International Journal of Environmental Research and Public Health

Research

11 pages, 328 KiB

Open AccessArticle

Analysis of Tobacco Price Elasticity in Albania Using Household Level Data

by Aida Gjika, Edvin Zhllima, Klodjan Rama and Drini Imami

Int. J. Environ. Res. Public Health 2020, 17(2), 432; https://doi.org/10.3390/ijerph17020432 - 9 Jan 2020

Cited by 5 | Viewed by 4536

This paper analyzes the determinant factors of tobacco consumption in Albania, which is one of the countries with the highest smoking prevalence in Europe. To empirically estimate the elasticity of cigarettes demand in Albania, the paper uses the Living Standard Measurement Survey (LSMS) [...] Read more.

This paper analyzes the determinant factors of tobacco consumption in Albania, which is one of the countries with the highest smoking prevalence in Europe. To empirically estimate the elasticity of cigarettes demand in Albania, the paper uses the Living Standard Measurement Survey (LSMS) applying Deaton’s (1988) demand model. This paper estimates an Almost Ideal Demand System (AIDS), which allows disentangling quality choice from exogenous price variations using unit values from cigarette consumption. Following Deaton’s model, the results suggest that the demand for tobacco is inelastic, with a price elasticity of −0.57. The price elasticity appears to be within the range of elasticity estimates frequently reported for low- and middle-income countries. The results suggest that total expenditure, household size, male-to-female ratio, and adult ratio are important determinants of tobacco demand in Albania. The increase in the tobacco price, which has been mainly driven by increased excises, has demonstrated a significant impact on reducing tobacco consumption. Consequently, the Albanian government may engage in gradual increases in excise taxes given the inelastic tobacco demand. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

15 pages, 631 KiB

Open AccessArticle

The Role of Marketing Practices and Tobacco Control Initiatives on Smokeless Tobacco Sales, 2005–2010

by Mary Hrywna, Irina B. Grafova and Cristine D. Delnevo

Int. J. Environ. Res. Public Health 2019, 16(19), 3650; https://doi.org/10.3390/ijerph16193650 - 28 Sep 2019

Cited by 5 | Viewed by 3856

Abstract

Background: Little is known about how policies and industry activities impact smokeless tobacco demand. We examined how tobacco control policies and retail promotion may affect smokeless tobacco sales. Methods: We used Nielsen market-level retail scanner data for smokeless tobacco sales in convenience stores [...] Read more.

Background: Little is known about how policies and industry activities impact smokeless tobacco demand. We examined how tobacco control policies and retail promotion may affect smokeless tobacco sales. Methods: We used Nielsen market-level retail scanner data for smokeless tobacco sales in convenience stores in 30 US regions from 2005 to 2010. Tobacco policy variables, including excise taxes, state tobacco control program expenditures, and clean indoor air laws, were merged to Nielsen markets. We estimated regression models for per capita unit sales. Results: Higher cigarette tax was significantly associated with lower sales volume of smokeless tobacco. Sales of smokeless tobacco in markets with a weight-based SLT excise tax were higher than in markets with an ad valorem tax. A higher average product price was associated with decreased sales overall but results varied by package quantity and brand. Conclusions: This study observed that smokeless tobacco products were both complements and substitutes to cigarettes. Thus, smokeless tobacco may act as complements for some population segments and substitutes for others. A weight-based tax generally favors premium smokeless tobacco products. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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11 pages, 834 KiB

Open AccessArticle

How Raising Tobacco Prices Affects the Decision to Start and Quit Smoking: Evidence from Argentina

by Martin Gonzalez-Rozada and Giselle Montamat

Int. J. Environ. Res. Public Health 2019, 16(19), 3622; https://doi.org/10.3390/ijerph16193622 - 27 Sep 2019

Cited by 12 | Viewed by 3417

Abstract

We used a two-part model for the estimation of the price elasticity of participation and consumption of cigarettes by the duration of the smoking habit and a continuous-time split-population model for the estimation of prevalence and duration of smoking onset and smoking addiction, [...] Read more.

We used a two-part model for the estimation of the price elasticity of participation and consumption of cigarettes by the duration of the smoking habit and a continuous-time split-population model for the estimation of prevalence and duration of smoking onset and smoking addiction, allowing for covariates in the participation component of the model. Results: We computed the total price elasticity of consumption of cigarettes by quartiles of addiction and found that for the people located in the lowest quartile of addiction the total price elasticity is around −0.51; while for those located in the highest quartile of addiction this figure is only −0.19. Then, a 10% increase in cigarette prices, via taxes, reduces the consumption of those in the early stages of the addiction by 5% and for those with a longer history of addiction by only 1.9%. Estimating the continuous-time split-population model we found that, at the mean starting age of 15 years, an increase of 10% in real cigarette prices is expected to delay smoking onset by almost two and a half years. On the other hand, the same policy is less effective to reduce the duration of the habit because there is no meaningful relationship between the duration of the smoking habit and the real price of cigarettes.The policy of raising cigarette excise taxes, to increment prices, seems to be more effective to delay smoking onset. On the other hand, the same policy is less effective to reduce the duration of the habit. A policy recommendation that emerges from this evidence is that for people with a developed addiction a combination of increasing taxes and other public health policies, like cessation therapies, could prove more effective. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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13 pages, 305 KiB

Open AccessArticle

Attitudinal Spillover from Misleading Natural Cigarette Marketing: An Experiment Examining Current and Former Smokers’ Support for Tobacco Industry Regulation

by Stefanie K. Gratale, Angeline Sangalang, Erin K. Maloney and Joseph N. Cappella

Int. J. Environ. Res. Public Health 2019, 16(19), 3554; https://doi.org/10.3390/ijerph16193554 - 23 Sep 2019

Cited by 3 | Viewed by 3098

Abstract

This research examined the influence of natural cigarette advertising on tobacco control policy support, and the potential for misbeliefs arising from exposure to cigarette marketing to affect such support. Ample research indicates that natural cigarettes such as Natural American Spirit (NAS) are widely [...] Read more.

This research examined the influence of natural cigarette advertising on tobacco control policy support, and the potential for misbeliefs arising from exposure to cigarette marketing to affect such support. Ample research indicates that natural cigarettes such as Natural American Spirit (NAS) are widely and erroneously perceived as safer than their traditional counterparts because of their marketed “natural” composition. Yet regulatory action regarding natural cigarette marketing has been limited in scope, and little research has examined whether misleading product advertising affects support for related policy, an important component of the policy process. Here, we administered a large-scale randomized experiment (n = 1128), assigning current and former smokers in the United States to an NAS advertising condition or a control group and assessing their support for tobacco industry regulation. Results show that exposure to NAS advertising reduces support for policies to ban potentially misleading terminology from cigarette advertising, and these effects are stronger for daily smokers. Further, misinformed beliefs about the healthy composition of NAS partially mediate effects on policy support. Yet interestingly, exposure to NAS marketing does not reduce support for policies to establish standards for when certain terms are permissible in cigarette advertising. The results of this analysis indicate potential spillover effects from exposure to NAS advertising in the realm of support for regulatory action pertaining to tobacco industry marketing. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

13 pages, 931 KiB

Open AccessArticle

Graphic Warning Labels Affect Hypothetical Cigarette Purchasing Behavior among Smokers Living with HIV

by Lauren R. Pacek, Meredith S. Berry, Olga Rass, Melissa Mercincavage, F. Joseph McClernon and Matthew W. Johnson

Int. J. Environ. Res. Public Health 2019, 16(18), 3380; https://doi.org/10.3390/ijerph16183380 - 12 Sep 2019

Cited by 7 | Viewed by 4366

Abstract

Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing [...] Read more.

Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing behavior among HIV-positive smokers. Participants (n = 222) completed a cigarette valuation task by making hypothetical choices between GWL cigarette packs at a fixed price ($7.00) and text-only warning label cigarette packs at increasing prices ($3.50 to $14.00; $0.25 increments). More than one-quarter (28.8%) of participants paid more to avoid GWLs. The remaining participants’ purchasing decisions appear to have been driven by price: 69.8% of participants chose the cheaper pack. Across all participants, overall monetary choice value observed for GWL cigarette packs (mean = $7.75) was greater than if choice was driven exclusively by price ($7.00). Most (87.4%) preferred the text-only warning label when GWL and text-only cigarette packs were equally priced. Correlation analysis indicated GWL pack preference was associated with agreement with statements that GWLs would stop individuals from having a cigarette or facilitate thoughts about quitting. These data suggest that GWLs may influence some HIV-positive smokers in such a way that they are willing to pay more to avoid seeing GWLs. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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16 pages, 314 KiB

Open AccessArticle

Support for Local Tobacco Policy in a Preemptive State

by Rebekah R Rhoades, Laura A Beebe and Nasir Mushtaq

Int. J. Environ. Res. Public Health 2019, 16(18), 3378; https://doi.org/10.3390/ijerph16183378 - 12 Sep 2019

Cited by 2 | Viewed by 2141

Abstract

Policy at the local level is a critical component of comprehensive tobacco control programs. This study examined the relationships of individual and social factors with support for tobacco-related public policy using cross-sectional data (n = 4461) from adults participating in a statewide survey. [...] Read more.

Policy at the local level is a critical component of comprehensive tobacco control programs. This study examined the relationships of individual and social factors with support for tobacco-related public policy using cross-sectional data (n = 4461) from adults participating in a statewide survey. Weighted multivariate, multinomial logistic regression examined associations between individual and social factors and support for tobacco-free city properties and support for limiting the number of stores that sell tobacco near schools. Oklahomans were more likely to favor policies that create tobacco-free city properties than policies that limit the number of stores that sell tobacco near schools. While non-smokers were most likely to favor both policies, support for both policies was greater than 50% among current smokers. Knowledge of secondhand smoke (SHS) exposure harm and female gender were predictors of support for both policies and among current, former, and never smokers. Rural-urban status was a predictor of support among former smokers and never smokers. Tobacco use among friends and family was only a predictor among never smokers’ support for limiting the sale of tobacco near schools. This study demonstrates that level of support differs by policy type, individual smoking status, as well as among subpopulations, and identifies critical elements in the theory of change for tobacco control programs. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

17 pages, 457 KiB

Open AccessArticle

Advertising Restrictions and Market Concentration in the Cigarette Industry: A Cross-Country Analysis

by Maryam Mirza

Int. J. Environ. Res. Public Health 2019, 16(18), 3364; https://doi.org/10.3390/ijerph16183364 - 12 Sep 2019

Cited by 6 | Viewed by 4766

Abstract

There has been a large increase in the adoption of tobacco advertising restrictions worldwide over the last two decades. Much of the literature studies their direct effect on cigarette demand. This paper investigates the indirect effect of advertising restrictions by evaluating the effect [...] Read more.

There has been a large increase in the adoption of tobacco advertising restrictions worldwide over the last two decades. Much of the literature studies their direct effect on cigarette demand. This paper investigates the indirect effect of advertising restrictions by evaluating the effect of the policies on the degree of concentration in the tobacco market. By using the variation between countries in timing of adoption of advertising restrictions, I estimate difference-in-difference models to examine the effect of an advertising ban on market-concentration, as measured by HHI. I find that advertising bans lead to an increase in market-concentration: HHI increased by 0.06 points for countries that adopted a ban between 2001 and 2017 conditional on trade and socio-economic characteristics, representing a 13% increase with respect to the mean (0.44). The effect is higher in developing countries (0.08 points increase). Further, I find that ‘comprehensive’ restrictions have a stronger impact on concentration, and ‘limited’ restrictions have little or no impact. These findings point to an important trade-off for policymakers: on one hand, advertising restrictions are likely to reduce consumption of cigarettes; on the other hand, due to an increase in market-concentration, they may be giving more power to tobacco companies. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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12 pages, 653 KiB

Open AccessArticle

Smoke-Free Policies and Smoking Cessation in the United States, 2003–2015

by Andrea R. Titus, Lucie Kalousova, Rafael Meza, David T. Levy, James F. Thrasher, Michael R. Elliott, Paula M. Lantz and Nancy L. Fleischer

Int. J. Environ. Res. Public Health 2019, 16(17), 3200; https://doi.org/10.3390/ijerph16173200 - 2 Sep 2019

Cited by 17 | Viewed by 5044

Abstract

(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic [...] Read more.

(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic characteristics. (2) Methods: We analyzed data from the Tobacco Use Supplement to the Current Population Survey, 2003–2015, to explore whether multiple measures of smoking restrictions were associated with cessation across population subgroups. We examined area-based measures of exposure to smoke-free laws, as well as self-reported exposure to workplace smoke-free policies. We used age-stratified, fixed effects logistic regression models to assess the impact of each smoke-free measure on 90-day cessation. Effect modification by gender, education, family income, and race/ethnicity was examined using interaction terms. (3) Results: Coverage by workplace smoke-free laws and self-reported workplace smoke-free policies was associated with higher odds of cessation among respondents ages 40–54. Family income modified the association between smoke-free workplace laws and cessation for women ages 25–39 (the change in the probability of cessation associated with coverage was most pronounced among lower-income women). (4) Conclusions: Heterogeneous associations between policies and cessation suggest that smoke-free policies may have important implications for health equity. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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14 pages, 662 KiB

Open AccessArticle

Effects of Prices on Youth Cigarette Smoking and Tobacco Use Initiation in Ghana and Nigeria

by Samuel Asare, Michal Stoklosa, Jeffrey Drope and Aidan Larsen

Int. J. Environ. Res. Public Health 2019, 16(17), 3114; https://doi.org/10.3390/ijerph16173114 - 27 Aug 2019

Cited by 17 | Viewed by 6598

Abstract

Background: Population growth in the African region is set to outpace the rate of decline in smoking prevalence, leading to a projected increase in the total number of smokers. As most tobacco users initiate during their adolescent years, tobacco prevention strategies targeting [...] Read more.

Background: Population growth in the African region is set to outpace the rate of decline in smoking prevalence, leading to a projected increase in the total number of smokers. As most tobacco users initiate during their adolescent years, tobacco prevention strategies targeting youth will be particularly important. Methods: This study estimated the impact of cigarette prices on youth cigarette smoking and tobacco use initiation in Ghana and Nigeria using the Global Youth Tobacco Survey data. First, we used cross-section data and logit models to estimate the effects of prices on youth cigarette smoking. Second, we created pseudo longitudinal data and used continuous-time hazard models to evaluate the impact of cigarette prices on tobacco use initiation. Results: We found that higher cigarette prices decreased both 30-day cigarette smoking and tobacco use onset significantly in both Ghana and Nigeria. Additionally, the price elasticity of cigarette smoking and tobacco use initiation ranged from −0.44 to −1.13, and −1.04 to −3.66, respectively. Conclusions: As one of the first studies on youth tobacco consumption in Sub-Saharan Africa, this study strongly suggests that policies that increase real cigarette prices can lower both cigarette smoking and tobacco use initiation among youth in Ghana and Nigeria. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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19 pages, 1212 KiB

Open AccessArticle

E-Cigarettes: A Disruptive Technology? An Analysis of Health Actors’ Positions on E-Cigarette Regulation in Scotland

by Heide Beatrix Weishaar, Theresa Ikegwuonu, Katherine E. Smith, Christina H. Buckton and Shona Hilton

Int. J. Environ. Res. Public Health 2019, 16(17), 3103; https://doi.org/10.3390/ijerph16173103 - 26 Aug 2019

Cited by 13 | Viewed by 5635

Abstract

Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent [...] Read more.

Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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12 pages, 279 KiB

Open AccessArticle

Tobacco Control Policy in Scotland: A Qualitative Study of Expert Views on Successes, Challenges and Future Actions

by Yvonne Laird, Fiona Myers, Garth Reid and John McAteer

Int. J. Environ. Res. Public Health 2019, 16(15), 2659; https://doi.org/10.3390/ijerph16152659 - 25 Jul 2019

Cited by 8 | Viewed by 4543

Abstract

The Scottish Government launched a tobacco control strategy in 2013 with the ambition of making Scotland tobacco smoke-free by 2034. However, 17% of the adult population in Scotland smoke cigarettes. This study aimed to provide insight into why policies are successful or not [...] Read more.

The Scottish Government launched a tobacco control strategy in 2013 with the ambition of making Scotland tobacco smoke-free by 2034. However, 17% of the adult population in Scotland smoke cigarettes. This study aimed to provide insight into why policies are successful or not and provide suggestions for future policy actions. Individual interviews with ten tobacco control experts were conducted and the results were analyzed using thematic analysis. Key successes included strong political leadership, mass media campaigns, legislation to address availability and marketing of cigarettes and tobacco products, and legislation to reduce second-hand smoke exposure. Challenges included implementing policy actions, monitoring and evaluation of tobacco control actions, addressing health inequalities in smoking prevalence, and external factors that influenced the success of policy actions. Key suggestions put forward for future policy actions included addressing the price and availability of tobacco products, maintaining strong political leadership on tobacco control, building on the success of the ‘Take it Right Outside’ mass media campaign with further mass media campaigns to tackle other aspects of tobacco control, and developing and testing methods of addressing inequalities in cigarette smoking prevalence. The findings of this study can inform future tobacco control policy in Scotland and have relevance for tobacco control policies in other countries. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

17 pages, 407 KiB

Open AccessArticle

State-Level Affordability of Factory-Made Cigarettes among Current US Smokers: Findings from the ITC US Survey, 2003–2015

by Pete Driezen, Nigar Nargis, Mary E. Thompson, K. Michael Cummings, Geoffrey T. Fong, Frank J. Chaloupka, Ce Shang and Kai-Wen Cheng

Int. J. Environ. Res. Public Health 2019, 16(13), 2439; https://doi.org/10.3390/ijerph16132439 - 9 Jul 2019

Cited by 2 | Viewed by 4350

Abstract

Cigarette affordability measures the price smokers pay for cigarettes in relation to their incomes. Affordability can be measured using the relative income price of cigarettes (RIP), or the price smokers pay to purchase 100 packs of 20 cigarettes divided by their per capita [...] Read more.

Cigarette affordability measures the price smokers pay for cigarettes in relation to their incomes. Affordability can be measured using the relative income price of cigarettes (RIP), or the price smokers pay to purchase 100 packs of 20 cigarettes divided by their per capita household income. Using longitudinal data from 7046 smokers participating in the International Tobacco Control (ITC) US Survey, the purpose of this study was to test whether affordability significantly changed following the US federal tax increase implemented on 1 April 2009. This study also estimated temporal trends in affordability from 2003–2015 at state and national levels using small area estimation methods and segmented linear mixed effects regression models. RIP increased slightly during 2003–2008. This was followed by a 30% increase during 2008–2010, indicating cigarettes were less affordable after the federal tax increase. RIP continued to increase during 2010–2013 but decreased during 2013–2015, suggesting cigarettes have recently become more affordable for US smokers. State-level trends in RIP were consistent with overall national trends. Controlling for other factors, a $1 increase in the state excise tax was significantly associated with a 9% increase in RIP, indicating state taxes reduced affordability. Tax-induced price increases must keep pace with underlying economic conditions to ensure cigarettes do not become more affordable over time. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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11 pages, 305 KiB

Open AccessArticle

Why Do Farmers Grow Tobacco? A Qualitative Exploration of Farmers Perspectives in Indonesia and Philippines

by Adriana Appau, Jeffrey Drope, Firman Witoelar, Jenina Joy Chavez and Raphael Lencucha

Int. J. Environ. Res. Public Health 2019, 16(13), 2330; https://doi.org/10.3390/ijerph16132330 - 2 Jul 2019

Cited by 30 | Viewed by 10991

Abstract

Tobacco supply remains a pressing challenge to tobacco control. Tobacco remains a dominant cash crop in many low- and middle-income countries, despite the evidence suggesting that it is not as profitable as industry claims and is harmful to health and the environment. In [...] Read more.

Tobacco supply remains a pressing challenge to tobacco control. Tobacco remains a dominant cash crop in many low- and middle-income countries, despite the evidence suggesting that it is not as profitable as industry claims and is harmful to health and the environment. In order to implement successful and sustainable alternative livelihood interventions, it is important to understand why farmers continue to grow tobacco. This study explores this question from the perspective of farmers in Indonesia and Philippines. This study was informed by interpretive description methodology. Data was collected through focus group discussions (FGDs) (n = 7) with farmers (n = ~60). The FGDs were audio recorded, transcribed verbatim, and then translated into English. An inductive thematic analysis of the data was conducted to identify and categorize the reason provided by participants. We identified two overarching themes: (1) perceived viability (profitability, ready market, and environmental factors) and (2) financial context. Financial context included lumpsum payments and access to financial loans and credit facilities in light of their lack of capital. These results highlight that, in addition to identifying viable alternatives to tobacco, institutional factors such as improved access to credit and well-developed supply chains are key to the successful uptake of alternative livelihoods. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

11 pages, 308 KiB

Open AccessArticle

Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views

by Eliza Skelton, Flora Tzelepis, Anthony Shakeshaft, Ashleigh Guillaumier, William Wood, Marianne Jauncey, Allison M. Salmon, Sam McCrabb and Billie Bonevski

Int. J. Environ. Res. Public Health 2019, 16(11), 2050; https://doi.org/10.3390/ijerph16112050 - 10 Jun 2019

Cited by 3 | Viewed by 3155

Abstract

Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components [...] Read more.

Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF. Staff and client views on the acceptability, facilitators, and barriers to the provision of smoking cessation care were also examined. Methods: This paper presents findings from the qualitative component conducted post-intervention implementation. Face-to-face semi-structured staff interviews (n = 14) and two client focus groups (n = 5 and n = 4) were conducted between September and October 2016. Recruitment continued until data saturation was reached. Thematic analysis was employed to synthesise and combine respondent views and identify key themes. Results: Staff viewed the organizational change intervention as acceptable. Commitment from leadership, a designated champion, access to resources, and the congruence between the change and the facility’s ethos were important facilitators of organizational change. Less engaged staff was the sole barrier to the intervention. Smoking cessation care was deemed suitable. Key facilitators of smoking cessation care included: Written protocols, ongoing training, and visually engaging information. Key barriers of smoking cessation care included: Lack of access to nicotine replacement therapy (NRT) outside of business hours, practical limitations of the database, and concerns about sustainability of NRT. Conclusion: This study develops our understanding of factors influencing the implementation of an organisational change intervention to promote sustainable provision of smoking cessation care in the SIF setting. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

12 pages, 471 KiB

Open AccessArticle

Illicit Cigarette Consumption and Government Revenue Loss in Vietnam: Evidence from a Primary Data Approach

by Minh T. Nguyen, Son The Dao, Nga Que Nguyen, Mike Bowling, Hana Ross and Anthony D. So

Int. J. Environ. Res. Public Health 2019, 16(11), 1960; https://doi.org/10.3390/ijerph16111960 - 2 Jun 2019

Cited by 7 | Viewed by 4899

Abstract

This article provides the first comprehensive picture and independent estimates of both illicit cigarette consumption and the resulting government tax revenue loss in Vietnam using data from a representative survey of cigarette smokers in 12 Vietnamese provinces. The survey consisted of face-to-face interviews [...] Read more.

This article provides the first comprehensive picture and independent estimates of both illicit cigarette consumption and the resulting government tax revenue loss in Vietnam using data from a representative survey of cigarette smokers in 12 Vietnamese provinces. The survey consisted of face-to-face interviews and on-site cigarette pack examinations. We find that more than 720 million illicit cigarette packs, or 20.7% of total cigarette consumption, circulated in Vietnam in 2012. Consequently, government tax revenue loss due to illicit trade ranged from US $223 to 295 million. Our estimates also indicate that (1) the most popular illicit brands were Jet and Hero, both were sold at higher prices than the average legal brand; (2) the average price of illicit cigarettes was 51% higher than the average price of legal cigarettes; and (3) majority of illicit cigarettes were sold at convenience stores, which were registered and licensed businesses. Our findings suggest that prices are not a driver of illicit cigarette consumption in Vietnam, and this illicit trade is at least partially a consequence of weak market control enforcement. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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11 pages, 295 KiB

Open AccessFeature PaperArticle

Analysis of Gender Differences in the Impact of Taxation and Taxation Structure on Cigarette Consumption in 17 ITC Countries

by Anh Ngo, Geoffrey T. Fong, Lorraine V. Craig and Ce Shang

Int. J. Environ. Res. Public Health 2019, 16(7), 1275; https://doi.org/10.3390/ijerph16071275 - 10 Apr 2019

Cited by 6 | Viewed by 3232

Abstract

Although increasing taxes has been established as the most effective tobacco control policy, it is not clear whether these policies reduce cigarette consumption equally among women and men. In this study, we examine whether the association between taxation/taxation structure and cigarette consumption differs [...] Read more.

Although increasing taxes has been established as the most effective tobacco control policy, it is not clear whether these policies reduce cigarette consumption equally among women and men. In this study, we examine whether the association between taxation/taxation structure and cigarette consumption differs by gender. The data is from the International Tobacco Control Policy Evaluation (ITC) Projects in 17 countries. Cigarette consumption was measured by gender for each ITC country. Generalized estimating equations (GEE) were employed to investigate gender differences in the association between cigarette consumption and tax structures, while controlling for time-variant demographic characteristics such as unemployment rates, proportions of adults, and percent of female population. Tiered tax structures are associated with higher cigarette consumption among both males and females. Female smokers are more responsive to an average tax increase than male smokers. Among males, higher ad valorem share in excise taxes is associated with lower cigarette consumption, but it is not the case for females. Females may not be as responsive to the prices raised by ad valorem taxes, despite being responsive to average taxes, suggesting that smokers by gender may face different prices. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

21 pages, 358 KiB

Open AccessArticle

Cigarette Affordability in China, 2006–2015: Findings from International Tobacco Control China Surveys

by Nigar Nargis, Rong Zheng, Steve S. Xu, Geoffrey T. Fong, Guoze Feng, Yuan Jiang, Yang Wang and Xiao Hu

Int. J. Environ. Res. Public Health 2019, 16(7), 1205; https://doi.org/10.3390/ijerph16071205 - 3 Apr 2019

Cited by 16 | Viewed by 5122

Abstract

China is world’s largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers—50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to [...] Read more.

China is world’s largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers—50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to the detriment of public health. This study investigated whether the level and growth in cigarette affordability in China was equally shared by smokers from all demographic and socio-economic statuses (SES) and across all price tiers of cigarette brands. The data came from the urban smoker sample (≥18 years) of the International Tobacco Control China Surveys conducted in five waves over 2006–2015. Cigarette affordability was measured by Relative Income Price—percentage of per capita household income needed to purchase 100 cigarette packs of the last purchased brand. Overall and group-specific trends in affordability by age, gender, SES (e.g., income, education, and employment status), and price tiers were analyzed using generalized estimating equations method. Cigarette affordability was higher among older, female, and higher-SES smokers, and for cheaper brands. It increased overall and across all groups over time. The increase was significantly larger among younger and lower-SES smokers, a trend that poses an added challenge to tobacco control and health equity. To reduce cigarette affordability and consumption among these vulnerable groups, a uniform specific excise system should be introduced in place of the existing tiered ad valorem excise. The specific excise should be periodically adjusted to inflation and per capita income growth observed among younger and lower-SES people, who can potentially experience faster income growth than the national average. The excise tax policy can also be complimented with minimum price regulations and restrictions on price promotions. Full article

(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)

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