Tobacco Control Funding Research Articles

Implementation strategies to increase smoking cessation treatment provision in primary care: a systematic review of observational studies

BackgroundInternationally, there is an ‘evidence-practice gap’ in the rate healthcare professionals assess tobacco use and offer cessation support in clinical practice, including primary care. Evidence is needed for implementation strategies enacted in the ‘real-world’. Aim: To identify implementation strategies aiming to increase smoking cessation treatment provision in primary care, their effectiveness, cost-effectiveness and any perceived facilitators and barriers for effectiveness.Methods‘Embase’, ‘Medline’, ‘PsycINFO’, ‘CINAHL’, ‘Global Health’, ‘Social Policy & Practice’, ‘ASSIA Applied Social Sciences Index and s’ databases, and grey literature sources were searched from inception to April 2021. Studies were included if they evaluated an implementation strategy implemented on a nation-/state-wide scale, targeting any type of healthcare professional within the primary care setting, aiming to increase smoking cessation treatment provision. Primary outcome measures: implementation strategy identification, and effectiveness (practitioner-/patient-level). Secondary outcome measures: perceived facilitators and barriers to effectiveness, and cost-effectiveness. Studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool. A narrative synthesis was conducted using the Expert Recommendations for Implementing Change (ERIC) compilation and the Consolidated Framework for Implementation Research (CFIR).ResultsOf 49 included papers, half were of moderate/low risk of bias. The implementation strategy domains identified involved utilizing financial strategies, changing infrastructure, training and educating stakeholders, and engaging consumers. The first three increased practitioner-level smoking status recording and cessation advice provision. Interventions in the utilizing financial strategies domain also appeared to increase smoking cessation (patient-level). Key facilitator: external policies/incentives (tobacco control measures and funding for public health and cessation clinics). Key barriers: time and financial constraints, lack of free cessation medications and follow-up, deprioritisation and unclear targets in primary care, lack of knowledge of healthcare professionals, and unclear messaging to patients about available cessation support options. No studies assessed cost-effectiveness.ConclusionsSome implementation strategy categories increased the rate of smoking status recording and cessation advice provision in primary care. We found some evidence for interventions utilizing financial strategies having a beneficial impact on cessation. Identified barriers to effectiveness should be reduced. More pragmatic approaches are recommended, such as hybrid effectiveness-implementation designs and utilising Multiphase Optimization Strategy methodology.Protocol registrationPROSPERO:CRD42021246683

Do demographic and socioeconomic characteristics underpin differences in youth smoking initiation across Canadian provinces? Evidence from the Canadian Community Health Survey (2015-2018).

Youth initiation may drive differences in smoking prevalence across Canadian provinces. Provincial differences in initiation relate to tobacco control strategies and public health funding, but have also been attributed to population characteristics. We test this hypothesis by examining the extent to which seven characteristics-immigration, language, family structure, education, income, home ownership and at-school status-explain differences in initiation across provinces. We used data from 16 897 youth aged 12 to 17 years in the Canadian Community Health Survey collected from 2015 to 2018. To examine the proportion of provincial differences explained by population characteristics, we compared average marginal effects (AMEs) from partially and fully adjusted models regressing "having ever initiated" on province and other characteristics. We also tested interactions to examine differences in the association between population characteristics and initiation across provinces. Initiation varied from 4% in British Columbia to 10% in Quebec. Being born in Canada, speaking French, not living in a two-parent household, being in the lowest household income quintile, having parents without postsecondary education, living in rented accommodation and not being in school were each associated with initiation. Taking these results into consideration, the AME of residing in another province compared with Quebec was attenuated by between 3% and 9%. Family structure and household income were more strongly associated with initiation in the Atlantic region and Manitoba, but not in Quebec. Differences in initiation between Quebec and other provinces are unlikely to be substantially explained by their demographic or socioeconomic composition. Reprioritizing tobacco control and public health funding are likely key in attaining the "tobacco endgame" across provinces.

DOMESTICATION OF INTERNATIONAL STRATEGIES IN TOBACCO CONTROL: THE CASE OF SOUTH AFRICA

With an estimated 1.2 billion smokers in the world, tobacco use is of pandemic proportions. The relationship between tobacco use, and death and disease is well established. It is not only active, but also passive or secondary smoking that is injurious to health. The morbidity and mortality from tobacco rivals that of HIV/AIDS. According to the World Health Organisation (WHO), tobacco and AIDS have become the two leading global causes of premature death. Smoking causes an estimated 4 million deaths per year (World Health Organisation). Unless checked, tobacco-related mortality is projected to rise phenomenally to 10 million by the year 2030, with the preponderance of the mortality (about 7 million deaths) occurring in developing countries.In the last twenty years or so, there has been a reversal in smoking trends between the developed world and the developing world. In the developed world, smoking has decreased. In the developing world, smoking has increased, with women and children constituting the most vulnerable group. There is little doubt that the developing world has been targeted by the tobacco industry for exploitation in tobacco use, in part to make up for lost profits in the developed world. The reasons for the increase in smoking prevalence are, however, composite. In part, the increase in prevalence is an outcome of vulnerability to aggressive advertising and sponsorship by the tobacco industry. In part it is also an outcome of poor knowledge about the risks associated with smoking, poor health promotion infrastructure, absent or weak tobacco control activism, poor government funding for tobacco control, and lack of political will to control tobacco products on the part of government.There is consensus among health experts that tobacco-related diseases are the single most preventable cause of death and disease, and that measures must be taken to control tobacco use. Moreover, there is international consensus on the use of law and other coercive measures as instruments for controlling tobacco use. This article seeks to explore and evaluate the extent to which South Africa has responded to the challenge of controlling tobacco use. It is submitted that though the efficacy of the South African strategies has yet to be tangibly demonstrated in terms of translating into positive health gains, South Africa has made substantial progress in implementing international tobacco control norms. The Tobacco Products Control Act of 1999 is significant evidence in this regard.

Successful countering of tobacco industry efforts to overturn Thailand's ENDS ban

BackgroundAfter Thailand enacted laws to ban the import and sale of all types of electronic nicotine delivery systems (ENDS, including e-cigarettes and heated tobacco products (HTPs)) in 2015, pro-ENDS advocacy...

The Impact of Smoke-Free Air Laws and Conventional Cigarette Taxes on Cardiovascular Hospitalizations.

Smoke-free air legislation and conventional cigarette taxes have long been used to reduce smoking initiation, prevalence, and conventional cigarette consumption. However, the extent to which these policies affect population health across a range of diagnoses and age groups remains less well understood. Analyses use 2005-2014 hospital inpatient discharge data from up to 40 US states to estimate the effects of smoke-free air laws and conventional cigarette taxes on cardiovascular hospitalizations among working age and older adults. An increase in the percent of a county's population covered by smoke-free air laws yielded a significant decline of 2.4% (Relative risk [RR]: 0.976, 95% confidence interval [95% CI]: 0.954, 0.997) in acute cerebrovascular disease hospitalizations among older adults. Moreover, significant declines of 2.0% (RR: 0.980, 95% CI: 0.967, 0.994) and 2.8% (RR: 0.972, 95% CI: 0.949, 0.996) in acute cerebrovascular disease were observed among older adults in the first year and subsequent years after smoke-free air legislation was implemented, respectively. Conventional cigarette taxes did not yield a significant change in acute cerebrovascular disease hospitalizations, nor did either tobacco control policy lead to a significant decline in acute myocardial infarction hospitalizations. Smoke-free air laws play an important role in reducing adult cardiovascular hospitalizations. These findings confirm existing research on acute cerebrovascular disease outcomes, as well as the modest effects on acute myocardial infarction hospitalizations observed in state- and national-level analyses. Current research at the local level finds smoke-free air laws yield 40% declines in acute myocardial infarction hospitalizations and 29% declines in acute cerebrovascular disease. State- and national-level analyses find smaller effects of smoke-free air laws, and largely omit analyses of working age adults. Existing research likely suffers from omitted variable bias, including state-level tobacco control funding and local-level conventional cigarette taxes. Using adult hospitalization data from up to 40 states, this study confirms existing evidence at the national and state level, and provides new evidence that smoke-free air laws significantly reduce acute cerebrovascular disease hospitalizations among older adults.

Needs of LMIC-based tobacco control advocates to counter tobacco industry policy interference: insights from semi-structured interviews

IntroductionAdvocacy is vital for advancing tobacco control and there has been considerable investment in this area. While much is known about tobacco industry interference (TII), there is little research on...

Differential Relationship between Tobacco Control Policies and U.S. Adult Current Smoking by Poverty.

The study’s purpose was to identify differences in the relationship between tobacco control policies and smoking by poverty. We matched state smoke-free air law coverage (SFALs), tobacco control funding (TCF), and cigarette taxes with individual current smoking and demographics from supplements to the Current Population Survey (1985–2015). We regressed (logistic) smoking on policy variables, poverty (<138% of poverty line versus ≥138% of poverty line), interactions of policy and poverty, and covariates, presenting beta coefficients instead of odds ratios because it is difficult to interpret interactions using odds ratios (they are ratios of odds ratios). We coded SFALs as (1) proportion of state covered by 100% workplace, restaurant and bar laws (SFAL-All) or (2) proportion of state covered by workplace laws (SFAL-WP) and proportion covered by restaurant or bar laws (SFAL-RB). In the SFAL-All model, SFAL-All (Beta coeff: −0.03, 95% CI: −0.06, −0.002), tax (Coeff: −0.06, 95% CI: −0.07, −0.05), and TCF (Coeff: −0.01, 95% CI: −0.01, −0.001) were associated with less smoking. In this model, the interaction of SFAL-All by poverty was significant (Coeff: 0.08, 95% CI: 0.02, 0.13). In the SFAL-WP/RB model, SFAL-RB (Coeff: −0.05, 95% CI: −0.08, −0.02), tax (Coeff: −0.05, 95% CI: −0.06, −0.04), and TCF (Coeff: −0.01, 95% CI: −0.01, −0.00) were significant. In the same model, SFAL-WP (Coeff: 0.09, 95% CI: 0.03, 0.15), SFAL-RB (Coeff: −0.14, 95% CI: −0.19, −0.09), and TCF (Coeff: 0.01, 95% CI: 0.00, 0.02) interacted with poverty. Tax by poverty was of borderline significance in this model (Coeff = 0.02, 95% CI: −0.00, 0.04, p = 0.050). Among adults, SFALs, TCF, and tax were associated with less current smoking, and SFALs and TCF had differential relationships with smoking by poverty.

Establishing a tobacco control fund in Vietnam: some learnings for other countries

In response to the need for stable and adequate funding for tobacco control and the shortage of personnel working in the field, the Vietnam Tobacco Control Fund (VNTCF) was established...

National Institutes of Health Funding for Tobacco Control: 2006 and 2016.

The study objective was to describe and compare changes in newly funded National Institutes of Health (NIH) tobacco-related awards between fiscal year (FY) 2006 and FY2016. Secondary analysis of NIH data. National Institutes of Health Research Portfolio Online Reporting Tool database was used. National Institutes of Health tobacco-related awards newly funded during FY2006 and FY2016. Search terms included tobacco, smoking, nicotine, secondhand smoke, and e-cigarettes. Grants and funding amounts were retrieved. We calculated frequency distributions to determine the number and percentage of total NIH grants funded overall and by specific institute, and inflation-adjusted total and median funding amounts. We computed percentage differences in number of new grants, funding amounts, and percentage of funding allocated overall, and by institute. There was a 187% increase in the percentage of total NIH funding allocated to new tobacco-related awards from 0.09% in FY2006 to 0.25% in FY2016. Total number of awards increased by 67% in FY2016 (n = 144; $56 015 931) compared to FY2006 (n = 86; $22 076 987), and there was a 154% increase in inflation-adjusted total funding for tobacco control. The top funding institutes were National Institute on Drug Abuse and National Cancer Institute; National Institute on Alcohol Abuse and Alcoholism was third in FY2006; and National, Heart, Lung and Blood Institute in FY2016. Research grants were the most frequently funded. Smoking cessation was a common topic area and increased by 64%. NIH funding is critical for advancing the science of nicotine and tobacco research.

Utilization of smoking cessation medication benefits among medicaid fee-for-service enrollees 1999-2008.

ObjectiveTo assess state coverage and utilization of Medicaid smoking cessation medication benefits among fee-for-service enrollees who smoked cigarettes.MethodsWe used the linked National Health Interview Survey (survey years 1995, 1997–2005) and the Medicaid Analytic eXtract files (1999–2008) to assess utilization of smoking cessation medication benefits among 5,982 cigarette smokers aged 18–64 years enrolled in Medicaid fee-for-service whose state Medicaid insurance covered at least one cessation medication. We excluded visits during pregnancy, and those covered by managed care or under dual enrollment (Medicaid and Medicare). Multivariate logistic regression was used to determine correlates of cessation medication benefit utilization among Medicaid fee-for-service enrollees, including measures of drug coverage (comprehensive cessation medication coverage, number of medications in state benefit, varenicline coverage), individual-level demographics at NHIS interview, age at Medicaid enrollment, and state-level cigarette excise taxes, statewide smoke-free laws, and per-capita tobacco control funding.ResultsIn 1999, the percent of smokers with ≥1 medication claims was 5.7% in the 30 states that covered at least one Food and Drug Administration (FDA)-approved cessation medication; this increased to 9.9% in 2008 in the 44 states that covered at least one FDA-approved medication (p<0.01). Cessation medication utilization was greater among older individuals (≥ 25 years), females, non-Hispanic whites, and those with higher educational attainment. Comprehensive coverage, the number of smoking cessation medications covered and varenicline coverage were all positively associated with utilization; cigarette excise tax and per-capita tobacco control funding were also positively associated with utilization.ConclusionsUtilization of medication benefits among fee-for-service Medicaid enrollees increased from 1999–2008 and varied by individual and state-level characteristics. Given that the Affordable Care Act bars state Medicaid programs from excluding any FDA-approved cessation medications from coverage as of January 2014, monitoring Medicaid cessation medication claims may be beneficial for informing efforts to increase utilization and maximize smoking cessation.

State-Level Cancer Mortality Attributable to Cigarette Smoking in the United States

State-specific information about the health burden of smoking is valuable because state-level initiatives are at the forefront of tobacco control. Smoking-attributable cancer mortality estimates are currently available nationally and by cancer, but not by state. To calculate the proportion of cancer deaths among adults 35 years and older that were attributable to cigarette smoking in 2014 in each state and the District of Columbia. The population-attributable fraction (PAF) of cancer deaths due to cigarette smoking was computed using relative risks for 12 smoking-related cancers (acute myeloid leukemia and cancers of the oral cavity and pharynx; esophagus; stomach; colorectum; liver; pancreas; larynx; trachea, lung, and bronchus; cervix uteri; kidney and renal pelvis; and urinary bladder) from large US prospective studies and state-specific smoking prevalence data from the Behavioral Risk Factor Surveillance System. The PAF of cancer deaths due to cigarette smoking in each US state and the District of Columbia. We estimate that at least 167 133 cancer deaths in the United States in 2014 (28.6% of all cancer deaths; 95% CI, 28.2%-28.8%) were attributable to cigarette smoking. Among men, the proportion of cancer deaths attributable to smoking ranged from a low of 21.8% in Utah (95% CI, 19.9%-23.5%) to a high of 39.5% in Arkansas (95% CI, 36.9%-41.7%), but was at least 30% in every state except Utah. Among women, the proportion ranged from 11.1% in Utah (95% CI, 9.6%-12.3%) to 29.0% in Kentucky (95% CI, 27.2%-30.7%) and was at least 20% in all states except Utah, California, and Hawaii. Nine of the top 10 ranked states for men and 6 of the top 10 ranked states for women were located in the South. In men, smoking explained nearly 40% of cancer deaths in the top 5 ranked states (Arkansas, Louisiana, Tennessee, West Virginia, and Kentucky). In women, smoking explained more than 26% of all cancer deaths in the top 5 ranked states, which included 3 Southern states (Kentucky, Arkansas, and Tennessee), and 2 Western states (Alaska and Nevada). The proportion of cancer deaths attributable to cigarette smoking varies substantially across states and is highest in the South, where up to 40% of cancer deaths in men are caused by smoking. Increasing tobacco control funding, implementing innovative new strategies, and strengthening tobacco control policies and programs, federally and in all states and localities, might further increase smoking cessation, decrease initiation, and reduce the future burden of morbidity and mortality associated with smoking-related cancers.

The Internationalisation of Tobacco Control, 1950-2010.

This article explores the internationalisation of tobacco control as a case study in the history of international health regulation. Contrary to the existing literature on the topic, it argues that the history of international anti-smoking efforts is longer and richer than the making of the World Health Organisation’s Framework Convention on Tobacco Control in the early twenty-first century. It thereby echoes the point made by other scholars about the importance of history when making sense of contemporary global health. Specifically, the article shows how the internationalisation of tobacco control started in the 1950s through informal contacts between scientists working on cancer research and how these initial interactions were followed by a growing number of more formal initiatives, from the World Conferences on Tobacco or Health to the Bloomberg Initiative to Reduce Tobacco Use. Rather than arranging these efforts in a linear narrative of progress culminating with the Framework Convention on Tobacco Control, we take anthropological claims about global health’s uneven terrain seriously and portray a history of international tobacco control marked by ruptures and discontinuities. Specifically, we identify three successive periods, with each of them characterised by specific understandings of international action, tobacco control expertise, advocacy networks and funding strategies.

Screening and Counseling for Tobacco Use in Student Health Clinics: Reports of Health Care Providers.

To assess tobacco screening and counseling in student health clinics, including facilitators, barriers, and associations with campus- and state-level variables. We conducted a mixed-methods study with an online survey and qualitative interviews. Study setting was student health clinics on college campuses. Subjects included 71 clinic directors or designees from 10 Southeastern states (quantitative survey) and 8 directors or designees from 4 Southeastern states (qualitative interviews). Quantitative measures included demographics, screening and counseling practices, clinic-level supports for such practices, perceptions of tobacco on campus, institution size, public/private status, state tobacco farming revenue, and state tobacco control funding. Qualitative measures included barriers and facilitators of tobacco screening and counseling practices. Logistic and linear regression models assessed correlates of screening and counseling. Qualitative data were analyzed using multistage interpretive thematic analysis. A total of 55% of online survey respondents reported that their clinics screen for tobacco at every visit, whereas 80% reported their clinics offer counseling and pharmacotherapy. Barriers included lack of the following: time with patients, relevance to chief complaint, student self-identification as a tobacco user, access to pharmacotherapy, and interest in quitting among smokers. In multivariable models, more efforts to reduce tobacco use, student enrollment, and state-level cash receipts for tobacco were positively associated with clinic-level supports. This study highlights missed opportunities for screening. Although reports of counseling were higher, providers identified many barriers.

Tobacco policy in Israel: 1948-2014 and beyond.

BackgroundTobacco is the only consumer product known to kill half of its users, and is a significant cause of death and disability to exposed nonsmokers. This presents a unique conundrum for modern democracies, which emphasize personal liberty, yet are obligated to protect citizens.In Israel, the death toll in 2014 from smoking is expected to reach 8000 deaths; nearly a fifth of the population smokes, and over two-thirds of the population are exposed to tobacco smoke.AimThis paper provides an overview of tobacco policy in Israel since the inception of the State, presents the development of the National Tobacco Control Plan, and recommends future actions.MethodsSources for this article included the Knesset (Israeli Parliament) and Ministry of Health websites, Health Minister Reports to the Knesset on Smoking, and the scientific literature.ResultsIsrael has an impressive record on tobacco control policy, beginning with taxation in 1952, landmark smoke-free air and marketing legislation in the early 1980’s, tax increases and expansions of smoke-free air and marketing legislation in the ensuing years, and the addition of subsidized smoking cessation technologies in 2010. Until 2011, actions were taken by various organizations without formal coordination; since the passage of the National Tobacco Control Plan in 2011, the Ministry of Health has held responsibility for coordinating tobacco control, with an action plan.The plan has been partially implemented. Smoke-free air laws were expanded, but enforcement is poor. Passage of critical marketing and advertising restrictions is stalled. Requested funds for tobacco control did not materialize.RecommendationsIn order to prevent hundreds of thousands of preventable premature deaths in the coming decades, Israel should considerably strengthen tobacco control policies to include: guaranteed funding for tobacco control; strong curbs on advertising, promotion and sponsorship of tobacco and smoking products; public education; law enforcement; protection of children from exposure to tobacco; regulation of electronic cigarettes and other alternative harm-reducing products; tobacco control research; and systematic monitoring of, and periodic updates to, the National Tobacco Control Plan. Israel should also begin discussions of Endgame scenarios, and consider abolition of tobacco, as it continues its progress towards making smoking history.

Progress with the global tobacco epidemic

During the 20th century, tobacco smoking killed some 100 million people, most of them in high-income countries. 1 Jha P Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer. 2009; 9: 655-664 Crossref PubMed Scopus (364) Google Scholar In the 21st century the corresponding figure is likely to be about 1 billion, most in low-income and middle-income countries. 1 Jha P Avoidable global cancer deaths and total deaths from smoking. Nat Rev Cancer. 2009; 9: 655-664 Crossref PubMed Scopus (364) Google Scholar , 2 Mathers CD Loncar D Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006; 3: e442 Crossref PubMed Scopus (7392) Google Scholar Similar to the evolution of smoking within populations of high-income countries, the global smoking epidemic is now moving from the rich to the poor. Driven by the financial heft of transnational tobacco companies with a combined income higher than most individual countries, 3 Callard C Follow the money: how the billions of dollars that flow from smokers in poor nations to companies in rich nations greatly exceed funding for global tobacco control and what might be done about it. Tob Control. 2010; 19: 285-290 Crossref PubMed Scopus (32) Google Scholar built on a business model of peddling an addictive product to children and young people, and sustained by practices that prioritise corporate profit over health, the current global epidemic of smoking represents a triumph of corporate self-interest over human wellbeing. 4 Gilmore AB Fooks G Drope J Bialous SA Jackson RR Exposing and addressing tobacco industry conduct in low-income and middle-income countries. Lancet. 2015; 385: 1029-1043 Summary Full Text Full Text PDF PubMed Scopus (199) Google Scholar It is also a challenge that national and international health systems remain ill-equipped to face. What will it take to create a tobacco-free world?Last month, British American Tobacco released their preliminary results for 2014. “I am delighted with the excellent progress we have made”, said chief executive, Nicandro Durante. It has been “another strong performance in 2014”, he added. The Group's revenue continued to grow by 2·8% and its adjusted profit from operations increased by 4·4%. Of the 667 billion cigarettes sold in 2014, 197 billion were sold in the Asia-Pacific and 227 billion were sold in Europe, the Middle East, and Africa—regions known as “high-growth markets”. Full-Text PDF Deaths and taxes: stronger global tobacco control by 202510 years ago the WHO Framework Convention on Tobacco Control (FCTC) entered into force, and more than 170 countries have now signed this treaty.1 This anniversary marks an appropriate time to review progress on global tobacco control. Full-Text PDF Global trends and projections for tobacco use, 1990–2025: an analysis of smoking indicators from the WHO Comprehensive Information Systems for Tobacco ControlOur findings show that striking between-country disparities in tobacco use would persist in 2025, with many countries not on track to achieve tobacco control targets and several low-income and middle-income countries at risk of worsening tobacco epidemics if these trends remain unchanged. Immediate, effective, and sustained action is necessary to attain and maintain desirable trajectories for tobacco control and achieve global convergence towards elimination of tobacco use. Full-Text PDF Exposing and addressing tobacco industry conduct in low-income and middle-income countriesThe tobacco industry's future depends on increasing tobacco use in low-income and middle-income countries (LMICs), which face a growing burden of tobacco-related disease, yet have potential to prevent full-scale escalation of this epidemic. To drive up sales the industry markets its products heavily, deliberately targeting non-smokers and keeps prices low until smoking and local economies are sufficiently established to drive prices and profits up. The industry systematically flaunts existing tobacco control legislation and works aggressively to prevent future policies using its resource advantage to present highly misleading economic arguments, rebrand political activities as corporate social responsibility, and establish and use third parties to make its arguments more palatable. Full-Text PDF

Understanding increases in smoking prevalence: case study from France in comparison with England 2000-10.

In France, following a long-term decline in smoking prevalence, an increase in smoking was observed between 2005 and 2010, an unusual occurrence in countries in the 'mature' stage of the smoking epidemic. By contrast, smoking prevalence in England, the neighbouring country, continued its long-term decline. We identified and translated recent reports on smoking and tobacco control in France and using these assessed the main data sources on smoking and compared them with similar sources in England, in order to explore possible explanations. In France, national smoking prevalence data are collected 5-yearly, minimizing opportunities for fine-grained analysis; the comparable study in England is implemented annually. We identified several probable causes of the recent increased prevalence of smoking in France, the primary one being the absence of sufficient price rises between 2005 and 2010, due probably to the lack of a robust tobacco control strategy, which also appeared to have empowered tobacco industry influence. Funding to compensate tobacconists appears to incentivize tobacco sales and is significantly higher than tobacco control funding. Mindful of the limitations of a case-study approach, the absence of sufficient price rises in the context of a weak tobacco control strategy seems the most likely explanation for the recent increase in smoking prevalence in France. A new cancer control plan and a national smoking reduction programme have been proposed by the French government in 2014 which, depending on implementation, may reverse the trend. In both countries, the higher levels of smoking among the more disadvantaged groups are of great concern and require greater political leadership for effective action.

Intermediate cessation outcomes among quitline callers during a national tobacco education campaign.

From March 19 through June 10, 2012, the Centers for Disease Control and Prevention launched the first federally funded National Tobacco Education Campaign: Tips From Former Smokers (Tips). This study examined the campaign's impact on quitline callers' intermediate cessation outcomes. We used quitline data from 23 states to examine changes in enrollment, service utilization, quit attempts, and self-reported quitting for 7 days or longer during Tips versus a similar time period in 2011. We used multivariate models to examine the relationship between Tips exposure (measured as gross rating points [GRPs]) and cessation outcomes during the campaign in 2012. We also assessed whether the Tips campaign's impact differed by state tobacco control funding. Compared with similar weeks in 2011, the number of quitline callers and callers who received counseling and/or nicotine replacement therapies increased by 88.6% (48,738 in 2011 vs. 91,911 during Tips) and 70.8% (40,546 in 2011 vs. 69,254 during Tips), respectively. Greater numbers of callers reported having made 24-hr quit attempts or quitting for 7 days or longer during the campaign. Higher Tips campaign GRPs were positively associated with quit attempts and with quitting for 7 days or longer among persons from states with higher tobacco control funding. In states with lower funding, the highest GRP group (2,000+ GRPs) had lower levels of cessation compared with the middle GRP group (1,200-1,999 GRPs). An evidence-based national tobacco education campaign with adequate reach and frequency can lead to substantial increases in quitline use and, to a lesser degree, intermediate cessation outcomes.

Tobacco control funding for low-income and middle-income countries in a time of economic hardship

ObjectiveTo assess how levels of tobacco control funding for low-income and middle-income countries (LMIC) changed following the 2008–2009 global economic downturn.MethodsIn order to estimate the amount of tobacco control funding...

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...

Are Tobacco Control Policies Effective in Reducing Young Adult Smoking?

We examined the influence of tobacco control program funding, smoke-free air laws, and cigarette prices on young adult smoking outcomes. We use a natural experimental design approach that uses the variation in tobacco control policies across states and over time to understand their influence on tobacco outcomes. We combine individual outcome data with annual state-level policy data to conduct multivariable logistic regression models, controlling for an extensive set of sociodemographic factors. The participants are 18- to 25-year-olds from the 2002-2009 National Surveys on Drug Use and Health. The three main outcomes are past-year smoking initiation, and current and established smoking. A current smoker was one who had smoked on at least 1 day in the past 30 days. An established smoker was one who had smoked 1 or more cigarettes in the past 30 days and smoked at least 100 cigarettes in his or her lifetime. Higher levels of tobacco control program funding and greater smoke-free-air law coverage were both associated with declines in current and established smoking (p < .01). Greater coverage of smoke-free air laws was associated with lower past year initiation with marginal significance (p = .058). Higher cigarette prices were not associated with smoking outcomes. Had smoke-free-air law coverage and cumulative tobacco control funding remained at 2002 levels, current and established smoking would have been 5%-7% higher in 2009. Smoke-free air laws and state tobacco control programs are effective strategies for curbing young adult smoking.