Tobacco Control Policies Research Articles

Predicting the long-term effects of electronic cigarette use on population health: a systematic review of modelling studies

ObjectiveTo systematically review and synthesise the findings of modelling studies on the population impacts of e-cigarette use and to identify potential gaps requiring future investigation.Data source and study selectionFour databases...

New nicotine products, new risks: Navigating the challenges of novel products and poly-tobacco use in Europe’s tobacco control policies

New nicotine products, new risks: Navigating the challenges of novel products and poly-tobacco use in Europe’s tobacco control policies

Tobacco control policy in the Netherlands: A success story under threat

Tobacco control policy in the Netherlands: A success story under threat

P1.01C.05 Potential Impact of Tobacco Control Policies in Preventing Incident Lung Cancers in the Eastern Mediterranean Region

P1.01C.05 Potential Impact of Tobacco Control Policies in Preventing Incident Lung Cancers in the Eastern Mediterranean Region

Unlocking the power of tobacco taxation to mitigate the social costs of smoking in Mexico: a microsimulation model.

Despite being the most cost-effective tobacco control policy, tobacco taxation is the least implemented component of the World Health Organization MPOWER package to reduce smoking worldwide. In Mexico, both smoking prevalence and taxation have remained stable for more than a decade. This study aims to provide evidence about the potential effects of taxation to reduce the burden of tobacco-related diseases and the main attributable social costs in Mexico, including informal (unpaid) care costs, which are frequently ignored. We employ a first-order Monte Carlo microsimulation model that follows hypothetical population cohorts considering the risks of an adverse health event and death. First, we estimate tobacco-attributable morbidity and mortality, direct medical costs and indirect costs, such as labour productivity losses and informal care costs. Then, we assess the potential effects of a 50% cigarette price increase through taxation and two alternative scenarios of 25% and 75%. The inputs come from several sources, including national surveys and vital statistics. Each year, 63 000 premature deaths and 427 000 disease events are attributable to tobacco in Mexico, while social costs amount to MX$194.6 billion (US$8.5)-MX$116.2 (US$5.1) direct medical costs and MX$78.5 (US$3.4) indirect costs-representing 0.8% of gross domestic product. Current tobacco tax revenue barely covers 23.3% of these costs. Increasing cigarette prices through taxation by 50% could reduce premature deaths by 49 000 over the next decade, while direct and indirect costs averted would amount to MX$87.9 billion (US$3.8) and MX$67.6 billion (US$2.9), respectively. The benefits would far outweigh any potential loss even in a pessimistic scenario of increased illicit trade. Tobacco use imposes high social costs on the Mexican population, but tobacco taxation is a win-win policy for both gaining population health and reducing tobacco societal costs.

Is unassisted smoking cessation choice and success associated with high mental stress? Evidence from six cities in China.

Unassisted smoking cessation (USC) is a method of quitting smoking driven by self-determination without the support of professional cessation assistance. This approach may contribute to a potential decrease in overall smoking prevalence within a population. However, the factors potentially influencing smokers' choice of USC and their success remain unclear. This study examined the associations between mental stress and USC choice and success. Between June and September 2016, a cross-sectional multistage sampling design was used to interview subjects from six selected cities in China. A standardized questionnaire was used to obtain information on sociodemographic characteristics, USC choice, and success. Mental stress was measured by the Chinese version of the Perceived Stress Scale (CPSS). Multivariate logistic regression models were used to examine the association between mental stress, USC choice, and success, with adjustments for relevant covariates. Among 1647 smokers who had attempted or had quit, 91.6% (95% CI: 90.9-97.5) reported that they had done so without assistance, and 42.1% (95% CI: 32.4-61.3) of them achieved abstinence. While mental stress was not significantly associated with USC success (χ2=2.02, p=0.1547), smokers experiencing high levels of mental stress were 0.34 times less likely (95% CI: 0.23-0.50) to attempt USC compared to those with low levels of mental stress. Moreover, a significant negative linear association was observed between varying levels of mental stress and the prevalence of USC use (R2=0.910, p<0.001). The study findings should help to understand USC and its role in reducing smoking prevalence in the Chinese population. These findings can inform future tobacco control programs and policies in China. Government and social agencies should prioritize understanding smokers' preferences for USC and providing USC services to promote success within the population.

Global landscape of nicotine and tobacco products additives policies

IntroductionProduct design is a key tobacco industry strategy to recruit consumers and hinder cessation. An important technology in tobacco product design is the use of additives including those that create...

Comprehensive guide to tobacco control policy implementation

Background: Tobacco use remains one of the leading causes of preventable death and disease worldwide. Effective tobacco control policies are essential in mitigating these health risks. The Framework Convention on Tobacco Control (FCTC), adopted by the World Health Organization (WHO) in 2003, provides a comprehensive framework for implementing evidence-based tobacco control measures globally. This project aims to develop and implement robust tobacco control policies to reduce tobacco consumption and its associated health risks. Methods and Materials: The project involved a comprehensive review of existing tobacco control policies, data collection on tobacco use and related health outcomes, and the development of a multi-sectoral task force. Key strategies included setting clear goals, stakeholder engagement, public awareness campaigns, and the drafting of legislative and policy documents. Implementation mechanisms such as enforcement and evaluation systems were also established to ensure compliance and measure the policy's impact. Results: The implementation of the tobacco control policies resulted in a significant reduction in smoking prevalence and exposure to secondhand smoke. Public awareness of the health risks associated with tobacco use increased, and there was enhanced support for smoking cessation services. The project also identified best practices and strategies that can be adopted by other regions to achieve similar outcomes. Conclusion: This project highlights the importance of comprehensive research, effective coordination, and well-planned implementation in developing and executing tobacco control policies. The findings and recommendations presented serve as a valuable resource for policymakers and public health professionals aiming to reduce smoking rates and protect public health. Continued collaboration and adaptation of these strategies are essential for sustaining the progress made in tobacco control.

Waterpipe size matters: the effect of waterpipe size on toxicant exposures and subjective experiences.

Waterpipe (WP) tobacco smoking remains popular among US young adults, yet specific regulations for WP devices are lacking. This study examines how WP device size (base volume and height) affects smoking behavior, toxicant exposures, and subjective experiences. Thirty-eight individuals who smoke WP aged 21 to 39 participated in a randomized crossover study. Each completed three 45-minute ad libitum smoking sessions using small, medium, and large WP sizes. Saliva nicotine and exhaled carbon monoxide (eCO) were measured before and after smoking. Puff topography was recorded during sessions, and subjective smoking experiences were collected afterward. Significant differences were observed in saliva nicotine between the three WP sizes, with higher concentrations for the small WP relative to larger sizes (Ps<0.05). Exhaled CO was significantly higher after smoking the large WP compared to smaller sizes (Ps<0.05). Puff topography revealed significant differences and followed a dose-response pattern, with larger size associated with longer puff duration, greater smoke volume inhaled, and larger puff volume (Ps<0.05). The large WP was associated with enhanced subjective experiences for satisfaction and concentration compared to the small WP (Ps<0.05). WP size substantially impacts smoking experiences and exposures. Regulation of WP size should be essential in comprehensive tobacco control policies aimed at curbing WP use among young adults. These findings will aid in developing of WP size-specific standards to regulate the marketing and sales of WP devices. Such regulations should aim to minimize toxicant exposure by controlling the dimensions and design of WP components, which can significantly influence smoking behavior and toxicant intake. This study underscores the critical role of waterpipe (WP) size in shaping smoking behavior, experiences, and exposures among young adults.

Crowding-out effect of tobacco consumption on household food expenditures in Cameroon

This study delves into the critical issue of household budgets in Cameroon, specifically focusing on the impact of tobacco expenditure. Tobacco use often represents a significant portion of a household’s financial resources, potentially leading to a phenomenon known as the “crowding-out effect.” This effect describes a situation where increased tobacco spending leads to a decrease in the budget allocated to other essential goods and services. To gain a deeper understanding of this phenomenon, this study employs a quantitative approach. The analysis utilizes data from a nationally representative household survey conducted in Cameroon during 2014 (ECAM4). A two-stage least squares (2SLS) technique is implemented to address a potential statistical issue known as endogeneity, which could otherwise skew the results. The study’s findings reveal a concerning trend: tobacco expenditure has a negative impact on the budget shares allocated to essential goods such as food, clothing, and household equipment. This negative impact appears to be particularly pronounced for male consumers within households. Based on these findings, the study suggested that implementing tobacco control policies could lead to significant improvements in household well-being and overall health status. These policies, by encouraging a reduction in tobacco use, could free up resources that could then be reallocated towards essential goods, ultimately improving household financial stability and health outcomes.

Forecasting the effects of smoking prevalence scenarios on years of life lost and life expectancy from 2022 to 2050: a systematic analysis for the Global Burden of Disease Study 2021

Smoking is the leading behavioural risk factor for mortality globally, accounting for more than 175 million deaths and nearly 4·30 billion years of life lost (YLLs) from 1990 to 2021. The pace of decline in smoking prevalence has slowed in recent years for many countries, and although strategies have recently been proposed to achieve tobacco-free generations, none have been implemented to date. Assessing what could happen if current trends in smoking prevalence persist, and what could happen if additional smoking prevalence reductions occur, is important for communicating the effect of potential smoking policies. In this analysis, we use the Institute for Health Metrics and Evaluation's Future Health Scenarios platform to forecast the effects of three smoking prevalence scenarios on all-cause and cause-specific YLLs and life expectancy at birth until 2050. YLLs were computed for each scenario using the Global Burden of Disease Study 2021 reference life table and forecasts of cause-specific mortality under each scenario. The reference scenario forecasts what could occur if past smoking prevalence and other risk factor trends continue, the Tobacco Smoking Elimination as of 2023 (Elimination-2023) scenario quantifies the maximum potential future health benefits from assuming zero percent smoking prevalence from 2023 onwards, whereas the Tobacco Smoking Elimination by 2050 (Elimination-2050) scenario provides estimates for countries considering policies to steadily reduce smoking prevalence to 5%. Together, these scenarios underscore the magnitude of health benefits that could be reached by 2050 if countries take decisive action to eliminate smoking. The 95% uncertainty interval (UI) of estimates is based on the 2·5th and 97·5th percentile of draws that were carried through the multistage computational framework. Global age-standardised smoking prevalence was estimated to be 28·5% (95% UI 27·9-29·1) among males and 5·96% (5·76-6·21) among females in 2022. In the reference scenario, smoking prevalence declined by 25·9% (25·2-26·6) among males, and 30·0% (26·1-32·1) among females from 2022 to 2050. Under this scenario, we forecast a cumulative 29·3 billion (95% UI 26·8-32·4) overall YLLs among males and 22·2 billion (20·1-24·6) YLLs among females over this period. Life expectancy at birth under this scenario would increase from 73·6 years (95% UI 72·8-74·4) in 2022 to 78·3 years (75·9-80·3) in 2050. Under our Elimination-2023 scenario, we forecast 2·04 billion (95% UI 1·90-2·21) fewer cumulative YLLs by 2050 compared with the reference scenario, and life expectancy at birth would increase to 77·6 years (95% UI 75·1-79·6) among males and 81·0 years (78·5-83·1) among females. Under our Elimination-2050 scenario, we forecast 735 million (675-808) and 141 million (131-154) cumulative YLLs would be avoided among males and females, respectively. Life expectancy in 2050 would increase to 77·1 years (95% UI 74·6-79·0) among males and 80·8 years (78·3-82·9) among females. Existing tobacco policies must be maintained if smoking prevalence is to continue to decline as forecast by the reference scenario. In addition, substantial smoking-attributable burden can be avoided by accelerating the pace of smoking elimination. Implementation of new tobacco control policies are crucial in avoiding additional smoking-attributable burden in the coming decades and to ensure that the gains won over the past three decades are not lost. Bloomberg Philanthropies and the Bill & Melinda Gates Foundation.

Public Support for Tobacco Control Policies Among Mississippi Adults

Public Support for Tobacco Control Policies Among Mississippi Adults

Association Between Cigarette and Bidi Purchase Behavior (Loose vs Pack) and Health Warning Label Exposure: Findings From the Tobacco Control Policy India Survey and In-Depth Interviews With People Who Smoke.

The sale of loose cigarettes or bidis can undermine the purpose of requiring health warning labels (HWLs) on cigarette packs and bidi bundles by diminishing their visibility and legibility. This mixed-methods study aims to examine the association between purchase behavior (loose vs pack or bundle), HWL exposure, and responses to HWLs among Indian adults who smoke. Data were analyzed from the 2018-2019 India Tobacco Control Policy Survey and from 28 in-depth interviews conducted with Indian adults who smoked in 2022. The Tobacco Control Policy Survey sample included tobacco users who bought cigarettes (n=643) or bidis (n=730), either loose or in packs or bundles at their last purchase. Ordinal regression models were fit separately for cigarettes and bidis, whereby HWL variables (noticing HWLs, reading and looking closely at HWLs, forgoing a cigarette or bidi because of HWLs, thinking about health risks of smoking, and thinking about quitting smoking cigarettes or bidis because of HWLs) were regressed on last purchase (loose vs packs or bundles). In-depth interviews with participants from Delhi and Mumbai who purchased loose cigarettes in the last month were conducted, and thematic analysis was used to analyze the interview data. Survey findings indicated that about 74.3% (478/643) of cigarette users and 11.8% (86/730) of bidi users reported having bought loose sticks at their last purchase. Those who purchased loose cigarettes (vs packs) noticed HWLs less often (estimate -0.830, 95% CI -1.197 to -0.463, P<.001), whereas those who purchased loose bidis (vs bundles) read and looked closely at HWLs (estimate 0.646, 95% CI 0.013-1.279, P=.046), thought about the harms of bidi smoking (estimate 1.200, 95% CI 0.597-1.802, P<.001), and thought about quitting bidi smoking (estimate 0.871, 95% CI 0.282-1.461, P=.004) more often. Interview findings indicated lower exposure to HWLs among those who purchased loose cigarettes, primarily due to vendors distributing loose cigarettes without showing the original cigarette pack, storing them in separate containers, and consumers' preference for foreign-made cigarette brands, which often lack HWLs. While participants were generally aware of the contents of HWLs, many deliberately avoided them when purchasing loose cigarettes. In addition, they believed that loose cigarette purchases reduced the HWLs' potential to deliver consistent reminders about the harmful effects of cigarette smoking due to reduced exposure, an effect more common among those who purchased packs. Participants also noted that vendors, especially small ones, did not display statutory health warnings at their point of sale, further limiting exposure to warning messages. Survey and interview findings indicated that those who purchased loose cigarettes noticed HWLs less often. Loose purchases likely decrease the frequency of exposure to HWLs' reminders about the harmful effects of smoking, potentially reducing the effectiveness of HWLs.

Shaping people’s preferences: liberal neutrality, means paternalism and tobacco control

Abstract Liberal neutrality compels governments to respect individual preferences. Yet health-promotion campaigns, such as modern tobacco control policies, often seek to cultivate a preference for a healthy lifestyle. Liberal theorists have attempted to justify these policies by appealing to the concept of ‘means paternalism’, whereby these policies align with existing preferences. In contrast, this article argues that shaping preferences can be not only permissible but also morally required. Governments can preserve neutrality while influencing preferences by promoting generic goods valued in diverse societies and considering the preference-formation of future generations. This argument provides a stronger rationale for tobacco control policies.

Trends in smoking initiation and cessation over a century in two Australian cohorts

Background Historical data on smoking can enhance our comprehension of the effectiveness of past tobacco control policies and play a key role in developing targeted public health interventions. This study was undertaken to assess trends in smoking initiation and cessation in Australia for the period 1910–2005. Methods Rates of smoking initiation and cessation were calculated for participants in two population-based cohorts, the Busselton Health Study and the Tasmanian Longitudinal Health Study. The effects of time trends, gender and age group were evaluated. Results Of the 29,971 participants, 56.8% ever smoked. In males, over the period 1910–1999, the rate of smoking initiation in young adolescents remained high with a peak in the 1970s; in older adolescents it peaked in the 1940s and then declined; in young adults it showed a steady decline. In females, the rate of smoking initiation in young adolescents rose sharply in the 1960s and peaked in the 1970s, in older adolescents it increased throughout the period, and in young adults it declined after 1970. In the period 1930–2005, 27.3% of 9,605 people aged 36–50 years who smoked ceased smoking. Rates of cessation in this age group increased throughout but decreased in males after 1990 and plateaued around 2000 in females. Conclusion Our findings show substantial variation in the efficacy of tobacco control policies across age groups, with a notable lack of success among the younger population.

Return on investment of tobacco control measures: a systematic review protocol.

The objective of this systematic review will be to estimate the return on investment (ROI) and social return on investment (SROI) on tobacco control measures. Tobacco consumption has been proven to be associated with a huge epidemiological, humanistic, and economic burden. National and international organizations are making concerted efforts to control tobacco use. However, currently, there are no conclusive estimates of the ROI and SROI of such programs and policies. This review will include all studies that evaluate the ROI or SROI on tobacco control programs and policies on tobacco users and probable tobacco users globally. This review will follow the JBI methodology for systematic reviews of economic evidence. Databases to be searched will include Embase (Ovid), MEDLINE (PubMed), Cochrane Central Register of Controlled Trials (CENTRAL), Health Economic Evaluation Database (HEED), National Health Service Economic Evaluation Database (NHS EED), CEA Registry, LILACS, Science Direct, Web of Science, EconLit, and Google Advanced Search. Gray literature will also be searched for in non-academic databases, including the websites of various civil societies and non-governmental organizations involved in tobacco control. Two independent reviewers will screen titles/abstracts, and later full-text studies. Critical appraisal will be conducted using the JBI checklist for economic evaluations and the SROI Quality Framework. Data will be extracted and synthesized using JBI data extraction forms and synthesis tools. The MPOWER framework will be considered for data synthesis across all selected studies using narrative synthesis, tables, and figures. PROSPERO CRD42023391591.

Secondhand smoke exposure among adolescents in the gulf cooperation council countries: analysis of global youth tobacco surveys

This study aimed to analyze patterns and predictors of secondhand smoke (SHS) exposure among adolescents (12–16 years old) in Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and the United Arab Emirates. Nationally representative data from the most recent Global Youth Tobacco Survey in each country were analyzed (N = 17,220). SHS exposure at home, in public places, and at school was assessed. Descriptive statistics summarized exposure prevalence overall and by sex. Multivariable logistic regression examined factors associated with each SHS exposure’s outcome. The results showed that SHS exposure was high overall, with exposure at home and school ranging from 12.7 to 20.7%, respectively, in Oman to 39.4% and 36.7%, respectively, in Kuwait. Almost half of the adolescents reported exposure to SHS in public places, with a prevalence of 40.8% in Saudi Arabia to 65.9% in Kuwait. The prevalence of exposure varied between countries, with the highest rates occurring in Kuwait. Girls had higher exposure at home, while boys had higher exposure in public and at school. Factors associated with higher exposure included parental smoking, friend smoking, and tobacco advertising. The belief that SHS is harmful was associated with lower home exposure. In conclusion, adolescents in the Gulf Cooperation Council countries are exposed to concerning levels of SHS, especially in public places. These findings underscore the urgent need for stronger tobacco control policies, including comprehensive smoke-free laws covering all public venues, to protect youth from SHS exposure. Additionally, the results support the development of targeted interventions promoting smoke-free homes and social norms against smoking.

A Scoping Review of Vaping Among the Asian Adolescent Population.

Little is known about vaping and its associated factors among Asian adolescents worldwide. We did a scoping review of the international literature on vaping among Asian adolescents. The prevalence of Asian adolescent vaping varied by the country's e-cigarette policies: the highest prevalence in Indonesia 32.2% (ever vapers) and 11.8% (current vapers) in 2019 and the lowest in Japan with 2.1% to 3.5% (ever vapers) and 0.7% to 1.0% (current vapers) in 2017. In New Zealand, a Western country with strong tobacco control but liberal policies on vaping, the prevalence of ever vaping was 20.4%, regular vaping 4.2%, and weekly vaping 2.8% in 2019. The most common reasons for vaping in both contexts were curiosity and peer influence. The internet as a popular source of information on vaping was identified mostly in Asian studies. In Asian contexts, the most common reasons for more frequent vaping were the desire to quit smoking and the ability to vape indoors, whereas in Western countries, the top three reasons were nicotine concentration, nicotine dependence, and more daily vaping sessions. Regular monitoring and more targeted research to understand adolescents' vaping behaviors will need to be undertaken on this heterogeneous population to inform appropriate policies and regulations.

Sociodemographic inequalities in cigarette, smokeless tobacco, waterpipe tobacco, and electronic cigarette use among adolescents aged 12-16 years in 114 countries: A cross-sectional analysis.

The majority of users of tobacco and nicotine products start using them in adolescence. In order to keep equity considerations at the forefront of tobacco control, it is crucial to assess whether inequalities in prevalence of tobacco and nicotine use exist among adolescents globally. We conducted a secondary analysis of Global Youth Tobacco Survey (GYTS) data from 538644 school-based adolescents (79.3% aged 13-15 years) in 114 countries (2013-2019). Data were collected on current (past 30-day) use of cigarettes, smokeless tobacco, waterpipe tobacco and electronic cigarettes. We used weighted Poisson regression models adjusted for sex, pocket money, and age to assess differences in prevalence of current use between boys and girls, and between students with high versus low pocket money. Although there was substantial regional variation, in most countries boys were statistically significantly more likely to report current use of all assessed products (ranging from 50.0% of countries for waterpipe tobacco to 73.3% of countries for electronic cigarettes). Inequalities by sex were less pronounced in Europe compared to other regions. Inequalities by pocket money were less consistent; students with more pocket money were more likely to report current use of cigarettes (vs those with less pocket money) in 61.8% of the countries, but more likely to report current use of smokeless tobacco in only 18.3% of countries. Globally, boys and adolescents with more pocket money are generally more likely to use a range of tobacco and nicotine products. However, these patterns are not universal and local variations should be taken into consideration to design effective and equitable tobacco control policies.

Tobacco control policies and the multidimensional context of tobacco use by gender: The case of Türkiye.

This study aims to determine the indicators of tobacco use in Türkiye within a multidimensional context as socio-demographic, physical, behavioural, and psychological as a response to the tobacco control policies. The Turkish Health Survey data in 2014 and 2019 are employed within a probit model approach and the differences in tobacco are decomposed use by gender in order to reveal the gender differences. The samples in 2014 (total n=19,129; males=8 721, females=10,408) and 2019 (total n=17,084; males=7 784, females=9300) were restricted to 15-year-old and above. The findings indicate that being in the 30-49 age cohort, having lower education, and being married increase the likelihood of tobacco use. Future policies and campaigns should specifically target the single, pre-obese, employed males who consume alcohol. For females, the gender-specific policies should aim to reduce the prevalence of smoking, especially among separated or widows, obese, and out of the labour force. The contribution of mental health indicators on tobacco use has declined over the 5years, which could be a result of the supportive free health services in Türkiye. The findings provide evidence for a significant and increasing gender difference in tobacco use in Türkiye along with reporting that the most significant contributors to gender differences in tobacco use are alcohol consumption and education level. Even though the Ministry of Health and the government have been implementing anti-tobacco policies, legislations, and campaigns for years, the tobacco use prevalence has remained high and even increased in Türkiye.