prices after tax increases to reduce the cost of continued smoking for established users. These results provide support for expanding smoke-free laws and establishing a minimum tobacco floor price, which could improve public health by reducing the risk of initiation as well as use among occasional and established smokers.
Collapse
Affiliation(s)
- Dorie E. Apollonio
- Department of Clinical Pharmacy, School of Pharmacy, University of California San Francisco, San Francisco, California, United States of America
| | - Lauren M. Dutra
- Center for Health Analytics, Media, and Policy, RTI International, Berkeley, California, United States of America
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, University of California San Francisco, San Francisco, California, United States of America
| |
Collapse
|
2
|
Driezen P, Guindon GE, Hammond D, Thompson ME, Quah ACK, Fong GT. Contraband Cigarette Purchasing from First Nation reserves in Ontario and Quebec: Findings from the 2002-2014 ITC Canada Survey. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2019; 75:102612. [PMID: 31811974 DOI: 10.1016/j.drugpo.2019.102612] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2019] [Revised: 11/06/2019] [Accepted: 11/21/2019] [Indexed: 10/25/2022]
Abstract
Backround: The availability of contraband cigarettes provides incentives for price-sensitive smokers to reduce their monetary costs of smoking. The objectives of this study were to examine whether Canadian smokers' geographic proximity to First Nations reserves and attempts to quit smoking influenced the likelihood of purchasing lower-cost cigarettes from reserves. METHODS Data were from the International Tobacco Control (ITC) Canada Survey, a prospective survey of Canadian adult smokers conducted from 2002 to 2014 using telephone and online interviewing methods. Analysis was restricted to smokers from Ontario (n=2105) and Quebec (n=1427) participating in at least one survey wave. Smokers' postal codes were used to calculate distance to the nearest reserve. Weighted logistic generalised estimating equations (GEE) regression examined the linear relationship between distance and the log odds of last purchasing cigarettes on reserve in each province. GEE models also examined the relationship between past-year quit attempts and the log odds of on-reserve purchasing. RESULTS Controlling for other factors, from 2002-2014, smokers from Ontario who lived 10 km closer to reserves than otherwise similar smokers had significantly higher odds of last purchasing on reserve (OR ranged from 1.16 to 1.65). Distance had little effect on smokers' purchasing behaviours in Quebec. Moreover, in Ontario, for every 10 km increase in distance, smokers who did not try to quit had significantly greater odds of purchasing from a reserve than smokers who tried to quit (p=0.002). CONCLUSION In order for tobacco taxation policies to achieve their maximal benefit, governments must limit potential sources of lower-cost cigarettes. Collaborative governance arrangements can ensure tobacco products sold on reserve to non-Indigenous people are appropriately taxed while allowing First Nations communities to keep the revenue generated by such taxes.
Collapse
Affiliation(s)
- Pete Driezen
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada; School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada.
| | - G Emmanuel Guindon
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada; Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada
| | - David Hammond
- School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Mary E Thompson
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| | - Anne C K Quah
- 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
| |
Collapse
|
3
|
Jetty R, Banerji A, Berry M, Leigh FR, Goldade R, Irvine J, Jetty R, Menard K, Pelletier V, Wong S, Bell S, Morningstar M, Monkman L, Ryan AC, Vides E, Wiebe P, Mazerolle M. L’utilisation du tabac à des fins rituelles et le tabagisme chez les enfants et les adolescents autochtones du Canada. Paediatr Child Health 2017. [DOI: 10.1093/pch/pxx122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
4
|
Jetty R. Tobacco use and misuse among Indigenous children and youth in Canada. Paediatr Child Health 2017; 22:395-405. [PMID: 29491724 DOI: 10.1093/pch/pxx124] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
While tobacco is sacred in many Indigenous cultures, the recreational misuse of commercial tobacco is highly addictive and harmful. Tobacco misuse is the leading preventable cause of premature death in the world. Smoking rates among Canadian Indigenous youth are at least three times higher than for their non-Aboriginal peers, an alarming statistic on many levels. The tolls on health from extensive tobacco use range from disproportionately high individual mortality and morbidity to heavy socioeconomic burdens on Indigenous communities. Paediatric health care providers are uniquely positioned to collaborate with community stakeholders to prevent and treat tobacco misuse in young people and their families, while understanding the cultural value of tobacco for many Indigenous peoples. Targeted interventions can positively impact length and quality of life, improve overall health and decrease the immense social and human costs of tobacco misuse.
Collapse
|
5
|
Guindon GE, Burkhalter R, Brown KS. Levels and trends in cigarette contraband in Canada. Tob Control 2016; 26:518-525. [PMID: 27601454 PMCID: PMC5574406 DOI: 10.1136/tobaccocontrol-2016-052962] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2016] [Revised: 07/26/2016] [Accepted: 07/29/2016] [Indexed: 11/30/2022]
Abstract
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.
Collapse
Affiliation(s)
- G Emmanuel Guindon
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, Ontario, Canada.,Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada.,Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Robin Burkhalter
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, Ontario, Canada
| | - K Stephen Brown
- Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada
| |
Collapse
|
6
|
Wherry AE, McCray CA, Adedeji-Fajobi TI, Sibiya X, Ucko P, Lebina L, Golub JE, Cohen JE, Martinson NA. A comparative assessment of the price, brands and pack characteristics of illicitly traded cigarettes in five cities and towns in South Africa. BMJ Open 2014; 4:e004562. [PMID: 24812192 PMCID: PMC4025410 DOI: 10.1136/bmjopen-2013-004562] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE The prevalence of illicitly traded cigarettes in South Africa has been reported to be 40-50%. However, these estimates do not account for the more nuanced characteristics of the illicit cigarette trade. With the goal of better understanding contraband cigarettes in South Africa, this study piloted three methods for assessing the price, brands, pack features and smoker's views about illicit cigarettes in five cities/towns. Data were collected in June and July 2012. SETTING A convenience sample of three South African cities (Johannesburg, Durban and Nelspruit) and two smaller towns (Musina and Ficksburg) were chosen for this study. OUTCOME MEASURES Three cross-sectional approaches were used to assess the characteristics of contraband cigarettes: (1) a dummy purchase of cigarettes from informal retailers, (2) the collection of discarded cigarette packs and (3) a survey of tobacco smokers. PARTICIPANTS For the purposes of the survey, 40 self-reported smokers were recruited at taxi ranks in each downtown site. Adults who were over the age of 18 were asked to verbally consent to participate in the study and answer a questionnaire administered by a researcher. RESULTS The leading reason for labelling a pack as illicit in each city/town was the absence of an excise stamp (28.6% overall), and the least common reason was an illegal tar or nicotine level (11.1% overall). The overall proportion of informal vendors who sold illicit cigarettes was 41%. Singles and packs of 20 were consistently cheaper at informal vendors. Survey participants' responses reflected varied perspectives on illicit cigarettes and purchasing preferences. CONCLUSIONS Each approach generated an interesting insight into physical aspects of illicit cigarettes. While this pilot study cannot be used to generate generalisable statistics on illicit cigarettes, more systematic surveys of this nature could inform researchers' and practitioners' initiatives to combat illicit and legal cigarette sales and usage.
Collapse
Affiliation(s)
- Anna E Wherry
- Kreiger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | - Cheyenne A McCray
- Kreiger School of Arts and Sciences, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Xolani Sibiya
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Peter Ucko
- National Council against Smoking, Johannesburg, South Africa
| | - Limakatso Lebina
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - Jonathan E Golub
- Johns Hopkins University School of Medicine, Center for Tuberculosis Research, Baltimore, Maryland, USA
| | - Joanna E Cohen
- Department of Health, Behavior and Society, Johns Hopkins University Bloomberg School of Public Health, Baltimore, Maryland, USA
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Neil A Martinson
- Perinatal HIV Research Unit, University of the Witwatersrand, Johannesburg, South Africa
- Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| |
Collapse
|
7
|
Guindon GE, Driezen P, Chaloupka FJ, Fong GT. Cigarette tax avoidance and evasion: findings from the International Tobacco Control Policy Evaluation (ITC) Project. Tob Control 2014; 23 Suppl 1:i13-22. [PMID: 24227541 PMCID: PMC4254713 DOI: 10.1136/tobaccocontrol-2013-051074] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND Decades of research have produced overwhelming evidence that tobacco taxes reduce tobacco use and increase government tax revenue. The magnitude and effectiveness of taxes in reducing tobacco use provide an incentive for tobacco users, manufacturers and others, most notably criminal networks, to devise ways to avoid or evade tobacco taxes. Consequently, tobacco tax avoidance and tax evasion can reduce the public health and fiscal benefit of tobacco taxes. OBJECTIVES First, this study aims to document, using data from the International Tobacco Control Policy Evaluation Project (ITC), levels and trends in cigarette users' tax avoidance and tax evasion behaviour in a sample of 16 low-, middle- and high-income countries. Second, this study explores factors associated with cigarette tax avoidance and evasion. METHODS We used data from ITC surveys conducted in 16 countries to estimate the extent and type of cigarette tax avoidance/evasion between countries and across time. We used self-reported information about the source of a smoker's last purchase of cigarettes or self-reported packaging information, or similar information gathered by the interviewers during face-to-face interviews to measure tax avoidance/evasion behaviours. We used generalised estimating equations to explore individual-level factors that may affect the likelihood of cigarette tax avoidance or evasion in Canada, the USA, the UK and France. FINDINGS We found prevalence estimates of cigarette tax avoidance/evasion vary substantially between countries and across time. In Canada, France and the UK, more than 10% of smokers reported last purchasing cigarettes from low or untaxed sources, while in Malaysia some prevalence estimates suggested substantial cigarette tax avoidance/evasion. We also found important associations between household income and education and the likelihood to engage in tax avoidance/evasion. These associations, however, varied both in direction and magnitude across countries.
Collapse
Affiliation(s)
- G. Emmanuel Guindon
- Département d’administration de la santé, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
- Institut de recherche en santé publique de l’Université de Montréal (IRSPUM), Université de Montréal, Montréal, QC, Canada
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada
| | - Pete Driezen
- Propel Centre for Population Health Impact, University of Waterloo, Waterloo, ON, Canada
| | - Frank J. Chaloupka
- Department of Economics, University of Illinois at Chicago, Chicago, IL, United States
- National Bureau of Economic Research (NBER), Cambridge, MA, United States
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, United States
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, ON, Canada
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| |
Collapse
|
8
|
Stead M, Jones L, Docherty G, Gough B, Antoniak M, McNeill A. 'No-one actually goes to a shop and buys them do they?': attitudes and behaviours regarding illicit tobacco in a multiply disadvantaged community in England. Addiction 2013; 108:2212-9. [PMID: 23962384 DOI: 10.1111/add.12332] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 04/29/2013] [Accepted: 08/06/2013] [Indexed: 11/28/2022]
Abstract
AIMS To explore attitudes towards, and experience of, illicit tobacco usage in a disadvantaged community against a backdrop of austerity and declining national trends in illicit tobacco use. DESIGN Qualitative study using 10 focus groups. SETTING Multiply disadvantaged community in Nottingham, United Kingdom. PARTICIPANTS Fifty-eight smokers, ex- and non-smokers aged 15-60 years. MEASUREMENTS Focus group topic guides. FINDINGS There was high awareness and use of illegal tobacco sources, with 'fag houses' (individuals selling cigarettes from their own homes) being particularly widespread. Rather than being regarded as marginal behaviour, buying illicit tobacco was perceived as commonplace, even where products were known to be counterfeit. Smokers' willingness to smoke inferior 'nasty' counterfeit products may be testament to their need for cheap nicotine. Illicit tobacco was seen to be of mutual benefit to both user (because of its low cost) and seller (because it provided income and support for the local economy). Illicit tobacco sellers were generally condoned, in contrast with the government, which was blamed for unfair tobacco taxation, attitudes possibly heightened by the recession. Easy access to illicit tobacco was seen to facilitate and sustain smoking, with the main concern being around underage smokers who were perceived to be able to buy cheap cigarettes without challenge. CONCLUSIONS National strategies to reduce illicit tobacco may have limited impact in communities during a recession and where illicit trade is part of the local culture and economy. There may be potential to influence illicit tobacco use by building on the ambivalence and unease expressed around selling to children.
Collapse
Affiliation(s)
- Martine Stead
- Institute for Social Marketing, UKCTAS (UK Centre for Tobacco and Alcohol Studies), University of Stirling, Stirling, UK
| | | | | | | | | | | |
Collapse
|
9
|
Pesko MF, Licht AS, Kruger JM. Cigarette price minimization strategies in the United States: price reductions and responsiveness to excise taxes. Nicotine Tob Res 2013; 15:1858-66. [PMID: 23729501 DOI: 10.1093/ntr/ntt068] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Because cigarette price minimization strategies can provide substantial price reductions for individuals continuing their usual smoking behaviors following federal and state cigarette excise tax increases, we examined independent price reductions compensating for overlapping strategies. The possible availability of larger independent price reduction opportunities in states with higher cigarette excise taxes is explored. METHODS Regression analysis used the 2006-2007 Tobacco Use Supplement of the Current Population Survey (N = 26,826) to explore national and state-level independent price reductions that smokers obtained from purchasing cigarettes (a) by the carton, (b) in a state with a lower average after-tax cigarette price than in the state of residence, and (c) in "some other way," including online or in another country. Price reductions from these strategies are estimated jointly to compensate for known overlapping strategies. RESULTS Each strategy reduced the price of cigarettes by 64-94 cents per pack. These price reductions are 9%-22% lower than conventionally estimated results not compensating for overlapping strategies. Price reductions vary substantially by state. Following cigarette excise tax increases, the price reduction available from purchasing cigarettes by cartons increased. Additionally, the price reduction from purchasing cigarettes in a state with a lower average after-tax cigarette price is positively associated with state cigarette excise tax rates and border state cigarette excise tax rate differentials. CONCLUSIONS Findings from this large, nationally representative study of cigarette smokers suggest that price reductions are larger in states with higher cigarette excise taxes, and increase as cigarette excise taxes rise.
Collapse
Affiliation(s)
- Michael F Pesko
- Department of Public Health, Weill Cornell Medical College, New York, NY
| | | | | |
Collapse
|
10
|
Barkans M, Lawrance KA. Contraband tobacco on post-secondary campuses in Ontario, Canada: analysis of discarded cigarette butts. BMC Public Health 2013; 13:335. [PMID: 23577796 PMCID: PMC3637540 DOI: 10.1186/1471-2458-13-335] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2012] [Accepted: 04/01/2013] [Indexed: 11/13/2022] Open
Abstract
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.
Collapse
Affiliation(s)
- Meagan Barkans
- Brock University, Leave The Pack Behind (PL514), 500 Glenridge Avenue, St, Catharines L2S 3A1, ON, Canada
| | | |
Collapse
|
11
|
Mecredy GC, Diemert LM, Callaghan RC, Cohen JE. Association between use of contraband tobacco and smoking cessation outcomes: a population-based cohort study. CMAJ 2013; 185:E287-94. [PMID: 23460630 DOI: 10.1503/cmaj.111861] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND High tobacco prices, typically achieved through taxation, are an evidence-based strategy to reduce tobacco use. However, the presence of inexpensive contraband tobacco could undermine this effective intervention by providing an accessible alternative to quitting. We assessed whether the use of contraband tobacco negatively affects smoking cessation outcomes. METHODS We evaluated data from 2786 people who smoked, aged 18 years or older, who participated in the population-based longitudinal Ontario Tobacco Survey. We analyzed associations between use of contraband tobacco and smoking cessation outcomes (attempting to quit, 30-d cessation and long-term cessation at 1 yr follow-up). RESULTS Compared with people who smoked premium or discount cigarettes, people who reported usually smoking contraband cigarettes at baseline were heavier smokers, perceived greater addiction, identified more barriers to quitting and were more likely to have used pharmacotherapy for smoking cessation. People who smoked contraband cigarettes were less likely to report a period of 30-day cessation during the subsequent 6 months (adjusted relative risk [RR] 0.23, 95% confidence interval [CI] 0.09-0.61) and 1 year (adjusted RR 0.30, 95% CI 0.14-0.61), but they did not differ significantly from other people who smoked regarding attempts to quit (at 6 mo, adjusted RR 0.74, 95% CI 0.43-1.20) or long-term cessation (adjusted RR 0.24, 95% CI 0.04-1.34). INTERPRETATION Smoking contraband cigarettes was negatively associated with short-term smoking cessation. Access to contraband tobacco may therefore undermine public health efforts to reduce the use of tobacco at the population level.
Collapse
|
12
|
Corsi DJ, Lear SA, Chow CK, Subramanian SV, Boyle MH, Teo KK. Socioeconomic and geographic patterning of smoking behaviour in Canada: a cross-sectional multilevel analysis. PLoS One 2013; 8:e57646. [PMID: 23469038 PMCID: PMC3585192 DOI: 10.1371/journal.pone.0057646] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Accepted: 01/24/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To describe the socioeconomic and geographic distribution of smoking behaviour in Canada among 19,383 individuals (51% women) aged 15-85 years. METHODS Current smoking and quitting were modeled using standard and multilevel logistic regression. Markers of socioeconomic status (SES) were education and occupation. Geography was defined by Canadian Provinces. RESULTS The adjusted prevalence of current smoking was 20.2% (95% confidence interval [CI]: 18.8-21.7) and 63.7% (95% CI: 61.1-66.3) of ever smokers had quit. Current smoking decreased and quitting increased with increasing SES. The adjusted prevalence of current smoking was 32.8% (95% CI: 28.4-37.5) among the least educated compared to 11.0% (95% CI: 8.9-13.4) for the highest educated. Among the least educated, 53.0% (95% CI: 46.8-59.2) had quit, rising to 68.7% (95% CI: 62.7-74.1) for the most educated. There was substantial variation in current smoking and quitting at the provincial level; current smoking varied from 17.9% in British Columbia to 26.1% in Nova Scotia, and quitting varied from 57.4% in Nova Scotia to 67.8% in Prince Edward Island. Nationally, increasing education and occupation level were inversely associated with current smoking (odds ratio [OR] 0.64, 95% CI: 0.60-0.68 for education; OR 0.82, 95% CI: 0.77-0.87 for occupation) and positively associated with quitting (OR 1.27, 95% CI: 1.16-1.40 for education; OR 1.20, 95% CI: 1.12-1.27 for occupation). These associations were consistent in direction across provinces although with some variability in magnitude. CONCLUSION Our findings indicate that socioeconomic inequalities in smoking have persisted in Canada; current smoking was less likely and quitting was more likely among the better off groups and in certain provinces. Current prevention and cessation policies have not been successful in improving the situation for all areas and groups. Future efforts to reduce smoking uptake and increase cessation in Canada will need consideration of socioeconomic and geographic factors to be successful.
Collapse
Affiliation(s)
- Daniel J Corsi
- Harvard Center for Population and Development Studies, Harvard University, Cambridge, Massachusetts, United States of America.
| | | | | | | | | | | |
Collapse
|
13
|
Licht AS, Hyland AJ, O’Connor RJ, Chaloupka FJ, Borland R, Fong GT, Nargis N, Cummings KM. Socio-economic variation in price minimizing behaviors: findings from the International Tobacco Control (ITC) Four Country Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:234-52. [PMID: 21318026 PMCID: PMC3037072 DOI: 10.3390/ijerph8010234] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/14/2011] [Accepted: 01/15/2011] [Indexed: 11/29/2022]
Abstract
This paper examines how socio-economic status (SES) modifies how smokers adjust to changes in the price of tobacco products through utilization of multiple price minimizing techniques. Data come from the International Tobacco Control Policy Evaluation (ITC) Four Country Survey, nationally representative samples of adult smokers and includes respondents from Canada, the United States, the United Kingdom and Australia. Cross-sectional analyses were completed among 8,243 respondents (7,038 current smokers) from the survey wave conducted between October 2006 and February 2007. Analyses examined predictors of purchasing from low/untaxed sources, using discount cigarettes or roll-your-own (RYO) tobacco, purchasing cigarettes in cartons, and engaging in high levels of price and tax avoidance at last purchase. All analyses tested for interactions with SES and were weighted to account for changing and under-represented demographics. Relatively high levels of price and tax avoidance behaviors were present; 8% reported buying from low or untaxed source; 36% used discount or generic brands, 13.5% used RYO tobacco, 29% reported purchasing cartons, and 63% reported using at least one of these high price avoidance behaviors. Respondents categorized as having low SES were approximately 26% less likely to report using low or untaxed sources and 43% less likely to purchase tobacco by the carton. However, respondents with low SES were 85% more likely to report using discount brands/RYO compared to participants with higher SES. Overall, lower SES smokers were 25% more likely to engage in at least one or more tax avoidance behaviors compared to their higher SES counterparts. Price and tax avoidance behaviors are relatively common among smokers of all SES strata, but strategies differed with higher SES groups more likely to report traveling to a low-tax location to avoid paying higher prices, purchase duty free tobacco, and purchase by cartons instead of packs all of which were less commonly reported by low SES smokers. Because of the strategies lower SES respondents are more likely to use, reducing price differentials between discount and premium brands may have a greater impact on them, potentially increasing the likelihood of quitting.
Collapse
Affiliation(s)
- Andrea S. Licht
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA; E-Mails: (A.J.H.); richard.o’ (R.J.O.); (K.M.C.)
- Department of Social and Preventive Medicine, School of Public Health and Health Professions, University at Buffalo, Buffalo, NY 14214, USA
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +1-716-845-7619; Fax: +1-716-845-8487
| | - Andrew J. Hyland
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA; E-Mails: (A.J.H.); richard.o’ (R.J.O.); (K.M.C.)
| | - Richard J. O’Connor
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA; E-Mails: (A.J.H.); richard.o’ (R.J.O.); (K.M.C.)
| | - Frank J. Chaloupka
- Department of Economics, University of Illinois at Chicago, Chicago, IL 60607, USA; E-Mail:
| | - Ron Borland
- Vic Health Center for Tobacco Control, The Cancer Council Victoria, Carlton, VIC 3053, Australia; E-Mail:
| | - Geoffrey T. Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; E-Mails: (G.T.F.); (N.N.)
- Ontario Institute for Cancer Research, Toronto, Ontario M5G 0A3, Canada
| | - Nigar Nargis
- Department of Psychology, University of Waterloo, Waterloo, Ontario N2L 3G1, Canada; E-Mails: (G.T.F.); (N.N.)
| | - K. Michael Cummings
- Department of Health Behavior, Roswell Park Cancer Institute, Elm and Carlton Streets, Buffalo, NY 14263, USA; E-Mails: (A.J.H.); richard.o’ (R.J.O.); (K.M.C.)
| |
Collapse
|
14
|
Moss TG, Weinberger AH, Vessicchio JC, Mancuso V, Cushing SJ, Pett M, Kitchen K, Selby P, George TP. A tobacco reconceptualization in psychiatry: toward the development of tobacco-free psychiatric facilities. Am J Addict 2010; 19:293-311. [PMID: 20653636 DOI: 10.1111/j.1521-0391.2010.00051.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Tobacco dependence is the leading cause of death in persons with psychiatric and substance use disorders. This has lead to interest in the development of pharmacological and behavioral treatments for tobacco dependence in this subset of smokers. However, there has been little attention paid to the development of tobacco-free environments in psychiatric institutions despite the creation of smoke-free psychiatric hospitals mandated by the Joint Commission for Accreditation of Health Organizations (JCAHO) in 1992. This review article addresses the reasons why tobacco should be excluded from psychiatric and addictions treatment settings, and strategies that can be employed to initiate and maintain tobacco-free psychiatric settings. Finally, questions for further research in this field are delineated. This Tobacco Reconceptualization in Psychiatry is long overdue, given the clear and compelling benefits of tobacco-free environments in psychiatric institutions.
Collapse
Affiliation(s)
- Taryn G Moss
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Varcoe C, Bottorff JL, Carey J, Sullivan D, Williams W. Wisdom and influence of elders: possibilities for health promotion and decreasing tobacco exposure in First Nations communities. Canadian Journal of Public Health 2010. [PMID: 20524382 DOI: 10.1007/bf03404363] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This community-based project examined the interpersonal and system influences on smoking practices and exposure to cigarette smoke that place young pregnant and parenting First Nations women and their children at risk. The aim was to work with the community using this information to develop meaningful strategies to support tobacco reduction and reduce exposure to second-hand smoke. METHOD Ethnographic methods informed by decolonizing approaches were used to study smoking practices and exposure within the context of six First Nations rural reserve villages in the Gitxsan territory in North-Western British Columbia. Data were collected through individual interviews with key community members, individual and group interviews with women, men, youth and older people, including Elders, and participant observation. FINDINGS Older people, including grandparents and Elders expressed great interest in being more involved in their communities, particularly with youth. Other community members, especially mothers, saw such older people as important in diminishing the tobacco exposure problem, with ideas for their involvement ranging from role modeling non-smoking or respectful smoking to teaching cultural traditions. CONCLUSION Elders in First Nations communities represent a culturally-relevant resource for health that is currently underused. Communities might draw upon their wisdom and influence to decrease tobacco exposure and promote community health in other ways. This offers a concrete, practical strategy in response to widespread calls for supporting the culture of Aboriginal people as part of health promotion.
Collapse
Affiliation(s)
- Colleen Varcoe
- University of British Columbia, School of Nursing, T201-2211 Wesbrook Mall, Vancouver, BC V6T 285.
| | | | | | | | | |
Collapse
|
16
|
Callaghan RC, Veldhuizen S, Leatherdale S, Murnaghan D, Manske S. Use of contraband cigarettes among adolescent daily smokers in Canada. CMAJ 2009; 181:384-6. [PMID: 19737829 PMCID: PMC2742140 DOI: 10.1503/cmaj.090665] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Current tobacco-control strategies seek to inhibit and reduce smoking among adolescents. However, such strategies are probably undermined by the contraband tobacco market. Using data from Canada's 2006/2007 Youth Smoking Survey, we found that 13.1% of respondents who were daily smokers reported that contraband cigarettes were their usual brand. They consumed significantly more cigarettes than respondents who smoked other brands. Contraband cigarettes accounted for about 17.5% of all cigarettes smoked by adolescent daily smokers in Canada overall, and for more than 25% in the provinces of Ontario and Quebec.
Collapse
Affiliation(s)
- Russell C. Callaghan
- From the Centre for Addiction and Mental Health (Callaghan, Veld-huizen), Toronto, Ont.; the Dalla Lana School of Public Health (Callaghan, Leatherdale), University of Toronto, Toronto; the Department of Population Studies and Surveillance (Leatherdale), Cancer Care Ontario, Toronto; the Department of Health Studies and Gerontology (Leatherdale, Manske) and the Centre for Behavioural Research and Program Evaluation (Manske), University of Waterloo, Waterloo, Ont.; and the School of Nursing (Murnaghan), University of Prince Edward Island, Charlottetown, PEI
| | - Scott Veldhuizen
- From the Centre for Addiction and Mental Health (Callaghan, Veld-huizen), Toronto, Ont.; the Dalla Lana School of Public Health (Callaghan, Leatherdale), University of Toronto, Toronto; the Department of Population Studies and Surveillance (Leatherdale), Cancer Care Ontario, Toronto; the Department of Health Studies and Gerontology (Leatherdale, Manske) and the Centre for Behavioural Research and Program Evaluation (Manske), University of Waterloo, Waterloo, Ont.; and the School of Nursing (Murnaghan), University of Prince Edward Island, Charlottetown, PEI
| | - Scott Leatherdale
- From the Centre for Addiction and Mental Health (Callaghan, Veld-huizen), Toronto, Ont.; the Dalla Lana School of Public Health (Callaghan, Leatherdale), University of Toronto, Toronto; the Department of Population Studies and Surveillance (Leatherdale), Cancer Care Ontario, Toronto; the Department of Health Studies and Gerontology (Leatherdale, Manske) and the Centre for Behavioural Research and Program Evaluation (Manske), University of Waterloo, Waterloo, Ont.; and the School of Nursing (Murnaghan), University of Prince Edward Island, Charlottetown, PEI
| | - Donna Murnaghan
- From the Centre for Addiction and Mental Health (Callaghan, Veld-huizen), Toronto, Ont.; the Dalla Lana School of Public Health (Callaghan, Leatherdale), University of Toronto, Toronto; the Department of Population Studies and Surveillance (Leatherdale), Cancer Care Ontario, Toronto; the Department of Health Studies and Gerontology (Leatherdale, Manske) and the Centre for Behavioural Research and Program Evaluation (Manske), University of Waterloo, Waterloo, Ont.; and the School of Nursing (Murnaghan), University of Prince Edward Island, Charlottetown, PEI
| | - Steve Manske
- From the Centre for Addiction and Mental Health (Callaghan, Veld-huizen), Toronto, Ont.; the Dalla Lana School of Public Health (Callaghan, Leatherdale), University of Toronto, Toronto; the Department of Population Studies and Surveillance (Leatherdale), Cancer Care Ontario, Toronto; the Department of Health Studies and Gerontology (Leatherdale, Manske) and the Centre for Behavioural Research and Program Evaluation (Manske), University of Waterloo, Waterloo, Ont.; and the School of Nursing (Murnaghan), University of Prince Edward Island, Charlottetown, PEI
| |
Collapse
|