Tobacco Control最新文献

Background: Smokeless tobacco (SLT) packaging in India had a single symbolic (a scorpion) health warning label (HWL) in 2009 covering 40% of the front surface. In 2011, it was replaced with four pictorial images. In 2016, HWLs were enlarged to 85% on the front and back. This study aimed to assess the effectiveness of the old (symbolic and smaller images) and larger HWLs.

Methods: Data were from the Tobacco Control Project India Survey and included respondents who used SLT in Wave 1 (2010-2011, n=5911), Wave 2 (2012-2013, n=5613) and Wave 3 (2018-2019, n=5636). Using a repeated-measures design, weighted logistic regression models assessed whether there were changes in seven HWL effectiveness measures within the domains of awareness, salience, cognitive and behavioural responses. A cohort design was employed to test whether HWL effectiveness in Waves 1 and 2 was associated with quitting SLT in Waves 2 and 3, respectively.

Results: The 2011 HWL revision did not result in any significant changes in HWL effectiveness. There was no significant change in HWL awareness and salience after larger HWLs were introduced in 2016, but respondents were more likely to consider SLT health risks (Wave 2=17.9%, Wave 3=33.6%, p<0.001) and quitting SLT (Wave 2=18.9%, Wave 3=36.5, p<0.001). There was no change in HWLs stopping SLT use (Wave 2=36.6%, Wave 3=35.2%, p=0.829); however, respondents were more likely to avoid looking at HWLs (Wave 2=10.1%, Wave 3=40.2%, p<0.001). Effectiveness of older, symbolic and smaller pictorial HWLs was not associated with quitting SLT.

Discussion: There was no significant change in HWL effectiveness following the revision from a symbolic to a pictorial image, but enlarging pictorial images resulted in some improved cognitive and behavioural effects. Results suggested wear-out of HWL salience and that the effectiveness of warnings depends on both their design and time since implementation.

Background: Public policy measures aimed at regulating tobacco use should consider the net gains for the nation, as the tobacco sector contributes to employment and tax revenue while also imposing substantial economic burden on the country. This study investigates the economy-wide impact of reducing tobacco consumption in India through the implementation of fiscal measures.

Methods: The study uses a computable general equilibrium model based on the Global Trade Analysis Project model and database and augments the same with several country-specific information on tobacco products, to examine the macroeconomic impact of a targeted reduction in the consumption of bidis, cigarettes and smokeless tobacco by 10% by the year 2026 through the adoption of fiscal measures.

Results: The model results suggest that the targeted reduction in consumption may result in a 0.14% reduction in the gross domestic product (GDP) and a 0.44% reduction in overall employment in the economy. However, after accounting for the averted premature deaths due to tobacco use, the results indicate a net 0.22% increase in GDP and a net increase in employment of about 1.36 million jobs (or 0.29% of the labour force) over 5 years. Further, the tax increase measures proposed in this model to achieve the targeted reduction in consumption would generate an additional US$2774 million in revenues to the exchequer.

Conclusion: The impact of targeted prevalence reduction of tobacco use is a win-win for the country considering its positive macroeconomic impacts in terms of net increases in both GDP as well as employment.

Background: In 2020, Ethiopia passed a landmark tax proclamation implementing an evidence-based mixed excise system aimed at curbing tobacco use. This study evaluates the impact of the tax increase of more than 600% on both legal and illegal cigarette prices in order to gauge the impact of the tax reform in the presence of a sizeable illicit cigarette market.

Methods: Data on 1774 cigarette prices were obtained from retailers during Empty Cigarette Pack Surveys in the capital and major regional cities conducted in 2018 and 2022. Packs were categorised as 'legal' or 'illicit' using criteria from the tobacco control directives. Descriptive and regression analyses were used to study the cigarette price changes during the period of 2018-2022, capturing the impact of the 2020 tax increase.

Result: Prices of both legal and illegal cigarettes increased in response to the tax increase. In 2018, the stick prices ranged from ETB0.88 (Ethiopian birr) to ETB5.00 for legal cigarettes while they ranged from ETB0.75 to ETB3.25 for illegal ones. In 2022, a legal stick sold for ETB01.50-ETB2.73 and an illegal stick for ETB1.92-ETB8.00. The average real price of legal and illegal brands increased by 18% and 37%, respectively. The multivariate analysis confirms that prices of illicit cigarettes grew faster compared with the legal ones. By 2022, illicit brands were on average more expensive compared with their legal counterparts. This result is statistically significant at p<0.01.

Conclusion: The prices of both legal and illegal cigarettes increased following the 2020 tax increase, with the average real cigarette price increasing by 24%. As a result, the tax increase likely had a positive impact on public health despite a sizeable illicit cigarette market.

The World No Tobacco Day 2022 theme emphasised tobacco's adverse environmental effects, including through agriculture, manufacturing, distribution, use and the disposal of tobacco product waste. A main concern regarding this toxic waste is the cigarette filter, which is attached to nearly all commercial cigarettes and is predominantly made from a plant-based plastic (cellulose acetate). Laboratory studies have demonstrated the chemical toxicity of discarded cigarette butts, and there is growing public concern regarding environmental plastic pollution resulting from single-use cellulose acetate filters. Important considerations are whether the filter has any protective role against the harms of smoking and whether it should be regulated as a plastic environmental pollutant. There is persistent misunderstanding among smokers and policy makers about the implied value of the cigarette filter. The cellulose acetate filter is simply a marketing tool that encourages smoking initiation and reduces intentions to quit smoking. This is because it makes smoking easier and implies added safety through the presumed filtration of inhaled smoke. The sale of filtered cigarettes should be prohibited to protect public health and the environment.

Introduction: Vuse Solo is the first electronic nicotine delivery system (ENDS) authorised by the US Food and Drug Administration for marketing in the USA. Salient features of the Vuse Solo product such as nicotine form, draw resistance, power regulation and electrical characteristics have not been reported previously, and few studies have examined the nicotine and other toxicant emissions of this product. We investigated the design characteristics and toxicant emissions of the Solo as well as Alto, another Vuse product with a greater market share than Solo.

Methods: Total/freebase nicotine, propylene glycol to vegetable glycerin ratio, carbonyl compounds (CC) and reactive oxygen species (ROS) were quantified by gas chromatography, high-performance liquid chromatography and fluorescence from aerosol emissions generated in 15 puffs of 4 s duration. The electric power control system was also analysed.

Results: The average power delivered was 2.1 W and 3.9 W for Solo and Alto; neither system was temperature-controlled. Vuse Solo and Alto, respectively, emitted nicotine at a rate of 38 µg/s and 115 µg/s, predominantly in the protonated form (>90%). Alto's ROS yield was similar to a combustible cigarette and one order of magnitude greater than that of Solo. Total carbonyls from both products were two orders of magnitude lower than combustible cigarettes.

Conclusion: Vuse Solo is an above-Ohm ENDS that emits approximately one-third the nicotine flux of a Marlboro Red cigarette (129 µg/s) and considerably lower CC and ROS yields than a combustible cigarette. With its higher power, the nicotine flux and ROS yield from Alto are similar to Marlboro Red levels; Alto may thus present greater abuse liability than the lower sales-volume Solo.

Objective: This review aimed to assess interventions designed to reduce harm from illicit tobacco (IT). We evaluated health outcomes, cost-effectiveness, the advantages and disadvantages of interventions, and contextual factors affecting implementation.

Data sources: We searched MEDLINE and EMBASE databases from January 2002 to June 2024, the grey literature and undertook backward and forward citation searches of included studies without geographical restrictions.

Study selection: Eligible study types included non-randomised trials, interrupted time series, before-after studies, economic simulations and mixed-methods studies. Case studies providing outcome data linked to specific interventions were also included. Studies were screened by multiple reviewers for eligibility.

Data extraction: Data was extracted on geographical location and dates of interventions, descriptions of the interventions, contexts and outcome data relevant to review objectives which were checked by a second reviewer. Quality assessment was conducted using the Joanna Briggs Institute (JBI) critical appraisal tools appropriate for each study design.

Data synthesis: Five studies and 16 case studies were included. These reported on a range of interventions (including track-and-trace systems, anti-counterfeit measures and communications campaigns) and outcomes (including tax revenue and population attitudes toward IT). There was some evidence for the effectiveness of track-and-trace systems. Case studies, predominantly on national-level interventions, reported decreases in IT market share and increases in tax revenue suggesting potential benefits of multicomponent strategies.

Conclusions: There is promising limited evidence for interventions to tackle IT but they are seldom systematically evaluated. Comprehensive, independent evaluations are required to support policymaking and avoid tobacco industry influence in IT research.

Prospero registration number: CRD42023452732.

Objectives: The last 5 years have seen substantial changes in England's social and economic landscape as a result of Brexit, the COVID-19 pandemic and cost of living crisis. We aimed to examine changes in cross-border and illicit tobacco purchasing over this period.

Design: Nationally representative monthly cross-sectional survey.

Setting: England, 2019-2022.

Participants: 11 232 adults (≥18 years) who smoked in the past year.

Main outcome measures: We estimated time trends in the proportion reporting purchasing tobacco from (1) cross-border and (2) illicit sources in the past 6 months.

Results: Between February 2019 and October 2022, there was a non-linear increase in the proportion of participants reporting cross-border tobacco purchases (from 5.2% to 16.1% overall; prevalence ratio (PR)=3.10, 95% CI 2.03-4.73). Prevalence first increased from 5.2% to 15.4% between February 2019 and April 2020, before falling to 7.8% between April 2020 and September 2021 during the COVID-19 pandemic, and then increasing again to 16.1% by the end of the period. Changes in cross-border tobacco purchasing were more pronounced among participants from more advantaged (from 6.6% to 23.3%; PR=3.52, 95% CI 2.05-5.91) compared with less advantaged (4.4% to 11.5%; PR=2.61, 95% CI 1.17-5.20) social grades (p_interaction=0.034). There was no overall change in the proportion reporting illicit tobacco purchases (from 9.2% to 8.5%; PR=0.92, 95% CI 0.70-1.21), nor any significant difference in trends by social grade (p_interaction=0.783).

Conclusions: Despite a fall in cross-border tobacco purchasing during the first year of the COVID-19 pandemic among adults in England who smoke, the proportion reporting cross-border tobacco purchases is now three times higher than it was at the start of 2019. The proportion reporting illicit tobacco purchases has not changed substantially.