Tobacco Control Legislation Research Articles

Impacts of local public smoking bans on smoking behaviors and tobacco smoke exposure.

This paper examines the immediate and long-term effects of public smoking bans on smoking prevalence, smoking regularity, smoking intensity, and secondhand tobacco smoke exposure. We supplement the extensive literature on the effects of various types of tobacco control legislation on smoking behavior in developed countries by studying the provincial smoking bans and more recent national ban of a middle-income country, Argentina. We focus on the difference between full and partial smoking bans, and take advantage of the time and province variation in ban implementation in order to determine the causal effects of each type of ban. We find that full bans reduce national smoking prevalence over time, especially among younger demographic groups, but have no significant impact on intensity of smoking among smokers. Full bans also benefit nonsmokers, as they are associated with a significant reduction in environmental tobacco smoke exposure. Partial bans do not significantly impact smoking prevalence, and are found to increase smoking intensity among individuals who smoke every day. These findings provide support for ratification of full bans by all provinces according to the National Tobacco Control Law of 2011.

Snus and snus-like nicotine products moving across Nordic borders: Can laws protect young people?

Background:Use of snus and snus-like nicotine products is increasing, in particular among young people, in several Nordic countries and Estonia, while snus is legally on the market only in Sweden and Norway. Snus is available in a great variety of tastes and packaging particularly catering for young users. Recently, strong snus-resembling nicotine pouches have emerged on the market. This research investigates the regulatory means to counteract this development.Methods:European Union (EU) and national tobacco control legislation, case law of the European Court of Justice (CJEU) and relevant public health studies are analysed.Results:The research finds that the judgement of the CJEU relating to the sale of snus on Finnish ferries has not been enforced. Permitted large traveller imports for personal use have contributed to wide availability of snus in Finland. Even if the legislation in Sweden is in conformity with the exemption it obtained in the Accession Treaty, the public health impact of snus use for young people in its neighbouring countries has become considerable. Nicotine pouches, -which are not regarded as medical products in terms of medicine legislation, lack harmonised EU-wide regulation. Controlling smuggling across open borders is challenging.Conclusions:The legislation at the EU and national levels should be able to protect young people from new tobacco and nicotine products. It is urgent to harmonise regulation relating to new tobacco and nicotine products taking as a base a high level of protection of health as required in the Treaty on the Functioning of the EU.

Indirect tobacco advertising, promotion and sponsorships in the Indian Premier League 2020: Tobacco Industry's continuous presence in Indian cricket

BackgroundIndian Premier League (IPL) cricket tournament - a shorter version of the sport which is played between assorted company-owned or individual owner teams - has grown immensely popular over the last decade. There is long history of tobacco advertisement, promotion and sponsorship (TAPS) in cricket. While direct and indirect TAPS is completely prohibited under the Cigarettes and Other Tobacco Products Act (COTPA), 2003 the nexus between tobacco industry and cricket in India continues. We monitored any tobacco product and allied brand or surrogate advertisement, promotion, sponsorship (TAPS) or placement during every match played in the IPL-13 season in the year 2020. MethodsUsing an investigative approach, 60 match highlights during IPL-13 (during September 19 to November 10, 2020) were monitored for TAPS (both on-site i.e. sportswear and/or in stadia) shown on the official website (www.iplt20.com). All sponsors and advertisers were validated using brand names or logos from their respective official website. ResultsTwo IPL teams (Rajasthan Royals and Royal Challengers Bangalore) were sponsored by major tobacco industry owned brands. Violations by a major smokeless tobacco company promoting their brand extension product i.e. Vimal Elaichi, on the official telecast websites (www.espncricinfo.com and www.cricbuzz.com) and television channels (www.Zeenews.india.com/Gujarati) was observed. Tobacco companies i.e. Kamla Pasand and ITC Limited were also listed as associate sponsors for the 2020 championship. ConclusionDespite comprehensive ban under India's tobacco control law (COTPA, 2003), sponsorship by tobacco industry was found widespread in IPL-13. Advertisement and logos of tobacco companies are persistent during the telecast and promotion of the IPL events, in clear violation of India's tobacco control legislation and Article 13 of WHO's Framework Convention on Tobacco Control (WHO-FCTC) and its guidelines. Given that India and South Asia comprise the largest audience for televised cricket, strong exclusion criteria is needed by the international cricket authority and national cricket associations to ensure compliance with the national law and global good practice, making the cricketing world truly tobacco free.

Abstract PO-036: University of Guam/University of Hawai‘i Cancer Center Partnership: A seventeen-year investment in cancer health equity in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawai‘i Cancer Center (UHCC) Partnership aims to grow cancer research capacity at UOG, develop cancer health disparities research at UHCC focusing on Pacific Islanders (PI), raise awareness of cancer and cancer prevention in Guam (GU), Hawai‘i (HI) and the United States Associated Pacific Islands (USAPI), and increase the number of cancer and biomedical science researchers of PI ancestry in the US. An infrastructure comprised of 4 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 17 years of research, training, and outreach designed to reduce cancer health disparities and advance health equity among PI in GU, HI, and the USAPI. Since 2009, the Partnership has funded 22 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and Areca (betel) nut chewing - a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Over 100 peer-reviewed manuscripts have been published, over 100 abstracts presented, and 21 grants secured. To address the underrepresentation of PI in biomedical sciences, the Partnership has supported and trained 35 graduate scholars; 23 master’s students at UOG and 12 doctoral students at UH. Two PhD graduates are now faculty members at UOG and engaged in cancer health disparities research. UOG’s Micronesian Studies Program offers a cancer health disparities track, developed by the Partnership and tailored for the Pacific region. In addition, UOG/UHCC faculty, junior investigators, and pre/postdocs receive mentorship, career development, and summer research fellowships; since 2015, 16 early career professionals have received support. Outreach projects have explored community-based participatory approaches to cancer prevention. Youth tobacco use prevention and cessation projects in Guam resulted in landmark tobacco control legislation, decreased tobacco use and increased tobacco taxes, which now sustain cancer programs and patient services in Guam including the Guam Cancer Registry. Current outreach efforts aim to increase colorectal cancer screening and HPV vaccination while building knowledge and awareness among physicians serving PI in GU and HI. Dedicated leadership and longstanding partner collaborations led to the first NCI Community Oncology Research Program site in 2019, providing therapeutic cancer clinical trials in Guam. In conclusion, research capacity at UOG has significantly increased, disparities research at UHCC has expanded, underrepresented PI students are pursuing careers in cancer research, and communities have been engaged in research, training and outreach to advance cancer health equity in HI, GU and the USAPI. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Rachael T. Leon Guerrero, Margaret Hattori-Uchima, Hali R. Robinett, Carl-Wilhelm Vogel, Neal A. Palafox. University of Guam/University of Hawai‘i Cancer Center Partnership: A seventeen-year investment in cancer health equity in Pacific Islanders [abstract]. In: Proceedings of the AACR Virtual Conference: Thirteenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2020 Oct 2-4. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(12 Suppl):Abstract nr PO-036.

Creating a market for IQOS: analysis of Philip Morris’ strategy to introduce heated tobacco products to the Australian consumer market

BackgroundPhilip Morris International has made efforts to expand the sale of its heated tobacco product, IQOS, into new domestic markets globally. In Australia, where heated tobacco products are prohibited, the...

Economic impact evaluation of tobacco control legislation in Georgia

1. Impact of comprehensive smoke-free policy compliance on SHS exposure and health condition of the Georgian population George Bakhturidze, Nana Peikrishvili, Kakha Gvinianidze Tobacco Prevention & Cessation CrossRef

Smoking Chills? Tobacco Regulatory Chill, Foreign Investment, and the NCD Crisis in the Post-Soviet Space: A Case Study from Ukraine

Abstract This article engages with the ongoing debate on regulatory chill in the context of the international investment regime. By analyzing trends in tobacco legislation and delineating empirical findings on policymaking, it examines the hypothesis that international investment agreements affect tobacco control legislation and lead to regulatory chill in Ukraine. The article finds no direct evidence of a causal linkage between the State’s investment treaty commitments and the level of tobacco regulatory standards. Instead, it argues that the regulatory deterrence is likely to be attributed to other determinants, including strong tobacco lobby, the State’s dependency on foreign direct investment and related capital flight concerns. In addition, it observes similar dynamics in relation to the pharmaceutical and food industries.

Tobacco industry tactics in response to extensive tobacco control legislation in Israel

Abstract Issue Tobacco control in Israel has been lagging, and smoking rates have remained stable in the last decade (∼20%). In 2018, landmark legislation was passed to go into effect during 2019- 2020. The tobacco and vaping industry employed several tactics to circumvent and test the ability to enforce the new legislation. Examining industry responses to legislative reform in Israel may inform policy and enforcement internationally. Description of the Problem Resulting from strong political will, supportive media, and a strong coalition of tobacco control advocates, the legislation involves: 1) advertising bans in all media, excluding print press; 2) point-of-sales display bans; 3) plain packaging with textual health warning labels; and 4) extending the legislation to include also vaping products. Industry tactics to circumvent/test this legislation were communicated through an active social media group of tobacco control coalition members who shared information regarding such tactics in all geographical areas in Israel and via different media outlets. Results Various measures employed by the industry included, for example, print media advertisements with branded elements in the background (prohibited by law); new signs and display boxes for heated tobacco products and e-cigarettes, at the point-of-sale, that say “An alternative to cigarettes”; distributing branded tin cases for cigarettes; Highlighting different brands online and in print media using colors and fonts that are not allowed as part of plain packaging, and including branded elements inside the cigarette package Lessons Anything not specifically covered or detailed or verbiage that is open to interpretation provides an opening for the industry to circumvent the legislation intentions. It is crucial that legislation be as specific and detailed as possible, anticipate industry efforts to identify such 'loopholes', and compel industry compliance through efficient enforcement. Key messages In response to extensive tobacco control legislation in Israel, the tobacco industry employed various tactics to bypass legislative efforts. Tobacco control legislation and regulation need to use detailed wording to prevent alternative interpretations by the tobacco industry.

Does smoke-free legislation work for teens too? A logistic regression analysis of smoking prevalence and gender among 16 years old in Ireland, using the 1995–2015 ESPAD school surveys

ObjectivesTo assess the role of tobacco control legislation (TCL) in youth smoking in Ireland. To examine the effects of smoke-free legislation in youth. To consider whether TCL contributed to the...

Tobacco sales to underage buyers in France: findings from a mystery shopping study

ObjectivesIn 2017, one in four French 17-year-olds was a daily smoker, even though France prohibited the sale of tobacco to under-18 minors in 2009. This research aims to evaluate the retail violation rate for sale to minors (RVRms) and the associated factors. Study designThe study design used is observational mystery shopping study. MethodsWe conducted a mystery shopping study enlisting 12-year-old and 17-year-old youths in a representative sample of 527 tobacco outlets during three weeks in spring 2019. Multinomial Logit and Probit regressions were estimated on the data collected. ResultsThe law is not respected. Two of three sellers (65.2%) were willing to make an illegal sale to a 17-year-old minor, and almost one in 12 (8.1%) were willing to sell to a 12-year-old child attempting to buy tobacco. Illegal sales were more likely to be made by male sellers, retailing in big cities, when there were no in-shop queues, and to 17-year-old females. The absence of the mandatory enforcement poster flagging up the ban on the sale of tobacco to minors appears to be a strong factor associated with RVRm. ConclusionsThese findings show that progress needs to be made to better enforce tobacco control legislation to help decrease underage smoking in France. Rate of compliance with the law could be improved by stronger enforcement measures and tougher sanctions, but also by training and the provision of age-verification tools for sellers, as demonstrated by experiments in other countries.

Smoke-free workplaces are associated with smoke-free homes in India: evidence for action.

India enacted a smoke-free law in 2003. It is believed that smoke-free workplaces will lead to more smoking in private places such as homes. The national Global Adult Tobacco Survey (GATS 2) India 2016-2017 collects information on the self-reported prevalence of SHS exposure in homes and workplaces. The present study utilised the GATS 2 dataset to establish the association between working in a smoke-free workplace and living in a smoke-free home. 70.1% of respondents who worked indoors reported smoke-free workplace; 64.5% of respondents reported that they live in a smoke-free home. Respondents who reported that their workplace was smoke-free were significantly more likely to live in smoke-free homes compared with those who are exposed to SHS at the workplace (69.5% vs 45.5%, AOR = 1.8, 95% CI 1.5-2.1). Males, urban residents, family with fewer members, non-smokers and non-smokeless tobacco users were significantly more likely to live in a smoke-free home. Significant differences were also observed with respect to religion, caste, region and education levels. Our results provide conclusive evidence to support that smoke-free workplaces influence smoke-free homes in India. Thus, it highlights the importance of accelerating the implementation of existing national tobacco control legislation on smoke-free public places.

Characteristics of proposed and enacted state tobacco control legislation in the United States, 2010-2015.

This study documents all tobacco control proposals (bills) introduced in the United States into all 50 state legislatures from the start of 2010 through 2015 and assesses associations between tobacco-related strategies and tobacco product types with enactment of the bills into law. In total, members of state legislatures introduced 2801 tobacco control bills, and state legislatures enacted 17.4%. Bills most introduced addressed clean air (n = 696) and tax or price bills (n = 582), yet both had lower likelihood of enactment (each OR, 0.51; 95% CI 0.38-0.69) compared to bills on any other tobacco control strategy. Legislators introduced only 147 product manufacturing bills, but these had the highest odds of enactment (OR, 3.70, 95% CI 2.52-5.44) compared to any other intended strategy, followed by tax evasion (OR, 3.08; 95% CI 2.33-4.08) and retailer licensing or location (OR, 1.73; 95 CI 1.24-2.41). Compared to other products, bills regulating e-cigarettes had the highest enactment rate (21.2%). Despite introduction of many bills promoting traditional, evidence-based tobacco control strategies, these had less likelihood of enactment than others.

‘Pro-tobacco propaganda’: a case study of tobacco industry-sponsored elementary schools in China

BackgroundChina is the largest producer and consumer of tobacco products worldwide. While direct marketing and advertisement of tobacco products is restricted, indirect marketing still exists under the guise of sponsorship...

Association of tobacco control policies with cigarette smoking among school youth aged 13-15 years in the Philippines, 2000-2015.

INTRODUCTIONIn 2003, the Philippines implemented legislation that prohibited the sale of tobacco products to youth, placed text warning labels on tobacco products, and prohibited tobacco smoking in public places. This study assessed if this legislation was associated with reduced cigarette smoking among youth.METHODSData came from the 2000–2015 Philippines Global Youth Tobacco Survey (GYTS), a nationally representative, cross-sectional survey of students aged 13–15 years. GYTS data were used to determine associations between tobacco control legislation and current, past 30-day, current cigarette smoking (CCS). Logistic regression models were adjusted for age, sex, current other tobacco product use (COTPU), and price per cigarette stick (PPCS).RESULTSIn the unadjusted model, the 2003 legislation was not associated with CCS (OR=0.77; 95% CI: 0.54–1.10). After adjusting for covariates, it was negatively associated (AOR=0.65; 95% CI: 0.53–0.80). Being 15 years old (OR=1.31; 95% CI: 1.08–1.58), male (OR=2.54; 95% CI: 2.17–2.98), and COTPU (OR=4.12; 95% CI: 3.47–4.91) were positively associated with CCS in unadjusted models. In adjusted models, being 14 years old (AOR=1.29; 95% CI: 1.08–1.53), 15 years old (AOR=1.55; 95% CI: 1.31–1.84), male (AOR=2.49; 95% CI: 2.13–2.91), and COTPU (AOR=3.96; 95% CI: 3.32–4.73), were associated with CCS. PPCS was not associated with CCS in either the unadjusted (OR=1.32; 95% CI: 0.82–2.11) or adjusted (AOR=1.32; 95% CI: 0.79–2.18) models.CONCLUSIONSAfter adjusting for covariates, the 2003 tobacco control legislation was associated with lower current cigarette smoking, but price per cigarette stick was not.

Abstract D040: University of Guam/University of Hawaii Cancer Center Partnership: Sixteen years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to grow cancer research capacity at UOG, develop cancer health disparities research at UHCC focusing on Pacific Islanders (PI), raise awareness of cancer and cancer prevention in Guam (GU), Hawaii (HI) and the US Associated Pacific Islands (USAPI), and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprised of 4 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 16 years of research, training, and outreach designed to reduce cancer health disparities and advance health equity among PI in GU, HI, and the USAPI. Since 2009, the Partnership has funded 19 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and Areca (betel) nut chewing - a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Ninety peer-reviewed manuscripts have been published, over 100 abstracts presented, and 19 grants secured. To address the underrepresentation of PI in biomedical sciences, the Partnership has supported 33 graduate students including 7 doctoral students at UH. Two PhD graduates are now faculty members at UOG and engaged in cancer health disparities research. UOG’s Micronesian Studies Program now offers a cancer health disparities track, developed by the Partnership and tailored for the Pacific region. In addition, UOG/UHCC faculty, junior investigators, and pre/postdocs receive mentorship, career development, and summer research fellowships; to date, eight UOG faculty have participated in the summer fellowship program at UHCC and most had received U54pilot funding. Outreach projects have explored community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the use of social networking to reduce tobacco-related cancer risk. Community-based participatory research has also led to landmark tobacco control legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports cancer programs and patient services in Guam including the Guam Cancer Registry. Current outreach efforts aim to increase colorectal cancer screening and HPV vaccination while building knowledge and awareness among physicians who serve Pacific Islanders in Guam and Hawaii. In conclusion, research capacity at UOG has significantly increased, disparities research at UHCC has expanded, and underrepresented minority students are pursuing careers in cancer research. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Rachael T Leon Guerrero, Margaret Hattori-Uchima, Hali R Robinett, Carl-Wilhelm Vogel, Neal A Palafox. University of Guam/University of Hawaii Cancer Center Partnership: Sixteen years of progress in addressing cancer health disparities in Pacific Islanders [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D040.

Abstract C125: University of Guam/University of Hawaii Cancer Center partnership: Fifteen years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to grow cancer research capacity at UOG; develop cancer health disparities research at UHCC focusing on Pacific Islanders (PI); raise awareness of cancer and cancer prevention in Guam (GU), Hawaii (HI) and the US Associated Pacific Islands (USAPI); and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprising 5 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 15 years of research, training, and outreach designed to reduce cancer health disparities and advance health equity among PI in GU, HI, and the USAPI. Since 2009, the Partnership has funded 18 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and betel nut chewing—a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Approximately 75 manuscripts have been published, approximately 100 abstracts presented, and 16 grants secured. To address the under-representation of PI in biomedical sciences, the Partnership has supported 30 graduate fellows, including 8 doctoral students at UH. Two PhD graduates are now faculty members at UOG and engaged in cancer health disparities research. UOG's Micronesian Studies Program now offers a cancer health disparities track, developed by the Partnership and tailored for the Pacific region. In addition, UOG/UHCC faculty, junior investigators, and pre/postdocs receive mentorship, career development, and summer research fellowships; to date, 8 UOG faculty have participated in the summer fellowship program at UHCC, and two have subsequently secured pilot funding. Outreach projects have explored community-based participatory approaches to youth tobacco use prevention and cessation in Guam, and the use of social networking to reduce tobacco-related cancer risk. Community-based participatory research has also led to landmark tobacco-control legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports cancer programs and patient services in Guam, including the Guam Cancer Registry. Current outreach efforts aim to increase cervical cancer screening among Micronesian migrants and build cancer-prevention knowledge and awareness among physicians who serve them in Guam and Hawaii. In conclusion, the Partnership has significantly increased research capacity at UOG and cultivated interest in cancer research among under-represented minority students at the partnering institutions. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Carl-Wilhelm Vogel, David C. Ward, Neal A. Palafox, Hali R. Robinett, Rachael T. Leon Guerrero, John A. Peterson. University of Guam/University of Hawaii Cancer Center partnership: Fifteen years of progress in addressing cancer health disparities in Pacific Islanders [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C125.

Historic tobacco legislation in Israel: a moment to celebrate

BackgroundIsrael was once a leader in tobacco control, but fell behind other countries, particularly during the past decade, as smoking rates stagnated.TextLandmark tobacco control legislation, which banned advertising (with the exception of the print press) and limited marketing, was passed in Israel on Dec. 31rst, 2018. The changes occurred following years of attempts which culminated in successful last-minute efforts to promote the legislation just before the early disbanding of the 20th Knesset (Israeli Parliament). Regulations concerning marketing and advertising were substantially strengthened to address all tobacco, nicotine and smoking products. Digital media was included for the first time. Electronic cigarettes, which were previously largely unregulated, now fall under existing tobacco legislation. The changes overcame intense opposition from the tobacco lobby, and occurred despite the fact that the basic elements for prevention policy postulated by the Richmond model were not in place.ConclusionsThis legislation represents an important and long-awaited change in Israeli tobacco control policy. Many deficiencies in existing tobacco control regulation were overcome, and some measures went beyond current international regulations. The cohesive partnership between legislators, public health organizations and professionals, advocacy groups, academia, and leading journalists was critical to this success. The progress was lauded by the World Health Organization with its highest award for tobacco control, which was presented to Smoke Free Israel. This case study provides important lessons for up-to-date tobacco control policy, in the age of rapid global changes in the tobacco, vaping and nicotine landscape.

Tobacco control in China and the road to Healthy China 2030.

Healthy China 2030 aims to reduce the adult smoking rate from 27.7% in 2015 to 20% by 2030. Achieving this goal requires a review of the tobacco control measures introduced in China to date, the gaps that remain and the opportunities ahead. In 2008, the World Health Organization introduced six measures to reduce demand for tobacco called MPOWER. The progress China has made in implementing these measure varies: 1) monitor tobacco use and prevention policies. The surveillance on tobacco use has been rigorous, but the monitoring and evaluation of tobacco control policies needs to be strengthened; 2) protect people from tobacco use: pushes for national tobacco control legislation have stalled, but 18 subnational legislations have passed; 3) offer help to quit tobacco use. The accessibility and quality of cessation services needs to be improved; 4) warn about the dangers of tobacco. While there are no pictorial health warnings, tobacco control advocates have launched a series of anti-smoking media campaigns to inform the public; 5) enforce bans on tobacco advertising, promotion, and sponsorship. Legal loopholes and poor enforcement remain challenges; 6) raise taxes on tobacco: cigarettes in China are relatively cheap and increasingly affordable, which demonstrates the need for further tobacco tax increases indexed to inflation and income. China maintains a tobacco monopoly that interferes with tobacco control efforts and fails to regulate tobacco products from the public health perspective. Effective MPOWER measures, which depend upon the removal of tobacco industry interference from policymaking, are key to achieving the goal set by Healthy China 2030.

Smoking in cars and motorcycles in Italy over the last decade

to estimate the prevalence of smoking while driving a car or a motorcycle, and its determinants, and to analyze the trends of these habits before and after the transposition of the European Directive 40/2014 (Legislative Decree 6/2016) adopted in 2016, which bans smoking in cars in the presence of minors. eight different population-based surveys conducted in Italy by Doxa between 2007 and 2018. 21,807 subjects aged >=18 years, representative of the Italian adult population. prevalence of smokers who smoke while driving a car, with and without minors, or a motorcycle. Prevalence of non-smokers exposed to second-hand smoke (SHS) in cars, with or without minors. Estimate of multivariate odds ratios (ORs) and 95% confidence intervals (CIs), using multiple logistic regression models adjusted by gender, age, education, geographic area, and year of survey. the prevalence of smokers who smoked in cars decreased from 69.6% in 2007-2008 to 57.5% in 2016, and to 51.5% in 2017-2018. Those who smoked in cars in presence of minors were 20.9% in 2011-2012 and 11.7% in 2017-2018. The prevalence of smokers who smoked while driving a motorcycle decreased from 15.0% in 2007-2008 to 6.5% in 2017-2018. Smoking while driving a car in presence of minors decreased with increasing age (p=0.004) and education level (p=0.029) and was more frequent in Southern than in Northern Italy (OR 4.40; 95%CI 2.21-8.74). In 2017-2018, 16.2% of non-smokers reported being exposed to SHS in cars. Of these, 42.3% were exposed also in presence of minors. the tobacco control legislations adopted over the last 15 years, in particular the last one adopted in 2016, have largely contributed in reducing smoking in private vehicles, even in the presence of minors. This notwithstanding, 50% of Italian smokers smoke while driving and more than 15% of non-smokers are exposed to SHS in cars. It is suggested to adopt informative campaigns that inform people about the risks associated with smoking in cars, both for drivers and for passengers, and to increase the fines for those who smoke in cars in the presence of minors or driving a motorcycle.

Household environmental tobacco smoke exposure in healthy young children in Hong Kong: Prevalence and risk factors.

BackgroundEnvironmental tobacco smoke (ETS) exposure attributable respiratory illness burden is huge in paediatric population. Understanding the epidemiology of ETS exposure is important to guide health promotion planning. Therefore, we designed this study to determine the prevalence of household ETS exposure in healthy young children under 2 years of age in Hong Kong, and to explore risk factors associated with the exposure. Our secondary goal was to characterise children’s exposure profile to maternal smoking.MethodsA secondary analysis was performed based on the data collected from our 2013–2014 territory-wide cross-sectional pneumococcal carriage surveillance study, with a sample size of 1541. We conducted descriptive analysis for exposure prevalence, univariate and multivariate analysis for identification of risk factors.Results1541 children (mean age: 11.2 ± 6.4 months, male: 50.7%) were included in the analysis. The overall prevalence of current household ETS exposure was 31.5%, prevalence of prenatal and postnatal maternal smoking was 3.5% and 1.6% respectively. Independent factors associated with children’s ETS exposure were: never breastfed (AOR: 1.48, 95% CI: 1.13–1.93, p = 0.004); prenatal maternal smoking (AOR: 7.46, 95% CI: 2.73–20.39, p< 0.001); overcrowding of household living place (AOR: 3.17, 95% CI: 2.02–4.96, P< 0.001); lower household income (AOR: 1.34, 95% CI: 1.04–1.72, p = 0.02). Interestingly, children residing in Kowloon (AOR: 1.66, 95% CI: 1.19–2.33, p = 0.003) and New Territories West (AOR: 1.54, 95% CI: 1.11–2.15, p = 0.01) were associated with exposure compared with children residing in Hong Kong Island.ConclusionExposure to household ETS is prevalent among Hong Kong young children, particularly in children with maternal unfavourable behaviour and lower socioeconomic status. The identified risk factors should be considered while tobacco control interventions and legislations are planned.