Tobacco Control最新文献

Background: Since strict new tobacco control laws were introduced in 2019 and 2020, the National Tobacco Enterprise (NTE), the main manufacturer and distributor of cigarettes in Ethiopia, strategically engaged in corporate social responsibility (CSR) activities and other tactics to interfere in tobacco control policymaking. This study systematically identified and reviewed tobacco industry activities that undermine Ethiopia's strict new tobacco control laws.

Methods: We collated, reviewed and analysed evidence on tobacco industry CSR activities from February 2019 to November 2022 in Ethiopia, including newspapers, organisational websites, social media and government documents related to tobacco industry activities, contract agreements and other policy interference attempts.

Results: NTE's CSR activities included: (1) Funding educational programmes (eg, postgraduate scholarships); (2) Community service (eg, donating COVID-19 prevention materials, providing water, sanitation and hygiene supplies); and (3) Supporting government programmes (eg, greening initiatives and training programmes). NTE facilitated CSR activities via a contract agreement with the Ethiopian government that was created when Japan Tobacco International purchased the Government's majority share in NTE. NTE subsequently partnered with the Japanese Embassy in Addis Ababa and private law firms on CSR activities. The tobacco control community stopped NTE distributing free COVID-19 prevention products in Addis Ababa but had limited impact on other identified breaches of laws prohibiting tobacco advertising promotion and sponsorship.

Conclusion: The new laws have not stopped NTE using multiple CSR activities to interfere in tobacco control policy. Regular monitoring of tobacco industry CSR activities to identify potential breaches is recommended. Moreover, the Ethiopian government should revise its contractual agreement with NTE to end NTE's participation in law-making processes and partnerships on illicit tobacco control.

Significance: The marketing of cigars, little cigars and cigarillos (CLCCs) and cigar wraps is under-regulated and understudied in the USA. To describe strategies CLCC manufacturers and vendors used to advertise their products across marketing channels, we systematically tracked CLCC marketing expenditures from January 2017 to July 2022.

Methods: Using the Kantar Media's Strategy (presently Vivvix) platform, we collected marketing expenditures for 624 CLCC products, vendors, venues, events and media outlets. Advertising data were collected from consumer magazines, B-to-B magazines, newspapers, television, radio, outdoor and internet media. Advertising expenditures were aggregated by month, designated market area, manufacturer and product category.

Results: Across the study period, cigarillo marketing comprised the largest proportion of CLCC product expenditures (49.5%), followed by little/filtered cigars (44.7%). Cigarillos dominated advertising expenditures in 2018 ($19.9M), declined to $1.4M by 2020 when little/filtered cigars emerged as the most promoted category ($10.4M); cigarillos re-surfaced as the top category in 2022. Radio advertising expenditures for CLCCs increased substantially in 2021. Outdoor CLCC vendor expenditures steadily increased during the period. Online marketing expenditures by CLCC vendors increased from 2020 to 2021, and newly reported mobile app expenditures occurred in 2021 ($22K).

Conclusion: Advertising expenditures for little/filtered cigars declined following the April 2021 Food and Drug Administration (FDA) announcement of forthcoming flavoured cigar sale restrictions. As the FDA considers prohibiting flavoured cigars, it is essential to monitor CLCC marketing expenditures to inform policy design, promotion and implementation efforts. Surveillance of new digital marketing channels is critical as they can readily reach minoritised populations.

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: Product design is a key tobacco industry strategy to recruit consumers and hinder cessation. An important technology in tobacco product design is the use of additives including those that create characterising flavours, that is, flavours that are perceived by taste and or smell by the user. To curb youth use, many countries are implementing policies to limit the use of flavours and other additives in tobacco products. This paper reviews the global landscape of tobacco additives policies including those focusing only on flavouring additives, updating a previous review.

Methods: We gathered additives policy data from available online sources of tobacco control policies including parties' reports to the WHO Framework Convention on Tobacco Control (where WHO refers to World Health Organization), the website Tobacco Control Laws, government websites, searches with the Google search engine and consultations with the WHO to ensure comprehensiveness of the assessment. The policies were classified according to their objective and characteristics: Labelling regulations, sales bans and tobacco product design regulations. We classified and organised the regulations according to their stated intent.

Results: We found that 62 countries had tobacco products' additives-related regulations at the regional, national or subnational levels. Most of these regulations focused on flavouring additives especially bans on the selling, importing and manufacturing tobacco products with characterising flavours.

Conclusions: The data demonstrate various global policies addressing additives and/or flavours and a range of definitions of additives and flavours. Establishing common definitions and standards could facilitate cooperation between countries and regions.

Introduction: Single cigarette sales at tobacco-selling points of sale (POS) may promote smoking. We explored visibility and availability of single cigarettes in POS around schools in Argentina, Guatemala, Mexico and Peru, countries where their sale is banned.

Methods: Between April and July 2023, an observational study was conducted at POS around high schools in urban and rural areas in Argentina, Guatemala, Mexico and Peru. A sampling frame of schools was generated from public registries, with schools categorised according to their socioeconomic status and randomly selected within socioeconomic strata. A total of 2081 POS were surveyed based on their proximity to these randomly selected schools. Data were collected on the visibility of single cigarettes (any cigarette sticks or open cigarette packs on display and able to be seen by customers were coded as visible) and their availability (ie, whether singles were sold, whether visible or not).

Results: Single cigarettes were visible in 37.2% of POS and available in most (84.9%), with neighbourhood stores the primary source. In most (84.1%) POS with visible single cigarettes, they were displayed near candy or toys. Prices of the cheapest single cigarette sticks ranged from US$0.03 in Argentina to US$0.13 in Guatemala.

Conclusion: The findings indicate widespread availability of single cigarettes in four Latin American countries where their sale is banned. The low price of single cigarettes, and their proximity to candy/toys, may increase the appeal of smoking to youth. Stricter enforcement of bans on single cigarettes, which may serve as a gateway to experimentation and continued smoking, is needed.

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.

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.

Background: For decades, the tobacco industry has engineered the sensory characteristics of combustible tobacco products including the degree of harshness experienced at the back of the throat. Commonly referred to as 'throat hit', this harshness derives from absorption of gas phase nicotine and other constituents by the sensory nerves. People who use tobacco products associate throat hit with the positive psychological effects of nicotine, making it a secondary reinforcer for smoking. On the other hand, high throat hit can make products aversive to naïve nicotine users and serves as a barrier to consumption of tobacco products.

Methods: We developed a first-principles theoretical model to predict nicotine absorption in the throat as a function of electronic nicotine delivery systems (ENDS) device power, liquid composition and puffing topography. The predicted nicotine absorption was compared with subjective throat harshness reported by human participants. We also simulated several ENDS use scenarios to identify the most important processes and factors that govern nicotine absorption in the throat.

Results: Across various ENDS configurations, we found that computed nicotine gas absorption in the throat was associated with subjective harshness scores (r=0.62; p<0.00001). We also found that liquid nicotine concentration, nicotine form, aerosol temperature and inhalation rate strongly influence nicotine absorption in the throat per unit of nicotine emitted by an ENDS.

Conclusions: Nicotine throat hit can be predicted and manipulated through ENDS device and liquid design variables. Regulating ENDS throat hit is feasible and may help reduce product appeal to nicotine-naïve individuals while maintaining acceptability for smokers.

Introduction: Electronic nicotine delivery systems (ENDS) may serve as a cessation tool for people who smoke cigarettes. However, for people who do not smoke, ENDS may be a gateway to nicotine addiction and cigarette use. This paper aims to quantify these behaviours in South Africa.

Methods: We analysed a nationally representative telephone survey of 21 263 South Africans living in urban areas. For those respondents who had used both products (N=771), we developed a typology that describes the sequence in which cigarette and ENDS initiation occurred. 'On-rampers' describe people who used ENDS first and later initiated cigarette smoking. 'Off-rampers' describe people who used cigarettes first, took up ENDS and later quit cigarettes while still using ENDS. 'Failed off-rampers' describe people who started using ENDS while smoking cigarettes but later quit using ENDS. 'Continuing dual consumers' describe people still using both products at the time of the interview.

Results: Of the overall sample (N=21 263), 1.7% used or had used ENDS but had no history of using cigarettes. Of dual consumers (N=771), 8.8% were classified as 'on-rampers', 13.9% as 'off-rampers', 20.9% as 'failed off-rampers' and 56.4% as 'continuing dual consumers'. Roughly half of those classified as off-rampers, failed off-rampers or continuing dual consumers stated that they started using ENDS to help them quit cigarettes.

Conclusions: The typology reveals a multifaceted relationship between ENDS and cigarette use in South Africa. Policy interventions should aim to minimise on-ramping and maximise off-ramping. Given the high prevalence of continued dual use and failed off-ramping, targeted cessation support should be provided for people who use ENDS and are trying to quit cigarettes.