Tobacco Control最新文献

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.

The European Union (EU) aims for a tobacco use prevalence of less than 5% by 2040 with its Tobacco-Free Generation goal, aligning with the tobacco endgame approach. In the Joint Action on Tobacco Control 2 (JATC-2) -project, we examined adopted and planned endgame goals and measures as well as preparedness to counter tobacco industry interference in the process. We surveyed key informants in 24 out of 50 countries in the WHO European Region (19 of the 27 EU Member States, MS). Altogether, eight countries (7 EU MS) had official governmental endgame goals, and an additional six EU MS had similar proposals from government, civil society or research entities. Movement towards tobacco endgame was most evident in retail-oriented and consumer-oriented policies. These include restricting the sales of tobacco and related products and raising the age limit above 18 years. Product standards were used especially to regulate flavours but no measures to substantially reduce addictiveness were reported. Market-oriented measures that tap into industry profits were predominantly missing, and countries often lacked concrete tools to prevent industry interference. Respondents' concerns around tobacco endgame were related to high smoking prevalence in some population groups, non-combustible and new nicotine products, cross-border marketing, political will, challenges with the existing regulations and industry interference. Results indicate both momentum and challenges in adopting and disseminating measures that facilitate achieving tobacco endgame goals. The EU goal can be used to advocate for national endgame goals and measures, and for the strengthened implementation of the WHO Framework Convention on Tobacco Control.

Introduction: International interest in a smokefree generation policy has grown as more local authorities and governments move to introduce this policy. Young people strongly support this measure, but we know less about how they view a nicotine-free generation policy that includes electronic nicotine delivery systems (ENDS). We addressed this gap by probing adolescents' views on a birth-year policy that included all nicotine products.

Methods: We undertook in-depth interviews with 20 adolescents aged 16-18 who self-assessed as moderately or severely addicted to vaping and lived in Aotearoa New Zealand. In semistructured interviews, we explored participants' views on a nicotine-free generation, its rationale, implementation and likely impact. We interpreted the data using a reflexive thematic analysis approach.

Results: Most participants supported a nicotine-free generation, rejected arguments that ENDS use was a 'choice', and called for government leadership to protect them and future generations; a small minority saw the measure as unwarranted interference. Several participants thought compliance would be low, given their experiences of lax age verification practices and the widespread social supply of ENDS, but suggested measures to improve compliance.

Conclusions: Although participants thought a nicotine-free generation could impose personal hardship, most privileged the freedom they thought it could bring over the illusory 'choice' they currently had. Policy-makers should consider looking beyond a smokefree generation to a nicotine-free generation; alongside this measure, they should implement strong enforcement and provide comprehensive support so young people addicted to nicotine can be empowered to stop using ENDS.

Introduction: The tobacco endgame, policies aiming to end the commercial tobacco epidemic, requires sustained public support, including among youth. We assessed endgame support among California (USA) adolescents, including their reasons and associated participant and policy-specific factors.

Methods: Teens, Nicotine and Tobacco Project online surveys (n=4827) and focus groups were conducted in 2021 and 2022 among California residents aged 12-17 years. Cross-sectional survey participants were asked their agreement level with eight policy statements related to tobacco and/or cannabis sales restrictions, use in public places and use in multiunit housing. Ordered logistic regression modelled level of agreement according to respondent characteristics, behaviours and statement content. Qualitative data were collected through focus groups (n=51 participants), which were analysed to provide insight into support for different policies.

Results: Most survey participants agreed or strongly agreed with tobacco product sales restrictions (72%-75%, depending on the policy), bans on use in public spaces (76%-82%) and smoke-free (79%) and vape-free (74%) apartment buildings. Support was stronger among younger, female, Asian and tobacco non-using participants and for policies directed at 'tobacco' (vs 'vapes' or cannabis), at flavoured tobacco (compared with all tobacco), and when statements featured 'should end' (vs 'not allowed'). Focus group participants who were supportive viewed policies as protecting children from harmful products, while those less supportive cited concerns about limiting adults' freedoms and unintended consequences.

Conclusions: Most participants supported strong tobacco control policies. Public communication that promotes broader endgame benefits besides protecting youth and accelerates industry denormalisation may counter youth concerns and further bolster their support.

In Malaysia, tobacco smoking continues to be one of the leading public health concerns; hence, the tobacco control community aims to see a generation free of tobacco use by 2040. Drafted and presented to the parliament, the Malaysian Control of Smoking Products for Public Health Bill 2022 highlighted the Generational Endgame (GEG) policy, which forbids the use and sale of tobacco products and smoking substances to individuals born on or after 1 January 2007. Stakeholders, including government and non-governmental organisations, policymakers, healthcare professionals, tobacco industry representatives and retailers, have expressed differing opinions indicating non-support of the policy. The Attorney General Chamber deemed the policy as 'unconstitutional' for discriminating against those within the implementation age range, which prompted its omission from the revised Control of Smoking Products for Public Health 2023 Bill. This paper discusses the obstacles and possible implications of the GEG policy implementation in Malaysia and details its implementation in other countries. This paper also proposes several recommendations for future directions in tackling the obstacles mentioned more effectively.

Endgame thinking means transitioning from merely trying to 'control' the tobacco epidemic to developing plans and measures to bring it to an end within a specific time, by changing the underlying dynamics that have created and perpetuated it for more than a century. Among the innovative policies characterised as 'endgame' policies are so-called 'tobacco-free generation' or 'smoke-free generation' policies, which prohibit sales of some or all tobacco products to individuals born on or after a particular date. Such birthdate-based sales restrictions (BSR) have intuitive appeal, largely because they do not appreciably disrupt the status quo of retail sales, which continue unchanged for all those born before the designated cut-off date. They also hold the potential for further denormalising tobacco use and sales by anticipating the long-term end of tobacco sales. In this Special Communication, we analyse BSR policies through an endgame lens and propose questions that should be discussed in jurisdictions considering them. We suggest that this policy has potential underexamined pitfalls, particularly related to equity, and that if enacted, it should include policy guardrails and be part of a package of endgame measures.

The eradication of the commercial tobacco industry is a crucial goal for health and well-being, particularly from a public health and health justice perspective. The term 'eradication' is applied in epidemiology to mean the process and outcome of elimination of the-commercial tobacco industry as a human-made-agent of disease and death. In this commentary, we outline why the eradication of the tobacco industry is necessary, urgent and realistic.The potential impact of eradication of the industry is substantial. Without the industry and the commercial tobacco that it produces, it is expected that globally over 22 000 lives will be saved daily (over 8 million annually), and life expectancy will increase. The human right to health underscores the need for tobacco industry accountability for the harms it causes and given the enormous human and financial costs, it is time for action towards eradication of the industry.The tobacco industry's opposition to tobacco control, particularly strategies focused on market supply and industry reform, has been fierce. Their strategies have involved circumventing, attacking and undermining public health measures to preserve profits. However, with insights learnt from over 70 years of incremental successes in reducing commercial tobacco use, we know that through comprehensive and locally tailored eradication strategies involving legislation, regulation and public health initiatives across multiple levels of governments, we can overcome the resistance from the tobacco industry and their affiliates. Given the cost of commercial tobacco and the ever-growing global consensus on its harms, the time to act is now.