Tobacco Control最新文献

Background: In May 2020, England banned menthol as a characterising flavour in cigarettes. However, the sale of menthol accessories (eg, filters, flavour cards) remains permitted. This study assessed the impact of England's menthol ban on quit attempts and quit success.

Methods: Longitudinal data came from Waves 3 (2020, preban) and 4 (2022, postban) of the England arm of the International Tobacco Control Four Country Smoking and Vaping Survey. A nationally representative sample of 839 adults who smoke, were followed up, and provided sufficient data to derive menthol smoking (defined as smoking menthol cigarette brands/varieties) were included (n=112 smoked menthol, n=727 non-menthol, cigarettes preban). Logistic regressions examined associations between smoking menthol (vs non-menthol) preban and quit attempts and quit success postban. Menthol accessory use postban was also examined.

Results: At baseline (preban), 12.8% of adults who smoked used menthol (vs non-menthol) cigarettes, compared with 6.3% postban (AOR 0.46, 95% CI=0.30-0.69, p<0.001). Quit attempts were similar between participants who smoked menthol (vs non-menthol) preban (29.5% vs 27.0%; AOR 0.72, 95% CI=0.31-1.67). Quit success was higher among participants who smoked menthol (vs non-menthol) preban, although wide CIs included the possibility of no difference (20.1% vs 14.2%; AOR 1.25, 95% CI=0.56-2.79). Among those who smoked menthol cigarettes preban, 43.4% continued smoking menthol and 32.1% reported using menthol accessories postban.

Conclusions: While quit success was higher among participants who smoked menthol, small sample sizes and wide CIs limited the ability to detect associations. Continued menthol use and widespread accessory use suggest regulatory loopholes may be undermining the ban's effectiveness.

Background: Aotearoa-New Zealand (A/NZ) was the first country to pass a comprehensive commercial tobacco endgame strategy into law. Key components include the denicotinisation of smoked tobacco products and a major reduction in tobacco retail outlets. Understanding the potential long-term economic impacts of such measures is important for government planning.

Design: A tobacco policy simulation model that evaluated the health impacts of the A/NZ Smokefree Action Plan was extended to evaluate the economic effects from both government and citizen perspectives. Estimates were presented in 2021 US$, discounted at 3% per annum.

Results: The modelled endgame policy package generates considerable growth in income for the A/NZ population with a total cumulative gain of US$31 billion by 2050. From a government perspective, increased superannuation payments and reduced tobacco excise tax revenue result in a negative net financial position and a cumulative shortfall of US$11.5 billion by 2050. In a sensitivity analysis considering future labour force changes, the government's cumulative net position remained negative by 2050, but only by US$1.9 billion.

Conclusions: A policy such as the A/NZ Smokefree Action Plan is likely to produce substantial economic benefits for citizens, and modest impacts on government finances related to reduced tobacco tax and increases in aged pensions due to increased life expectancy. Such costs can be anticipated and planned for and might be largely offset by future increases in the size of the labour force and the proportion of people 65+ years old working in the formal economy.

Background: Many people continue to smoke despite strong policies to deter use, thus stronger regulatory measures may be required. In four high-income countries, we examined whether people who smoke would support a total ban on smoked tobacco products under two differing policy scenarios.

Methods: Data were from 14 363 adults (≥18) who smoked cigarettes (≥monthly) and participated in at least one of the 2018, 2020 or 2022 International Tobacco Control Four Country Smoking and Vaping Surveys in Australia, Canada, England and the USA. In 2018, respondents were asked whether they would support a law that totally bans smoked tobacco if the government provides smoking cessation assistance (Cessation Assistance scenario). In 2020 and 2022, respondents were asked a slightly different question as to whether they would support a law that totally bans smoked tobacco if the government encourages people who smoke to use alternative nicotine products like vaping products and nicotine replacement products instead (substitution scenario). Responses (support vs oppose/don't know) were estimated on weighted data.

Results: Support was greater for the cessation assistance scenario (2018, 36.6%) than the nicotine substitution scenario (2020, 26.9%; 2022, 26.3%, both p<0.0001). In the longitudinal analysis, there was a significant scenario by country interaction effect with lower support in Canada, the USA and Australia under the substitution scenario than in the cessation scenario, but equivalent levels in England under both scenarios. The strongest correlates of support under both scenarios were planning to quit smoking within 6 months, wanting to quit smoking 'a lot' and recent use of nicotine replacement therapy.

Conclusions: Opposition to banning smoked tobacco predominates among people who smoke, but less with a cessation assistance scenario than one encouraging nicotine substitution. Wanting to quit a lot was the strongest indicator of support.

Tobacco-free generation (TFG) policies, also conceptualised as smoke-free or nicotine-free generation in some geographies, envision the elimination of tobacco use initiation by preventing tobacco sales to generations born after a specified birth date. This cohort-based policy approach eventually aims to phase out tobacco use. This paper defines TFG, reviews its international developments and explores the feasibility of the TFG policy approach in India, considering the country's federal governance structure with health as a state responsibility, within a national policy framework. Our review suggests that the concept of TFG aligns well with existing tobacco control measures in India, such as the Cigarette and Other Tobacco Products Act (COTPA), the National Tobacco Control Programme, Tobacco-free Educational Institutes and innovations such as tobacco vendor licensing and various tobacco-free campaigns. Amending section 6(a) of COTPA to replace the current prohibition of sale to and by those below 18 years of age with a specific section on TFG would be an effective approach to ensure policy coherence. Supporting grassroots movements countrywide at the state and/or substate level may activate the process within the Ministry of Health and Family Welfare, Government of India to table this proposal as an amendment in Section 6 of COTPA for the Parliament to adopt.

Introduction: Tobacco endgame strategies often include measures to reduce tobacco availability by decreasing retailer numbers. Recently, some US pharmacies have delisted tobacco, though overall retailer numbers have not reduced markedly. Paradoxically, others have suggested limiting tobacco sales to pharmacies, to reduce supply and support cessation. We explored how pharmacists from Aotearoa New Zealand, a country planning to reduce tobacco supply, perceived supplying tobacco.

Methods: We undertook in-depth interviews with 16 pharmacists from Ōtepoti Dunedin; most served more deprived communities with higher smoking prevalence. We probed participants' views on supplying tobacco, explored factors that could limit implementation of this policy, and analysed their ethical positions. We used qualitative description to analyse data on limiting factors and reflexive thematic analysis to interpret the ethical arguments adduced.

Results: Most participants noted time, space and safety concerns, and some had strong moral objections to supplying tobacco. These included concerns that supplying tobacco would contradict their duty not to harm patients, reduce them to sales assistants, undermine their role as health experts, and tarnish their profession. A minority focused on the potential benefits of a pharmacy supply measure, which they thought would use and extend their skills, and improve community well-being.

Conclusions: Policy-makers will likely encounter strongly expressed opposition if they attempt to introduce a pharmacy supply measure as an initial component of a retail reduction strategy. However, as smoking prevalence falls, adopting a health-promoting supply model, using pharmacies that chose to participate, would become more feasible and potentially enhance community outreach and cessation support.

Background: In December 2022, California prohibited the sale of most flavoured tobacco products; however, limited data are available assessing the impact on adolescent tobacco use behaviours.

Methods: We compared data from youth in 11th grade prior to (fall 2022; n=1212; 'prelaw') and after implementation of the law (fall 2023; n=1026; 'postlaw') at four schools in Southern California (panel study). We assessed past 30-day e-cigarette use, e-cigarette flavours used, perceived difficulty in getting preferred flavours and (among new initiators), flavour at first use, and support for, anticipated impact, and perceived actual impact of the law. We also assessed change in e-cigarette use behaviours prelaw, prelaw to postlaw and postlaw in the same individuals (cohort study).

Results: There was little change in past 30-day e-cigarette use prelaw (5.8%) vs postlaw (4.1%) (p=0.11). At both time points, all new initiators (100%) reported starting vaping with a flavoured product, most reported past 30-day flavoured e-cigarette use (89.8% vs 90.9%), and most also reported that access to flavours was very or somewhat easy (85.5% vs 83.9%). Youth observed limited impact on e-cigarette use among peers. In the cohort study, few (6.3%) switched completely from e-cigarettes to another nicotine product; many (46.5%) reported no past 30-day nicotine use postlaw (demonstrating a similar pattern as prelaw).

Conclusions: We observed limited change in the use of flavoured e-cigarettes after a state-wide law restricting flavoured tobacco sales was enacted. Findings may reflect inadequate implementation (eg, insufficient enforcement efforts), which warrants further study to reduce youth access to flavoured tobacco products.

Objectives: To examine the associations between tobacco industry denormalisation (TID) beliefs and support for tobacco endgame policies.

Methods: A total of 2810 randomly selected adult respondents of population-based tobacco policy-related surveys (2018-2019) were included. TID beliefs (agree vs disagree/unsure) were measured by seven items: tobacco manufacturers ignore health, induce addiction, hide harm, spread false information, lure smoking, interfere with tobacco control policies and should be responsible for health problems. Score of each item was summed up and dichotomised (median=5, >5 strong beliefs; ≤5 weak beliefs). Support for tobacco endgame policies on total bans of tobacco sales (yes/no) and use (yes/no) was reported. Associations between TID beliefs and tobacco endgame policies support across various smoking status were analysed, adjusting for sociodemographics.

Results: Fewer smokers (23.3%) had strong beliefs of TID than ex-smokers (48.4%) and never smokers (48.5%) (p<0.001). Support for total bans on tobacco sales (74.6%) and use (76.9%) was lower in smokers (33.3% and 35.3%) than ex-smokers (74.3% and 77.9%) and never smokers (76.0% and 78.3%) (all p values<0.001). An increase in the number of TID beliefs supported was positively associated with support for a total ban on sales (adjusted risk ratio 1.06, 95% CI 1.05 to 1.08, p<0.001) and use (1.06, 95% CI 1.05 to 1.07, p<0.001). The corresponding associations were stronger in smokers than non-smokers (sales: 1.87 vs 1.25, p value for interaction=0.03; use: 1.78 vs 1.21, p value for interaction=0.03).

Conclusion: Stronger TID belief was associated with greater support for total bans on tobacco sales and use. TID intervention may increase support for tobacco endgame, especially in current smokers.

Background: Philip Morris International (PMI) claims to be transforming and has committed to a 'smoke-free' future. In 2020, it announced an 'aspirational' target for reduced cigarette shipments by 2025.

Methods: PMI cigarette shipment data are taken from PMI quarterly financial reports 2008-2023. Trends in these data before and after the 2020 announcement are analysed using linear regression, and auto regressive integrated moving average and error, trend, seasonal time-series models to assess if PMI's 2025 target would be met on pre-existing trends, and if the trend changed after the announcement. These trends are also compared with the global retail market for cigarettes, using sales data from Euromonitor.

Results: Findings were consistent across all three models. PMI's shipment target of 550 billion cigarette sticks by 2025 would readily have been met given pre-existing shipment trends. Following the 2020 announcement, the decline in PMI cigarette shipments stalled markedly with a statistically significant change in trend (p<0.001). The current and projected trend to 2025 is consistent with no further decline in cigarette volumes, meaning PMI is unlikely to hit its target. This mirrors a global pattern in which declines in cigarette sales have stalled since 2020.

Conclusions: PMI's 2025 target was not 'aspirational' but highly conservative-it would have been met based on pre-existing trends in declining cigarette shipments. Yet PMI will nonetheless fail to meet that target providing evidence it is not transforming. Stalling of the decline of PMI and global cigarette sales raises significant concerns about progress in global tobacco control.