Bans on electronic cigarette sales to minors and smoking among high school students

Many states have banned electronic cigarette sales to minors under the rationale that using e-cigarettes leads to smoking traditional combustion cigarettes. Such sales bans would be counterproductive, however, if e-cigarettes and traditional cigarettes are substitutes, as bans might push teenagers back to smoking the more dangerous combustion cigarettes. We provide evidence that these sales bans reduce the incidence of smoking conventional cigarettes among high school seniors. Moreover, we provide evidence suggesting that sales bans reduced e-cigarette usage as well. This evidence suggests that not only are e-cigarettes and smoking regular cigarettes positively related and not substitutes for young people, banning retail sales to minors is an effective policy tool in reducing tobacco use.     

How does electronic cigarette access affect adolescent smoking?

Understanding electronic cigarettes’ effect on tobacco smoking is a central economic and policy issue. This paper examines the causal impact of e-cigarette access on conventional cigarette use by adolescents. Regression analyses consider how state bans on e-cigarette sales to minors influence smoking rates among 12 to 17 year olds. Such bans yield a statistically significant 0.9 percentage point increase in recent smoking in this age group, relative to states without such bans. Results are robust to multiple specifications as well as several falsification and placebo checks. This effect is both consistent with e-cigarette access reducing smoking among minors, and large: banning electronic cigarette sales to minors counteracts 70 percent of the downward pre-trend in teen cigarette smoking for a given two-year period.     

The effect of the tobacco settlement and smoking bans on alcohol consumption

In the last few years, the price of cigarettes has increased considerably in the USA. In addition, a number of states have also imposed smoking bans. These increases in the cost and barriers to smoking have created a natural experiment to study relationships between smoking and drinking behaviors. In this study, we employ data from the first six waves of the Health and Retirement Survey (HRS) to analyze the effects of smoking bans and cigarette prices on alcohol consumption. We also test if past cigarette and alcohol consumption affect current alcohol consumption as predicted by co-addiction models. We estimate dynamic panel models using GMM estimators. Our approach allows us to obtain consistent estimates irrespective of the number of time periods. The three main findings of this study are: (1) there is positive reinforcement effect of past cigarette consumption on current alcohol consumption, (2) smoking bans reduce alcohol consumption and (3) there is a positive effect of cigarette prices on alcohol consumption.     

Cigarette taxes. The straw to break the camel's back.

Teenage cigarette smoking is sensitive to the price of cigarettes. The most recent research suggests that a 10% increase in price would reduce the number of teenagers who smoke by 7%. If the proposed 43-cent hike in the Federal excise tax rate on cigarettes contained in the Hatch-Kennedy Bill were enacted, the number of teenage smokers would fall by approximately 16%. This translates into more than 2.6 million fewer smokers and more than 850,000 fewer smoking-related premature deaths in the current cohort of 0 to 17-year-olds. Adjusted for inflation, the current 24-cent-a-pack tax costs the buyer about half of the original cigarette tax of 8 cents imposed in 1951. A substantial tax hike would curb youth smoking; this strategy should move to the forefront of the antismoking campaign.     

SMOKING IN MILTON: FACTORS ASSOCIATED WITH SMOKING IN AN ADULT COMMUNITY

The factors associated with smoking in 80 per cent of an entire adult New Zealand community have been studied on two occasions exactly three years apart and compared with other studies. The smoking habits of a population are dynamic and there is today a very much higher proportion of young adult smokers, particularly women, than there was 15 years ago and this proportion is increasing. Cigarette consumption is associated with the father's smoking habit in the case of men and the mother's habit in the case of women; early school leaving age; being a member of a large family; being of lower socio-economic level; the taking of oral contraceptives or any minor tranquilliser in the case of women; considerably greater alcohol consumption, especially beer, by either sex; preference for a brand of cigarette with a higher tar and nicotine content; and a tendency to inhale the smoke deeply. However it is shown that most if not all of these factors are interactive and not simple cause-and-effect relationships. Light smokers smoke proportionately much more at weekends than do heavy smokers and this is not directly attributable to varying opportunities to smoke during the week. Weight increases markedly when smoking stops and this is not due to a compensatory increase in alcohol intake. It is suggested that obesity, excess beer drinking, heavy smoking and anxiety may all be part of an identifiable tetrad of symptoms.     

Cigarette smoking in China: public health, science, and policy

Throughout the world, cigarette smoking is a habit that causes serious health, economic, and social problems. Therefore, many countries have taken an active role to control and to ban smoking. The chronic smoking problem in China is particularly acute because China has the largest population of smokers in the world, over 300 million currently. If 30% of these smokers were to die of smoke-related diseases in the next 20 years, the impact from the more than 90 million premature deaths could be damaging to China. In addition, numerous non-smokers also experience health problems from exposure to environmental tobacco smoke. China's efforts to reduce or to ban smoking in certain public places have not been well-coordinated or enforced compared with those in other countries. Therefore, success has been minimal. Consequently, leaders in China should not be complacent about combating the serious national health problem. A multiprong approach in combination with the MPOWER policy from the World Health Organization that targets different levels of acquisition of the smoking habit must be used. Examples may include the government's reduced reliance on profits from the sale of cigarettes, the elimination of advertisements that encourage smoking among young individuals, the presentation of more graphic illustration of harmful effects from smoking on every pack of cigarettes, higher taxes/prices on cigarettes, and the implementation of enforceable bans on smoking in public places. As shown in other countries, such coordinated effort can be highly effective in the reduction of smoking and can have healthy consequences.     

Response error in self-reported current smoking frequency by black and white established smokers

As compared with white smokers, black smokers, although they report using fewer cigarettes per day, are at higher risk for most smoking-related diseases. Among black smokers serum cotinine levels are also higher in proportion to cigarettes per day; this observation has led to suggestions of bias in self-reporting. The purpose of this study was to evaluate and compare the extent of errors in self-reported smoking patterns among black and white established smokers. Ninety-seven white and 66 black smokers participated in structured telephone interviews, filled out two self-administered questionnaires one week apart, and collected all of their cigarette butts for a week. Group differences in the validity of self-reported smoking patterns were assessed by comparison with cigarette butt counts and the measured butt lengths. Both black and white smokers significantly overestimated smoking on our measure of smoking frequency (both P < 0.001); the group difference in bias was not significant (P = 0.13). There was no evidence that underreporting was more common among blacks than among whites (P = 0.67). Test-retest reliability was not significantly different in the two groups (P = 0.09). Both groups performed poorly when asked to categorize their smoking frequency according to the cutpoints of the Fagerström Test for Nicotine Dependence. Black smokers smoked more of each cigarette and smoked longer cigarettes, but they smoked fewer total millimeters of cigarettes per day (all P < 0.001). Contrary to an earlier report, the disproportionately high cotinine levels could not be attributed to reporting error.     

Smoking bans,cigarette prices and life satisfaction

The consequences of tobacco control policies for individual welfare are difficult to assess, even more so when related consumption choices challenge people's willpower. We therefore evaluate the impact of smoking bans and cigarette prices on subjective well-being by analyzing data for 40 European countries and regions between 1990 and 2011. We exploit the staggered introduction of bans and apply an imputation strategy to study the effect of anti-smoking policies on people with different propensities to smoke. We find that higher cigarette prices reduce the life satisfaction of likely smokers. Overall, smoking bans are barely related to subjective well-being, but increase the life satisfaction of smokers who would like to quit smoking. The latter finding is consistent with cue-triggered models of addiction and the idea of bans as self-control devices.     

Smoking or health: the Brazilian option

Tobacco plays a key role in both disease and the economy in Brazil. In 1981 about 135 billion cigarettes were smoked, and cigarette-related diseases far outnumber infections as the leading cause of death. Brazil is the 4th largest world producer and the 2nd largest exporter of tobacco. 2.1% of the total population -- 2.5 million people -- are maintained by tobacco-related activities. Cigarette sales taxes provide 11.6% of the country's total taxes. Involved in a deep economic crisis, Brazil depends on this revenue and has not introduced any measures to control or counteract the high pressure marketing of cigarette manufacturers. Ischemic heart disease is the leading cause of death in Brazil, taking 90,000 lives in 1979. Based on World Health Organization estimates, at least 25% of these deaths could be ascribed to smoking. Cancer is the 2nd largest cause of death. In 1979, 10% of 60,000 cancer deaths were from lung cancer. Based on estimate that 30% of cancer deaths are provoked by smoking, more than 20,000 of those deaths were caused by tobacco. In Brazil, lung cancer is the 2nd highest cause of death from cancer in men and 3rd among women. Smoking in Brazil is definitely associated with low birth weight, the single most important predictive factor of perinatal and infant mortality. Rural workers giving up subsistence crops to grow tobacco may also affect their children's health. Also in such low-income populations, expenditures for cigarettes leave less money for essential goods. As a result of the high tax rate and the enormous number of cigarettes sold, 11.6% of all the country's revenue comes from the tobacco industry. The Brazilian Association of Tobacco Industries has been trying to link cigarette sales to Brazilian social development but does not mention the cost of disease, disability, and early death provoked by smoking. In Brazil tobacco companies have a huge market free of constraints, and the country lacks consistent smoking control policies. Recently some Brazilian medical associations have urged the government to take stronger measures, but physicians remain reluctant to speak out. Specific legislation regulating cigarette sales and advertisements is needed. The 1st task is convincing politicians and other policymakers that aiding and abetting the cigarette companies is, in the long run, bad for the economy. Medical institutions are in a key position to pressure the government and the tobacco industry.     

Renal cancer and cigarette smoking in a 26-year followup of U.S. veterans

The cigarette smoking habits of a cohort of almost 250,000 U. S. veterans were analyzed for their relationship to renal cancer. Information on smoking habits was collected in 1954 and in 1957 for nonrespondents to the first effort. Of the veterans, 84 percent returned their questionnaires. The cohort was followed for mortality until 1980, or 26 years. The followup of these military veterans, mostly of World War I, revealed 719 deaths from renal cancer, making this the largest study of renal cancer and cigarette smoking to date. Current smokers had a 47 percent increase in risk relative to nonsmokers. The relative risk for renal cancer increased significantly with the number of cigarettes smoked per day, from 1.31 for 1-9, 1.37 for 10-20, 1.60 for 21-39, and 2.06 for 40 or more. This analysis was unable to separate the risks of cigarette smoking for tumors of the renal parenchyma from those for tumors of the renal pelvis and ureter. However, the results suggest that almost one-fifth of all renal cancer deaths are attributable to cigarette smoking.     

Taking ad-Vantage of lax advertising regulation in the USA and Canada: reassuring and distracting health-concerned smokers

We explored the evolution from cigarette product attributes to psychosocial needs in advertising campaigns for low-tar cigarettes. Analysis of previously secret tobacco industry documents and print advertising images indicated that low-tar brands targeted smokers who were concerned about their health with advertising images intended to distract them from the health hazards of smoking. Advertising first emphasized product characteristics (filtration, low tar) that implied health benefits. Over time, advertising emphasis shifted to salient psychosocial needs of the target markets. A case study of Vantage cigarettes in the USA and Canada showed that advertising presented images of intelligent, upward-striving people who had achieved personal success and intentionally excluded the act of smoking from the imagery, while minimal product information was provided. This illustrates one strategy to appeal to concerned smokers by not describing the product itself (which may remind smokers of the problems associated with smoking), but instead using evocative imagery to distract smokers from these problems. Current advertising for potential reduced-exposure products (PREPs) emphasizes product characteristics, but these products have not delivered on the promise of a healthier alternative cigarette. Our results suggest that the tobacco control community should be on the alert for a shift in advertising focus for PREPs to the image of the user rather than the cigarette. Global Framework Convention on Tobacco Control-style advertising bans that prohibit all user imagery in tobacco advertising could preempt a psychosocial needs-based advertising strategy for PREPs and maintain public attention on the health hazards of smoking.     

Compliance and support for bans on smoking in licensed venues in Australia: findings from the International Tobacco Control Four‐Country Survey

Objective: To examine attitudes towards and compliance with the recent Australian bans on smoking in licensed venues, and to explore effects on smoking behaviour. Methods: Three Australian states (Queensland, Tasmania and Western Australia) implemented a total ban on smoking in all enclosed licensed premises in 2006, and two others (Victoria and New South Wales) did so in mid‐2007. We used data from smokers residing in these states for each of the six waves of the ITC‐4 country survey (2002–2007; average n=1,694). Results: Consistent with the majority of international findings, observed compliance was reported by more than 90% of smokers from a pre‐ban situation of indoor smoking being the norm. Attitudes became more positive in the year before the ban, but more than doubled in the year the bans were implemented. The associations found for the leading states were replicated by the lagging states a year later. We found no evidence for any increase in permitting smoking inside the home after the bans took effect. Further, we were unable to find any evidence of reductions in daily cigarette consumption or any increase in quitting activity due to the bans. Implications: These results add to a growing body of international research that suggests that smokers are readily able to comply with, and increasingly support, smoke‐free bars, though the bans may have limited effect on their smoking habits.     

The Impact of Massachusetts�� Smoke-Free Workplace Laws on Acute Myocardial Infarction Deaths

Objectives. We examined the rate of acute myocardial infarction (AMI) deaths in Massachusetts before and after the implementation of a comprehensive smoke-free workplace law in July 2004.Methods. We used Poisson regression models to examine the impact of the state law in cities and towns with and without previous local smoking bans and the effect of the local laws for the period of 1999 through 2006.Results. The AMI mortality rate decreased by 7.4% (95% confidence interval [CI] = 3.3%, 11.4%) after implementation of the state law. The state ban had an impact in cities and towns with no prior local smoking ban (9.2% decrease; P < .001) but not cities and towns with a prior local smoking ban. However, there was a nonsignificant 4.9% (95% CI = −5.0%, 13.9%) decrease associated with the local smoking ban that preceded the effect of the state ban. The effect of the state ban was modest (−1.6%) in the first 12 months after implementation but much larger after the first 12 months (−18.6%; P < .001).Conclusions. Comprehensive statewide smoke-free workplace laws in Massachusetts were associated with an estimated 270 fewer AMI deaths per year. These results add to the evidence suggesting that smoke-free air laws are associated with lower rates of AMI.Comprehensive smoking bans prohibit smoking in workplaces, including public and private worksites, restaurants, and bars. Studies have shown that comprehensive smoking bans reduce exposure to environmental tobacco smoke, whereas smoking restrictions, which permit designated smoking areas or provide separately ventilated sections, are not effective at preventing or eliminating exposure to environmental tobacco smoke.¹In addition to reducing exposure to environmental tobacco smoke, comprehensive smoking bans may change social norms regarding the acceptability of smoking in a community, resulting in fewer people smoking in public places.¹ Comprehensive smoking bans have been shown to reduce smoking prevalence by 3.8% (95% confidence interval [CI] = 2.8%, 4.7%) and to reduce the number of cigarettes smoked per smoker per day by 3.1 (95% CI = 2.4, 3.8).²Both cigarette smoking and exposure to environmental tobacco smoke increase the risk of coronary heart disease (CHD).¹ It is hypothesized that a decrease in these exposures as a result of a comprehensive smoking ban would result in reductions in CHD. The association between comprehensive smoking bans and acute myocardial infarction (AMI) hospital admissions was examined previously in the United States and Europe. Several meta-analyses have been conducted that pooled the results of these studies and found that comprehensive smoking bans were associated with a 17% to 19% lower AMI hospital admission rate.^3–5The first comprehensive workplace smoking ban in Massachusetts was implemented in 1994 in the town of Amherst.⁶ Individual cities and towns enacted comprehensive smoking bans over the next decade. In 2003, Boston, Cambridge, and Somerville implemented comprehensive smoking bans. All residents of Massachusetts were covered by the state comprehensive smoking ban in July 2004, which banned smoking in all workplaces, including restaurants and bars.⁷The experience in Massachusetts, in which local laws introduced comprehensive workplace smoking bans at various times, offers the opportunity to assess the impact of the local and statewide laws both separately and jointly. We examined the AMI mortality rate before and after the Massachusetts smoke-free air law in cities and towns with and without prior local comprehensive smoking bans. We also examined the impact of the local smoking bans before the statewide smoke-free law took effect.     

The relationship between home smoking bans and exposure to state tobacco control efforts and smoking behaviors

PURPOSE: To examine the relationship between home smoking bans and adult smokers' exposure to the statewide California Tobacco Control Program (TCP) and their cigarette smoking behavior. DESIGN: Cross-sectional survey that was part of the statewide Independent Evaluation of the California Tobacco Control, Prevention and Education Program. SETTING: Random telephone interviews within 18 California counties. SUBJECTS: A representative sample of 1315 adult smokers, aged 25 years and older. MEASURES: The telephone survey included questions about smoking behavior, quitting smoking, exposure to tobacco control program components, home smoking rules, and attitudes related to tobacco use and environmental tobacco smoke (ETS). RESULTS: Smokers with a home smoking ban were twice as likely (OR = 2.29; 95% CI 1.22, 4.29) to have heard of TCP community programs and three times more likely (OR = 3.18; 95% CI 1.34, 7.57) to have seen and talked about the ETS media spot than smokers with no home smoking policy. Multivariate regression models indicated that having a home smoking ban was related to smoking fewer cigarettes per day and greater interest in quitting smoking compared with smokers with no smoking rules in the home (p < .05). CONCLUSIONS: These findings suggest that smokers reporting exposure to the California TCP were more likely to have restrictive home smoking policies and that more restrictive home smoking policies were associated with reduced smoking behavior.     

Perceptions About the Impact of Cigarette Filters on the Environment and Smoking-Related Behaviors

PurposeExamine adolescents’ and young adults’ (AYAs) knowledge and perceptions about the composition and environmental harms of cigarette filters and determine how perceptions are associated with support for policy interventions.MethodsCross-sectional, convenience sample from 10 California schools. AYAs (N = 429; 70% < 21 years) were surveyed about tobacco use, perceptions of cigarette filters, their impact on the environment, and cigarette sales bans.ResultsMost agreed that filters are harmful to the environment and not biodegradable (89%, n = 383 respectively); fewer knew filters are made of plastic (43%, n = 185). AYAs who agreed that filters are harmful to the environment were more supportive of cigarette sales bans (OR = 2.78 [95% CI: 1.18, 6.58]).ConclusionsKnowledge of the environmental harms of cigarettes among AYAs may strengthen support for tobacco control. More research is needed to further understand the knowledge and attitudes about the environmental impact of tobacco and to clarify how this might add support for tobacco-related policies.     

吸烟对精子凋亡的影响

目的　探讨吸烟对精子凋亡的影响。方法　应用流式细胞术检测吸烟与不吸烟男性不育患者精子凋亡情况。结果　大量、长时间吸烟组与不吸烟组相比精子凋亡存在显著性差异(P <0 . 0 1 ) ,且精子凋亡率与吸烟量、吸烟时间呈显著正相关(P <0 . 0 1 )。结论　长期大量吸烟对精子凋亡有明显影响,且吸烟量越大,吸烟时间越长,影响越大。     

Smoking restrictions in the home and car among rural Native American and white families with young children

BACKGROUND: This paper examines the prevalence of household and car smoking restrictions, factors associated with these restrictions, and children's exposure to secondhand smoke in homes with varying levels of household smoking restrictions in rural Native American and White families. METHODS: In-person interviews were conducted with 380 rural, low-income Native American and White parents or guardians who were the primary caregivers of children aged 1-6 in northeastern Oklahoma. RESULTS: Prevalence of complete smoking bans was 49.1% in Native American homes and 42.7% in White homes. Car smoking bans were less common, with 34.9% of Native American and 39.6% of White caregivers reporting complete bans. Among nonsmoking households, the proportion of friends who smoked was associated with both car and home smoking bans. Race and education of the caregivers were also associated with car smoking bans in homes with no adult smokers. Among smokers, cigarettes smoked per day, quit attempts within the past year, and the strong belief that secondhand smoke harmed children and babies were related to household smoking bans, whereas cigarettes smoked per day and the proportion of friends who smoked were related to car smoking bans. CONCLUSIONS: Despite the relatively low prevalence of smoking bans in our population, factors associated with household and car smoking bans were similar to those found in the general population.     

Mentholated cigarette smoking and lung-cancer risk

PURPOSE: Menthol smoking may lead to a greater increase in lung-cancer risk than smoking of nonmentholated cigarettes. Mentholation of cigarettes adds additional carcinogenic components to cigarette smoke and increases retention times for cigarette smoke in the lungs. Only two epidemiologic studies have been conducted on menthol smoking and lung cancer, and their results are conflicting. Of note, African American males have much higher rates of lung cancer than Caucasian males despite smoking fewer cigarettes per day. Because the consumption of menthol cigarettes is much more frequent among African Americans, it is of interest to examine the possible association between menthol smoking and lung-cancer risk in this population. METHODS: We examined the association between menthol cigarette smoking and lung-cancer risk among smokers by comparing 337 incident cases of lung cancer with 478 population controls enrolled in a case-control study of lung cancer. Information on smoking history and other known and potential risk factors for lung cancer, including dietary intake, was obtained by in-person interviews. RESULTS: The adjusted odds ratios did not differ appreciably between smokers of mentholated cigarettes versus exclusive nonmentholated cigarette smokers in the overall study group of smokers. The odds ratio (OR) for 32 pack-years or more of mentholated vs. nonmentholated cigarettes was 0.90 (95% confidence interval (CI) = 0.38-2.12) in African Americans and 1.06 (95% CI = 0.47-2.36) in Caucasians, and did not differ for either ethnic group (p = 0.98). CONCLUSIONS: Our results suggest that the lung-cancer risk from smoking mentholated cigarettes resembles the risk from smoking non-mentholated cigarettes. Our data do not support the hypothesis that the increased risk of lung cancer among African Americans is due to the increased prevalence of menthol smoking.     

Cigarette purchasing behaviour in Thailand and Malaysia: Comparative analysis of a semi-monopolistic and a free-market structure

Abstract

A wide range of cigarette prices can undermine the impact of tobacco tax policy when smokers switch to cheaper cigarettes instead of quitting. In order to better understand this behaviour, we study socio-economic determinants of price/brand choices in two different markets: a semi-monopolistic market in Thailand and a competitive market in Malaysia. The hypothesis that the factors affecting the price/brand choice are different in these two markets is analysed by employing a 2005 survey among smokers. This survey provides a unique perspective on market characteristics usually described only in business reports by the tobacco industry.

We found that smokers in Thailand have fewer opportunities to trade down to save money on cigarettes, but pay lower prices than smokers in Malaysia, despite Thailand's higher tax rate. The Malaysian market, on the other hand, offers many possibilities to shop around for cheaper cigarettes. Higher income and education increase the price paid per cigarette in both countries, but the impact of these factors is larger in Malaysia. This has implications for sensitivity to cigarette prices. Using tax policy alone should be a more effective tobacco control measure in Thailand as compared to Malaysia. The effectiveness of a tax increase in Malaysia can be improved by adding programmes focusing on smoking cessation among low-income/low-educated smokers.     

RESPIRATORY SYMPTOMS AND SMOKING HABITS OF SENIOR INDUSTRIAL STAFF

The prevalence of respiratory symptoms and the smoking habits of 224 industrial `executives' aged 30 to 69 years in Social Classes I and II were ascertained by means of the Medical Research Council's questionnaire on respiratory symptoms; 31% had persistent cough, 25% had persistent phlegm, and 21% were short of breath on hurrying or going up a hill; 9% had had one or more chest illnesses in the past three years lasting for about a week, and 4% had `chronic bronchitis'—defined as persistent phlegm and one or more chest illnesses in the past three years; 67% were smokers, 21% smoking more than 25 cigarettes (or equivalent tobacco) per day; another 20% had stopped smoking. The prevalence of cough, phlegm, and breathlessness was closely related to smoking habit.