Tobacco Marketing Research Articles

A multi-country analysis of transnational tobacco companies' market share.

The international tobacco market is dominated by five transnational tobacco companies (TTCs) which continue to interfere with measures to reduce tobacco consumption. The aim of this study is to better understand the current international tobacco industry market structure by providing an overview of the market share of these five companies globally. A longitudinal multi-country study design was used to understand market share trends across 90 different countries from 2011 to 2020. Descriptive analyses were conducted based on market share and market size data obtained from Euromonitor Passport. Market share (%), maximal market share (%) and cumulative market share (%) were calculated. Maps and boxplots are used to present the descriptive analyses. Median cumulative TTC market share and interquartile ranges for each year were calculated and stratified by country income level. The average maximal market share of one company in a country was 50% (IQR: 40.0-63.5) in 2020 compared to 51.5% in 2011 (IQR: 41.3-69.0). One of the five TTCs had the highest market share in 77 out of the 90 countries. Philip Morris International was the main market player in 38 countries, followed by British American Tobacco (24), Japan Tobacco International (8), Imperial Brands (6), and lastly China National Tobacco Corporation was only dominant in China. The percentage of cigarettes manufactured by one of the five TTCs remained relatively stable between 2011 (86.4%) and 2020 (85.2%). Average cumulative TTC market shares increased between 2011 and 2020 in both low- and middle-, and high-income countries. The international tobacco market is concentrated with a small number of large players, and this has not changed substantially between 2011 and 2020. The impact of this on the ability of the tobacco industry to resist policy changes is unknown but presents a cause for concern.

US and EU Free Trade Agreements and implementation of policies to control tobacco, alcohol, and unhealthy food and drinks: A quasi-experimental analysis.

Identifying and tackling the factors that undermine regulation of unhealthy commodities is an essential component of effective noncommunicable disease (NCD) prevention. Unhealthy commodity producers may use rules in US and EU Free Trade Agreements (FTAs) to challenge policies targeting their products. We aimed to test whether there was a statistical relationship between US and EU FTA participation and reduced implementation of WHO-recommended policies. We performed a statistical analysis assessing the probability of at least partially implementing 10 tobacco, alcohol, and unhealthy food and drink policies in 127 countries in 2014, 2016, and 2019. We assessed differences in implementation of these policies in countries with and without US/EU FTAs. We used matching to conduct 48 covariate-adjusted quasi-experimental comparisons across 27 matched US/EU FTA members (87 country-years) and performed additional analyses and robustness checks to assess alternative explanations for our results. Out of our 48 tests, 19% (9/48) identified a statistically significant decrease in the predicted probability of at least partially implementing the unhealthy commodity policy in question, while 2% (1/48) showed an increase. However, there was marked heterogeneity across policies. At the level of individual policies, US FTA participation was associated with a 37% reduction (95%CI: -0.51 to -0.22) in the probability of fully implementing graphic tobacco warning policies, and a 53% reduction (95%CI: -0.63 to -0.43) in the probability of at least partially implementing smoke-free place policies. EU FTA participation was associated with a 28% reduction (95%CI: -0.45 to -0.10) in the probability of fully implementing graphic tobacco warning policies, and a 25% reduction (95%CI: -0.47 to -0.03) in the probability of fully implementing restrictions on child marketing of unhealthy food and drinks. There was a positive association with implementing fat limits and bans, but this was not robust. Associations with other outcomes were not significant. The main limitations included residual confounding, limited ability to discern precise mechanisms of influence, and potentially limited generalisability to other FTAs. US and EU FTA participation may reduce the probability of implementing WHO-recommended tobacco and child food marketing policies by between a quarter and a half-depending on the FTA and outcome in question. Governments negotiating or participating in US/EU FTAs may need to establish robust health protections and mitigation strategies to achieve their NCD mortality reduction targets.

Profiles of tobacco product use and related consumer characteristics in the US and Israel: A multiple-group latent class analysis

ABSTRACT Despite tobacco marketing diversification, limited research has examined use profiles across countries, particularly in relation to consumer values (e.g. appeal of innovation, conscientiousness). Using 2021 data, latent class analysis assessed past-month use of seven tobacco products (cigarettes, electronic cigarettes [e-cigarettes], heated tobacco products, cigars, hookah, pipe, smokeless) among adults reporting past-month use in the United States (US n = 382) and Israel (n = 561). Multivariable multinomial regression examined consumer values and sociodemographics in relation to country-specific class membership. US classes included: primarily cigarette 58.1%; e-cigarette–no cigarette 17.5%; primarily cigar 14.9%; and poly-product 9.9%. Higher innovation correlated with e-cigarette–no cigarette and poly-product (vs. primarily cigarette) use. Other correlates included being: younger with e-cigarette–no cigarette; male, Black, and more educated with primarily cigar; and Black and Asian (vs. White) with poly-product. Israel classes included: primarily cigarette 39.0%; moderate poly-product 40.3%; high poly-product 13.4%; and hookah 7.3%. Lower conscientiousness correlated with moderate poly-product (vs. primarily cigarette) use; higher innovation correlated with high poly-product; lower innovation correlated with hookah. Other correlates included being: younger, male, and more educated with moderate poly-product; male and sexual minority with high poly-product; and Arab with hookah. Tobacco consumer segments within and across countries likely reflect different consumer values and industry marketing targets.

An assessment of differential supplier category performance in the agro processing industry: A case for supplier development in the Zimbabwean tobacco industry

This study sought to determine whether farm categories influence the key agro business supply chain metric of crop yield. The investigated farm categories are the communal farms, A1 farms, A2 farms, and commercial farms that reflect the agricultural structure that emerged from the post-fast-track land reform programme in Zimbabwe. Secondary data for crop yield was collected from the Tobacco Industry and Marketing Board publications of a five-year period spanning from 2014-2018. Tobacco Industry and Marketing Board is the regulatory authority of the Zimbabwean tobacco industry. The study used One-way ANOVA to test the specified hypotheses. A post hoc test was conducted using the Bonferroni procedure. The results indicated that crop yield is a function of the farm category. Communal farms had low crop yield, while A1 farm models proved to be very productive as evidenced by higher crop yield than any other farm category. A2 farms and commercial farms had unexpectedly low crop yield. The study recommended consolidation and transformation of communal areas into small-to-medium plots for the purposes of improving their agricultural viability, while at the same time downsizing the redundant A2 and commercial farms into small scale plots for the purposes of improving their efficiency. The study also recommended entering into resource-providing contract farming with A2 farmers whose current low yield might be due to lack of adequate input resources.

E-cigarette use in global digital youth culture. A qualitative study of the social practices and meaning of vaping among 15–20-year-olds in Denmark, Finland, and Norway

The introduction of e-cigarettes on the tobacco market has brought new regulatory challenges, and particular concerns relate to e-cigarette uptake among young people. The aim of this study was to explore the use and social meaning of e-cigarettes among Nordic young people and to discuss this in the context of current legislation. Thirteen focus groups were conducted with 46 Danish, Finnish, and Norwegian young people (24 boys) with vaping experience aged 15-20 years (mean age 17 years). Young people's vaping stood out as an inherently social practice that was commonly interlinked with experimental use patterns. Relative to smoking, vaping was seen as socially acceptable and less harmful to health. Product innovations like flavour additives and nicotine-free liquid options added to perceptions of low harm, and innovative device design features facilitated new and playful user practices. Finally, digital markets eased the young people's access to e-cigarettes, and the digital world also represented an arena for e-cigarette exposure and self-presentation. They commonly viewed vaping-related content in their social media feeds and also produced such content themselves. Young people's vaping is a social practice interwoven in contemporary digital and global youth culture. Transnational regulations are needed to support individual countries in preventing e-cigarette use and exposure among young people.

An Epidemiological Study of Addictive Behavior Pattern Among Adolescent Tobacco Users.

The risk of developing tobacco-related cancer and chronic heart and lung disease is greater if addiction starts in adolescence. Even experimental use of tobacco in adolescents significantly increases the risk of addiction in adulthood. This study intends to collect valuable data regarding sociodemographic characteristic of tobacco use, pattern of dependence among adolescent tobacco users, which will be essential for formulating recommendations, and their possible intervention aimed at reducing the problem of tobacco use. A community-based cross-sectional study was done where 400 subjects were enrolled. Nonprobability Snowball sampling technique was used to locate adolescents aged 12-18 years, who were practicing tobacco use. Face-to-face interviews were taken for data collection. Fragerstorm dependency test for tobacco was used to classify dependency of tobacco product into high and low dependency. Data was analyzed using Chi-square test and proportions using SPSS software version 21. Majority of the subjects were in the age group of 16-18 years; mean age for initiation of tobacco was 15.6 years. Gutkha was the predominant form of tobacco product being used. Peer pressure 192 (48.0%) was the major reason for initiation of tobacco use. A significant association was found between dependency on tobacco and age, literacy, and socioeconomic status. Tobacco use starting from early age has many health implications. There is a need for stringent laws against the selling of tobacco to adolescents and targeted health awareness program against tobacco.

УПРАВЛІНСЬКЕ РІШЕННЯ ЩОДО ВИБОРУ КРАЇН-КОНТРАГЕНТІВ ДЛЯ ІМПОРТУ ТЮТЮНОВОЇ СИРОВИНИ

The article defines management decisions as one of the components of the managerial activity of an entity as a subject of foreign economic activity. It is emphasized that it is necessary to make reasonable management decisions based on the information analysis from open sources of world statistics and the experience of import operations of tobacco-producing companies. The article examines the global tobacco market conditions, analyzes the global volume of tobacco raw materials exports, identifies the leading exporters of the product (HS 2401, 2403) in 2018–2022. In addition, the article reveals the trends of annual increase/decrease in deliveries, ranks the leaders in world exporter (Brazil with a share in world exports at the level of 21.2%, in second and third place, respectively, Zimbabwe – 9.0% and the USA – 8.0% of exports of unprocessed tobacco (HS 2401)). The top 10 European exporting countries include Belgium (3rd place), Italy (8th place) and Germany (10th place). As an importer of tobacco raw materials, Ukraine occupies 23rd and buys 0.9% of world imports. Brazil, Mozambique and Italy are identified as the leaders in terms of supply volumes. The article highlights trade indicators considering the geography of imports, such as: the share in Ukraine's imports, the share in the partner's exports, the growth of imports in 2018–2022, 2021–2022, the place in the world ranking of exporters, the average distance between the supplier country and the importer. The carried-out analysis allows filtering of potential counterparties and choosing of Brazil, Mozambique and Italy among the priority ones. The article carries out a comparative analysis based on logistics criteria, the average customs value of a product unit, and the level of the import duty rate. The conducted comparative analysis based on the criteria of logistics, the average customs value of goods (per unit), the level of the import duty rate ensured justifying the adoption of a management decision regarding the choice of Italy as a priority counterparty for the import of raw tobacco (HS 2401).

Current status of tobacco use, cessation and control policy in Korea

Background: Tobacco use is a leading cause of countless deaths and disabilities worldwide. An estimated 11 million Korean adults were still using tobacco in 2020, according to the Korea National Health and Nutrition Examination Survey. This review aims to explain the current trends in tobacco use, sales, cessation, and control policies in South Korea.Current Concepts: Heated tobacco products (HTPs), a hybrid between conventional and electronic cigarettes, were first launched in South Korea in June 2017. Advertisements stating that HTPs are odorless, tar-free, and less harmful to health have caused sales of HTPs to grow quickly over the past 5 years, such that they account for about 15% of the total tobacco market. According to national smoking rate statistics and tobacco sales trends, declines in current smoking rates have slowed and even risen in some groups, and declines in total tobacco sales have slowed but also risen again during the coronavirus 19 pandemic. In addition, the number of visitors to smoking cessation clinics decreased just after the advent of HTPs and social distancing policies triggered by the coronavirus. Nicotine replacement therapy can serve as a drug therapy for smoking cessation, or bupropion and varenicline can be prescribed. Korea’s representative tobacco control policies include the tax increase policy, non-smoking area policy, cigarette pack warning picture policy, and support policy for visiting smoking cessation clinics.Discussion and Conclusion: There is a pressing need to reflect tobacco control policies in line with changes in tobacco user behaviors and tobacco company marketing strategies.

A Text-Based Smoking Cessation Intervention for Sexual and Gender Minority Groups: Protocol for a Feasibility Trial.

Smoking among sexual and gender minority (SGM) groups, which include lesbian, gay, bisexual, transgender, and queer individuals, has been reported to be highly prevalent. This is attributed to several factors, including minority-specific stress and targeted tobacco marketing. Therefore, this population is at an increased risk for tobacco-related diseases. SMS text messaging programs have been found to be effective for smoking cessation and appeal to traditionally hard-to-reach populations over other interventions. It has also been suggested that targeted and tailored interventions could be more effective among SGM smokers because they can be designed to assure a safe, validating health care environment that enhances receptivity to cessation. The aim of this study is to develop SmokefreeSGM, a text-based smoking cessation program tailored to and tested among SGM smokers. The study consists of three phases, culminating in a feasibility trial. In Phase 1, our research team will collaborate with a Community Advisory Board to develop and pretest the design of SmokefreeSGM. In Phase 2, the tailored text messaging program will be beta tested among 16 SGM smokers. Our research team will use a mixed-methods approach to collect and analyze data from participants who will inform the refinement of SmokefreeSGM. In Phase 3, a feasibility trial will be conducted among 80 SGM smokers either enrolled in SmokefreeSGM or SmokefreeTXT, the original text-based program developed by the National Cancer Institute for the general population. Our research team will examine recruitment, retention, and smoking abstinence rates at 1-, 3-, and 6-month follow-up. Additionally, a qualitative interview will be conducted among 32 participants to evaluate the feasibility and acceptability of the programs (SmokefreeSGM and SmokefreeTXT). This study received approval from The University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects to begin research on August 21, 2020. Recruitment for the beta testing of SmokefreeSGM (Phase 2) began in January 2022. We estimate that the feasibility trial (Phase 3) will begin in September 2022 and that results will be available in December 2023. Findings from this research effort will help reduce tobacco-related health disparities among SGM smokers by determining the feasibility and acceptability of SmokefreeSGM, an SGM-tailored smoking cessation intervention. ClinicalTrials.gov NCT05029362; https://clinicaltrials.gov/ct2/show/NCT05029362. DERR1-10.2196/42553.

Using marketing frameworks to predict the effects of e-cigarette commercials on youth

PurposeThis paper aims to apply the Product Life Cycle (PLC) and Product Evolutionary Cycle (PEC) frameworks to the nicotine and tobacco market to predict the impact of television commercials for electronic cigarettes (e-cigarettes) on youth.Design/methodology/approachSurveys were administered over a three-year period to 417 alternative high school students from Southern California who had never used e-cigarettes, cigarettes or cigars at the baseline. Covariate-adjusted logistic regression causal mediation models were used to test competing hypotheses from the PLC and PEC frameworks.FindingsResults support a refined version of the PEC framework where e-cigarette commercials increase the odds of e-cigarette use, which leads to subsequent use of competing products including cigarettes and cigars.Practical implicationsThis investigation demonstrates the utility of frameworks that conceptualize youth-oriented marketing as a two-part process in which potential customers are first convinced to adopt a behavior and then enticed to use a specific product to enact the behavior.Social implicationsRising rates of nicotine and tobacco product use among youth may be partially attributable to e-cigarette commercials.Originality/valueRegulations in the USA that permit television commercials for e-cigarettes but restrict the promotion of cigarettes and cigars have created an opportunity to study product adoption among youth consumers when one product has a strategic marketing advantage.

“Seeing all these shootings at school, this makes me feel unsafe”: a mixed-methods study to explore the impact of social disadvantages on adolescents' unsafe neighborhood perceptions

Community safety is critical for adolescent health and development. This study was to (1) explore social factors contributing to adolescents' unsafe feelings and (2) measure the combined effects of multiple social disadvantages by mixed methods approach. The quantitative analysis using structural equation modeling (N = 24,356) showed that adolescents exposed to high levels of social disadvantages (e.g., gun violence, drug selling, gang activity, and poverty) had up to 19 times greater odds of perceiving their community as unsafe, and concentrated social disadvantages strongly and cumulatively impacted adolescents' unsafe perceptions. The qualitative study applied photovoice to collect photographs and viewpoints from six adolescents. The findings added new insights (e.g., living close to sexual offenders, child abduction) on social disadvantages and confirmed the quantitative results (e.g., mass shooting, tobacco selling). This mixed method study indicates safety promotion programs are highly needed for children and adolescents exposed to gun violence and concentrated social disadvantages.

Variations in the patterns of tobacco usage among indian females - findings from the global adult tobacco survey India

BackgroundMales dominate in tobacco usage, as well as in tobacco research, knowing that women face more severe health consequences. There is a specific lack of information on epidemiological statistics, risks, and the level of knowledge among women regarding tobacco. This study examines the Global Adult Tobacco Survey (GATS)-India dataset to estimate female tobacco usage and assess socio-economic variations in tobacco consumption, awareness regarding the adverse effects of tobacco, noticing pack health warnings (PHW), and intention to quit tobacco use well as factors influencing these domains.MethodsUsing a geographically clustered multistage sampling method, the nationally representative GATS II (2016–17) interviewed 40,265 female respondents aged 15 years and above from all Indian states and union territories. Standard operational definitions were used to estimate the primary independent variables (community, individual, and household categories) and dependent variables like awareness regarding the adverse effects of tobacco, noticing pack health warning (PHW), and intention to quit tobacco. Sampling weights were adjusted while performing the analysis. Bivariate and multivariable analysis were used to generate the estimates.ResultsOf the total female respondents, 84.2% were never-users, 13.3% ever consumed Smokeless Tobacco (SLT) products, 1.8% ever smoked tobacco, and 0.8% were dual users once in their lives. Around 16% of the women had exposure to Second Hand Smoke (SHS) either at their homes, workplaces or in public places. Overall, maximum awareness was seen among non-smoker females (64.7%) and dual users (64.7%), followed by women exposed to SHS, SLT users, and smokers. PHW was noticed more by the bidi smokers, followed by SLT users and cigarette smokers. Factors that positively affected intention to quit smoking included younger age, secondary school education, self-employed status, the habit of buying packed cigarettes/bidi, believing that smoking causes serious illness, and attempted quitting in the last 12 months.ConclusionA high proportion of women consume tobacco which is significantly influenced by socio-demographic factors. Tobacco regulators should be especially concerned about women as the tobacco marketing experts target them. Mobilizing self-help groups and organizations working for women and children could assist broader campaigns to generate awareness and motivate quitting attempts.

A content analysis of e-cigarette marketing on social media: Findings from the Tobacco Enforcement and Reporting Movement (TERM) in India, Indonesia and Mexico.

The use of e-cigarettes is proliferating globally, especially among youth and even children. Marketing is a known risk factor for e-cigarette initiation, yet little is known of e-cigarette marketing on social media in low- and middle-income countries. This study compares e-cigarette social media marketing in India, Indonesia, and Mexico, three such countries with different regulatory environments. Instances of e-cigarette marketing on social media platforms were identified via the Tobacco Enforcement and Reporting Movement (TERM), a digital tobacco marketing monitoring system. Through systematic keyword-based searches, all tobacco marketing posts observed between 15 December 2021 and 16 March 2022 were included in the analysis. The final sample included 1,437 e-cigarette-related posts on Instagram, Facebook, Twitter, YouTube, and TikTok, which were systematically content analyzed by independent coders after inter-reliability (Cohen's Kappa K > 0.79) was established using a theory-derived codebook. The final data is represented in percentages and frequencies for ease of presentation. We observed e-cigarette marketing online in all countries studied, yet there was variation in the volume of marketing and types of accounts identified. In India, where e-cigarettes were comprehensively banned, we identified 90 (6%) posts; in Mexico, where e-cigarettes were partially restricted, 318 (22%) posts were observed; and in Indonesia, where there were no restrictions, 1,029 (72%) posts were observed. In both India and Mexico, marketing originated from retailer accounts (100%), whereas in Indonesia, it was primarily product brand accounts (86%). Across countries, e-cigarettes were mostly marketed directly to sell products (India: 99%, Indonesia: 69% and Mexico: 93%), though the sales channels varied. Product features, including e-liquid flavors, device colors and technical specifications, was the most prominent message framing (India: 86%; Mexico: 73%; Indonesia: 58%). Harm reduction messaging was most popular in Mexico (8%) and was not common in Indonesia (0.3%) or India (0%). Our study provides important insights for tobacco control stakeholders on the evolving nature of e-cigarette marketing in low- and middle-income countries. It underscores the presence of e-cigarette marketing, including in countries where comprehensive regulations exist, and suggests the importance of continuous monitoring to keep up with industry practices and strengthen tobacco control stakeholder efforts to counter them.

A Long-Term National Survey of Compliance with the Ban on Selling Tobacco Products to Adolescents of Taiwan's Tobacco Hazards Prevention Act.

The data on long-term trends and factors of tobacco retailers’ compliance in Taiwan are limited. The new regulations of the Tobacco Hazards Prevention Act were established in 2009. Now, the government is planning to raise the minimum legal age (MLA) for purchasing tobacco products from 18 to 20, so the results of this study will be an important reference to promote new regulations in the future. We carried out an observational mystery shopping study design and data were collected from 2009 to 2019. In total, 6320 undercover tests were conducted to investigate selling by tobacco retailers to persons aged less than 18 years by an impartial third party annually. Logistic regression was used to analyze the factors influencing compliance by adjusting test variables and independent variables. The compliance rate increased by 8.4% annually and was better among tests conducted during summer vacation (AOR = 1.324), chain convenience stores (AOR = 3.651), supermarkets or hypermarkets (AOR = 1.973), and verifications with age (AOR = 15.345). It is the first study to explore long-term and national tobacco retailers’ enforcement effects by an impartial third party in Asia. The findings suggest that local health agencies should enhance enforcement on those stores which were tested during non-summer holidays and weekends, betel nut stands, and grocery stores.

Measuring Malaysia’s Illicit Tobacco Trade: An Excise Tax Gap Analysis

There is a lack of independent data regarding the illicit tobacco trade in Malaysia. Tobacco Industry (TI) commissioned data has previously been criticised for overestimating the illicit tobacco trade and for a lack of methodological transparency. The aim of this study is to present an independent overview of Malaysia’s illicit tobacco market by measuring the country’s factory-made cigarette excise tax gap. Using data sourced from Malaysian government publications we calculate the excise tax gap between 2011 and 2019 based on existing approaches whereby the excise tax actually paid is compared with that theoretically due based on estimates of total tobacco consumption. For sensitivity analysis, we established 4 different scenarios of tobacco consumption levels. Our central estimate is that the tax gap increased from 49% (2012) to 65% (2017), indicating that about two-thirds of cigarettes consumed were illicit, untaxed cigarettes. Increases in the tax gap occurred when taxes increased (e.g., 2014) and when they did not (e.g., 2017), and a slight decline was also evident when taxes were unchanged (e.g., 2012). The size of the tax gap was sensitive to the consumption estimates, where a 10% increase in consumption was generally associated with 3–5 percentage point increase in the tax gap. This study, to our knowledge, is the first independent estimate of Malaysia’s tax gap/rate of the illicit tobacco trade. We suggest the Malaysian government maintain its tax policies whilst strengthening its anti-illicit tobacco trade measures, including ratifying the Protocol to Eliminate Illicit Trade in Tobacco Products. <strong>Highlights</strong><ul><li>An independent view of the illicit tobacco trade in Malaysia by measuring the country’s tobacco excise tax gap.</li><li>Insights into the accuracy of TI estimates on Malaysia’s tobacco trade.</li><li>Suggestions for actions that should be taken by the Malaysian government to combat the illicit tobacco trade.</li><li>Government Survey data is used to measure consumption which isn’t available each year, so yearly consumption estimates are produced via linear interpolation between survey waves.</li><li>Consumption estimates cover those aged 15 or above.</li></ul>

Association of Non-Cigarette Tobacco Advertisements and Racial Discrimination With Non-Cigarette Tobacco Product Use Among Black Adults.

Black communities are targeted by more cigarette advertisements than White communities and racial discrimination among Black people is related to cigarette use. However, little is known about these factors with non-cigarette tobacco product use among Black adults. Therefore, this study assessed the association of non-cigarette advertisement exposure and racial discrimination with use of non-cigarette tobacco products among Black adults. Black adults (n = 533) from The Family and Community Health Study in 2016 were asked if they had seen advertisements for e-cigarettes, snus pouches, filtered cigars, large cigars, cigarillos, dissolvable tobacco, smokeless tobacco, hookah, and tobacco pipe and if they used these in the past month. For products with the highest past month use and significant correlations with advertisement exposure, separate logistic regression models were performed that evaluated the association between advertisement exposure, racial discrimination, and non-cigarette tobacco product use while controlling for cigarette use, sex, socioeconomic status, and age. Use of cigarillos, large cigars, and hookah were higher than other non-cigarette tobacco products assessed. Logistic regressions revealed that more advertisement exposure in the past month was associated with higher odds of using cigarillos, large cigars, and hookah (p < .01). More experiences of racial discrimination were associated with past month cigarillo use, but not hookah or large cigars (p < .01). Non-cigarette tobacco advertisement exposure was associated with the use of non-cigarette tobacco products. Experiences of racial discrimination were associated with the most used non-cigarette tobacco product among Black adults, cigarillos. This is the first time that a specific type of cigar (ie cigarillos) has been associated with experiences of racial discrimination among Black adults. Efforts to reduce non-cigarette tobacco marketing and eradicate exposure to racial discrimination among Black adults may aid in eliminating tobacco-related health disparities.

Non-compliant packaging and illicit smokeless tobacco in Bangladesh, India and Pakistan: findings of a pack analysis

IntroductionIllicit smokeless tobacco (ST) trade has seldom been documented despite ST use in at least 127 countries across the world. Based on non-compliance with packaging regulations, we report the proportion...

Effects of Purchase Restrictions on Smoking During Pregnancy: An Analysis of U.S. Birth Records.

In December 2019, the minimum legal sales age (MLSA) for tobacco products in the United States was raised from 18 to 21 years as a measure of preventing smoking initiation. Smoking during pregnancy, which causes maternal, fetal, and infant morbidity and mortality, is a major public health concern. We first study the effects of purchase restrictions on smoking during different stages of pregnancy covering the entire United States and using the records of all live births during 2014-2018 by birthing people aged 18-21 years. Our identification strategy utilizes the variation in the MLSA of tobacco products over time and across counties in the United States during 2014-2018 using a two-way fixed effects model, modified to accommodate a partially observable treatment indicator. The results show that 37.4% of potential smokers in our study population would have been prevented from smoking before pregnancy, 50.5% during the first trimester, 53.4% during the second trimester, and 14.8% during the third trimester if the law prevented selling tobacco products to them in the locality they live. A purchase restriction is estimated to cause the smoking intensity of those who smoke, the intensive margin, to drop by 5.4% before pregnancy, 10.4% during the first trimester, 14.8% during the second trimester, and 5.2% during the third trimester. Our results show that purchase restrictions are highly effective in preventing smoking among birthing people in the 18-21 years age group. The effect on smoking prevalence during the first and second trimesters is more pronounced. Many countries around the world have recently tightened age-based purchase restriction policies as a tobacco control measure. We first study the effects of purchase restrictions on smoking during different stages of pregnancy using the birth records of all pregnancies in the United States by birthing people aged 18-21 years during 2014-2018. The study utilizes the variation in the MLSA of tobacco products over time and across counties during that period. Our results show that purchase restrictions are highly effective in preventing smoking among birthing people in the 18-21 years age group.

The Lebanese Regie state-owned tobacco monopoly: lessons to inform monopoly-focused endgame strategies

BackgroundMany countries have started pursuing tobacco ‘endgame’ goals of creating a ‘tobacco-free’ country by a certain date. Researchers have presented models to attain this goal, including shifting the supply of tobacco to a monopoly-oriented endgame model (MOEM), wherein a state-owned entity controls the supply and distribution of tobacco products. Although not designed to end tobacco use, the Regie in Lebanon exhibits some of the key features identified in MOEM and hence can serve as a practical example from which to draw lessons.MethodsWe comprehensively review previous literature exploring tobacco endgame proposals featuring a MOEM. We distil these propositions into core themes shared between them to guide a deductive analysis of the operations and actions of the Regie to investigate how it aligns (or does not) with the features of the MOEM.ResultsAnalysing the endgame proposals featuring MOEM, we generated two main themes: the governance of the organisation; and its operational remit. In line with these themes, the investigation of the Regie led to several reflections on the endgame literature itself, including that it: (i) does not seem to fully appreciate the extent to which the MOEM could end up acting like Transnational Tobacco Companies (TTC); (ii) has only vaguely addressed the implications of political context; and (iii) does not address tobacco growing despite it being an important element of the supply chain.ConclusionThe implementation of tobacco endgame strategies of any type is now closer than ever. Using the Regie as a practical example allows us to effectively revisit both the potential and the pitfalls of endgame strategies aiming to introduce some form of monopoly and requires a focus on: (i) establishing appropriate governance structures for the organisation; and (ii) adjusting the financial incentives to supress any motivation for the organisation to expand its tobacco market.

Variations in Tobacco Retailer Type Across Community Characteristics: Place Matters.

IntroductionThe density of tobacco retailers varies by community characteristics such as poverty levels or racial and ethnic composition. However, few studies have investigated how specific types of tobacco retailers vary by community characteristics. Our objective was to assess how the types of tobacco retailers in Ohio varied by the characteristics of the communities in which they were located.MethodsAll census tracts in Ohio were coded for 3 characteristics: poverty (high or low), prevalence of racial and ethnic minorities (high or low), and urban, suburban, or rural status. We then coded all 11,392 tobacco retailers in the state for its retailer type category. Finally, we tested whether the prevalence of particular types of tobacco retailers varied by particular types of census tracts.ResultsFor all US Census tracts, convenience stores were the most common type of retailer selling tobacco. Yet, the prevalence of convenience stores was higher in high-poverty urban tracts than in low-poverty urban tracts. Discount stores were the second-most common type of tobacco retailer and were most prevalent in rural tracts and high-racial and ethnic minority urban tracts. Grocery stores, pharmacies, and vape or hookah shops typically had the highest prevalence in more advantaged tracts.ConclusionOur findings demonstrate that the distribution of specific retailer types varies by community characteristics. The distribution of these retailer types has implications for product availability and price, which may subsequently affect tobacco use and cessation. To create equitable outcomes, policies should focus on retailers such as convenience and discount stores, which are heavily located in communities experiencing tobacco-related health disparities.