Tobacco Control最新文献

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.

Introduction: Smoke-free policies are often regarded as an imposition on the economy which has hindered their adoption in countries like China. In reality, they increase workforce productivity, including via fewer sick days (absenteeism) and unsanctioned breaks (presenteeism), culminating in an increase in effective work hours. This paper measures the potential impact on productivity levels in China via these short-term channels following the introduction of a national smoke-free law for indoor public places.

Methods: We use existing systematic reviews to identify effect sizes for smoke-free policies on smoking behaviour in the workplace, with this evidence being supplemented by local studies. A baseline model of aggregate hours worked across China's economy was developed using a 2018 survey of adult smoking, National Account Statistics and International Labour Organization data. The effect sizes were introduced to test the impact of the law on effective hours worked by those who quit smoking.

Results: A national smoke-free law would cause the smoking rate among employed adults to decrease by 5.3% in relative terms, representing 11.6 million fewer adults who smoke. This decrease in smoking would, in turn, increase total effective work hours across China by 0.07% and expand Gross Domestic Product by ¥90 billion per annum or by 0.10% on current levels.

Conclusion: The productivity gains from a national smoke-free law in China are potentially very sizeable even before considering the impact of long-term reductions in mortality and healthcare spending. As China's working-age population declines, such a law would strongly support high-quality development.

Background: In 2023, the UK government proposed a Bill introducing a generational ban on the sale of tobacco products and measures targeting youth nicotine product (NP) use. Industries' responses remain unexplored.

Methods: We analysed 43 consultation and evidence submissions from tobacco and nicotine industry-linked actors, assessing their connections to transnational tobacco companies (TTCs) and using an evidence-based taxonomy to examine framing strategies.

Results: TTCs and actors with known current TTC links accounted for 42% of submissions. Other actors-some with historic TTC ties-were other tobacco products (OTPs) specialists, NP specialists and retailers. Tobacco and nicotine industries were generally portrayed as 'good' with TTCs framing themselves as public health champions, while policymakers, the public health community and non-compliant sellers were depicted as 'bad' actors. TTCs, linked groups and additional OTP actors opposed the generational ban, arguing it lacked evidence and would harm the economy and increase violence against retailers. Proposed alternative approaches included exempting heated tobacco products (HTPs) and OTPs, and raising the age of sale to 21. TTCs, linked actors and NP actors opposed restrictions on NP flavours, packaging and display, arguing these would infringe on rights, harm retailers, stifle innovation, and increase smoking and illicit trade. They framed youth NP use as resulting from irresponsible individuals and advocated for education, stricter penalties and self-regulation.

Conclusion: When faced with tobacco endgame and nicotine control policies in the UK, tobacco and nicotine industries pushed back using framing strategies common to health-harming industries. Despite contradicting their 'transformation' narratives, TTCs still sought to position themselves as public health actors deserving policy access. Advocates, researchers and policymakers can anticipate opposition to endgame policies-such as a generational sales ban-and NP restrictions, proactively preparing to counter this opposition in order to safeguard public health policy from vested interests.

Background: The tobacco industry targets future generations to maintain its profits. One of its tactics is to maintain its presence noticed at the level of retail environment. Measures to address this high presence are identified in the literature. Our study examines the effects of six of these identified tobacco retail reduction measures in reducing the total number of tobacco retailers and the number of retailers within 500, 1000 and 2000 m from youth-oriented facilities.

Methods: Data were collected by scraping Google Places on examination points including locations, opening hours, type and subtype of tobacco retailers in addition to educational, youth, health and religious facilities. The six studied measures were enacted using Python codes to assess the reduction percentage. The measures included restricting tobacco retail outlets per density of population, requiring a minimum distance between tobacco retailers, banning tobacco retail outlets within a minimum distance from specific facilities, banning tobacco sale in specific retail outlets, restricting tobacco retail outlets per geographic area and limiting the number of hours in which tobacco can be sold.

Results: The data collected showed a high presence of tobacco retailers around vital facilities, particularly youth-oriented ones. The six scenarios implemented showcased a positive reduction in the number of tobacco retailers in total and around youth-oriented facilities. The total reduction of retailers varied from 4% up to total elimination of availability.

Discussion and conclusions: Our study presents an example of measurable reduction impact of six tobacco retail reduction measures. The high percentage in reduction achieved, especially around youth-oriented facilities, is worth the attention of policy-makers to be considered as countermeasures for the high tobacco industry presence in retail.

Objective: To systematically review available data on the effects of heated tobacco products (HTPs) on biomarkers of potential harm (BoPH) and adverse events, including comparison to cigarettes, e-cigarettes and smoking abstinence.

Data sources: Web of Science, Scopus, MedRxiv, ClinicalTrials.gov, ICTRP database and HTP manufacturer libraries were searched from January 2010 to December 2024.

Study selection: Included studies were interventional clinical trials of any design that measured BoPH or adverse events in adults assigned a marketed HTP and another assigned either cigarettes, e-cigarettes or smoking abstinence.

Data extraction: Two reviewers independently extracted data into a predesigned form and assessed risk of bias using Cochrane's Risk of Bias tool version 1.

Data synthesis: BoPH data were synthesised using effect direction plots. A random-effects model was used to calculate pooled risk ratios for adverse event data. 40 studies (10 independent, 29 industry-affiliated and 1 of unclear affiliation) were included. Only nine studies lasted longer than 5 days. 19 involved using the intervention just once. Risk of bias was high for 32 studies and unclear for 8. Data on 143 BoPH indicated short-term HTP use had mixed effects compared with cigarettes, e-cigarettes and smoking abstinence. The rate of adverse event reporting was not significantly different between HTP and any comparator group.

Conclusions: Despite a growing evidence base, significant limitations hinder interpretation of the data, which do not yet provide clear indication of harm or benefit, even compared with cigarettes. Longer, better quality studies independent of tobacco industry funding are needed to determine the health impacts of HTPs.

Introduction: This study offers a comprehensive examination of the pricing strategies/dynamics used by the tobacco/nicotine industry in response to tax increases using Ukraine as a case study during the 2019-2022 tax reforms. This period saw the introduction of new tax categories for heated tobacco products (HTPs) and electronic cigarettes (e-cigs) with concomitant tax increases. This is the first systematic consideration of taxation on these products. The primary objectives are to examine how tax changes influence product pricing and how HTPs are priced vis-a-vis cigarettes, particularly in the context of harmonisedspecific tax rates.

Methodology: NielsenIQ monthly price and sales data for cigarettes, HTPs, and e-cigs, along with official tax data, were used. Tax pass-through analysis was conducted to examine the relationship between tax increases and retail prices by market segment, with net revenue calculations used to evaluate impacts.

Results: The industry usually overshifted taxes on cigarettes (mid-price and premium), HTPs, and e-cigs while undershifting on economy cigarettes during the study period. However, a big HTP tax increase in 2021 was not overshifted to a great extent. The industry also employed a price-smoothing strategy where initial price increases following tax increases were kept moderate, with further increases introduced gradually throughout the year.

Conclusion: The study shows that the industry has used tax increases on HTPs and e-cigs as an opportunity to raise prices but with lower net revenue per stick. The findings suggest that fully harmonising HTP taxes with those on traditional cigarettes could limit the industry's pricing strategies and hence help reduce consumption and generate additional government revenue.