Transnational tobacco companies and health in underdeveloped countries: recommendations for avoiding a smoking epidemic

This paper examines the impact of transnational tobacco companies on health in underdeveloped countries and makes recommendations for avoiding a coming smoking epidemic. Although tobacco is generally seen as primarily a health problem, tobacco's future in the Third World depends upon a number of nonhealth related considerations, especially political and economic factors. Unfortunately, there is very little relationship between what the World Health Organization and others have recommended, and what most Third World countries are doing today. Although the controversy concerning cigarette smoking and health has only become a 'burning issue' in recent decades, tobacco products have been used around the world for hundreds of years. The public outcry against cigarette smoking has become increasingly widespread since the 1964 U.S. Surgeon General's report on smoking and health. The ill effects of cigarette smoking are now widely considered collectively as the number one preventable health problem in the world, responsible for an estimated 2.5 million deaths per year. In response to declining sales in developed countries, the tobacco transnational corporations have begun focusing their attention on Third World markets, where tobacco consumption has increased dramatically in recent years. Cigarettes not only take precious limited resources away from desperately needed basic human needs, but they also inflict future health problems on vast numbers of Third World people who have only a vague understanding of the risks involved in cigarette smoking. Until Third World governments address the long-term consequences of their short-term lust for cash, the probabilities of a smoking epidemic in the Third World grow increasingly likely.(ABSTRACT TRUNCATED AT 250 WORDS)     

State-level tobacco control policies and youth smoking cessation measures

ObjectiveResearch on the effects of state-level tobacco control policies targeted at youth has been mixed, with little on the effects of these policies and youth smoking cessation. This study explored the association between state-level tobacco control policies and youth smoking cessation behaviors from 1991 to 2006.MethodsThe study design was a population-based, nested survey of students within states. Study participants were 8th, 10th, and 12th graders who reported smoking “regularly in the past” or “regularly now” from the Monitoring the Future study. Main cessation outcome measures were: any quit attempt; want to quit; non-continuation of smoking; and discontinuation of smoking.ResultsResults showed that cigarette price was positively associated with a majority of cessation-related measures among high school smokers. Strength of sales to minors’ laws was also associated with adolescent non-continuation of smoking among 10th and 12th graders.ConclusionsFindings suggest that increasing cigarette price can encourage cessation-related behaviors among high school smokers. Evidence-based policy, such as tax increases on tobacco products, should be included as an important part of comprehensive tobacco control policy, which can have a positive effect on decreasing smoking prevalence and increasing smoking cessation among youth.     

The impact of the tobacco market opening on smoking status in Taiwan: findings from a secular smoking rates analysis

The forced opening of Taiwan's tobacco market in 1987 has changed the smoking environment. This study analyzes the effects this market opening had on Taiwan's secular smoking rates over 15 years. The data sources used were consumer surveys conducted by the Taiwan Tobacco & Wine Monopoly Bureau 1964-1996, the 2001 National Health Interview Survey, and a series of annual per capita gross national product (GNP) data reported by the Directorate-General of Budget, Accounting & Statistics. After Taiwan's tobacco market was forced open in 1987 by the U.S. government in trade negotiations, smoking rates rose (7%-10% for males and 39%-75% for females) for the first three years. After the initial 3-year surge, smoking rates gradually declined to 1986 baseline rates or even lower for all groups except females aged 30 and younger, who have shown a small but steady increase in cigarette consumption. Results of multiple regression analysis showed per capita GNP and age to be the two major factors affecting smoking rate change after the Taiwan market opening. National tobacco control policies and campaigns seem to have an impact on tempering the effect of foreign tobacco imports in all groups, except young females, whose rise in smoking rate is significant and alarming.     

The impact of tobacco control programs on adult smoking

Objectives. We examined whether state tobacco control programs are effective in reducing the prevalence of adult smoking.Methods. We used state survey data on smoking from 1985 to 2003 in a quasi-experimental design to examine the association between cumulative state antitobacco program expenditures and changes in adult smoking prevalence, after we controlled for confounding.Results. From 1985 to 2003, national adult smoking prevalence declined from 29.5% to 18.6% (P<.001). Increases in state per capita tobacco control program expenditures were independently associated with declines in prevalence. Program expenditures were more effective in reducing smoking prevalence among adults aged 25 or older than for adults aged 18 to 24 years, whereas cigarette prices had a stronger effect on adults aged 18 to 24 years. If, starting in 1995, all states had funded their tobacco control programs at the minimum or optimal levels recommended by the Centers for Disease Control and Prevention, there would have been 2.2 million to 7.1 million fewer smokers by 2003.Conclusions. State tobacco control program expenditures are independently associated with overall reductions in adult smoking prevalence.Recent data from the Centers for Disease Control and Prevention (CDC) showed that adult smoking remained constant at 20.8% from 2004 to 2005 after years of steady decline.1 The CDC study cited a 27% decline in funding for tobacco control programs from 2002 through 2006 and smaller annual increases in cigarette prices in recent years as 2 possible explanations for stalled smoking rates. Our study is a systematic assessment of the association between adult smoking, funding for state tobacco control programs, and state cigarette excise taxes.In 1989, California began the first comprehensive statewide tobacco control program in the United States after passage of a state ballot measure that raised cigarette excise taxes by $0.25.2 Comprehensive programs include interventions such as mass media campaigns, increased cigarette excise taxes, telephone quit lines, reduced out-of-pocket costs for smoking cessation treatment, health care provider assistance for cessation, and restrictions on secondhand smoke in public places.3^–6 Subsequently, other states, including Massachusetts in 1992, Arizona in 1995, and Florida in 1998, began similar large-scale state tobacco control programs.3 Multistate tobacco control interventions with substantial financial support began in the 1990s, with assistance from US government programs (e.g., the CDC’s Initiatives to Mobilize for the Prevention and Control of Tobacco Use [IMPACT] and the National Cancer Institute’s Americans Stop Smoking Intervention Study [ASSIST]) and other national programs.3Some states also committed resources from other sources, such as revenue from the 1998 Master Settlement Agreement (MSA) between the 4 largest tobacco companies in the United States and 46 US states.7 The MSA imposes restrictions on the advertising, promotion, and marketing or packaging of cigarettes, including a ban on tobacco advertising that targets people younger than 18, and requires the tobacco companies to pay $246 billion over 25 years to the states. The MSA also established a foundation that became the American Legacy Foundation.Extensive research has shown that state tobacco control programs, combined with other efforts, such as the American Legacy Foundation’s national truth campaign, have been effective in reducing adolescent tobacco use.3^,8^,9 Following a large increase in adolescent smoking during the mid-1990s, there has been an unprecedented decline, with the national prevalence among high school students dropping from 36.4% in 1997 to 21.9% in 2003.10In marked contrast, there has been little research into the effects of state programs on the prevalence of adult smoking, which is unfortunate given that smoking cessation confers substantial health benefits to adults.3^,11^,12 To date, findings from California, Massachusetts, and Arizona suggest that state tobacco control programs have had some effect on adults.13^–16 From 1988 through 1999, the prevalence of adult smoking in California declined from 22.8% to 17.1%, compared with an overall national decline from 28.1% to 23.5% (a relative percentage decline of 25% in California and 16% elsewhere).13^,14 From 1992 through 1999, the relative percentage decline in adult smoking was 8% in Massachusetts compared with 6% nationwide.14^,15 Findings from Arizona from 1996 to 1999 suggest a greater effect: the relative percentage decline was 21% compared with 8% nationwide.16 In addition, per capita cigarette sales—a proxy for cigarette consumption—have declined faster in Arizona, California, Massachusetts, and Oregon (where another large-scale program began in 1997) than in the rest of the United States since the programs’ implementation.17 The ASSIST evaluation showed that smoking prevalence decreased more in ASSIST states than in non-ASSIST states by the end of an 8-year intervention; by contrast, the evaluation found no difference in per capita cigarette consumption.6^,18These few state-specific studies on the prevalence of adult smoking had important limitations. First, state-specific findings may not be generalizable. Second, none of the studies considered the key role of cigarette price increases on prevalence (i.e., through higher cigarette excise taxes, which have consistently been shown to reduce cigarette consumption and prevalence)3 or controlled for other state characteristics, such as demographic changes or secular trends. Third, the studies did not assess the potential effects of programs on adults of different ages. Although the ASSIST evaluation provides a more comprehensive view of state tobacco control programs, it failed to control for baseline differences in state-level demographics and policy variables between ASSIST and non-ASSIST states. Finally, none of the studies considered the possible long-term effects of tobacco control programs on adult smoking.In 1999, the CDC published Best Practices for Comprehensive Tobacco Control Programs,19 which provided states with guidelines and recommendations for 9 tobacco control program activities (e.g., community programs, counter-marketing, cessation), along with minimum and optimum funding levels for each specific activity. On the basis of this document, in fiscal year 2006, states should have allocated $6.47 per capita minimum and $17.14 optimally to tobacco control programs (i.e., the $5.98 and $15.85, respectively, recommended in the 1999 CDC document, adjusted for inflation).We used data on state tobacco control program expenditures and periodic surveys of adult smoking prevalence conducted by the US Census Bureau from 1985 to 2003 to answer the following questions: (1) After control for potentially confounding factors (e.g., cigarette excise taxes), were increases in state tobacco control program expenditures independently associated with declines in adult smoking prevalence, and did effects differ by age group? (2) What would have been the predicted effect of state tobacco control program expenditures on adult smoking prevalence if all states had met CDC-recommended minimum or optimum per capita funding levels from 1995 to 2003?     

High school seniors' smoking initiation and progression 1 year after graduation

We explored cigarette smoking prevalence rates in former high school seniors 1 year after graduation and found that among 12th grade never smokers, 25% initiated smoking, and among 12th grade ever smokers, 39% increased their cigarette use. Alcohol use in 12th grade, along with not attending college, were both positively related to smoking progression. Risk for smoking initiation does not end at adolescence, and the public health community must continue tobacco control initiatives throughout adolescence and young adulthood.     

Impact of Tobacco Control on Adult per Capita Cigarette Consumption in the United States

Objectives. We assessed the impact of tobacco control on adult per capita cigarette consumption in the United States from 1964 to 2011.Methods. We used logit regression to model the diffusion of smoking from 1900 to 2011. We also projected hypothetical cigarette consumption after 1963 in the absence of tobacco control. Model predictors included historical events such as wars, specific tobacco control interventions, and other influences.Results. Per capita consumption increased rapidly through 1963, consistent with S-shaped (sigmoid) diffusion. The course reversed beginning in 1964, the year of publication of the first surgeon general’s report on smoking and health. Subsequent tobacco control policy interventions significantly reduced consumption. Had the tobacco control movement never occurred, per capita consumption would have been nearly 5 times higher than it actually was in 2011.Conclusions. Tobacco control has been one of the most successful public health endeavors of the past half century. Still, the remaining burden of smoking in the United States augurs hundreds of thousands of deaths annually for decades to come. Reinvigorating the tobacco control movement will require novel interventions as well as stronger application of existing evidence-based policies.January 11, 2014, will mark the 50th anniversary of the release of the first surgeon general’s report on smoking and health,1 widely considered to demarcate the beginning of the tobacco control era in the United States. Tobacco control has consisted of development and dissemination of information on the hazards of smoking, policy implementation, and other interventions in the public, voluntary, and private sectors. These diverse efforts are linked by their dedication to reducing cigarette smoking and, with it, the most grievous toll of disease and death ever wrought by a single product (we use the terms tobacco control, tobacco control era, and tobacco control movement throughout as shorthand to refer to the totality of these efforts).Three measures of cigarette consumption have dominated discussions of the behavioral effects of tobacco control: adult cigarette smoking prevalence, average daily cigarette consumption per smoker, and annual adult per capita cigarette consumption, the latter defined as the total number of cigarettes consumed per year divided by the population older than 17 years. Adult smoking prevalence declined 55% from 1965 to 2011, from 42.4% to 19.0%. The number of cigarettes consumed per smoker per day has been falling steadily, from a peak of nearly 34 cigarettes in 1980 to 18 in 2011.2 Adult per capita consumption, which depends on both prevalence and quantity smoked per smoker, fell 72% between 1963 (the year before the first surgeon general’s report) and 2011, from 4345 cigarettes to 1236.As impressive as these results may be, they do not fully reflect the impact of tobacco control. The assumption implicit in these comparisons is that smoking had peaked immediately before 1964 and, hence, that the contribution of tobacco control has been simply to decrease smoking from those mid-1960s levels. In point of fact, cigarette consumption was rising sharply and quite steadily from 1900 through the early 1960s. It almost certainly would have continued to rise in the absence of the report and subsequent tobacco control initiatives because smoking among women was increasing rapidly at that time, paralleling the diffusion of smoking among men 2 to 3 decades earlier. The onset of the tobacco control movement stalled and eventually reversed the then rapidly growing prevalence of smoking among women.3Three previous analyses, to our knowledge, have assessed how much higher adult per capita consumption would have been in the absence of tobacco control, reflecting the increases in smoking that would have been anticipated had the movement never materialized.4–6 In the most recent of the 3 studies, Warner found that actual per capita consumption fell by 26% from 1963 to 1987, whereas consumption likely would have been 79% to 89% higher in 1987 had it not been for the salutary effects of tobacco control.6With no analysis of this phenomenon for a quarter of a century, we believed that it was time to estimate how much tobacco control has affected cigarette consumption as the movement concludes its fifth decade. Relative to previous studies, we employed a more sophisticated conceptual model to estimate tobacco control’s effects. The resulting change in methods has no impact on the qualitative conclusions of the earlier studies and indeed only a minor quantitative impact. Had the original methodology been used in our study, however, it would have overestimated the impact of tobacco control considerably.     

A psychopharmacological and psychophysiological evaluation of smoking motives.

Compared to alcohol or opiate dependence, the physical withdrawal symptoms which occur with the cessation of the tobacco smoking habit are relatively weak, although they can produce discomfort. Long-term abstinence rates, however, remain similarly low. This raises the question about the nature of the strength of this habit. When evaluating the complex mechanisms of cigarette smoking behavior and its determinants, a surprisingly large variety of pharmacological and nonpharmacological motives emerges. These appear to outweigh the health-related arguments for abstinence in the majority of smokers. An attempt has been made to categorize classes of motives according to their positive or negative reinforcing impacts on the habit. The acute tobacco withdrawal syndrome, problems with weight gain after cessation and the phenomenon of craving are classified as primarily negative reinforcers. Effects of smoking on cognitive functions and on "pleasure" are seen as primarily positive reinforcers. In conjunction with stress, the tranquillizing effects of smoking seem to have negative reinforcing properties in situations involving passive coping and anxiety, whereas smoking may have positive reinforcing effects in situations involving active coping. It is suggested that the memory of these reinforcing effects of smoking can contribute to the phenomenon of craving. Although substantially reduced after discontinuation of the smoking habit, craving may exacerbate and contribute significantly to late relapse.     

The effect of tobacco outlet density and proximity on smoking cessation

Objectives. We examined the influence of tobacco outlet density and residential proximity to tobacco outlets on continuous smoking abstinence 6 months after a quit attempt.Methods. We used continuation ratio logit models to examine the relationships of tobacco outlet density and tobacco outlet proximity with biochemically verified continuous abstinence across weeks 1, 2, 4, and 26 after quitting among 414 adult smokers from Houston, Texas (33% non-Latino White, 34% non-Latino Black, and 33% Latino). Analyses controlled for age, race/ethnicity, partner status, education, gender, employment status, prequit smoking rate, and the number of years smoked.Results. Residential proximity to tobacco outlets, but not tobacco outlet density, provided unique information in the prediction of long-term, continuous abstinence from smoking during a specific quit attempt. Participants residing less than 250 meters (P = .01) or less than 500 meters (P = .04) from the closest tobacco outlet were less likely to be abstinent than were those living 250 meters or farther or 500 meters or farther, respectively, from outlets.Conclusions. Because residential proximity to tobacco outlets influences smoking cessation, zoning restrictions to limit tobacco sales in residential areas may complement existing efforts to reduce tobacco use.Although the prevalence of smoking has decreased substantially over the past few decades, smoking remains the leading cause of preventable death and disability among adults in the United States.¹ A key public health strategy to reduce the deleterious health effects of tobacco use is to decrease the prevalence of smoking by increasing smoking cessation rates.² Previous public health and policy approaches to affect smoking prevalence have included restrictions on tobacco advertising, counter-advertising campaigns, bans on smoking in public places, increases in federal and state cigarette excise taxes, and increases in the availability of treatment programs. The effectiveness of these approaches in increasing smoking cessation rates has been supported by the literature.^3–5 However, additional tobacco control strategies are needed to achieve national public health goals.²One potential area of expansion for tobacco control policies is the regulation of tobacco retail outlets. Regulation strategies are designed to facilitate behavior change by altering structural aspects of the community context in which problematic behavior occurs.⁶ An analogous area in which regulation strategies have been applied is alcohol beverage retail outlets. In this case, regulation strategies have included the implementation of zoning restrictions to reduce the density of alcohol outlets and the proximity of alcohol outlets to residential areas. It was hypothesized that such regulations would affect problematic alcohol use at a community level by decreasing residents’ access to alcohol, reducing exposure to on-site product marketing, and changing social norms about alcohol use.⁷ Ultimately, research supported the success of these policies in reducing problematic alcohol use and alcohol-related injury, crimes, and violence.^7–9 In contrast to the alcohol arena, little attention has been paid thus far to the potential utility of tobacco outlet regulation strategies as a supplement to existing tobacco control policies.The Family Smoking Prevention and Tobacco Control Act, signed into law in June 2009, greatly expands the federal government''s ability to enact new public health policies related to tobacco sales in the United States. If one considers the success of alcohol outlet regulation strategies on curbing alcohol use, an increased understanding of the effects of tobacco retail outlets on smoking behaviors may provide direction to emerging tobacco control policies. Thus far, studies largely support associations between tobacco retail outlets and smoking behaviors. For example, the density of tobacco retail outlets around schools has been linked to adolescent smoking initiation¹⁰ and purchasing habits.¹¹ Similarly, the density of tobacco outlets around the home, as well as the proximity of tobacco outlets to the home, has been associated with the number of cigarettes consumed per day among adult smokers.¹² In another study, greater smoker sensitivity to point-of-sale advertising at tobacco outlets predicted a reduced likelihood of having quit smoking 18 months later.¹³ However, no previous studies have directly examined the effects of tobacco outlet density and proximity on smoking cessation during a specific quit attempt.The purpose of our study was to examine the effect of tobacco retail outlet density and proximity on smoking cessation among a racially/ethnically diverse group of smokers undergoing a specific quit attempt. We had two hypotheses. The first was that greater density of tobacco outlets around participants’ homes would be associated with lower odds of cessation. The second was that close residential proximity to a tobacco retail outlet would be associated with lower odds of cessation. All analyses controlled for participant demographics and tobacco-related variables. To our knowledge, this is the first study to examine the effects of tobacco retail outlets on a smoking quit attempt using a prospective, longitudinal design and biochemically verified smoking abstinence.     

Youth smoking, cigarette prices, and anti-smoking sentiment

In this paper, we develop a new direct measure of state anti-smoking sentiment and merge it with micro-data on youth smoking in 1992 and 2000. The empirical results from the cross-sectional models show two consistent patterns: after controlling for differences in state anti-smoking sentiment, the price of cigarettes has a weak and statistically, insignificant influence on smoking participation, and state anti-smoking sentiment appears to have a potentially important influence on youth smoking participation. The cross-sectional results are corroborated by results from the discrete time hazard models of smoking initiation that include state-fixed effects. However, there is evidence of price-responsiveness in the conditional cigarette demand by youth and young adult smokers.     

The Status and Future Challenges of Tobacco Control Policy in Korea

Tobacco use is the most important preventable risk factor for premature death. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC), the first international public health treaty, came into force in 2005. This paper reviews the present status of tobacco control policies in Korea according to the WHO FCTC recommendations. In Korea, cigarette use is high among adult males (48.2% in 2010), and cigarette prices are the lowest among the Organization for Economic Cooperation and Development countries with no tax increases since 2004. Smoke-free policies have shown incremental progress since 1995, but smoking is still permitted in many indoor public places. More than 30% of non-smoking adults and adolescents are exposed to second-hand smoke. Public education on the harmful effects of tobacco is currently insufficient and the current policies have not been adequately evaluated. There is no comprehensive ban on tobacco advertising, promotion, or sponsorship in Korea. Cigarette packages have text health warnings on only 30% of the main packaging area, and misleading terms such as "mild" and "light" are permitted. There are nationwide smoking cessation clinics and a Quitline service, but cessation services are not covered by public insurance schemes and there are no national treatment guidelines. The sale of tobacco to minors is prohibited by law, but is poorly enforced. The socioeconomic inequality of smoking prevalence has widened, although the government considers inequality reduction to be a national goal. The tobacco control policies in Korea have faltered recently and priority should be given to the development of comprehensive tobacco control policies.     

Influence of cigarette smoking on the overall perception of dental health among adults aged 20-79 years, United States, 1988-1994

OBJECTIVE: Investigation into the relationship between lifestyle factors (particularly cigarette smoking) and perceived oral health has been limited. Data from the third National Health and Nutrition Examination Survey (NHANES II), 1988-1994, were used to explore this relationship in a large sample of U.S. adults. METHODS: This study used data on 13,357 dentate participants in NHANES III aged 20-79 years. In NHANES III, information on perceived dental health, sociodemographic attributes, smoking status, frequency of dental visits, dental insurance, and general health perception were collected during a home interview, and oral health status was assessed at a mobile examination center. RESULTS: Overall, 34.4% of individuals in the study sample reported having an unfavorable perception of their dental health by qualifying it as "fair" or "poor." Furthermore, 46.6% of smokers had an unfavorable dental health perception, compared to 28.3% of non-smokers. An interaction between smoking and race/ethnicity was found in logistic regression modeling. Stratified results show that cigarette smoking was not a significant predictor for an unfavorable dental health perception among individuals who self-identified as Mexican American, but smoking was a significant predictor for an unfavorable dental health perception among those who identified as non-Hispanic black or non-Hispanic white. CONCLUSIONS: This is the first study to describe the effects of smoking on dental health perception while controlling for examined oral health status. Because perceived dental health is a potential indicator for dental care utilization, a better knowledge of the factors that influence dental health perception is not only important for dental services planning, but also for understanding oral health-related quality of life issues. Additionally, given that smoking may negatively affect dental health perception, these findings have potential implications for smoking cessation activities conducted by dental care providers.     

南宁市15岁及以上社区居民吸烟现状调查

目的:了解南宁市15岁及以上社区居民的吸烟现状及控烟态度,为相关部门制定有效的社区控烟措施,形成"有效的控烟局面"提供参考依据。方法:在2010年10月-2010年12月间,采用随机抽样入户一对一问卷调查方式,调查南宁市15岁及以上社区居民821人,其中有805份问卷记录合格用于分析。调查采用中国公共卫生控烟能力建设项目组统一设计的调查问卷。结果:南宁市15岁及以上社区居民吸烟率为29.81%,现在吸烟率为26.96%,其中男性吸烟率和现在吸烟率(50.56%和46.52%)明显高于女性吸烟率和现在吸烟率(4.17%和2.78%);35岁～64岁的人群现在吸烟率较高;不同民族现在吸烟率差异无统计学意义;不同文化程度的人群现在吸烟率差异有统计学意义,随着文化程度的升高,现在吸烟率有降低的趋势;从事技术工作的人群现在吸烟率最高;去年一年人均收入在3万-不足4万组和5万及以上组的人群现在吸烟率明显高于其他组。人群被动吸烟率为41.24%;家庭吸烟率达66.69%,只有22.11%的家庭家中禁止吸烟;78.14%的调查对象所居住的社区从未开展过任何关于控烟的活动;70.81%的人赞成社区公共场所禁烟;61.99%的人认为政府出台相关政策才是社区禁烟最有效可行的方式。结论:南宁市15岁及以上社区居民吸烟与被动吸烟率近年有所升高,家庭吸烟率较高,社区控烟宣传力度明显不足,但社区控烟有较强大的群众支持力量;应以社区为载体,以家庭为单位,以政府为后盾,加强相关的健康教育及行为干预,推动社区公共场所的禁烟立法。     

Mexico SimSmoke: how changes in tobacco control policies would impact smoking prevalence and smoking attributable deaths in Mexico

We examined the effect of tobacco control policies in Mexico on smoking prevalence and smoking-related deaths using the Mexico SimSmoke model. The model is based on the previously developed SimSmoke simulation model of tobacco control policy, and uses population size, smoking rates and tobacco control policy data for Mexico. It assesses, individually, and in combination, the effect of six tobacco control policies on smoking prevalence and smoking-related deaths. Policies included: cigarette excise taxes, smoke-free laws, anti-smoking public education campaigns, marketing restrictions, access to tobacco cessation treatments and enforcement against tobacco sales youth. The model estimates that, if Mexico were to adopt strong tobacco control policies compared to current policy levels, smoking prevalence could be reduced by 30% in the next decade and by 50% by 2053; an additional 470,000 smoking-related premature deaths could be averted over the next 40 years. The greatest impact on smoking and smoking-related deaths would be achieved by raising excise taxes on cigarettes from 55% to at least 70% of the retail price, followed by strong youth access enforcement and access to cessation treatments. Implementing tobacco control policies in Mexico could reduce smoking prevalence by 50%, and prevent 470,000 smoking-related deaths by 2053.     

Decrease in smoking prevalence--Minnesota, 1999-2010

Following the landmark 1998 settlement of the lawsuit, State of Minnesota versus Philip Morris, Inc., et al., Minnesota implemented a series of tobacco control efforts to limit the harm caused by tobacco use. In 2001, quitline services for tobacco users without health insurance coverage for cessation services were introduced and statewide mass media campaigns publicizing them were initiated. In 2005, Minnesota imposed a $0.75 per pack tax on cigarettes, followed in 2009 by a $0.62 per pack increase in federal excise tax, contributing in large part to a more than $2 increase in the average price of cigarettes. In 2007, a comprehensive, statewide smoke-free law was passed. Using surveillance data from the Minnesota Adult Tobacco Survey (MATS) and cigarette pack sales data, this report examines the effects of these tobacco-related public health efforts. Compared with a 15% decline in national adult smoking prevalence since 1999, adult smoking prevalence in Minnesota decreased 27.1%, from 22.1% in 1999 to 16.1% in 2010. During the same period, per capita cigarette sales in Minnesota decreased 40%. In addition, in 2010 compared with 1999, a higher percentage of adults reported that smoking was restricted in their homes (87.2% versus 64.5%), and adults were less likely to report exposure to secondhand smoke (45.6% versus 67.2%). In the past decade, Minnesota has benefited from sustained tobacco control. Future progress in decreasing adult smoking and reducing exposure to secondhand smoke will depend on a concerted effort across the public health community to keep tobacco control a priority.     

Hierarchical linear modelling of smoking prevalence and frequency in China between 1991 and 2004

This study uses the hierarchical linear modelling (HLM) growth curve technique to explore predictors of the change in the prevalence and frequency of cigarette smoking in China between 1991 and 2004. Using nationally representative data, the study introduces a number of previously unanalysed variables at both the individual and the community level. The findings show that a number of factors are associated with the change in both the prevalence and frequency of smoking in China. In addition, there is a trend of decreasing prevalence of smoking in China after the effects of other covariates are adjusted. Finally, the free market cigarette price has an inconsistent relationship with the change in the prevalence and frequency of smoking, which further reveals the daunting task of tobacco control for public health scholars and policymakers in China.     

Correlates of current cigarette smoking among school-going adolescents in Punjab, India: results from the Global Youth Tobacco Survey 2003

Background

Smoking is a leading cause of morbidity and mortality globally. There is therefore need to identify relevant factors associated with smoking among adolescents in order to better tailor public health interventions aimed at preventing smoking.

Methods

We used data from the Global Youth Tobacco Survey (GYTS) conducted in 2003 in Punjab, India, on 2014 adolescents of whom 58.9% were males. We conducted a weighted logistic regression analysis, adjusting for age and sex, to determine associations between predictor variables and current tobacco smoking status.

Results

A total of 2014 adolescents participated in the survey in 2003, and of these 58.9% were males. Male respondents tended to be older than females (21.2% of males, and 13.1% of females were of age 16 years or above). The percent of males and females in the other age groups were: 23.0% and 28.6% for <14 years, 27.3% and 31.0% for 14 years, and 28.4% and 27.0% for 15 years, respectively. The following factors were positively associated with smoking: adolescents who received pocket money; adolescents who had parents who smoked, chewed or applied tobacco; adolescents who said that boys or girls who smoke or chew tobacco have more friends; adolescents who said that smoking or chewing tobacco makes boys look less attractive; adolescents who said that there is no difference in weight between smokers and non-smokers; adolescents who said that smoking makes one gain weight; and adolescents who had most or all of their closest friends who smoked. The factors that were negatively associated with smoking were: adolescents who said that boys or girls who smoke or chew tobacco have less number of friends; adolescents who said that girls who smoke or chew tobacco are less attractive; and adolescents who had some of their closest friends who smoked.

Conclusion

The observed associations between current smoking on one hand and peer smoking, and perception that boys who smoke are less attractive on the other, deserve further studies. The factors reported in the current study should be considered in the design of public health interventions aimed to reduce adolescent cigarette smoking.     

State tobacco excise taxes and adolescent smoking behaviors in the United States.

The objective of the study described in this article was to examine the association between state cigarette excise taxes and smoking behaviors among youth in the United States. A survey was nationally mailed to adolescents in the Growing Up Today Study, an ongoing cohort of offspring of participants in the Nurses' Health Study II. A volunteer sample of 10,981 adolescent boy and girl participated in the Growing Up Today Study, who were 12 to 18 years old in 1999. Logistic regression was used to examine the relationship between state cigarette excise taxes (in quartiles) and experimentation (ever smoked) and established smoking (smoked at least 100 cigarettes in a lifetime). State tax levels in 1999 ranged from 2.5 to 100 cents. In a model that adjusted for age, gender, peer smoking, parental smoking, state clustering, state poverty level, and possession of tobacco promotional items, higher tax rates were associated with decreased odds of experimentation (test for trend p < 0.01). The highest quartile of tax (60-100 cents) was significantly associated with lower odds of experimentation (OR = 0.79; 95% CI, 0.64-0.98) and appeared protective against established smoking (OR = 0.80; 95% CI, 0.49-1.29). This study provides recent evidence that higher state cigarette excise taxes are associated with decreased experimental smoking among adolescent boys and girls. Higher state cigarette taxes may also be associated with lower odds of established smoking in this age group, although the association appears to be attenuated by peer and parental smoking. These results support the inclusion of tobacco taxes in state tobacco control programs.     

The impact of menthol cigarettes on smoking initiation among non-smoking young females in Japan

Japan presents an excellent case-study of a nation with low female smoking rates and a negligible menthol market which changed after the cigarette market was opened to foreign competition. Internal tobacco industry documents demonstrate the intent of tobacco manufacturers to increase initiation among young females through development and marketing of menthol brands. Japanese menthol market share rose rapidly from less than 1% in 1980 to 20% in 2008. Menthol brand use was dominated by younger and female smokers, in contrast with non-menthol brands which were used primarily by male smokers. Nationally representative surveys confirm industry surveys of brand use and provide further evidence of the end results of the tobacco industry's actions-increased female smoking in Japan. These findings suggest that female populations may be encouraged to initiate into smoking, particularly in developing nations or where female smoking rates remain low, if the tobacco industry can successfully tailor brands to them. The Japanese experience provides a warning to public health officials who wish to prevent smoking initiation among young females.     

Impact of tobacco control policies and mass media campaigns on monthly adult smoking prevalence

Objectives. We sought to assess the impact of several tobacco control policies and televised antismoking advertising on adult smoking prevalence.Methods. We used a population survey in which smoking prevalence was measured each month from 1995 through 2006. Time-series analysis assessed the effect on smoking prevalence of televised antismoking advertising (with gross audience rating points [GRPs] per month), cigarette costliness, monthly sales of nicotine replacement therapy (NRT) and bupropion, and smoke-free restaurant laws.Results. Increases in cigarette costliness and exposure to tobacco control media campaigns significantly reduced smoking prevalence. We found a 0.3-percentage-point reduction in smoking prevalence by either exposing the population to televised antismoking ads an average of almost 4 times per month (390 GRPs) or by increasing the costliness of a pack of cigarettes by 0.03% of gross average weekly earnings. Monthly sales of NRT and bupropion, exposure to NRT advertising, and smoke-free restaurant laws had no detectable impact on smoking prevalence.Conclusions. Increases in the real price of cigarettes and tobacco control mass media campaigns broadcast at sufficient exposure levels and at regular intervals are critical for reducing population smoking prevalence.Population-wide interventions that can reduce adult smoking prevalence are important for curbing the pandemic of tobacco-related disease.1^–3 However, evaluating the effects of tobacco control policies and mass media interventions on populations is difficult.4^,5 Generally, there are few comparable control populations to which policy or media interventions are not delivered. Tobacco policies and media campaigns often co-occur, complicating assessment of the relative contribution of each. In addition, most studies in which smoking prevalence is the outcome measure rely on annual population surveys to track change over time, despite policy and media interventions being generally implemented throughout the year, and at differing strengths relative to the time of survey administration. Small or transient impacts on smoking prevalence are difficult to detect and may be underestimated.Over the past decade, the Australian population has been exposed to changes in several tobacco control policies, including changes in taxes on tobacco products resulting in increases in the real price of cigarettes, increasing availability of pharmaceutical smoking cessation products such as nicotine replacement therapies (NRT) and bupropion, and the introduction of smoke-free restaurant laws. In addition, there has been considerable variation in exposure to public health–sponsored mass media campaigns and pharmaceutical advertising for NRT. We have assessed the independent effect of each tobacco control policy and type of media campaign with a data series in which self-reported smoking prevalence was measured every month over a period of 11 years. This method has the advantage over annual population surveys of more closely matching the timing and extent of policy implementation and media exposure to smoking prevalence, and it has the ability to examine the pattern of change in prevalence, such as the lag time to a measurable impact and the duration of influence.     

The impact of tobacco tax cuts on smoking initiation among Canadian young adults

BACKGROUND: Although the majority of smokers initiate smoking during their teenage years, significant rates of initiation occur among young adults. Adolescents are more price sensitive than adults, but little is known about the impact of tobacco taxation on smoking initiation among young adults. Using a longitudinal design, this study examined the impact of decreased cigarette price, resulting from tobacco tax cuts, on smoking initiation among Canadian young adults aged 20 to 24 years. METHODS: Using Statistics Canada's National Population Health Survey longitudinal file, this study examined young adults who did not smoke at baseline in 1994-1995 (n=636, representing over 1 million young adults) and who were reassessed at follow-up (1996-1997). Multivariable logistic regression analysis using bootstrap weights was conducted to estimate the impact of decreased cigarette price on smoking initiation. The analysis controlled for the potential confounding effect of sociodemographic and tobacco control variables. Sensitivity analyses were conducted. Price elasticity was estimated. Analyses were conducted in 2003 and 2004. RESULTS: Approximately 10% of young adults had initiated smoking at follow-up. Decreased cigarette price was significantly associated with higher smoking initiation (adjusted odds ratio per $1 decrease for a carton of cigarettes=1.15, 95% confidence interval [CI]=1.01-1.32, p=0.042). Sensitivity analyses showed similar results. Price elasticity was 3.36 (95% CI=0.07-6.75). CONCLUSIONS: Young adults are sensitive to cigarette prices. Reductions in cigarette prices will lead to increased smoking initiation among this group. Tobacco taxation should be an effective strategy to reduce smoking initiation among young adults.