Tobacco Control最新文献

Introduction: Africa has the lowest cigarette taxes of any region. Price data are needed to produce evidence that informs tax policy change.

Objective: To locate and describe datasets that provide information on cigarette prices in African countries and to identify opportunities for expanding the region's cigarette price information base.

Methods: Three data repositories and relevant literature were searched to locate free datasets that provide cigarette prices for African countries. 13 categories of information were extracted from each dataset, including the type of data collected (self-reported vs observational). The number of outliers and summary statistics, for the price of 20 cigarette sticks, was calculated using the most recent data available from each data collection project identified in a country. T-tests were conducted to compare these statistics for the 14 countries with both self-reported and observational price data available.

Results: A total of 131 datasets, covering 39/47 African countries, contain information on cigarette prices. Most datasets (N=111/131) provide self-reported information. Only 11 countries have used the three large-scale surveys that repeatedly collect information on smoking behaviour across Africa (Multiple Indicator Cluster Survey, Demographic and Health Survey and STEPwise) to collect information on cigarette prices. No active projects that collect self-reported price data sample from the youth (aged<15). Prices collected through retail observations exhibit fewer outliers than self-reported prices (p<0.05).

Conclusion: The tobacco-control community should lead the process of using existing data collection efforts to enhance Africa's cigarette price information base. Increasing observational data collection efforts at retailers could improve our understanding of the prices paid for cigarettes in the region.

Background: Tobacco Free Portfolios urges institutions to pledge against investing in, and to withhold financial services from, tobacco companies. Their goal is to create a 'tobacco-free world'. They argue that without financial and investor support, these companies' operations will become less sustainable.

Objective: To assess the financial rationale for investing in, or divesting from, tobacco companies.

Methods: Using data sourced from Bloomberg from 2008 to 2023, we evaluate historical sales volumes, real revenue, real gross profit per cigarette, stock performance and price-to-earnings trends for nine leading listed global tobacco companies.

Results: Cigarette sales volumes have steadily declined from 2008 to 2023. Despite efforts to diversify towards novel products, revenues from these products remain small, and cigarettes remain the primary revenue source. Excluding inorganic growth, six of the nine companies experienced real revenue declines from 2008 to 2023. Since 2016, many companies experienced declines in real gross profit per cigarette, indicating that they find it increasingly difficult to offset reduced cigarette sales through net-of-tax price increases. Since 2016, all nine tobacco companies' stocks have substantially underperformed the market. This stands in contrast to the 2008-2016 period, during which all nine companies' stocks substantially outperformed the market.

Conclusions: Tobacco companies have experienced deteriorating financial performance since 2016, amidst ever-escalating regulation. It remains unclear whether the growth in novel products will be rapid enough to mitigate the decline in cigarette sales. This uncertainty poses heightened risks for investors, and there is a real possibility of continued poor stock performance.

Background: Licensing of tobacco retailers, including high retail licence fees, is one tobacco control measure that may reduce tobacco retail availability. Between 2015 and 2018, the tobacco licence fee in Tasmania, Australia, tripled to $A1132/year. We sought to explore small retailer perspectives on selling tobacco following the tripling of the licence fee.

Methods: In-depth semistructured telephone interviews (n=21) were conducted with business owners and managers between March and July 2020. Participants were asked broad questions about their business, attitudes and intentions towards selling tobacco and the perceived importance of tobacco to their business.

Results: Participants' perspectives and decision-making about selling tobacco were influenced by an interplay of factors, including tobacco's perceived core business value and its waning importance in small retail due to declining demand. Although participants frequently reported tobacco as unprofitable, with many describing it as their least profitable product, most continued selling it. The high tobacco licence fee created a tipping point that challenged the cost-benefit balance previously weighted towards selling tobacco. While the fee, alongside the increasing cost of tobacco itself, pushed some retailers towards a critical decision point to stop selling tobacco, others continued to sell tobacco but appear to be headed in the same direction.

Conclusion: A high annual tobacco licence fee serves as a potential mechanism for phasing out the sale of commercial tobacco in small retailers in a jurisdiction with other strong tobacco control measures.

Background: In April 2020, Japan's revised Health Promotion Act (HPA) banned cigarette smoking and heated tobacco products (HTP) use in indoor public places but exempted small establishments and permitted smoking-designated/HTP-designated rooms. This pre-post study evaluated the effectiveness of the HPA.

Methods: Data were from waves 1 to 4 (2018-2021) of the International Tobacco Control Japan Surveys among a national cohort of adults who smoke cigarettes, use HTPs and do not use any tobacco products. The sample sizes in the respective surveys were 4615, 4222, 4387 and 4254. Multivariable logistic regression models employing generalised estimating equations estimated the prevalence of observed and self-reported indoor smoking/HTP use in key public venues (restaurants/cafés, bars/pubs and workplaces), smoke-free places, and homes, and smoke-free/HTP aerosol-free home policies (model 1). The models were additionally adjusted for waves 1-4 to estimate the impacts of the HPA (model 2).

Results: The implementation of the HPA significantly reduced observed indoor smoking in bars/pubs (model 1: 82.2% (pre) to 55.5% (post), model 2: p=0.04) but not in restaurants/cafés (model 1: 53.0%-24.9%, model 2: p=0.15) or workplaces (model 1: 35.3%-30.1%, model 2: p=0.62). Observed indoor HTP use was also common postimplementation (restaurants/cafés: 19.6%, bars/pubs: 53.9%, workplaces: 36.4%). The implementation of the HPA was associated with a significant increase in observed HTP use in smoke-free places (model 1: 26.3%-33.3%, model 2: p=0.001) and a suggestive increase in homes without HTP aerosol-free policies among adults who smoke (model 1: 64.0%-77.0%, model 2: p=0.09).

Conclusions: The implementation of the HPA was limited in its effectiveness. Comprehensive regulations with no exemptions are needed in Japan.

Introduction: Tobacco smoke exposure (TSE) among individuals who do not smoke has declined in the USA, however, gaps remain in understanding how TSE patterns across indoor venues-including in homes, cars, workplaces, hospitality venues, and other areas-contribute to TSE disparities by income level.

Methods: We obtained data on adults (ages 18+, N=9909) and adolescents (ages 12-17, N=2065) who do not smoke from the National Health and Nutrition Examination Survey, 2013-2018. We examined the prevalence of self-reported, venue-specific TSE in each sample, stratified by poverty income ratio (PIR) quartile. We used linear regression models with a log-transformed outcome variable to explore associations between self-reported TSE and serum cotinine. We further explored the probability of detectable cotinine among individuals who reported no recent TSE, stratified by PIR.

Results: Self-reported TSE was highest in cars (prevalence=6.2% among adults, 14.2% among adolescents). TSE in own homes was the most strongly associated with differences in log cotinine levels (β for adults=1.92, 95% CI=1.52 to 2.31; β for adolescents=2.37 95% CI=2.07 to 2.66), and the association between home exposure and cotinine among adults was most pronounced in the lowest PIR quartile. There was an income gradient with regard to the probability of detectable cotinine among both adults and adolescents who did not report recent TSE.

Conclusions: Homes and vehicles remain priority venues for addressing persistent TSE among individuals who do not smoke in the USA. TSE survey measures may have differential validity across population subgroups.

Objective: This study updates a previous paper that examined trends in the sale of cigarettes and heated tobacco products (HTPs) in Japan between 2011 and part way through 2019. The current study includes complete unit sales data through 2023.

Methods: Data on cigarette and HTP sales were obtained from public sources available from the websites and stockholder reports for the Tobacco Institute of Japan, Philip Morris International and Japan Tobacco. We used joinpoint regression using the parametric method to test for trends in both per capita and total sales for the three outcome variables assessed between 2011 and 2023: (1) cigarette sales, (2) HTP sales and (3) combined cigarette and HTP sales. Joinpoint regression identifies changes in trends and estimates the annual per cent change (APC) for each trend segment.

Results: Between 2011 and 2023, per capita and total cigarette sales declined by 52.6% and 52.7%, respectively. From 2011 to 2015, per capita cigarette sales in Japan decreased -1.5% APC; from 2015 to 2018, the decline accelerated to -10.5% APC and continued to fall -7.3% APC between 2018 and 2023. Between 2016 and 2018, per capita HTP sales increased by 149.0% APC, and since 2018, they have increased by 8.1% APC.

Conclusion: While many factors may account for the decreased sale of cigarettes in Japan over the past 12 years, the increased sale of HTPs appears to be a factor.

Significance: E-cigarettes with candy-themed marketing are implicated in decisions to first try e-cigarettes but have unknown effects on the experience of vaping. We compared adults' perceived appeal and sensory attributes after self-administering flavoured e-cigarettes in experimentally manipulated packaging with candy-themed versus standard marketing. We also assessed effect modification by salt vs free-base nicotine formulation.

Methods: Adults who currently used e-cigarettes and/or cigarettes (N=72; age M(SD)=31.4 (12.8) years) completed single-puff self-administrations from eight individually-packaged pods containing fruit or dessert-flavoured e-liquid via staff-guided video sessions. For each e-liquid flavour, we custom-manufactured packaging with standard (eg, 'mango'; mango fruit image) and candy (eg, 'mango gummy bear'; gummy bear image) marketing versions, which we varied within-subject (four pods candy; four pods standard). After participants opened the package and vaped the pod inside, they rated its sensory attributes and appeal (0-100 scale). Participants were randomised between subjects to salt or free-base ~2.3% nicotine in all pods.

Results: Marketing theme had no significant main effects on outcomes. Marketing theme × nicotine formulation interactions were significant; candy-themed (vs standard) packaging elevated composite appeal (B_{difference [estimated mean difference between marketing themes]}=7.7), liking (B_difference=8.4), and sweetness (B_difference=5.7) ratings in free-base but not salt nicotine formulations. Marketing theme did not affect smoothness, harshness and bitterness ratings regardless of nicotine formulation.

Conclusion: Candy-themed marketing may heighten the appeal and sweet sensory experience of vaping flavoured free-base nicotine e-cigarettes. While marketing restrictions are predominantly intended to prevent e-cigarette initiation, candy-themed marketing restrictions could also prevent persistent use by lowering the appeal of flavoured free-base nicotine e-cigarettes.

Significance: The tobacco industry uses different descriptors to market unflavoured cigarillos, which represent around half of all cigarillos sold. Limited research has focused on perceptions of unflavoured cigarillos.

Methods: We conducted an online between-subjects experiment with n=742 US youth and young adults (ages 15-20) recruited July-November 2024 through Qualtrics who reported ever/past 30-day little cigar or cigarillo use or susceptibility to using little cigars or cigarillos. Participants were randomly assigned to view one of four fictitious cigarillo packages with descriptors commonly used to market unflavoured cigarillos-'un-sweet', 'tobacco', 'silver' and no descriptor. Cigarillos were chosen for their popularity among youth and young adults and dominance in cigar sales. Outcomes included perceived product flavour and taste, appeal, susceptibility and purchase intentions.

Results: The silver descriptor led to more favourable flavour and taste perceptions, higher appeal and higher purchase intentions compared with the un-sweet descriptor (ps <0.05). The silver descriptor also led to higher purchase intentions compared with the tobacco descriptor and no descriptor (ps <0.05). The unsweet descriptor led to less favourable flavour and taste perceptions, compared with the tobacco descriptor and no descriptor (ps <0.05).

Conclusions: Among a sample of US youth and young adults who have used little cigars or cigarillos or are susceptible to use, the silver descriptor was the least effective way to communicate that cigarillos were unflavoured and was viewed the most favourably. Even though a silver descriptor is currently used to market unflavoured cigarillos, it likely still communicates flavour/taste characteristics and could therefore increase purchase intentions and use.

Trial registration number: Clinicaltrials.gov ID: NCT06413797.