Tobacco Control最新文献

Background: To control the illicit cigarette market, the government of Pakistan adopted a Tracking and Tracing System (TTS) that was fully operational by July 2022, despite many roadblocks. By this date, major tobacco companies had either registered their brands with the tax authority and/or installed TTS.

Methods: This paper is the first to evaluate the degree of compliance with the TTS by evaluating the extent and nature of illicit trade in tobacco products. We use randomised sampling to collect cigarette packs from waste recycling stores located in the ten most populous cities of Pakistan, to evaluate illicit trade penetration.

Results and policy implications: Almost a third of the packs collected did not bear a tax stamp, mostly due to the lack of compliance by local companies, confirming a recent review of the TTS implementation by the Federal Bureau of Revenue (FBR). Even the largest companies that ostensibly adopted the TTS did not fully comply with the system, signalling poor enforcement. This is a missed opportunity, since a well-functioning TTS combined with proper enforcement is an effective means of controlling illicit tobacco trade, boosting tax revenue and improving public health. However, the enforcement should not be limited to the TTS since 23.6% of packs did not comply with other regulatory requirements.

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.

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.

Background: E-cigarette products are the most popular tobacco/nicotine product used among youth and young adults in the USA. While emerging research has shown that e-cigarette taxes increase their price, no study to date has examined e-cigarette tax burdens nor their affordability for youth and young adults.

Methods: Using real (2021 US dollars) prices per mL of e-liquid data from NielsenIQ and annual real (2021 US dollars) personal income data from Integrated Public Use Microdata Series, we calculate relative income prices and examine average annual percentage changes in affordability using Joinpoint trend analysis from 2015 to 2021. In addition, we use tax data to calculate e-cigarette tax burdens as a percentage of price per 1 mL of e-liquid.

Results: In all states analysed, tax burdens increased from 2015 to 2021. E-cigarette prices decreased considerably from 2019 to 2021; in 2021 the real (2021 US dollars) average price of 1 mL of e-liquid was US$4.45. E-cigarettes on average became more affordable for all age groups and states; however, e-cigarettes tended to be less affordable in states with ad-valorem tax structures. On average, 16-17-year-olds needed 31% of their annual income to purchase 100 mL of e-liquid, whereas 18-19-year-olds, 20-24-year-olds and 25-34-year-olds needed 9%, 3% and 1%, respectively.

Conclusions: E-cigarettes have become more affordable for young people, but less so in states with ad-valorem tax structures. Policy efforts should focus on reducing e-cigarette affordability, especially for youth, through tax-induced increases in e-cigarette prices to levels high enough to outpace income growth.

Objective: To describe the scope of published literature about tobacco-related policy discussions from social media data and discuss implications for tobacco control policy and future research.

Data sources: PubMed, Medline, CINAHL and Web of Science were searched on 20 November 2023, using search terms for social media, tobacco, and policy. The search was limited from 2005 to 2023.

Study selection: After removing duplicates, 2 authors reviewed 1118 articles. Those found to be irrelevant based on title (1078) and abstract (18) review were removed.

Data extraction: Data included study descriptions (eg, policy discussed, social media platform and number of posts), study characteristics (eg, methodology, sentiment analysis (propolicy, antipolicy, neutral policy and unclear policy)), and major and additional findings.

Data synthesis: Of the 22 articles, most examined discussions about USA (n=18) federal regulations (n=17) via human annotation (n=18), using Twitter (X; n=20). Of the 14 papers that discussed sentiment, 4 collected data at different time points; frequency of positive posts typically decreased after policy announcements. Policies discussed in articles included flavour restrictions; USA ban of Puff Bar; Tobacco 21; tobacco taxes; e-cigarette regulation; UK's standardised packaging; product authorisation; regulating e-cigarettes as a medical product; WHO Framework Convention on Tobacco Control regulatory actions; Australia's import restrictions on vaping products and smoke-free and tobacco-free college campus policies.

Conclusions: Social media data can be leveraged to examine timely discourse regarding tobacco control policies. Identified methods of circumventing proposed tobacco control laws and enforcement challenges should be considered by regulatory agencies to close policy loopholes and inform implementation practices.

Introduction: This study explored the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity.

Methods: This cross-sectional study included 13 705 adults representative of the Korean population. The 18-item Household Food Security Survey Module was administered to the primary food managers in households with the scores applied to household members. The use of three tobacco products-combustible cigarettes, heated tobacco products and electronic cigarettes (e-cigarettes)-was assessed. Based on the urine cotinine level, the smoking status of each participant was classified into one of three groups: non-smoker, low-intensity smoker and high-intensity smoker. Logistic regression analysis was used to determine the association between food insecurity and tobacco product use and urine cotinine-measured smoking intensity. ORs and 95% CIs were estimated.

Results: Among the survey participants, 3.2% had mild food insecurity and 0.7% had moderate-to-severe food insecurity. Those with mild food insecurity (23.5%, OR: 1.38, 95% CI: 1.01 to 1.89) and those with moderate-to-severe food insecurity (45.1%, OR: 3.36, 95% CI: 1.87 to 6.03) compared with those with non-food insecurity (18.4%) were positively associated with combustible cigarette use. Those with moderate-to-severe food insecurity was positively associated with e-cigarette use (5.5%, OR: 3.49, 95% CI: 1.31 to 9.28). Compared with those with non-food security (7.9%), those with mild food insecurity (14.3%, OR: 1.61, 95% CI: 1.09 to 2.38) and moderate-to-severe food insecurity (22.1%, OR: 2.25, 95% CI: 1.04 to 4.86) were associated with high-intensity smoking.

Conclusion: Food insecurity is associated with both combustible and e-cigarette use. Those with food insecurity are associated with engagement in high-intensity smoking.

Background: The cellulose acetate filter is a plastic attachment on nearly all commercial cigarettes sold worldwide. It is the main component of discarded cigarette butts, and the most prevalent waste item collected during urban and beach cleanups. This waste leaches toxic chemicals, including nicotine, metals and tobacco-specific nitrosamines and contributes to environmental microplastic pollution. There is growing international interest in reducing plastic waste from single-use, non-essential products such as cellulose acetate cigarette filters. Public health and environmental advocates recommend a ban on the sale of filtered cigarettes to reduce environmental pollution caused by discarded cigarette butts and to discourage cigarette smoking.

Research question: What potential health and behavioural implications might arise among people who smoke if filtered cigarettes are removed from the market.

Methods: We conducted a cross-over, randomised clinical trial of 29 people who smoke to evaluate changes in biomarkers for nicotine and tobacco-specific nitrosamine exposure when switching between filtered and unfiltered cigarette smoking.

Results: Although unfiltered smoking showed a higher trend in the geometric means of 4-[(methylnitrosamino])-1-[3-pyridyl]-1-butanol (NNAL) compared with filtered cigarettes, regression models for urinary cotinine and NNAL showed no significant differences when switching between filtered and unfiltered cigarettes.

Conclusion: This proof-of-principle study suggests there is no increased risk to people who smoke when switching to unfiltered cigarette smoking. Although larger studies might provide more evidence regarding unfiltered cigarette smoking, banning the sale of filtered cigarettes may be an important policy intervention to both reduce hazardous tobacco waste and discourage smoking.

Introduction: Tobacco endgame strategy includes policies to end the tobacco epidemic. As tobacco smoking prevalence is higher among people with mental health conditions (MHC), understanding the impact of rigorous tobacco control strategies for this group is critical. This study examined support for five tobacco control strategies among people with MHCs: increasing tobacco product tax, reducing tobacco retail locations, ending tobacco sales in alcohol-licensed venues, limiting retailers to one tobacco point of sale and reduced nicotine in smoked tobacco.

Methods: Cross-sectional surveying of a representative sample of 3006 South Australians in 2021 aged ≥15 years included demographic, tobacco control strategy, smoking status and mental health indicators. Multivariable logistic regression was used to examine the influence of mental health on strategy support.

Results: Support was high for all tobacco control strategies, highest for reducing nicotine content (80.4%) and lowest for increasing tobacco tax (67.2%). Support for increased tobacco tax was lower among people with MHCs than for those without by 7.8% (aged 18+ years) to 9.5% (aged 15+ years). People who smoked had significantly lower support for all strategies, and smoking status and MHC did not interact in influencing support.

Conclusions: Support for tax-focused strategies was lower among people with MHCs. Retail and product-focused strategies may support equity in public acceptability of tobacco control action. Policy-makers must aim to maximise tobacco endgame support from populations most impacted by tobacco harms when implementing tobacco control strategies. Tax-focused approaches might be enhanced with consultation and advocacy for people with MHCs.

Objective: To systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation.

Data source and study selection: Four databases were searched for modelling studies of e-cigarette use on population health published between 2010 and 2023. A total of 32 studies were included.

Data extraction: Data on study characteristics, model attributes and estimates of population impacts including health outcomes and smoking prevalence were extracted from each article. The findings were synthesised narratively.

Data synthesis: The introduction of e-cigarettes was predicted to lead to decreased smoking-related mortality, increased quality-adjusted life-years and reduced health system costs in 29 studies. Seventeen studies predicted a lower prevalence of cigarette smoking. Models that predicted negative population impacts assumed very high e-cigarette initiation rates among non-smokers and that e-cigarette use would discourage smoking cessation by a large margin. The majority of the studies were based on US population data and few studies included factors other than smoking status, such as jurisdictional tobacco control policies or social influence.

Conclusions: A population increase in e-cigarette use may result in lower smoking prevalence and reduced burden of disease in the long run, especially if their use can be restricted to assisting smoking cessation. Given the assumption-dependent nature of modelling outcomes, future modelling studies should consider incorporating different policy options in their projection exercises, using shorter time horizons and expanding their modelling to low-income and middle-income countries where smoking rates remain relatively high.