Tobacco Control Spending Research Articles

Cigarette smoking decline among US young adults from 2000 to 2019, in relation to state-level cigarette price and tobacco control expenditure

ObjectiveTo investigate the association of state-level cigarette price and tobacco control expenditure with the large 2000–2019 decline in cigarette smoking among US 18–24 year-olds.MethodsSmoking behaviour was assessed in the 24...

Examination of the association between state tobacco control spending and the demand for electronic cigarettes by high school students

BackgroundWhile much is known about the influence of tobacco control spending on the demand for conventional cigarettes, little is known about the effects of tobacco control spending on the demand...

The Mexico SimSmoke tobacco control policy model: Development of a simulation model of daily and nondaily cigarette smoking.

BackgroundNondaily smoking has been on the rise, especially in Mexico. While Mexico has strengthened its tobacco control policies, their effects on nondaily smokers have gone largely unexamined. We developed a simulation model to estimate the impact of tobacco control policies on daily and nondaily smoking in Mexico.MethodsA previously validated Mexico SimSmoke model that estimated overall trends in smoking prevalence from 2002 through 2013 was extended to 2018 and adapted to distinguish daily and nondaily smoking prevalence. The model was then validated using data from Mexican surveys through 2016. To gauge the potential effects of policies, we compared the trends in smoking under current policies with trends from policies kept at their 2002 levels.ResultsBetween 2002 and 2016, Mexico SimSmoke underestimated the reduction in male and female daily smoking rates. For nondaily smoking, SimSmoke predicted a decline among both males and females, while survey rates showed increasing rates in both genders, primarily among ages 15–44. Of the total reduction in smoking rates predicted by the model by 2018, tax policies account for more than 55%, followed by health warnings, cessation treatment, smoke-free air laws, and tobacco control spending.ConclusionsAlthough Mexico SimSmoke did not successfully explain trends in daily and nondaily smoking, it helps to identify gaps in surveillance and policy evaluation for nondaily smokers. Future research should consider appropriate measures of nondaily smoking prevalence, trajectories between daily and nondaily smoking, and the separate impact of tobacco control policies on each group.

The Impact of State Tobacco Control Spending on High School Student Vaping

The rapid rise in e-cigarette use rates among high school students in the United States is a significant source of public policy concern for many states. This paper is the first study to examine the impact of state tobacco control spending on the demand for vaping products by high school students. The findings from this study provide strong evidence that funding for state tobacco control programs is associated with reduced vaping among youth and young adults in the US. These findings could help to inform decision making about how states should allocate scarce public resources.

One size fits all? Disentangling the effects of tobacco taxes, laws, and control spending on adult subgroups in the United States

ABSTRACTBackground: To determine the relative impact of each of the 3 state-level tobacco control policies (cigarette taxation, tobacco control spending, and smoke-free air [SFA] laws) on adult smoking rate overall and separately for adult subgroups in the United States. Methods: A difference-in-differences analysis was conducted with generalized propensity scores. State-level policies were merged with the individual-level Behavioral Risk Factor Surveillance System in 1995–2009. Results: State cigarette taxation was the only policy that significantly impacted smoking among the general adult population, with a 1-standard deviation increase in taxes (i.e., $0.68 in constant 2014 dollars) lowering the adult smoking rate by about a quarter of a percentage point. The taxation impact was consistent, regardless of the presence of, or interactions with, other policies. Taxation was also the only policy that significantly reduced smoking for some adult subgroups, including females, non-Hispanic whites, adults aged 51 or older, and adults with more than a high school education. However, other adult subgroups responded to the other 2 types of policies, either by mediating the taxation effect or by reducing smoking independently. Specifically, tobacco control spending reduced smoking among young adults (ages 18–25 years) and Hispanics. SFA laws affected smoking among men, young adults, non-Hispanic blacks, and Hispanics. Conclusions: State cigarette taxation is the single most important policy for reducing smoking among the general adult population. However, adult subgroups' reactions to taxes are diverse and mediated by tobacco control spending and SFA laws.

State tobacco control expenditures and tax paid cigarette sales.

This research is the first nationally representative study to examine the relationship between actual state-level tobacco control spending in each of the 5 CDC’s Best Practices for Comprehensive Tobacco Control Program categories and cigarette sales. We employed several alternative two-way fixed-effects regression techniques to estimate the determinants of cigarette sales in the United States for the years 2008–2012. State spending on tobacco control was found to have a negative and significant impact on cigarette sales in all models that were estimated. Spending in the areas of cessation interventions, health communication interventions, and state and community interventions were found to have a negative impact on cigarette sales in all models that were estimated, whereas spending in the areas of surveillance and evaluation, and administration and management were found to have negative effects on cigarette sales in only some models. Our models predict that states that spend up to seven times their current levels could still see significant reductions in cigarette sales. The findings from this research could help inform further investments in state tobacco control programs.

The Prevalence and Characteristics of E-Cigarette Users in the U.S.

Studies have examined the characteristics of individuals who use e-cigarettes, including sociodemographic and smoking characteristics, and the relationship of e-cigarette use to tobacco control policies. While most studies consider a subset of these characteristics with weak measures of regular e-cigarette use, this study uses a large, recent U.S. survey to simultaneously consider the association of each of these factors with different use measures. Data from the May 2014 Tobacco Use Supplement-Current Population Survey is supplemented with information on tobacco control policies. The prevalence of ever, current (at least 1 of the last 30 days), and regular (at least 20 of the last 30 days) e-cigarette use were 7.7%, 2.1% and 0.9%, implying that 27.0% of ever users were current users of which 45.3% were regular users. E-cigarette use varied by socio-demographic characteristics and by smoking status, and depended on the measure of use adopted. However, regardless of measures, e-cigarette use was higher among those smokers who smoked more cigarettes. The association with policies was generally weak, but we found more regular use by smokers in low tax and low tobacco control spending states. The results indicate that the user characteristics differ depending on the e-cigarette use measure. The measure of use should be carefully considered in analyzing how e-cigarette use affects cigarette use.

Gauging the Effect of U.S. Tobacco Control Policies From 1965 Through 2014 Using SimSmoke.

The year 2014 marked the 50th Anniversary of the first Surgeon General's Report. This paper estimates the effect of tobacco control policies in the U.S. after the 1964 Report using the SimSmoke tobacco control simulation model. SimSmoke uses National Health Interview Survey data from 1965 through 2012 on smoking prevalence, initiation, and cessation rates, and incorporates policies implemented since 1965. The model projects smoking prevalence and smoking-attributable deaths (SADs) from 1965 through 2065 and is validated against National Health Interview Survey data. Counterfactual scenarios with policies constant since 1965 and with individual policies are estimated. Analysis was conducted in February 2014. SimSmoke generally validated well during the time period from 1965 through 2012. As a result of all policies, smoking prevalence is estimated to have fallen by almost 55% by 2014, with a total of 2 million SADs averted from 1965 through 2014, increasing to 20.1 million SADs by 2065. The Fairness Doctrine is estimated to have reduced adult smoking prevalence by about 24% by 2014 and averted 10.4 million SADs by 2065, while price increases reduced smoking prevalence by 24% by 2014 and averted 7.3 million SADs by 2065. Smoke-free air laws, cessation treatment, and tobacco control spending individually reduced smoking rates by 3%-5.5% by 2014. By 2014, SimSmoke predicts a 53% reduction in smoking rates and almost 2 million SADs averted due to polices implemented since the 1964 Surgeon General's Report, with most of the health benefit still to occur in future years.

Measuring Armenia's progress on the Tobacco Control Scale: an evaluation of tobacco control in an economy in transition, 2005–2009

ObjectivesThis study aimed to measure the 5-year progress in the implementation of WHO Framework Convention on Tobacco Control (FCTC) in Armenia by applying the Tobacco Control Scale, a rapid assessment...

The political economy of tobacco control spending

This article investigates why some US states spend so comparatively little on Tobacco Control Funding (TCF). We find that cross-state variation in spending on tobacco control is significantly driven by a tobacco special interest effect.

A note on the determinants of substance abuse spending

Although many studies have addressed policies directed towards the use of licit drugs, namely, alcohol and tobacco, less attention has been paid on policies affecting the use of illicit drugs. Accordingly, similar to studies of tobacco control spending, this article addresses the determinants of US state-level spending on substance abuse. Substance abuse spending is found to be higher in states with higher illicit drug use, as well as more rural states with higher per capita income, whose legislatures are controlled by Democrats.

Reducing Prenatal Smoking: The Role of State Policies

Maternal smoking causes adverse health outcomes for both mothers and infants and leads to excess healthcare costs at delivery and beyond. Even with substantial declines over the past decade, around 23% of women enter pregnancy as a smoker and though almost half quit during pregnancy, half or more quitters resume smoking soon after delivery. To examine the independent effects of higher cigarette taxes and prices, smokefree policies, and tobacco control spending on maternal smoking prior to, during, and after a pregnancy during a period in which states have made changes in such policies. Data from pooled cross-sections of women with live births during 2000-2005 in 29 states plus New York City (n=225,445) were merged with cigarette price data inclusive of federal, state, and local excise taxes, full or partial bans on smoking in public places, and tobacco control spending. Probit regression models using a mixed panel, state fixed effects, and time indicators were used to assess effect of policies on smoking (during 3 months before pregnancy); quitting by last 3 months of pregnancy; and having sustained quitting at the time of completing the postpartum survey. Multivariate analysis indicated that a $1.00 increase in taxes and prices increases third-trimester quits by between 4 and 5 percentage points after controlling for the other policies and covariates. Implementing a full private worksite smoking ban increases quits by the third trimester by an estimated 5 percentage points. Cumulative spending on tobacco control had no effect on pregnancy smoking rates overall. Association of tobacco control policies with maternal smoking varied by age. States can use multiple tobacco control policies to reduce maternal smoking. Combining higher taxes with smokefree policies particularly can be effective.

The impact of changes in tobacco control funding on healthcare expenditures in California, 2012–2016

ObjectiveThis study presents estimates of the impact of changes in California tobacco control funding on healthcare expenditures for 2012–2016 under four funding scenarios.MethodsSmoking prevalence is projected using a cointegrated time...

What impact have tobacco control policies, cigarette price and tobacco control programme funding had on Australian adolescents' smoking? Findings over a 15‐year period

To assess the impact of tobacco control policies relating to youth access, clean indoor air and tobacco advertising at point-of-sale and outdoors, in addition to cigarette price and per capita tobacco control spending, on adolescent smoking prevalence. Repeated cross-sectional surveys. Logistic regression analyses examined association between policies and smoking prevalence. Australia, 1990-2005. A nationally representative sample of secondary students (aged 12-17 years) participating in a triennial survey (sample size per survey range: 20 560 to 27 480). Students' report of past-month smoking. In each jurisdiction, extent of implementation of the three policies for the year of the survey was determined. For each survey year, national per capita tobacco control spending was determined and jurisdiction-specific 12-month change in cigarette price obtained. Extent of implementation of the three policy areas varied between states and over the survey years. Multivariate analyses that adjusted for demographic factors, year and all tobacco control variables showed that 12-month cigarette price increases [odds ratio (OR): 0.98, 95% confidence interval (CI): 0.97-0.99], greater per capita tobacco control spending (OR: 0.99, 95% CI: 0.98-0.99) and stronger implementation of clean indoor air policies (OR: 0.93, 95% CI: 0.92-0.94) were associated with reduced smoking prevalence. Adult-directed, population-based tobacco control policies such as clean indoor air laws and increased prices of cigarettes, implemented as part of a well-funded comprehensive tobacco control programme are associated with lower adolescent smoking.

Why does tobacco-control spending vary so much across states?

Although tobacco-control spending is considered an essential component of comprehensive programmes aimed at lowering smoking, substantial variation exists across states. This article examines if variation is systematically related to cross-state differences in smoking prevalence, holding other factors constant that are expected to influence spending. An econometric model is estimated which considers effects of tobacco-settlement revenues, income, unemployment, political party of the governor, state debt and smoking prevalence on tobacco-control spending in all states during 2000–2007. Estimations control for the possibility that spending and smoking prevalence are co-determined to clearly determine the causal link from prevalence to spending. Spending variation is determined to be inconsistent with a ‘rational needs’ strategy whereby states with higher prevalence choose more funding than states with lower prevalence. This empirical result is consistent with recent studies indicating that spending on tobacco control exerts little to no effect on cigarette sales or smoking prevalence.

Quit attempts and quit rates among menthol and nonmenthol smokers in the United States.

We compared quit attempts and quit rates among menthol and nonmenthol cigarette smokers in the United States. We used data from the 2003 and 2006-2007 waves of the large, nationally representative Tobacco Use Supplement to the Current Population Survey with control for state-level tobacco control spending, prices, and smoke-free air laws. We estimated mean prevalence, quit rates, and multivariate logistic regression equations by using self-respondent weights for menthol and nonmenthol smokers. In 2003 and 2007, 70% of smokers smoked nonmenthol cigarettes, 26% smoked menthol cigarettes, and 4% had no preference. Quit attempts were 4.3% higher in 2003 and 8.8% higher in 2007 among menthol than nonmenthol smokers. The likelihood of quitting was 3.5% lower for quitting in the past year and 6% lower for quitting in the past 5 years in menthol compared with nonmenthol smokers. Quit success in the past 5 years was further eroded among menthol-smoking Blacks and young adults. Menthol smokers are more likely to make quit attempts, but are less successful at staying quit. The creation of menthol preference through marketing may reduce quit success.

Effectiveness of Massachusetts’ comprehensive tobacco control program

While Massachusetts's comprehensive programme of excise taxes, smoking bans and tobacco control has been argued to have significantly lowered cigarette consumption, this is the first study to examine the comprehensive nature of its programme and to control for factors other than tobacco programmes themselves while examining effects on taxed cigarette sales. Examination indicates strong support for the hypotheses that taxed sales in Massachusetts declined due to price increases, changes in income and smuggling. There is very limited support for the hypothesis that tobacco control spending or smoking bans contributed to falling cigarette sales. Possibilities are discussed that may explain why this study does not support most previous studies. These include failure to control for numerous factors that probably also influenced sales, that effects of tobacco control programmes might differ between states and that previous studies examined shorter time periods. It is hoped that this article will foster further examination of these issues so that we can better understand effectiveness of comprehensive tobacco control programmes when formulating recommendations about how governments should allocate their scarce resources towards such programmes.

Do expenditures on tobacco control decrease smoking prevalence?

Effectiveness of tobacco control programmes in reducing smoking prevalence during 2001 to 2005 is examined. Tobacco control spending is found to exert no significant effects on smoking prevalence across the 50 states. Cigarette prices are found to lower prevalence of daily smokers, but exert no effect on nondaily smoking prevalence. Several reasons are suggested for why these results might conflict with previous research. These include that most previous studies examined two states (California and Massachusetts) with long-standing tobacco control programmes and that most studies examined periods in which many of the states in their samples did not actively fund their programmes. Another reason may be that, unlike most previous studies, this study controls for the possibility that tobacco control spending is endogenous when, for example, states exhibiting relatively low smoking prevalence are also states with relatively high distaste for smoking and accordingly fund tobacco control programmes more generously. A negative relation between tobacco control spending and smoking prevalence does not necessarily indicate that higher spending causes lower prevalence when spending is endogenously determined.

Do state characteristics matter? State level factors related to tobacco cessation quitlines

Background:Quitline services are an effective population-wide tobacco cessation strategy adopted widely in the United States as part of state comprehensive tobacco control efforts. Despite widespread evidence supporting quitlines’ effectiveness, many...

Do Tobacco-Control Programs Lower Tobacco Consumption?

California is often considered the model for tobacco-control programs due to its early adoption of comprehensive programs aimed at lowering tobacco consumption. Tobacco control began when voters approved the California Tobacco Tax and Health Promotion Act of 1988. More than $2 billion has been spent on tobacco-control in California since 1988. The findings of this article indicate that tobacco-control spending is a significant factor for the widening gap between consumption in the United States and in California only in equations that exclude cigarette prices and smoking bans as control variables. When significant, however, estimates suggest that, for every $1 increase in tobacco-control spending per capita, the sales gap widens by only 0.11 to 0.18 cigarette packs per capita, or roughly 2 to 4 cigarettes per capita. This study suggests that future research should address the complexity of interactions among tobacco-control programs, cigarette prices, and smoking bans.