Restrictive Tobacco Research Articles

Trends in tobacco sales in Germany.

Based on data from the tobacco tax revenue statistics provided by Germany's Federal Statistical Office, we analyse the development of sales of various tobacco products. In 2016, per capita consumption of tobacco products taxed in Germany was 918 manufactured cigarettes, 37 cigars/cigarillos, 308 g fine cut (equivalent to 462 cigarettes), and 31 g of (water) pipe tobacco. Between 1991 and 2016, the sale of manufactured cigarettes decreased by nearly half, while the sale of fine cut increased by around two thirds. If the amount of fine cut is expressed as cigarette equivalents (whereby 1kg of fine cut equals 1,500 cigarettes) and added to the number of manufactured cigarettes sold, then cigarette sales have decreased by one third since 1991. Numerous facts indicate that measures implemented in the context of a more restrictive tobacco control policy, such as tax increases and smoking bans, have contributed to this decrease in tobacco sales.

Policy coherence, integration, and proportionality in tobacco control: Should tobacco sales be limited to government outlets?

Multiple factors, including marijuana decriminalization/legalization, tobacco endgame discourse, and alcohol industry pressures, suggest that the retail regulatory environment for psychoactive or addictive substances is a dynamic one in which new options may be considered. In most countries, the regulation of tobacco, marijuana, and alcohol is neither coherent, norintegrated, nor proportional to the potential harms caused by these substances. We review the possible consequences of restricting tobacco sales to outlets run by government-operated alcohol retail monopolies, as well as the likely obstacles to such a policy. Such a move would allow governments more options for regulating tobacco sales, and increase coherence, integration, and proportionality of substance regulation. It might also serve as an incremental step toward an endgame goal of eliminating sales of commercial combustible tobacco.

ED12.01 Tobacco Control Policies in Eastern Europe

ED12.01 Tobacco Control Policies in Eastern Europe

Effects of State-Level Tobacco Environment on Cigarette Smoking are Stronger Among Those With Individual-Level Risk Factors.

To better understand the impact of the state-level tobacco environment (eg, tobacco control policies, attitudes towards smoking) on cigarette smoking, we examined whether the relationship of state tobacco environments to smoking is modified by individual-level vulnerability factors. In a nationally representative sample of US adults (N = 34 638), past-year smoking and heavy smoking were examined. State-level tobacco environment was defined by tobacco-related control policies and attitudes, ranging from permissive to restrictive; individual vulnerability was defined by childhood maltreatment and/or parental substance problems. Additive interaction tested differences in state-level tobacco environment effects on smoking and heavy smoking by individual-level vulnerability. Significant interactions (P values < .01) indicated that the state tobacco environment had the strongest relationship to smoking outcomes among individuals with greatest individual vulnerability. For example, among respondents with childhood maltreatment and parental substance problems, those in states with permissive tobacco environments had 13.3% greater prevalence of smoking than those in restrictive states. Among respondents with neither individual-level risk factor, those in permissive states had 2.8% greater prevalence than those in restrictive states (interaction P value = .0002). Further restricting states' smoking environments could help reduce the prevalence of smoking and heavy smoking, particularly among those at increased individual risk in the general population. This study shows that the protective effect of restrictive state-level tobacco environments on smoking or heavy smoking was stronger among those especially vulnerable due to individual-level risk factors (parental substance problems, childhood maltreatment). Thus, public health campaigns to influence attitudes towards smoking or legislation to strengthen tobacco control could have a broad effect, particularly impacting those with vulnerability to smoking, which may help decrease smoking prevalence and reduce the massive public health burden of tobacco-related morbidity and mortality.

Double standards and arguments for tobacco regulation

Several ethicists recently defended regulations that aim to reduce the harm associated with nicotine and tobacco use. Halliday argues for smoking licences.1 van der Eijk endorses strict limits on access...

The sociodemographic patterning of opposition to raising taxes on tobacco and restricting tobacco advertisements in Argentina

BackgroundArgentina has enacted important tobacco control initiatives in recent years. Yet little is known about the social patterning of attitudes toward tobacco control. Research is needed to explore what predicts opposition to tobacco control initiatives such as higher taxes on tobacco and the prohibition of tobacco advertising. Study designSecondary analysis of Argentina's Global Adult Tobacco Survey (N = 6645). MethodsBinary logistic regression analysis examining opposition to raising tobacco taxes and banning tobacco publicity. Models were stratified by smoking status. ResultsRespondents generally indicated very little opposition to either tobacco control measure, with only 15.6% of respondents opposed to increasing taxes on tobacco products and 9.6% opposed to banning tobacco advertisements. Smoking status is the most important predictor of opposition to increasing taxes (OR = 7.85, 95% CI = 6.60–9.34) and banning advertisements (OR = 1.72, 95% CI = 1.39–2.11). Opposition to these measures is most likely among young respondents (aged 15–24) and least likely among older age groups (55–64 and 65 or over), compared to the 25–34 age group. Stratified models suggest that the effect of age may be different for smokers and non-smokers. Low income is a significant predictor of opposition, but only in stratified models for smokers. ConclusionThere is general support for stronger tobacco control measures in Argentina. Opposition to raising taxes on tobacco products and banning tobacco advertisement appears to be concentrated among young smokers with low and medium levels of household income.

State-level tobacco environments and sexual orientation disparities in tobacco use and dependence in the USA

ObjectiveTo describe relationships between tobacco-related environments and disparities in smoking by sexual orientation.MethodsWe examined three aspects of state-level tobacco environments, which were derived from the ImpacTeen State Level Tobacco Control...

Incidence and mortality trends of head and neck cancer in Croatia in the period 1988–2008

Conclusion: Head and neck cancer (HNC) incidence and mortality trends in men displayed a significant downward trend in Croatia during the study period. No significant changes of incidence and mortality trends were observed in women. Decreasing trends observed in men are similar to other European countries. Further decreases in HNC incidence and mortality could be achieved with more restrictive alcohol and tobacco control policies and adherence to national treatment guidelines. Objective: To describe and interpret trends in incidence and mortality of HNC in Croatia in the period 1988–2008. Methods: HNCs were defined as ICD-10 codes C00-C14, C32. Incidence data were obtained from the Croatian National Cancer Registry, while numbers of deaths were obtained from the WHO Mortality Databank. Joinpoint regression analysis of age-standardized rates (ASR, standard world population) and age-specific rates for 10-year age groups was used to estimate changes in trends of HNC incidence and mortality. Results: HNC incidence and mortality in men declined steadily during the study period (estimated annual percent change (EAPC) of –1.5% and –1.8%, respectively). The most prominent decreases of –5.7% annually for incidence and –9.3% for mortality were observed in the youngest age group, 30–39 years. A non-significant increase in incidence (EAPC 0.9%) and decrease in mortality (EAPC –1.3%) were observed in women.

The public's attitudes towards tobacco sales prohibitions: Evidence from a nationally representative survey in the former Soviet state of Georgia

BACKGROUND: In the Caucasus region country of Georgia, no data on public opinion regarding tobacco sales restrictions have been available until now. The aim of the study is to provide data from a nationally representative sample including non-smokers, ex-smokers and current smokers, on their level of support for restricting tobacco sales. METHODS: 1,588 people aged 13-70 were interviewed at home about their level of agreement with eight possible tobacco sales restrictions, which were combined to create a dichotomous scale indicating low agreement (agree with none to three of eight restrictions) or high agreement (agree with four or more of eight restrictions). Levels of agreement were analyzed by demographic segments defined by age, gender, education and income and by tobacco use status. RESULTS: Across all eight forms of tobacco sales restrictions, the average support for tobacco sales restrictions was 85.2% which is a high level of support. Among smokers, 71% of women and 87% of men indicated a high level of agreement for restricted tobacco sales; among occasional smokers 54% and 55% respectively. Above 95% of female and male ex-smokers and never smokers expressed high level of agreement with sales restrictions. After adjustment for other predictors, agreement was significantly associated with age (more agreement with higher age) and smoking status (more agreement among never-smokers, less in current smokers), while there were no significant differences in agreement by gender, education, and income. DISCUSSION: It is of high importance for Georgia to fully implement the Framework Convention on Tobacco Control, including strong sales restrictions, and there is good evidence of public support for doing so. CONCLUSION: The present findings indicate to Georgian public health authorities that the support for tightened tobacco sales restrictions is high. KEYWORDS: tobacco; tobacco control; tobacco control policy; public attitude; sales restriction; tobacco sales restriction; youth access; law; FCTC.

The RTM Resistance to Potyviruses in Arabidopsis thaliana: Natural Variation of the RTM Genes and Evidence for the Implication of Additional Genes

BackgroundThe non conventional RTM (Restricted Tobacco etch virus Movement) resistance which restricts long distance movement of some plant viruses in Arabidopsis thaliana is still poorly understood. Though at least three RTM genes have been identified, their precise role(s) in the process as well as whether other genes are involved needs to be elucidated.Methodology/Principal FindingsIn this study, the natural variation of the RTM genes was analysed at the amino acid level in relation with their functionality to restrict the long distance movement of Lettuce mosaic potyvirus (LMV). We identified non-functional RTM alleles in LMV-susceptible Arabidopsis accessions as well as some of the mutations leading to the non-functionality of the RTM proteins. Our data also indicate that more than 40% of the resistant accessions to LMV are controlled by the RTM genes. In addition, two new RTM loci were genetically identified.Conclusions/SignificanceOur results show that the RTM resistance seems to be a complex biological process which would involves at least five different proteins. The next challenges will be to understand how the different RTM protein domains are involved in the resistance mechanism and to characterise the new RTM genes for a better understanding of the blocking of the long distance transport of plant viruses.

Success Counteracting Tobacco Company Interference in Thailand: An Example of FCTC Implementation for Low- and Middle-income Countries

Transnational tobacco companies (TTCs) interfere regularly in policymaking in low- and middle-income countries (LMICs). The WHO Framework Convention for Tobacco Control provides mechanisms and guidance for dealing with TTC interference, but many countries still face ‘how to’ challenges of implementation. For more than two decades, Thailand’s public health community has been developing a system for identifying and counteracting strategies TTCs use to derail, delay and undermine tobacco control policymaking. Consequently, Thailand has already implemented most of the FCTC guidelines for counteracting TTC interference. In this study, our aims are to describe strategies TTCs have used in Thailand to interfere in policymaking, and to examine how the public health community in Thailand has counteracted TTC interference. We analyzed information reported by three groups with a stake in tobacco control policies: Thai tobacco control advocates, TTCs, and international tobacco control experts. To identify TTC viewpoints and strategies, we also extracted information from internal tobacco industry documents. We synthesized these data and identified six core strategies TTCs use to interfere in tobacco control policymaking: (1) doing business with ‘two faces’, (2) seeking to influence people in high places, (3) ‘buying’ advocates in grassroots organizations, (4) putting up a deceptive front, (5) intimidation, and (6) undermining controls on tobacco advertising, promotion and sponsorship. We present three case examples showing where TTCs have employed multiple interference strategies simultaneously, and showing how Thai tobacco control advocates have successfully counteracted those strategies by: (1) conducting vigilant surveillance, (2) excluding tobacco companies from policymaking, (3) restricting tobacco company sales, (4) sustaining pressure, and (5) dedicating resources to the effective enforcement of regulations. Policy implications from this study are that tobacco control advocates in LMICs may be able to develop countermeasures similar to those we identified in Thailand based on FCTC guidelines to limit TTC interference.

Tobacco control in the EU-15: the role of member states and the European Union

Various explanations have been advanced for the adoption of increasingly restrictive tobacco control policies in Western democracies, usually based on an examination of individual instruments. Some of the more popular explanations are socioeconomic modernization, interest group politics, political institutions, government ideology and vertical diffusion from the European Union (EU). This paper uses statistical models to test explanations of tobacco control policy across 15 EU member states adopting instruments of Comprehensive Tobacco Control Policy (CPTC) over two decades. Socioeconomic modernization, economic interest groups and domestic political factors all play a role in policy. Although there is declining influence of pro-tobacco domestic constituencies, adoption of CPTC is still inhibited by corporatist practices in member states. Vertical policy diffusion through the EU has aided domestic sources of policy adoption, making tobacco control policy one of multi-level governance and enhancing its comprehensiveness.

Camel No. 9 Cigarette-Marketing Campaign Targeted Young Teenage Girls

The 1998 Master Settlement Agreement (MSA) restricted tobacco industry advertising practices that targeted teens. To assess whether cigarette-advertising campaigns conducted after the MSA continue to influence smoking among adolescents. Participants were a national longitudinal cohort of 1036 adolescents (baseline age: 10-13 years) enrolled in a parenting study. Between 2003 and 2008, 5 sequential telephone interviews were conducted, including the participant's report of brand of "favorite" cigarette advertisement. The fifth interview was conducted after the start of RJ Reynolds' innovative "Camel No. 9" advertising campaign in 2007. Smoking outcome reported from the fifth survey. The response rate through the fifth survey was 71.8%. Teenagers who reported any favorite cigarette ad at baseline (mean age: 11.7 years) were 50% more likely to have smoked by the fifth interview (adjusted odds ratio: 1.5 [95% confidence interval: 1.0-2.3]). For boys, the proportion with a favorite ad was stable across all 5 surveys, as it was for girls across the first 4 surveys. However, after the start of the Camel No. 9 advertising campaign, the proportion of girls who reported a favorite ad increased by 10 percentage points, to 44%. The Camel brand accounted almost entirely for this increase, and the proportion of each gender that nominated the Marlboro brand remained relatively stable. After the MSA, adolescents continued to be responsive to cigarette advertising, and those who were responsive were more likely to start smoking. Recent RJ Reynolds advertising may be effectively targeting adolescent girls.

Decline in Smoking during Pregnancy in New York City, 1995–2005

The 1998 Master Settlement Agreement (MSA) between 46 states and four major tobacco companies increased tobacco control funding and restricted tobacco marketing. In 2002, New York City (NYC) began a comprehensive tobacco control program that raised the price of cigarettes, banned indoor workplace smoking, and increased access to cessation treatment. We examined the temporal pattern of smoking during pregnancy, including ethnic variation in smoking prevalence, relative to the implementation of the MSA and NYC's comprehensive tobacco control program using birth certificate data. Using multiple logistic regression, we analyzed NYC birth certificate data to examine prenatal smoking during three time periods: 1995-1998 (pre-MSA), 1999-2002 (post-MSA, pre-NYC tobacco control), and 2003-2005 (post-MSA, post-tobacco control). Overall, 3.0% of 1,136,437 births included were to smoking mothers. The proportion of smoking mothers declined from 4.5% in 1995-1998 to 1.7% in 2003-2005. Compared with non-Hispanic white women, African American women had 2.46 increased odds (95% confidence interval [CI] 2.36, 2.55) of smoking during 1995-1998, and 3.63 increased odds (95% CI 3.39, 3.88) of smoking during 2003-2005, despite an absolute reduction in smoking from 10.4% to 5.0%. Puerto Rican women also smoked considerably more than non-Hispanic white women. These findings document a striking temporal decline in prenatal smoking in NYC concurrent with changing tobacco control policies. Targeted efforts may be required to address the increasing disparity in prenatal smoking between non-Hispanic white and African American and Puerto Rican women.

Translating an Adolescent Smoking Cessation Program Into Policy and Practice in an Australian Context

Although Australia's restrictive tobacco control policies have made it an international leader in reducing smoking prevalence, and only 7% of teens smoke weekly, cessation efforts are still needed among adolescents. Of the campaigns and programs implemented in Australia to reduce this problem among adolescents, most have provided only abstinence messages and few have been effectively evaluated and translated into policy and practice. This article describes the translation of a harm minimization cessation program for teens, the Smoking Cessation for Youth Project (SCYP), derived from an approach developed with adults. In addition, the article describes the unique sociopolitical context of Australia in which the SCYP program was developed and the significant conceptual, contextual, and methodological factors that enabled and limited this program's effective implementation and translation.

Study of the impact of laws regulating tobacco consumption on the prevalence of passive smoking in Spain

In 2005, the Spanish parliament passed the Spanish anti-smoking law. This legislation restricted tobacco smoking in public places, including recreation venues (bars and restaurants), but smoking was not completely prohibited in bars and restaurants. The law was enforced in January 2006. With the objective of analysing the impact that this law has had on the general Spanish population, the Spanish Society of Pulmonology and Thoracic Surgery (SEPAR) designed and implemented a survey of a representative sample of the general Spanish population on two separate occasions: in 2005 and in 2007 (12 months after the ban came into effect). Two epidemiological, observational and cross-sectional surveys were performed among a random and representative sample of the general Spanish population, using the Computer-Assisted Telephone Interview system. In the first survey, a total of 6533 subjects were interviewed, of whom 3907 (59.8%) were non-smokers and in the second, a total of 3289 subjects were interviewed, of whom 2174 (65.9%) were non-smokers. The overall prevalence of exposure to environmental tobacco smoke (ETS) decreased from 49.5% in 2005 to 37.9% in 2007 (22% reduction). The greatest reduction in prevalence of ETS exposure was in workplaces (from 25.8% to 11%, a decrease of 58.8%). Smaller reductions occurred in the home (from 29.5% to 21.4%, a decrease of 27%) and in recreation venues (from 37.4% to 31.8%, a decrease of 8%). Implementation of the smoking ban resulted in a significant decrease in exposure to ETS.

Tobacco Policy Regression in Arizona Worksites

To learn how worksite tobacco policies in Arizona changed between 1998 and 2001. Telephone survey panel design. Arizona. Private workplaces with at least five employees (N = 1008). Workplace policies were rated as "smoke free" (no smoking by employees in any indoor areas or in company vehicles except for designated smoking areas enclosed by physical barriers and having separate ventilation systems), "partial" policies (restrictive tobacco policies that did not meet the "smoke-free" standard), or no tobacco policy. Bivariate statistical tests included chi2 and analysis of variance. Logistic regression was performed to identify the variables that best predicted the workplaces that weakened or eliminated their policies. . Tobacco policy in Arizona worksites improved overall, but 10.8% of worksites had weakened or eliminated tobacco policies present at baseline. Among worksites that were smoke free at baseline, 15.5% were no longer smoke free at follow-up. . Policy regression is a disturbing finding that should be further explored. Our findings suggest that efforts to promote workplace tobacco policies should not end when policies are in place.

Environmental Tobacco Smoke in Finnish Restaurants and Bars Before and After Smoking Restrictions were Introduced

The Finnish Tobacco Act was amended on 1 March 2000 to include restrictions on smoking in restaurants and bars. To evaluate the effectiveness of the restrictions, environmental tobacco smoke (ETS) concentrations in restaurants and bars were measured prior and after the amended Act entered into force. The Act was enforced in stages so that all stages were effective on 1 July 2003. According to the Act, smoking is prohibited in all Finnish restaurants and bars with certain exceptions. Smoking may be allowed in establishments where the service area is not larger than 50 m(2) if the exposure of employees working there to ETS can be prevented. On premises with larger service area, smoking may be allowed on 50% of the service area, provided tobacco smoke does not spread into the area where smoking is prohibited. At bar counters or gambling tables smoking is not allowed, if the spreading of tobacco smoke cannot be restricted to the employee side of the counter. Therefore, according to the Act all areas where smoking is prohibited are to be smoke-free. Establishments with a serving area larger than 100 m(2) were selected for the present study. The evaluation both before and after the enforcement of the Act included the following: The ventilation rate was first measured in each establishment. Then 3-5 area samplers, depending on the layout, were placed in locations that best described the establishment and the working areas of the personnel. The measurements were performed twice at each establishment, during peak hours. The sample collection time was 4 h during which the guests and the cigarettes smoked were counted. The air samples were analysed for nicotine, 3-ethenylpyridine (3-EP) and total volatile organic compounds (TVOC) by thermodesorption-gas chromatography-mass spectrometry. Altogether 20 restaurants and bars situated in three Finnish cities participated in the study out of which 16 participated during all four measurement periods. None of the establishments had introduced a total ban on smoking and they all had reserved only the smallest area allowed by the Finnish Tobacco Act as the smoke-free area. The measured geometric mean (GM) nicotine concentration in all participating establishments was 7.1 microg m(-3) before the amended act was in force and 7.3 microg m(-3) after all stages of the Act had been enforced. The GM concentration of nicotine in food and dining restaurants was 0.7 microg m(-3) before and 0.6 microg m(-3) after the enforcement of the Act, in bars and taverns the concentrations were 10.6 and 12.7 microg m(-3), and in discos and night-clubs 15.2 and 8.1 microg m(-3), respectively. The GM nicotine concentrations measured in the smoke-free sections varied between 2.9 and 3 microg m(-3). 3-EP concentrations measured correlated well with the nicotine concentrations and were approximately one-fifth of the nicotine concentrations. The measurements showed higher TVOC values in the smoking sections than in the smoke-free sections, but because there are many other sources of TVOC compounds in restaurants and bars TVOC cannot be regarded as a marker for ETS. The overall air nicotine concentration decreased in 10 out of the 18 establishments that participated in the study both before and after all stages of the amended Act had been in force. Structural changes or changes to the ventilation systems had been carried out in nine of these establishments, i.e. the smoke-free sections were actually non-smoking and were mainly separated from other sections by signs and very little was done to keep the smoke from spreading into the smoke-free sections. In four establishments, the highest air nicotine concentration was measured in the smoke-free section. In 10 establishments, the air nicotine concentration at bar counters had dropped after the Act. Exposure of the workers and the public to ETS was, therefore, not reduced as intended by the Finnish legislature. Thus, it seems obvious from the present study that improving ventilation will not be a solution to restricting tobacco smoke from reaching smoke-free areas and physical barriers separating smoking from smoke-free areas are required.

Tabakentwöhnung bei Personen mit einer Alkoholabhängigkeit im Setting der Suchtrehabilitation - Ein Überblick

Review of the international literature on smoking cessation with smokers having a concurrent alcohol abuse disorder. The three aims are: 1. discussion of the pros and cons of concurrent smoking cessation and treatment of alcohol use disorder, 2. smoking cessation strategies and 3. description of national and international studies evaluating smoking cessation interventions with patients who are at the same time treated for their alcohol abuse disorder. The results are collected on the basis of an extensive literature research in PsychInfo, Science Direct and Medicine. Considering the pros and cons, it can be concluded that smoking cessation should be offered to this subgroup of high risk smokers. The open question is which kind of interventions are effective. Intervention strategies should consist of a multi-level approach including structural as well as person-specific components. Evaluation studies show that a 12% abstinence rate at one year follow-up can be achieved in case of an intensive intervention in combination with a restrictive tobacco policy. Alcohol abstinence is not jeopardised by a concurrent smoking cessation, when smoking cessation is voluntary. On the basis of empiric research the common arguments against smoking cessation within the subgroup of alcohol-addicted smokers cannot be maintained on the basis of empiric research. Rehabilitation centres treating substance abuse disorders provide an excellent setting for the treatment of nicotine dependence. Interventions should include structural as well as subgroup-specific components.

Preferences and practices among renters regarding smoking restrictions in apartment buildings

Objective: This study assessed renters’ preferences for official smoking policies in their buildings and their practices concerning restricting tobacco smoking in their apartments. Design: Renters (n = 301) living in...