Tobacco Control Policies Research Articles

Prevalence and Covariates of Electronic Cigarette Use among Students Aged 13-15 Years in the Philippines: 2019 Global Youth Tobacco Survey.

Electronic cigarette use is growing in popularity and accessibility among youth in the Southeast Asia region. We analyzed data on 6670 students, aged 13-15 years, from the Philippines' 2019 Global Youth Tobacco Survey. Prevalence estimates and 95% confidence intervals (CI) were estimated for current use (i.e., past 30 days), ever use, and awareness of e-cigarettes. Chi-square tests compared prevalence differences between groups. Multiple logistic regression models assessed factors associated with e-cigarette use while controlling for sociodemographic characteristics, current use of other tobacco products, and secondhand smoke exposure. Prevalence of current e-cigarette use was 14.1% (95% CI = 12.4%, 15.8%), ever use was 24.6% (95% CI = 22.4%, 26.9%), and awareness was 75.5% (95% CI = 73.0%, 78.0%). Current use of any other tobacco products and exposure to secondhand smoke at home, school, or other public places were positively associated with current and ever use of e-cigarettes. Boys and youth living in Luzon or Mindanao had higher odds of current e-cigarette use compared to girls and youth in Visayas. Findings indicated that one in four Philippine students aged 13-15 years ever used e-cigarettes and one in seven currently use e-cigarettes. This study highlights the importance of implementing evidence-based strategies, including relevant tobacco control policies.

Parent’s awareness of, and influence on, their 14–17-year-old child’s vaping and smoking behaviours; an analysis of 3242 parent–child pairs in Australia

BackgroundVaping by young people in Australia is a rapidly emerging public health issue. Evidence shows that parental behaviours and attitudes can play a key role in influencing adolescent behaviours. Considering the health harms of vaping and evidence that it can be a gateway to tobacco smoking for never-smokers, it is important to understand whether parents’ smoking and vaping behaviours influence their teenage children’s smoking and vaping behaviours. MethodsOnline cross-sectional surveys as part of the Generation Vape study, conducted in Australia in 2021/2022, were used to assess parents' influence on, and awareness of, one of their 14–17-year-old child’s vaping and smoking behaviours. Participants were 3242 parents and 3242 14–17-year-old teenage children. ResultsThe risk of vaping and smoking uptake among 14–17-year-old teenagers was 42% (p = 0.003) and 97% (p < 0.001) higher, respectively, if their parent was an ever-vaper. The risk of vaping and smoking uptake among teenagers was 81% (p < 0.001) and 159% (p < 0.001) higher, respectively, if their parent was an ever-smoker. Parents of teenagers who have not vaped were considerably better at correctly predicting this (97% correct) than parents of teenagers who have vaped (70% correct). Compared to parents, teenagers tended to have less agreement with statements suggesting vaping is unsafe or harmful, and more agreement with statements suggesting vaping is relatively safe. ConclusionsParental smoking and vaping behaviours are associated with those of their children. Hence, it is important that both tobacco and vaping control policies and interventions are designed to influence behaviours of all demographics, consistent with the evidence.

Study of the prevalence of tobacco consumption among apparently healthy adult males in an urban area.

Keeping in view the role of tobacco consumption as a modifiable risk factor in various diseases and gaps in scientific knowledge among the apparently healthy adult male population in India, the researchers chose to undertake this study. A cross-sectional study was conducted among apparently healthy adult males employed in various government offices to determine the prevalence of tobacco consumption. The minimum sample size to estimate a 95% confidence interval for the prevalence of tobacco consumption with 5% absolute precision was calculated to be 340. However, 500 subjects were included in the study. The tool used for data collection was the "personal interview technique." Standard statistical methods were utilized for data analysis. The overall mean age (standard deviation (SD)) of the study subjects was 30.96 yrs (4.32). Overall, the mean (SD) of number of years of tobacco use was 5.64 years (1.98). The mean (SD) of number of cigarettes smoked per day was 6.36 (3.09). The prevalence of current smokers showed a statistically significant increase from the age groups of 20-29 yrs to 50-59 yrs (P < 0.001). All subjects in the study were able to name at least three harmful effects of tobacco consumption. The overall mean amount spent on tobacco consumption per month was Rs 536.97 (1.44% of basic salary). Overall, the most common reason for smoking was peer pressure, where 40 (93.02%) gave this reason. Of forty-three tobacco users, 27 (62.79%) expressed a desire to quit tobacco consumption. The most common reason for expressing a desire to quit tobacco was the ill effects of tobacco consumption, where 23 (85.18%) tobacco users gave this reason. Our study on the prevalence of tobacco consumption among government employees provides an adequately clear picture of this public health epidemic in India. There is an immediate need for target group-specific policies for tobacco control, which should be integrated with the relevant national health programs at all levels.

Tobacco Market Transformation in Hungary

Smoking has emerged as a longstanding global concern, with a significant number of individuals within our immediate and bariatric circles becoming addicted to this detrimental habit. The gravity of the issue is reflected in the staggering statistics, as smoking claims the lives of more than six million people worldwide annually, earning its notorious title as the leading cause of preventable death according to the World Health Organization (WHO). Despite strict regulations and restrictions on smoking imposed by many countries to combat the escalating health risks, smoking habits persist as a major problem, particularly among young people. In the 1960s, smoking was widely accepted in society, and smoking rates remained high across nations. However, the tides began to turn with the growing awareness of the dire health risks associated with smoking. Health professionals and policymakers took active measures against smoking, contributing to a decline in its prevalence. Nevertheless, the extent of change in smoking habits varies significantly from country to country. The intricate web of factors influencing smoking habits encompasses social and economic elements, stress and mental health considerations, as well as the alluring temptations surrounding tobacco products. Raising awareness about the devastating health impacts of smoking and taking relentless action against this harmful habit are pivotal in reducing smoking rates globally. However, it is crucial to acknowledge the diverse cultural, socioeconomic, and psychological aspects that underpin smoking behavior to implement effective strategies tailored to specific regions and demographics. To combat the persistent smoking epidemic, comprehensive and integrated efforts are required, ranging from targeted public health campaigns to comprehensive tobacco control policies. Empowering individuals with knowledge about the hazards of smoking and equipping them with effective cessation resources can be transformative in curbing the addiction. Equally vital is fostering a supportive environment that promotes mental well-being and addresses stressors, offering healthier alternatives to cope with challenges. In conclusion, the fight against smoking demands unwavering commitment from policymakers, health professionals, and society at large. By understanding the complex drivers behind smoking habits and adopting a multifaceted approach, we can endeavor to save lives, promote healthier communities, and ultimately work towards a smoke-free future for generations to come.

“Availability is the poor cousin of marketing and pricing”: qualitative study of stakeholders’ views on policy priorities around tobacco and alcohol availability

Background Reducing alcohol and tobacco availability is one potential way to reduce harm from these unhealthy commodities. This study explores key stakeholders’ views in relation to policy priorities and considerations for both alcohol and tobacco availability. Methods We conducted semi-structured interviews with 14 stakeholders from alcohol and/or tobacco third sector organizations, government, public health and licensing in Scotland. Interviews explored their views on alcohol/tobacco availability, including its place in the policy landscape and experiences in gaining support for policies. Data were analyzed using thematic analysis. Results Stakeholders believed that alcohol and tobacco availability have not received as much policy attention as pricing and marketing. Stakeholders highlighted the importance of public support and having sufficient evidence to inform policy. Key considerations for future policies include: drawing on lessons from tobacco control policies to address alcohol availability, considering different aspects of availability (especially online availability), ensuring policies reflect their local context, considering the impact of policies on children, and managing retailers’ involvement in the policy process. Conclusion This study highlights key considerations for policies to address alcohol and tobacco availability. There is a need for more research to consider retailers’ views and provide greater detail on specific policy suggestions.

The tobacco small farmers and impact of restrictive credit policies on the planted area in Brazil: assessment of tobacco control policies

The tobacco small farmers and impact of restrictive credit policies on the planted area in Brazil: assessment of tobacco control policies

Critical analysis of tobacco taxation policies in Pakistan after two decades of FCTC: Policy gaps and lessons for low- and middle-income countries.

Tobacco taxation remains a poorly used intervention to control tobacco use in many low- and middle-income countries (LMICs) including Pakistan even after two decades of FCTC adoption. This study identifies gaps and implementation challenges in the current Tobacco Taxation and Pricing Policies (TTPP) in Pakistan, and highlights key policy implications and lessons for LMICs to strengthen tobacco control measures. We used qualitative document analysis to examine the policy documents to assess the TTPP against the WHO Framework Convention on Tobacco Control (FCTC) guidelines for the implementation of Article 6 of the FCTC. In addition, we used secondary data on tobacco tax and prices to assess the impact of TTPP on tobacco affordability in the country. Although Pakistan taxes raw tobacco, cigarettes and other tobacco products (cigarillos, cigars, cheroots), the existing TTPP falls below the WHO FCTC requirements of: uniform tax level, simple tax structure and 70% share of excise tax in the price of a product's pack; among others. There are also multiple issues in tobacco tax administration such as lack of monitoring. This is leading to the availability of highly affordable tobacco products in the country. Pakistan does not have a clear strategy on using tobacco taxation and prices as a public health tool in the country. Existing TTPP face dual issues of flawed structure and poor administration translating into highly affordable tobacco products and low revenues in the country. There is a need to introduce multisectoral tobacco control policies in countries like Pakistan in the context of the tobacco sector political economy.

How has the brain disease model of addiction contributed to tobacco control?

Our paper evaluates the extent to which the brain disease model of addiction (BDMA) has contributed to reducing the prevalence of tobacco smoking and tobacco-related harm over the past 20 years. We discuss the ways in which genetic and neuroscience research on nicotine addiction have contributed to our understanding of tobacco smoking. We then examine the extent to which the BDMA has produced more effective treatments to assist smoking cessation. We also assess the degree to which the BDMA has contributed to the tobacco control policies that have produced substantial reductions in tobacco-related morbidity and mortality in the two decades since the model was first proposed by Alan Leshner. We also assess whether the BDMA has reduced the stigmatisation of people who smoke tobacco.

Causal effects of point-of-sale cigarette promotions and subjective social status on cigarette craving: a randomised within-person experiment

BackgroundCigarette smoking continues to be a leading cause of preventable deaths in the USA, in part because the USA has not adopted the WHO Framework Convention on Tobacco Control. One...

Engaging Students in Advancing Campus Tobacco-Free Policies: A Qualitative Study of California Community Colleges' Efforts.

Tobacco use remains a serious problem for young adults. Given the large number of young adults attending college, a tobacco-free campus is one strategy to reduce tobacco use. Young adult engagement is recognized as a common strategic practice in tobacco control policy efforts, especially in changing social norms around tobacco use. Community colleges can leverage and engage students in adoption of campus 100% tobacco-free policies. This qualitative study examines the importance of student engagement in advancing 100% tobacco-free policies in community colleges and identifies strategies for campuses to involve students in such efforts. We selected 12 community colleges and conducted key informant interviews with campus and community-based organizations that were involved in campus policy adoption efforts. We conducted 33 semistructured interviews and transcribed, coded, and analyzed them by using a thematic analytic framework with inductive and deductive approaches to examine student engagement processes. Community colleges represented campuses with (n = 6) and without (n = 6) tobacco-free policy and varied by geography (urban vs rural) and student population size. Three main themes emerged: 1) no "wrong door" for students to engage in tobacco control work, 2) a myriad of ways for students to be involved in policy adoption, and 3) benefits of student engagement. We found that students are doers, allies, and champions in adoption of 100% campus tobacco-free policy. Colleges should leverage their campuses' most important assets - students - to be agents of change and to involve them in the full spectrum of interventions and advocacy.

Abstract 15711: Association Between State Tobacco Surcharge Policy and Health Insurance Enrollment, Health Care Utilization, and Smoking Cessation Behaviors

Introduction: The Patient Protection and Affordable Care Act allows insurers to charge up to 50% higher premiums to people who use tobacco. Several states have outlawed tobacco surcharges or capped the surcharges to lower levels. Evidence on the impact of state policies limiting tobacco surcharges is limited. This study aims to examine the association between state tobacco surcharge policies and individuals’ health insurance enrollment, health care utilization, and smoking cessation behaviors. Methods: This study used data from the Population Assessment of Tobacco and Health (PATH) Study Wave 6 (Mar-Nov 2021). The study sample was adults 18-64 years old who reported smoking cigarettes 20 or more days in the past 30 days (N=4,235). Exposure was living in states limiting tobacco surcharges (outlawed or capped). Outcome variables were currently covered by health insurance, seen a health professional in the past 12 months, intention to quit within 12 months, and any quit attempt in the past 12 months. Single-wave sample weights and balanced repeated replication method were applied to generate representative estimates and variances. Multivariate logistic regressions were used to estimate the associations between exposure and outcomes, controlling for socio-demographic variables, other tobacco use status, and state Medicaid expansion and tobacco control policies. Results: Among study sample, 19.8% (95% CI: 16.0%-24.3%) lived in states limiting tobacco surcharges. Bivariate associations showed that people living in states limiting surcharges were more likely to be covered by health insurance (84.5%, 95% CI: 81.2%-87.3% vs. 75.0%, 95% CI: 72.9%-77.1%, p &lt; 0.001). After adjusting for covariates, the association between state policies and health insurance coverage became statistically insignificant (adjusted odds ratio, aOR=1.09, 95% CI: 0.80-1.47). Participants living in states limiting surcharges were less likely to have intention to quit within 12 months (aOR=0.78, 95% CI: 0.65-0.94). Other associations were not statistically significant. Conclusions: This study indicated that people living in states limiting tobacco surcharges had lower intention to quit smoking. More studies are needed to evaluate the impact of tobacco surcharge policies.

Health, economic, and equity consequences of future tobacco control policies in England: a microsimulation study

BackgroundSmoking still generates a huge, costly, and inequitable burden of disease. The UK tobacco-free generation target to reduce smoking prevalence to below 5% by 2030 will be missed if current trends continue. We aimed to determine whether additional policies could speed progress towards meeting the tobacco-free generation target. MethodsWe developed, calibrated, and validated a microsimulation model, IMPACTHINT simulating English adults aged 30–89 years from 2023 to 2072. The model included a detailed smoking history and quantified policy health outcomes including smoking prevalence and smoking-related diseases, economics, and equity. We simulated five scenarios: (1) baseline trends; (2) increasing the minimum age of access to tobacco to 21 years (MinAge21); (3) a 30% increase in tobacco duty (TaxUP); (4) improved smoking cessation services (ServicesUP); and (5) a combination of TaxUP and ServicesUP. We estimated the smoking prevalence, smoking-related diseases and cumulative cases prevented or postponed, and deaths. We evaluated the scenario cost-effectiveness from the societal perspective. Lastly, we analysed the results by deprivation quintile. We present in our findings cumulative cases prevented or postponed over 50 years. FindingsNone of the scenarios would reduce overall smoking prevalence to below 5% by 2030. However, that goal could be reached by 2035 under the TaxUP and the combination of TaxUP and ServicesUP scenarios, by 2037 under the ServicesUP scenario, or by 2038 under the MinAge21 and the baseline scenarios. By 2072, the combined scenario might reduce smoking-related diseases by 160 000 cases (95% CI 140 000–200 000), greatly exceeding the reductions by 140 000 cases (120 000–180 000) with TaxUP, 69 000 cases (53 000–86 000) with MinAge21, or 22 000 cases (14 000–31 000) with ServicesUP. Some 50% of all disease-years reduced by TaxUP would occur in the most deprived quintile. The most affluent quintile could reach the 5% goal sooner than the most deprived quintile (by 2032 for the least deprived vs 2038 for the most deprived), and it could reach the 5% target by 2030 under the combined TaxUP and ServicesUP scenario. Finally, all policies would save costs compared with the baseline trend. InterpretationAffluent groups will achieve the 5% tobacco-free goal a decade sooner than the most deprived. However, that goal could be achieved in all groups by 2035 through a 30% increase in tax and enhanced smoking cessation services. Our limitations included the uncertainties of any 50-year forecast. However, that long time-horizon can capture the potential policy benefits for younger age groups. FundingEconomic and Social Research Council.

Social Determinants and the Prevalence of Paan Masala Use among Adults in India: Results from Global Adult Tobacco Survey, 2016-17.

Gutkha or Paan masala with tobacco is commonly used smokeless tobacco product in India. Given the restrictions on advertisement and promotion of Gutkha and the necessity of warning labels on tobacco products, the tobacco industry has popularised paan masala without tobacco as a surrogate product. Paan masala itself is harmful for health but remains beyond scope of current tobacco control policies. It was important to understand prevalence and determinants of its use (with or without tobacco). Data from the Global Adult Tobacco Survey (GATS)-2, India was used to estimate prevalence of paan masala use (with or without tobacco) in India. Multi-nominal regression and logistic regression were used to calculate risk ratios and odds ratios. The prevalence of any form of paan masala was 12.1% among adults in India. Prevalence was higher among males (17.8%) than females (6.0%), aged 25-44 years (14.5%) than those aged 65 years or above (9.0%). Relative risk ratio (RRR) for Paan masala with tobacco was significantly high among those with no formal schooling (RRR:2.00) and among those in poorest wealth quintiles (RRR:1.26). While, RRR were lower for Paan masala use without tobacco among those with no formal schooling (RRR:0.95) and among poorest wealth quintiles (RRR:0.78). Region-wise AOR were highest for North-East (AOR:4.80) and Central regions (AOR:4.76) compared to South India. The prevalence of paan masala use is high in India. Persons belonging to lower socioeconomic status or having no formal schooling have higher risk of consuming paan masala with tobacco. However, persons from higher wealth quintiles or having formal schooling had higher risk of use of paan masala without tobacco. These findings need careful attention of policy makers and law enforcers as it indicates different marketing strategies might have adopted by industry to target these two mutually exclusive population groups.

Discussion of Heated Tobacco Products on Twitter Following IQOS's Modified-Risk Tobacco Product Authorization and US Import Ban: Content Analysis.

Understanding public opinions about emerging tobacco products is important to inform future interventions and regulatory decisions. Heated tobacco products (HTPs) are an emerging tobacco product category promoted by the tobacco industry as a "better alternative" to combustible cigarettes. Philip Morris International's IQOS is leading the global HTP market and recently has been subject to important policy events, including the US Food and Drug Administration's (FDA) modified-risk tobacco product (MRTP) authorization (July 2020) and the US import ban (November 2021). Although limited in their legal implications outside the United States, these policy events have been quoted in global news outlets and Philip Morris International's promotional communications, showing how they may potentially impact global tobacco regulation. Given the impending return of IQOS to the US market, understanding how the policy events were received through social media discourse will provide valuable insights to inform global tobacco control policy. This study aims to examine HTP-related social media discourse around important policy events. We analyzed HTP-related posts on Twitter during the time period that included IQOS's MRTP authorization in the United States and the US import ban, examining personal testimonial, news/information, and direct marketing/retail tweets separately. We also examined how the tweets discussed health and policy. A total of 10,454 public English tweets (posted from June 2020 to December 2021) were collected using HTP-related keywords. We randomly sampled 2796 (26.7%) tweets and conducted a content analysis. We used pairwise co-occurrence analyses to evaluate connections across themes. Tweet volumes peaked around IQOS-related policy events. Among all tweets, personal testimonials were the most common (1613/2796, 57.7%), followed by news/information (862/2796, 30.8%) and direct marketing/retail (321/2796, 11%). Among personal testimonials, more tweets were positive (495/1613, 30.7%) than negative (372/1613, 23.1%), often comparing the health risks of HTPs with cigarettes (402/1613, 24.9%) or vaping products (252/1613, 15.6%). Approximately 10% (31/321) of the direct marketing/retail tweets promoted international delivery, suggesting cross-border promotion. More than a quarter of tweets (809/2796, 28.9%) discussed US and global policy, including misinterpretation about IQOS being a "safer" tobacco product after the US FDA's MRTP authorization. Neutral testimonials mentioning the IQOS brand (634/1613, 39.3%) and discussing policy (378/1613, 23.4%) showed the largest pairwise co-occurrence. Results suggest the need for careful communication about the meaning of MRTP authorizations and relative risks of tobacco products. Many tweets expressed HTP-favorable opinions referring to reduced health risks, even though the US FDA has denied marketing of the HTP with reduced risk claims. The popularity of social media as an information source with global reach poses unique challenges in health communication and health policies. While many countries restrict tobacco marketing via the web, our results suggest that retailers may circumvent such regulations by operating overseas.

Association between tobacco control policies and smoking behaviour in Europe

Abstract Background Smoking is an important public health problem. The European Health Interview Survey (EHIS) provides regular data on prevalence and determinants of smoking for the populations of European countries, while the Tobacco Control Scale (TCS) quantifies the implementation of tobacco control measures. The aim is to examine the associations between tobacco control policies at country level and individual-level smoking prevalence. Methods Using multi-level regression modelling, individual data from EHIS 2019/2020 and country-level data from TCS 2019 were analysed. The outcome measure was self-reported current smoking (daily or occasional) at the individual level. Predictor variables were at the individual level: gender, age and education attainment level, and at country level: scores of TCS policy components ‘Price', ‘Public place bans', ‘Advertising bans', ‘Health warnings', ‘Treatment’ and ‘Illicit trade'. Microdata from the 3rd wave of EHIS for 28 European countries were used with a total of n = 66.934 individuals aged &amp;gt;15 years. A weighting factor was applied to consider each country proportionally according to its sample size in EHIS. Results There are large cross-national differences in current smoking prevalence ranged from 12.6% (95% confidence interval (CI) 11.9-13.3) in Sweden to 36.2% (95% CI 35.0-37.4) in Bulgaria. In the final multi-level model besides individual variables (female gender, age 60 years and over, medium or high education level), following variables at country level were significantly associated with lower prevalence of current smoking: ‘Price’ (Odds Ratio (OR)=0.96 (p &amp;lt; 0.05) and ‘Treatment’ OR = 0.88; (p &amp;lt; 0.01). For ‘Public place bans', ‘Advertising bans', ‘Health warnings’ and and ‘Illicit trade’ association were in same direction but without significance. Conclusions Tobacco control policies help to reduce the prevalence of smoking in population, although the different measures have differing impact. Key messages • Our study confirms the link between the implementation of tobacco control policies and smoking prevalence using recent data. • Policy components have different effects on smoking prevalence at population level.

Evaluating achieving tobacco control targets in Belgium using modelled projections

Abstract Background Tobacco use in Belgium remains a key public health concern with an estimated 15% of adults reporting daily tobacco use in 2018. In 2022, the Belgian government launched the “Interfederal Strategy 2022-2028 for a Smoke-free Generation.” The strategy outlines a number of targets for reducing daily tobacco use among adults 15+ years and young adults 15-24 years. We evaluate the feasibility of achieving these targets given current daily smoking trajectories at a national and regional level. Methods We modelled time trends of smoking in Belgium based on repeated cross-sectional data taken from the nationally representative Belgian Health Interview Survey. We applied a Bayesian inference model, the integrated nested Laplace approximation, to obtain a time series of daily tobacco use for adults by age, sex, and region of Belgium from 1997 to 2018. We then projected this model to 2070 using population projections from the Belgian Federal Planning bureau for population distributions. We compared trajectories with targets from the Interfederal Strategy to assess whether they are likely to be achieved. Results The national target of reducing daily smoking among adults 15+ years to 10% by 2028 and 5% by 2040 will not be achieved on current trajectories. Wallonia has the highest level of people smoking daily and is projected to miss the targets by the largest margin. Flanders is expected to reach the 10% threshold by 2032. The target for reduction of prevalence of daily smoking among youth 15-24 years to 6% by 2028 will not be achieved before 2040. Smoking among the youngest age group (15-24 years) is decreasing rapidly with prevalence of daily smoking in that age group projected to be &amp;lt; 2% in Flanders by 2059. Conclusions No region of Belgium is expected to achieve targets for reduction in daily smoking given current trajectories. Tobacco control policies in the country should be re-assessed, targeted and intensified. Key messages • The Belgian national target of 5% daily smoking prevalence in adults by 2040 will not be achieved. • Differences in smoking trajectories in Belgium exist by age and region; tobacco control policies should be targeted.

Secondhand Smoke Exposure and Smoking Prevalence Among Adolescents

Secondhand smoke is a substantial risk factor for youth health globally, including in Japan, where tobacco control policies should be reassessed. To assess trends in the prevalence of secondhand smoke exposure among Japanese adolescents from 2008 to 2017 and to examine the association between its frequency and smoking during the study period. This study comprised a nationally representative, self-administered, school-based, cross-sectional survey focusing on tobacco and alcohol use and related factors among students in grades 7 to 12 (ages 12-18 years) in Japan. This random sampling survey used single-stage cluster sampling. Using the national school directory, junior and senior high schools throughout Japan were randomly extracted from each regional block. All students enrolled in the sampled schools were included as participants, and school-based surveys were completed in 2008, 2012, and 2017. Data analysis was performed from January 1 to March 15, 2023. Prevalence of secondhand smoke exposure among adolescents in Japan from 2008 to 2017 and changes in the association between secondhand smoke exposure frequency and prevalence of smoking were examined using multiple logistic regression analysis. Data were analyzed for 95 680 adolescents in 2008 (50.7% boys), 100 050 in 2012 (51.6% boys), and 64 152 in 2017 (53.9% boys). At baseline, 42.0%, 38.5%, and 34.6% of the participants were junior high school students in 2008, 2012, and 2017, respectively. Based on the 2008 surveys, 51.0% of adolescents in grades 7 to 12 were exposed to secondhand smoke in any place (≥1 day during the past 7 days), 37.2% were exposed at home, and 36.5% were exposed in public places. In 2017, 36.3% of participants were exposed to secondhand smoke in any place, 23.8% were exposed at home, and 27.0% were exposed in public places. An association between secondhand smoke exposure frequency and prevalence of smoking was observed consistently regardless of survey year, location, or pattern of exposure (adjusted odds ratios ranged from 2.29 [95% CI, 1.81-2.91] for 1-2 days at home to 11.15 [95% CI, 8.50-14.62] for 7 days in public places). Stratified analysis by higher education intention indicated that the prevalence of smoking and secondhand smoke exposure decreased but remained higher among adolescents who did not intend to pursue higher education. The association between secondhand smoke and smoking did not differ substantially between groups. In this cross-sectional study, the prevalence of secondhand smoke exposure among adolescents in Japan decreased but remained at high levels overall. There may not be a hazard-free threshold for smoking. Enhancing comprehensive tobacco control strategies is Japan's first step toward achieving smoke-free environments to protect youths. Implementation and verification of the effectiveness of smoke-free legislation should be considered.

Trade agreements and tobacco control policy: analysis of the impact of FCTC on regulatory contents of trade agreements from 2001 to 2019

BackgroundThis study aims to analyze the impact of Framework of Convention of Tobacco Control (FCTC) on regulatory contents of trade agreements from 2001 to 2019.MethodsA search of trade agreements from‘WTO Regional Free Trade Agreement Database’ using keywords including “tobacco”, “cigarette”, “smoking” and “FCTC” from May to August 2020 resulted in a total sample of 268 trade agreements, from which 69 trade agreements were coded and analyzed. Provisions in trade agreements, identified via the aforementioned keywords, were categorized into 6 trade measures. The word counts of the provisions containing; FCTC; were calculated. Chi-square tests were applied to analyze the differences of regulatory patterns between different time frames. The import and export values (USD) of tobacco products under trade agreements containing the term “FCTC” were further collected from the “International Trade Statistics 2001–2020” for understanding the impact of the provision on the trade flow.ResultsAmong 69 agreements, the percentage of trade agreements containing keyword as “FCTC” increased significantly from 0% to 2011 to 12% after 2011. A significant decrease of using trade measures as “the exclusion list” was found after 2011 (from 10% to 0). The word counts of provisions containing; FCTC; increased from 24 words in 2011 to 164 words in 2018, and the content of the provisions became more concrete over time. There are six trade agreements containing “FCTC”, and all these 6 agreements were ratified by European Union (EU). Despite EU ratified trade agreements with “FCTC”, the import and export values of tobacco products between EU and the other party countries increased with time. But the gap of average trade values between trade agreements with and without “FCTC” being widened with time.ConclusionsAs a first study evaluated the impact of FCTC on regulatory contents of trade agreements, our study results showed that after countries signed trade agreements containing keyword FCTC, the regulatory contents changed significantly. Further studies are recommended to understand the reason and criteria for incorporating FCTC provisions into trade agreements, especially in the EU.

Perspectives on limiting tobacco access and supporting access to nicotine vaping products among clients of residential drug and alcohol treatment services in Australia

IntroductionTobacco endgame strategies aim to drive down population smoking rates, the success of which can be improved with public buy-in, including from populations with high smoking rates such as alcohol...

Shifting the gaze on implementation: examining the association between the implementation of tobacco control laws and prevalence of tobacco using data from a nationally representative survey

BackgroundTobacco use and the associated health burden is a cause of concern in India and globally. Despite several tobacco control policies in place, their sub-optimal and variable implementation across Indian states has remained a concern. Studies evaluating the real-world implementation of policies such as Cigarettes and Other Tobacco Products (COTPA) or National Tobacco Control Program (NTCP) in India and its association with reductions in tobacco use are limited. In this paper, we analyse data from a nationally representative survey to examine how policy implementation is associated with the tobacco use prevalence in India.MethodsWe analysed data from the Global Adult Tobacco Survey (GATS 2016–17) India using multivariable logistic regression. The dependent variables were the use of smoked tobacco, smokeless tobacco, and tobacco in any form. The independent variables were proxies of implementation of the COTPA and the NTCP. We followed a step-wise backward elimination technique to reach the best fit models.ResultsPeople exposed to no-smoking signages had lower odds of using tobacco (OR = 0.70, p < 0.001). People exposed to second-hand smoke (OR = 1.51, p < 0.001) and tobacco product advertisements (OR = 1.23, p < 0.001) had greater odds of using tobacco. Exposure to tobacco advertisements was associated with higher odds of using smokeless tobacco (OR = 1.23, p < 0.001), and smoked (OR = 1.33, p < 0.001) forms of tobacco.ConclusionWe find significant association between the implementation of tobacco control laws/programs and tobacco use in India. Our findings highlight the potential that policy implementation holds in reducing population-level tobacco use thus drawing attention towards the implementation phase of policies. The findings have implications on prioritising enforcement of specific tobacco control measures such as smokefree laws, modifying COTPA signages to encompass all tobacco products including against smokeless tobacco use and strengthening indirect advertising restrictions. Future research could focus on developing and validating predictors specific to policy implementation to support policy evaluation efforts.