Regulate Tobacco Products Research Articles

Quasi-Experimental Designs for Assessing Response on Social Media to Policy Changes

Regulation of tobacco products is rapidly evolving. Understanding public sentiment in response to changes is very important as authorities assess how to effectively protect population health. Social media systems are widely recognized to be useful for collecting data about human preferences and perceptions. However, how social media data may be used, in rapid policy change settings, given challenges of narrow time periods and specific locations and non-representative the population using social media is an open question. In this paper we apply quasi-experimental designs, which have been used previously in observational data such as social media, to control for time and location confounders on social media, and then use content analysis of Twitter and Reddit posts to illustrate the content of reactions to tobacco flavor bans and the effect of taxation on e-cigarettes. Conclusions distill the potential role of social media in settings of rapidly changing regulation, in complement to what is learned by traditional denominator-based representative surveys.

Overview of tobacco use transitions for population health

The Family Smoking Prevention and Tobacco Control Act provided the US Food and Drug Administration authority to regulate tobacco products using a population health standard. Models have been developed to...

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.

A Philip Morris advertisement for its heated tobacco product IQOS sets a troubling precedent

Philip Morris was allowed to market its IQOS brand of heated (or 'heat-not-burn') tobacco in the USA in April 2019 after receiving a marketing order from the Food and Drug...

Coronavirus Disease 2019 - FDA Updates

The aim of present review is to provide an insight on FDA updates in it’s own words on coronavirus disease 2019. The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Is it time for South Africa to end the routine high-dose vitamin A supplementation programme?

In accordance with World Health Organization guidelines, South Africa (SA) introduced routine periodic high-dose vitamin A supplementation (VAS) in 2002. These guidelines were developed after research in the 1980s and 1990s showed the efficacy of VAS in reducing childhood mortality. However, two recent studies in low- to middle-income countries (2013 and 2014) have shown no effect of high-dose VAS on mortality. Additionally, there is no clear research evidence that 6-monthly doses of vitamin A result in a sustained shift in serum retinol levels or reduce subclinical vitamin A deficiency. These two points should encourage SA to re-examine the validity of these guidelines. A long-term view of what is in the best interests of the majority of the people is needed. The short-term intervention of administering vitamin A capsules not only fails to improve serum retinol levels but may create dependence on a 'technical fix' to address the fundamental problem of poor nutrition, which is ultimately underpinned by poverty. It may also cause harm. Although there are those, some with vested interests, who will argue for continuation of the routine high-dose VAS programmes, SA policymakers and scientists need to evaluate the facts and be prepared to rethink this policy. There is cause for optimism: SA's health policymakers have previously taken bold stands on the basis of evidence. The examples of regulation of tobacco products and taxation of sugar-sweetened beverages, ending the free distribution of formula milk for HIV-positive mothers and legislating against the marketing of breastmilk substitutes provide precedents. Here is a time yet again for decision-makers to make bold choices in the interests of the people of SA. While the cleanest choice would be national discontinuation of the routine VAS programme, there may be other possibilities, such as first stopping the programme in Northern Cape Province (where there is clear evidence of hypervitaminosis A), followed by the other provinces in time.

Tobacco Product Use and Associated Factors Among Middle and High School Students - United States, 2019.

Tobacco Product Use and Associated Factors Among Middle and High School Students - United States, 2019.

Aldehyde and Volatile Organic Compound Yields in Commercial Cigarette Mainstream Smoke Are Mutually Related and Depend on the Sugar and Humectant Content in Tobacco.

IntroductionThe World Health Organization (WHO) Framework Convention on Tobacco control recognizes the need for tobacco product regulation. In line with that, the WHO Study Group on Tobacco Product Regulation (TobReg) proposed to regulate nine toxicants in mainstream cigarette smoke, including aldehydes, volatile organic compounds (VOCs), and carbon monoxide (CO). We analyzed their relations in 50 commercially available cigarette brands, using two different smoking regimes, and their dependence on sugar and humectant concentrations in tobacco filler.MethodsWe measured sugar and humectant in tobacco filler and aldehydes, VOCs, and tar, nicotine, and CO (TNCO) in mainstream smoke. The general statistics, correlations between emission yields, and correlations between contents and emissions yields were determined for these data.ResultsFor aldehydes, several significant correlations were found with precursor ingredients in unburnt tobacco when smoked with the Intense regime, most prominently for formaldehyde with sucrose, glucose, total sugars, and glycerol. For VOCs, 2,5-dimethylfuran significantly correlates with several sugars under both International Standards Organization (ISO) and Intense smoking conditions. A correlation network visualization shows connectivity between a sugar cluster, an ISO cluster, and an Intense cluster, with Intense formaldehyde as a central highest connected hub.ConclusionsOur multivariate analysis showed several strong connections between the compounds determined. The toxicants proposed by WHO, in particular, formaldehyde, can be used to monitor yields of other toxicants under Intense conditions. Emissions of formaldehyde, acetaldehyde, acrolein, and 2,5-dimethylfuran may decrease when sugar and humectants contents are lowered in tobacco filler.ImplicationsOur findings suggest that the aldehydes and VOCs proposed by TobReg are a representative selection for smoke component market monitoring purposes. In particular, formaldehyde yields may be useful to monitor emissions of other toxicants under Intense conditions. Since the most and strongest correlations were observed with the Intense regime, policymakers are advised to prescribe this regime for regulatory purposes. Policymakers should also consider sugars and humectants contents as targets for future tobacco product regulations, with the additional advantage that consumer acceptance of cigarette smoke is proportional to their concentrations in the tobacco blend.

Flavored Tobacco Product Use Among Middle and High School Students — United States, 2014–2018

The 2009 Family Smoking Prevention and Tobacco Control Act prohibits the inclusion of characterizing flavors (e.g., candy or fruit) other than tobacco and menthol in cigarettes; however, characterizing flavors are not currently prohibited in other tobacco products at the federal level.* Flavored tobacco products can appeal to youths and young adults and influence initiation and establishment of tobacco-use patterns (1). The Food and Drug Administration (FDA) and CDC analyzed data from the 2014-2018 National Youth Tobacco Surveys (NYTS) to determine prevalence of current (past 30-day) use of flavored tobacco products, including electronic cigarettes (e-cigarettes), hookah tobacco, cigars, pipe tobacco, smokeless tobacco, bidis, and menthol cigarettes among U.S. middle school (grades 6-8) and high school (grades 9-12) students. In 2018, an estimated 3.15 million (64.1%) youth tobacco product users currently used one or more flavored tobacco products, compared with 3.26 million (70.0%) in 2014. Despite this overall decrease in use of flavored tobacco products, current use of flavored e-cigarettes increased among high school students during 2014-2018; among middle school students, current use of flavored e-cigarettes increased during 2015-2018, following a decrease during 2014-2015. During 2014-2018, current use of flavored hookah tobacco decreased among middle and high school students; current use of flavored smokeless tobacco, cigars, pipe tobacco, and menthol cigarettes decreased among high school students. Full implementation of comprehensive tobacco prevention and control strategies, coupled with regulation of tobacco products by FDA, can help prevent and reduce use of tobacco products, including flavored tobacco products, among U.S. youths (2,3).

The Impact of E-Cigarette Regulation on the Illicit Trade in Tobacco Products in the European Union

This appendices to this report can be found at: (https://ssrn.com/abstract=3435260). In regulating tobacco products, governments seek to promote public health by discouraging consumption. However, imposing regulatory costs and taxes on licit producers and consumers presents an economic opportunity to criminal actors to profit from skirting these laws. Illicit trade in tobacco products (ITTP) thus frustrates the goals of tobacco regulation. We estimate that a 10% increase in the price of licit cigarettes (which might result, for example, from a tax increase) leads to a 3.6 percentage-point increase in the illicit share of the market, which averages about 11% in the EU. However, e-cigarettes and their apparent health advantages over traditional tobacco products present regulators with an opportunity to increase taxes without swelling the flow of illicit goods: By allowing consumers a third choice as an alternative to either paying higher prices or buying illicit products, e-cigarettes could serve as a “safety-valve” allowing for higher taxes (and stricter regulations) on traditional tobacco products without encouraging the illicit market. This study tests and find support for that hypothesis and seeks to investigate the effects of law and policy on the extent of that substitution. We begin by analyzing the current policies of European Union Member States toward tobacco products and e-cigarettes and reviewing the literature on the factors that drive consumers to use illicit tobacco products and the evidence that e-cigarettes substitute for conventional cigarettes. We then assemble a dataset of volumes and prices for legally sold conventional cigarettes and e-cigarettes, and for illicit or smuggled products. An econometric analysis of those data generates a model relating the size of the ITTP market to e-cigarette policies and market penetration. The results show that higher taxes and prices for licit cigarettes are positively associated with higher ITTP shares and illicit-cigarette quantity. When the e-cigarette market is small, increases in cigarette prices have a positive and statistically significant effect on ITTP. The elasticity remains positive throughout the range of the data, although it decreases with the size of the e-cigarette market. However, the availability of e-cigarettes moderates the effect of conventional-cigarette prices on ITTP volumes: the more available e-cigarettes become, the less ITTP market share rises in response to tax-driven price increases for conventional cigarettes. In the presence of sufficiently robust e-cigarette markets, cigarette prices have no measured effect on ITTP volumes. Thus, as e-cigarettes become more available, the positive association between cigarette prices and taxes is attenuated. This suggests that e-cigarettes are substitutes for illicit cigarettes. Conversely, demand for e-cigarettes responds positively to cigarette prices while demand for conventional cigarettes responds positively to e-cigarette prices, thus indicating that the two goods are substitutes. However, while higher cigarette prices are strongly associated with larger e-cigarette markets, the same cannot be found for cigarette regulation here. Other important findings include that: • E-cigarette revenue responds positively to cigarette prices, negatively to product bans, and negatively to stricter regulation (although the evidence is mixed regarding the last point). • More stringent tobacco regulation, particularly health warnings on packaging, is associated with lower demand for cigarettes. • Demand for e-cigarettes responds negatively to its own price and to the stringency of regulation aimed at vaping. • No e-cigarette regulation at all is most conducive to e-cigarette sales; all the other regulatory coefficients are negative. • Strict limits on public use and pharma-only regimes are about equally detrimental to e-cigarette sales, and the apparent impacts are large. • The Tobacco Products Directive has been more favorable for e-cigarette sales than either of those regimes, but not as good as no regulation. Policy discussions and recommendations are presented. Optimal taxation would establish excise duties for combustible nicotine products at a rate that deters initiation and incentivizes switching to lower-risk products, while avoiding diversion to the black market. Non-combustible products should then be taxed at a low, zero, or even a negative level. Furthermore, the optimal tax on conventional cigarettes will be higher in the presence of low-priced reduced-risk substitutes than in their absence.

Ewolucja regulacji wyrobów tytoniowych w prawie polskim

The evolution of the regulation of tobacco products in Polish lawAdministrative law plays a key role in regulating matters related to tobacco products. It regulates the competences of various administrative organs, issues of informing consumers about health dangers of using tobacco products as well as where tobacco products can be used. When regulating tobacco products, matters of health are taken into account, but the legislator also has to find compromises between the rights and interests of various groups. We should, for example, notice how much the companies making tobacco products influence legislature. Polish regulations of tobacco products — just like in many other countries — to a large degreereflect technological, scientific and social changes.

Why tobacco product regulation is no magic bullet

Alas, Collishaw’s interesting proposal1 has fatal flaws. As he admits, it effectively bans combustible cigarettes, with ‘heat not burn’ the standard to meet. Any government implementing such a draconian measure...

First Person: Howard Koh, MD, MPH: Physician devotes his career to improving public health on many fronts.

First Person: Howard Koh, MD, MPH: Physician devotes his career to improving public health on many fronts.

A Look Back at the Evolution of the Family Smoking Prevention and Tobacco Control Act and the Present-Day Impact on ‘Overlooked and Belated Issues’ — Electronic Nicotine Delivery Products and the Youth Epidemic, Menthol, Graphic Warnings and Corrective Statements

Although smoking has plagued the United States for generations, it was not until the past several years that smoking received more serious scrutiny. Yet, the reality is that as far back as the 1960s, tobacco products posed a serious threat to human health as evidenced by the Surgeon General’s report explaining that smoking causes cancer. Fast forward to current times, the Centers for Disease Control (“CDC”) has determined that over 1,300 people in the United States die each day due to smoking and over sixteen million Americans have a disease attributed to smoking. The CDC concluded that in the United States, cigarette smoking is responsible for more than 480,000 deaths annually, and secondhand smoke exposure caused more than 41,000 of these deaths. These statistics do not just cover the older generations that many associate with smoking. Over the years, the numbers in teen smoking statistics have escalated since the 1990s. Based on CDC statistics, about 2,000 youth start smoking their initial cigarette, and 300 youth become day-to-day smokers. This means that using current rates of smoking among youth, 5.6 million Americans younger than eighteen years of age are expected to die prematurely from a smoking-related illness. This denotes about 1 in every 13 Americans aged seventeen years or younger who are alive today. The Center for Tobacco Products (“CTP”) within the United States Food and Drug Administration (“FDA”) regulates tobacco products with a mission of diminishing tobacco related deaths and diseases. Since its creation, the CTP has maintained a critical mission on educating youth about the dangers of smoking. Yet, teen use of tobacco related products has increased. The Family Smoking Prevention and Tobacco Control Act (FSPTCA or Tobacco Act) became law on June 22, 2009. This legislation conferred authority to the FDA to regulate tobacco products. The FSPTCA amended the Food, Drug, and Cosmetic Act (FDCA) and other federal laws by permitting FDA regulatory authority over of tobacco products. This includes cigarettes, cigarette tobacco, roll-your-own tobacco, and smokeless tobacco. Yet, the FSPTCA, when enacted, was silent on issues of e-cigarettes and other electronic nicotine delivery systems (ENDS) and were eventually “deeming” as part of the FSPTCA. There are a myriad of matters concerning tobacco products regulation. However, this article highlights critical issues important to the public health in the United States. This article provides an overview of tobacco products regulation, including the FSPTCA. Yet, issues persist such as undue delay in reissuing graphic warnings for cigarettes and lengthy legal battles over the language used in court-ordered corrective statements. Further, the FSPTCA was silent on other tobacco products besides traditional cigarettes such as cigars, pipe tobacco and ENDS including e-cigarettes. To overcome the lack of inclusion in the FSPTCA, deeming regulations were enacted. Despite the deeming regulations, the use of tobacco products, including vaping and e-cigarettes, has escalated. Finally, this article discusses the FDA’s accomplishments along with further recommendations to stem the rise in youth use of e-delivery products.

U.S. Food and Drug Administration Regulation of Tobacco Products. Time for a Course Correction

U.S. Food and Drug Administration Regulation of Tobacco Products. Time for a Course Correction

Risk assessment of toxicants on WHO TobReg priority list in mainstream cigarette smoke using human-smoked yields of Korean smokers

Recently, the World Health Organization Study Group on Tobacco Product Regulation (WHO TobReg) announced a priority list of 38 toxicants among the more than 7000 chemicals found in cigarette smoke, building upon previous lists of toxicants in cigarette smoke. Here, we conducted a comprehensive study on the quantitative exposure and risk characterization of these priority toxicants in mainstream cigarette smoke listed by the WHO TobReg. The human-smoked toxicant yields estimated from spent cigarette butts of a total of 361 smokers using the part-filter method (PFM) were applied to current exposure and risk estimation for the first time. The PFM can estimate human-smoked yields of toxicants using smokers’ maximum mouth-level exposure. The human-smoked yield of each toxicant was converted to systemic uptake by considering bioavailability. Risk indicators—including the incremental lifetime cancer risk (ILCR), cumulative ILCR, hazard quotient (HQ), hazard indices (HIs), and margin of exposure (MOE)—were estimated from the systemic uptake of toxicants combined with Korean exposure factors by gender and age group as well as for total smokers. It was demonstrated that cigarette smoking results in significant cancer and non-cancer health risks. A sensitivity analysis showed that the human-smoked toxicant yield is one of the most important contributors to risk level variations. Our risk estimation suggested that previous risk assessments might have ignored or underestimated the uncertainty of risk assessment. In conclusion, we assessed the risk level of the 38 toxicants on the priority list developed by the WHO TobReg and provided a Korean-specific priority list for the regulations on the emission of cigarette smoke.

Heated tobacco product regulation under US law and the FCTC

Tobacco companies are marketing new ‘heated tobacco products’ (HTPs) composed of battery-powered holders, chargers and tobacco plugs or sticks. The non-tobacco HTP components have escaped effective regulation under many countries’...

Tobacco carcinogen research to aid understanding of cancer risk and influence policy.

Education regarding the health effects associated with tobacco use has made important progress worldwide over the last few decades. Still, tobacco remains a significant cause of cancer and other diseases. As a result, significant worldwide morbidity and mortality is still attributable to tobacco use in modern times. Research into tobacco products, the carcinogens they contain, and how users metabolize them is an important benefit to the advancement of research aimed at reducing harm associated with tobacco use. This review summarizes the use of this type of research to study tobacco users’ risk of developing cancer, especially head and neck cancer. In addition, we discuss the use of tobacco research to provide support for increasing levels of federal regulation of tobacco products.Level of Evidence4.

The Response of Retailers in Scotland to the Standardised Packaging of Tobacco Products Regulations and Tobacco Products Directive.

IntroductionWith most marketing channels prohibited, the retail environment has assumed greater importance for tobacco companies, even in markets with a ban on the open display of tobacco products. Research has yet to qualitatively explore how retailers respond to standardized packaging in a country where this has been introduced.MethodsAs part of the DISPLAY study, face-to-face interviews were conducted with 24 small retailers in Scotland between May 23 and June 26, 2017; the interviews were conducted after The Standardised Packaging of Tobacco Products Regulations and the Tobacco Products Directive were fully implemented.ResultsWe found high retailer compliance with the legislation. With price-marked packs and packs containing less than 20 cigarettes and 30 g of rolling tobacco banned, retailers stated that this helped simplify ordering and stock management. The removal of price-marked packs also allowed them some flexibility to set their own prices, but many chose to stick closely to recommended retail price in order to remain competitive and avoid complaints from customers. In contrast to one of the tobacco industry’s arguments against standardized packaging, most retailers suggested that transaction times had not increased, even though the changes had only recently come into force.ConclusionsThis study challenges some of the arguments used against standardized packaging and provides an insight into the storage and pricing strategies adopted by retailers following the removal of price-marked packs.ImplicationsThis study explores the response of the retailers to the introduction of standardized tobacco packaging and provides an insight into the storage and pricing strategies adopted by retailers following the removal of price-marked packs. It explores the importance of the retailer in tobacco companies’ desire to maintain tobacco sales and challenges some of the arguments used against standardized packaging, such as an increase in transaction times. Countries seeking to introduce standardized packaging should monitor the experiences of retailers, preferably from preimplementation through to post implementation, to help understand how retailers respond to this policy and to inform compliance.

Nicotine Reduction Strategy: State of the science and challenges to tobacco control policy and FDA tobacco product regulation

Nicotine addiction is the proximate cause of disease and death from cigarette smoking. In 1994, we proposed reducing the nicotine content of cigarettes to non-addicting levels to reduce the risk of youth becoming addicted smokers and promoting quitting in established smokers. In 2009, the Family Smoking Prevention and Tobacco Control Act provided the authority to FDA to reduce nicotine levels as appropriate to benefit public health. Over the past 15 years, considerable research has determined that nicotine reduction is feasible and safe, resulting in reduced nicotine dependence with little evidence of compensatory over-smoking. The availability of acceptable non-combusted form of nicotine would provide support and enhance acceptability of nicotine reduction in tobacco. Most recently, the FDA promulgated a nicotine-based regulatory framework, which includes nicotine reduction combined with ready availability of noncombustible nicotine products. Nicotine reduction could contribute to a virtual end to the use of cigarette smoking, with enormous benefits to public health.