Tobacco Purchase Research Articles

Sustained decline in tobacco purchasing in Denmark during the COVID-19 pandemic

BackgroundAn estimated 8 million people die every year due to tobacco use. The COVID-19 pandemic has increased the health consequences of smoking, which is a leading risk factor for more severe COVID-19 symptoms, hospitalization, and death. The pandemic has also led to reductions in physical activity, increases in stress and declines in mental well-being, all factors commonly associated with triggering higher tobacco use.MethodsUsing a longitudinal data set of purchasing behavior from 2019–2020 among a national sample of the Danish population (n = 4042), we estimate changes in tobacco use during the COVID-19 pandemic. Our analysis compares tobacco purchases prior to the pandemic to purchases during the pandemic, at the individual level. We also examine effects within subgroups based on smoking behavior in 2019 prior to the pandemic. We estimate effects for smokers and non-smokers and, within smokers, for occasional smokers and regular smokers.ResultsWe find large, sustained decreases in tobacco purchases during COVID-19. We estimate that weekly tobacco purchase rates decline by 24% and average quantities decline by 12% during the period spanning the onset of the pandemic in March 2020 through the end of the year. The declines are driven by regular smokers with little change in behavior among nonsmokers and increases in purchases among occasional smokers. Among regular smokers, purchase rates decline by about 30%, tobacco purchases decline by about 20% and quitting rates increase by about 10 percentage points.ConclusionsOur results suggest that the COVID-19 pandemic could lead to sustained reductions in smoking.

Evaluation of Restrictions on Tobacco Sales to Youth Younger Than 21 Years in Cleveland, Ohio, Area

Tobacco 21 (T21) policies raise the minimum legal age to purchase tobacco from 18 to 21 years to curb youth access to tobacco products. While some studies have found that T21 is associated with reducing prevalence of youth tobacco use, little is known about the impact it may have on youth of different racial and ethnic identities. To evaluate the association of T21 policy with the prevalence of high school youth tobacco use across sex, race, and ethnicity. This survey study used representative survey data collected from the local biennial Youth Risk Behavior Survey from 2013 to 2017 comparing Cleveland, Ohio (which has a T21 policy), to proximal jurisdictions in the first-ring suburbs in Cuyahoga County (which do not have T21 policies). Within-Cleveland demographic information was also collected for 2013 to 2019. Overall high school youth tobacco use rates were compared between Cleveland and the first-ring suburbs and then examined within Cleveland among Hispanic, non-Hispanic Black, and non-Hispanic White high school students. Percentage data were adjusted to more closely align with local population demographics. Data were analyzed from January to June 2022. T21 was implemented in Cleveland in 2016 and not adopted in proximal jurisdictions or at the state and federal level until at least 1 year later. The main outcomes were prevalence of past 30-day cigarette, cigar product, or e-cigarette use, measured using geographically representative high school youth survey data from 2013 to 2015 (prelegislation) and 2017 to 2019 (postlegislation) and compared using a difference-in-differences analysis. The unweighted sample included 12 616 high school students (27.0% [95% CI, 26.9%-28.0%] in 10th grade; 50.9% [95% CI, 50.3%-51.6%] females) participating in 1 or more Youth Risk Behavior Surveys from 2013 to 2019, including 7064 students in Cleveland and 5552 students in the first-ring suburbs. Compared with the first-ring suburbs, Cleveland had a greater proportion of younger students (1623 [28.5%] ninth grade students vs 2179 [34.0%] ninth grade students) and Hispanic students (436 students [1.1%] vs 1433 students [12.6%]) and non-Hispanic Black students (2000 students [53.1%] vs 3971 students [75.1%]). Cigars were the most commonly used tobacco product in Cleveland, with use reported by 6201 students (19.8%) in 2013, 5877 students (21.3%) in 2015, and 5784 students (16.8%) in 2019. Compared with the first-ring suburbs, there was a greater decline in prevalence of use of cigars in Cleveland (β = 0.18 [SE, 0.05]; P < .001). The disparity across race, ethnicity, and sex decreased for all current tobacco product use. For example, the maximum difference between demographic subpopulations in current cigarette use was 11.6 (95% CI, 9.5-13.7) percentage points in 2013 between White females (16.1% [95% CI, 11.3%-20.8%]) and Black males (4.5% [95% CI, 3.5%-5.4%]). This maximum difference in current cigarette use decreased significantly to 5.1 (95% CI, 3.5-6.7) percentage points in 2019 between White females (6.9% [95% CI, 3.4%-10.3%]) and Black females (1.8% [95% CI, 0.7%-2.8%]). This survey study found that there was a decline in youth-reported tobacco use across every tobacco product category from 2013 to 2019. This decline changed the trajectory of use among several demographic groups and brought the youth populations with the highest tobacco product use to similar rates of others.

The impact of the COVID-19 epidemic on where tobacco users purchased cigarettes and snus in different Norwegian regions.

Aims: With the spread of COVID-19, the Norwegian government introduced restrictions on cross-border travel starting March 2020. Purchase of tobacco when travelling, especially from Sweden and duty-free shops, has comprised a substantial part of Norwegian tobacco consumption for many years. We investigated whether COVID-19-related travel restrictions and recommendations led to changes in tobacco purchases from Norway, Sweden, duty-free, other countries, possible illicit sources and web shops. Design: Based on a survey conducted by Ipsos, we examined: (i) the prevalence of smoking and snus use and where smokers and snus users reported having purchased tobacco consumed during the last 24 hours from 2015 to 2019, by county; and (ii) the probabilities of having purchased tobacco from different sources in the period before and after COVID-19-related travel restrictions and recommendations. Results: The proportion of smokers varied from 12% to 19% and the proportion of snus users varied from 12% to 21% across counties. Cigarettes bought in Norway comprised from 27% to 79% of the previous day's consumption, depending on the respondent's county of residence. For snus, the percentages ranged from 20% to 70%. The probability of buying tobacco in Norway increased by around 30 percentage points during the period of COVID-19-related travel restrictions and recommendations, compared with previous years. The increase was greatest in border regions and was accompanied by fewer purchases in Swedish and duty-free shops. Conclusion: The increased share of tobacco purchases from shops in Norway means that, for many tobacco users, buying tobacco become more expensive and that taxes on tobacco to a greater extent were paid in Norway. However, whether these extraordinary circumstances will affect future cigarette and snus use, and place of purchase of tobacco products, remains to be seen.

Puff Bars, Tobacco Policy Evasion, and Nicotine Dependence: Content Analysis of Tweets.

BackgroundPuff Bars are e-cigarettes that continued marketing flavored products by exploiting the US Food and Drug Administration exemption for disposable devices.ObjectiveThis study aimed to examine discussions related to Puff Bar on Twitter to identify tobacco regulation and policy themes as well as unanticipated outcomes of regulatory loopholes.MethodsOf 8519 original tweets related to Puff Bar collected from July 13, 2020, to August 13, 2020, a random 20% subsample (n=2661) was selected for qualitative coding of topics related to nicotine dependence and tobacco policy.ResultsOf the human-coded tweets, 2123 (80.2%) were coded as relevant to Puff Bar as the main topic. Of those tweets, 698 (32.9%) discussed tobacco policy, including flavors (n=320, 45.9%), regulations (n=124, 17.8%), purchases (n=117, 16.8%), and other products (n=110, 15.8%). Approximately 22% (n=480) of the tweets referenced dependence, including lack of access (n=273, 56.9%), appetite suppression (n=59, 12.3%), frequent use (n=47, 9.8%), and self-reported dependence (n=110, 22.9%).ConclusionsThis study adds to the growing evidence base that the US Food and Drug Administration ban of e-cigarette flavors did not reduce interest, but rather shifted the discussion to brands utilizing a loophole that allowed flavored products to continue to be sold in disposable devices. Until comprehensive tobacco policy legislation is developed, new products or loopholes will continue to supply nicotine demand.

ОСОБЛИВОСТІ РОЗВИТКУ ТЮТЮНОВО-МАХОРКОВОЇ ПРОМИСЛОВОСТІ НА ТЕРИТОРІЇ СУЧАСНОЇ СУМЩИНИ НА РУБЕЖІ ХІХ–ХХ СТ.

The article is devoted to the analysis of the tobacco and shag industry, which developed on the territory of the modern Sumy region in the late XIX – early XX centuries. The authors draw attention to the peculiarities of the introduction of clear zoning in Ukraine on the cultivation of crops in general and tobacco in particular. It was also noted that the territory of Sumy region, as well as the whole north of Ukraine did not have powerful enterprises at that time, because the vast majority of tobacco was grown in the forest-steppe zone of Ukraine. In the course of the research, some pages of the development of tobacco enterprises in the territory of modern Sumy region were described. In particular, the launch of the first industrial enterprise on the Left Bank in Okhtyrka, which provided processing of tobacco products and the activities of a special office to provide the population with tobacco seeds in Romny. In addition, the article identifies periods with different rates of development of the tobacco and shag industry in the Ukrainian lands: growth (1861-1885), crisis and decline (1885-1900), active monopolization (1911-1914), having received a significant boost in development as a result of major reforms in the 1860s, the tobacco and shag industry was actively growing until 1885. After that, the Ukrainian lands are gradually reducing the area under tobacco and its gross harvest. The result was a decrease in the early twentieth century. the number of enterprises, which was accelerated by the reduction of markets for manufactured products and the introduction of the excise charter, according to which a small number were engaged in the purchase of leaf tobacco. Then, as a result of active monopolization of the domestic economy in the early twentieth century. the tobacco and shag industry, while reducing the number of enterprises due to their consolidation, was characterized by an increase in the number of manufactured products and the gradual introduction of mechanization into the production process.

Supplemental Material for Narrative Theory V: Narratives About Penalties Resulting From Illegal Tobacco Purchases Increase Psychological Distress

Supplemental Material for Narrative Theory V: Narratives About Penalties Resulting From Illegal Tobacco Purchases Increase Psychological Distress

Was COVID-19 associated with increased cigarette purchasing, consumption, and smoking at home among US smokers in early 2020? Findings from the US arm of the International Tobacco Control (ITC) Four Country Smoking and Vaping Survey

Evidence of the impact of COVID-19 and mandatory stay-at-home orders on cigarette smoking is mixed. In the United States, household tobacco purchases increased in early 2020, but it is unclear whether this was associated with increased smoking. Using individual-level, longitudinal data from a representative cohort of US smokers (n = 3046), this study tested whether (1) carton purchases of cigarettes increased in early 2020 relative to the same calendar period in 2018, (2) more smokers permitted smoking inside their homes, and (3) smokers increased the number of cigarettes they smoked per day. Weighted multivariable logistic regression tested whether trends in carton purchasing and smoke-free homes differed in 2020 compared to 2018 while weighted multivariable linear regression tested whether trends in cigarette consumption differed in 2020 compared to 2018. Overall, 24.0% of US smokers last purchased cigarettes by the carton in early 2018; this increased to 28.8% in early 2020 (p = 0.007). Average daily cigarette consumption and the percentage of smokers reporting that smoking was not allowed inside their homes did not differ between 2018 and 2020 (p = 0.92 and p = 0.054, respectively). Overall, these findings suggest that COVID-19 mitigation measures implemented in the spring of 2020 had limited impact on the smoking behavior of US adult smokers.

Raising the Age of Purchase and Use of Tobacco Product in Bangladesh: Benefits and Challenges in Protecting Youth from the Tobacco Epidemic.

Tobacco use among young and adolescents is the biggest threat to public health globally. In Bangladesh, every one in 14 youth (13-15 years) uses tobacco in some form. While this problem is growing in the country, we estimate the underage initiation of tobacco use and present evidence that policy measures like increasing the age of purchase and use from the current 18 years to 21 years in the country backed with current tobacco control efforts and adopting vendor licensing will significantly reduce future tobacco burden. We analysed the two rounds of nationally representative Global Adult Tobacco Survey (GATS) data: GATS-1 (2009-10) and GATS-2 (2016-17) and segregated the data for two categories of tobacco consumption (smokers and smokeless tobacco users) based on the age of initiation (<18, 18-21 and >21 years). Consumption patterns were also analyaed by using the GATS-2 data. Projections from sub-national level analysis for youth initiating tobacco use before 21 years and change in the prevalence of overall underage tobacco users were calculated based on weighted value. According to GATS-2, around 89% of current tobacco users initiated tobacco use into daily use before the age of 18 years in Bangladesh. Whereas, striking differences were observed (statistically significant) for the average age of initiation of smoking among smokers aged 20-34 increased from 17.4 in 2009 to 19.3 years; and 20.1 to 22 years for SLT. Moreover, more than 24% of them initiated into regular smoking before the age of 15 years. There is an increasing trends of tobacco initiation among the underage youth of Bangladesh. By increasing the age of access, sale, purchase, and use of tobacco from current 18 years to 21 years will significantly reduce youth initiation and taper down the overall adult tobacco use prevalence over the long run in Bangladesh.

Tobacco advertisement, sales, product displays, and purchase incentives around kindergartens, primary, and secondary schools in Sri Lanka

Tobacco advertisement, sales, product displays, and purchase incentives around kindergartens, primary, and secondary schools in Sri Lanka

Ability to Purchase Tobacco Products and Smoking Behavior of Cigarettes, E-cigarettes, and Heated Tobacco Products in Korean Adolescents.

Objectives: This study investigated the smoking behavior and its association with the availability of tobacco products purchases among Korean adolescents. Methods: The data of the 2019 Korea Youth Risk Behavior Survey were used (N =57,303). This study assessed 3 tobacco products: cigarettes, e-cigarettes, and heated tobacco products. Smoking behavior including lifetime, current, daily, heavy smoking, and attempting to quit and its association with the availability of tobacco products for purchase was assessed. Results: Overall, 92.9% did not try to purchase tobacco products during the past 30 days, 2.2% found it impossible to purchase, 0.8% could buy with a lot of effort, 1.7% could buy with little effort, and 2.3% could buy easily without any effort. Lifetime smokers were 13.8% (12.7% for cigarettes, 7.4% for e-cigarettes, and 4.9% for heated tobacco products). Among lifetime smokers, the current smoking rates for cigarettes, e-cigarettes, and heated tobacco products were 48.5%, 22.9%, and 19.0%, and the rates were lower in adolescents who responded that it was impossible to buy tobacco products. Among current smokers, the daily smoking rates were lower in adolescents who were found it impossible to buy tobacco products. Conclusions: The ease of access to tobacco products was associated with higher use of cigarettes, e-cigarettes, and heated tobacco products and lower attempts to quit smoking in Korean adolescents.

Tobacco purchasing motivations and behaviours in alcohol-licensed venues: A cross sectional survey of Australian young adults.

The widespread retail availability of tobacco contributes to increased tobacco consumption and undermines quit attempts. Given the ready availability of tobacco in alcohol-licensed venues which young adults frequent, tobacco sales in these venues are likely to influence the purchase and consumption of tobacco by young adults. This study aimed to investigate Australian young adults' tobacco purchasing motivations and behaviours in alcohol-licensed venues. A cross-sectional survey was conducted with a sample of 18- to 30-year-old Australians (n=307) who had purchased tobacco at an alcohol-licensed venue within the previous 6months. Purchaser characteristics, levels of alcohol consumption and whether the purchase was planned were assessed, along with anticipated responses to tobacco sales ceasing at the venue. The majority of participants (57%) reported their recent cigarette purchase at an alcohol-licensed venue as unplanned. Area of residence was the only characteristic associated with an unplanned purchase, with those living in urban areas significantly less likely to have made an unplanned purchase than regional participants (OR=0.51, 95% CI [0.29, 0.89]). During the occasion when the tobacco purchase was made, the majority of participants (51%) had consumed five or more standard alcoholic drinks. If tobacco sales ceased at the venue, 22% indicated they would stay and not smoke. Unplanned tobacco purchases appear to be influenced by the alcohol-licensed settings, rather than socio-demographic factors associated with the individual. SO WHAT?: Policies that restrict the sale of tobacco in alcohol-licensed venues are likely to reduce tobacco consumption among young adults and support smokers to quit.

Decrease in cross-border tobacco purchases despite intensification of antitobacco policies in France

BackgroundRecently, France has intensified tobacco control policies which included gradual increase in tobacco product price and the introduction of plain packaging. However, there has been suggestion that cross-border tobacco purchases...

Statistically derived patterns of smoking typologies among adolescents and their associations with demographic characteristics, interpersonal influences, and sources of cigarettes

ABSTRACT Cigarette use is one of the leading causes of death in the United States, with most smokers beginning cigarette use in adolescence. Despite not being of legal age to make tobacco purchases, adolescents are quite successful in their acquisition. The current study used latent variable mixture modeling to identify smoking typologies among adolescents and examine associations with various sources of cigarettes (i.e., stealing, obtaining from friends, obtaining from family members, purchasing), social influences (parental objection to smoking, smoking friends), and demographics. Participants were 195 high school students caught with tobacco in school who completed surveys questions about their cigarette use, and cigarette use of family and friends. Results identified three latent classes pertaining to smoking patterns: recent, heavy, frequent smokers (RHFS), low infrequent smokers (LIS), and recent moderate smokers (RMS). Students in the RHFS and RMS groups were more likely to obtain cigarettes by purchasing or borrowing from a friend, and reported more friends who smoke and lower parental objection compared to LIS members. RHFS members also were more likely to obtain cigarettes from family and be of White race compared to the other groups. These findings highlight the need for tailored prevention or intervention programs depending on risk profile.

Improving Retailer Compliance for Tobacco Purchases: Pilot Study Findings.

Objectives: Those underage should not use tobacco products, including electronic nicotine delivery systems. A technologically-based solution developed by Juul Labs Inc to restrict underage access seeks to automate transactions, structurally mandate age-verification, and limit the quantity of JUUL products purchased per transaction. A pilot of this standards-based approach, referred to as RACS™ (Retail Access Control Standards), was conducted to assess efficacy. Methods: RACS was implemented at 171 stores within 3 retail chains selling tobacco products in 3 states. "Secret shopper" compliance audits, in which a mystery shopper attempted to purchase JUUL products, were conducted at participating stores before and after implementation of RACS, to test compliance with age-verification and product-quantity limits. Audit failure rates were compared pre- and post-RACS implementation to assess effectiveness. Comparisons were made overall, by chain, state, and failure type. Results: A total of 3990 audits were conducted. We found large, statistically significant reductions (p < .001) in failure rates for age-verification and compliance with product-quantity limits after implementing RACS, as compared to pre-RACS rates, declining to near zero. Conclusions: Utilizing enhanced access controls can be part of a comprehensive, evidence-based tobacco-control strategy to address underage use of all tobacco products, including JUUL.

Effects of government cash subsidies on health risk behaviors of the rural elderly: Evidence from social pension expansions in China

INTRODUCTIONThere is relatively little research on the impact of government cash subsidies on health risk behaviors of the elderly in China. We thus analyzed the effect of pension subsidies on the smoking and drinking behaviors of rural elderly using a pension scheme introduced in rural China in 2009.METHODSBased on panel data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) in 2008 and 2011, a Difference-in-Differences (DID) method was applied to comprehensively analyze the impact of the new agricultural insurance on the health risk behaviors of the rural elderly. In order to solve possible sample selection biases, the Propensity Score Matching with Difference-in-Differences (PSM-DID) approach was used.RESULTSWe found that the implementation of the government cash subsidies clearly promoted smoking rather than drinking behavior among rural older adults. Specifically, the government cash subsidies facilitated smokers to smoke an additional 2.9 cigarettes/day, and the impact of government cash subsidies on the average cigarettes/day among smokers was more pronounced among the male elderly, lower age elderly, higher income elderly, and elderly with intact instrumental activities of daily living (IADL).CONCLUSIONSIn order to reduce the negative externalities of old-age subsidies, the government should place some restrictions on the use of cash subsidies for tobacco purchase by the elderly.

Retail Alcohol and Tobacco Sales During COVID-19

Retail Alcohol and Tobacco Sales During COVID-19

Age at Initiation of Cigarette Use in a Nationally Representative Sample of US Youth, 2013-2017

Cigarettes are still a commonly used tobacco product among youth despite recent declines in cigarette use. The aim of this study was to prospectively estimate the age of cigarette use initiation among youth (aged 12-17 years) overall, by sex, and by race/ethnicity. This cohort study used data from waves 1 through 4 of the nationally representative Population Assessment of Tobacco and Health (PATH) study, conducted from September 12, 2013, to January 3, 2018. Two subpopulations of youth were assessed: (1) those nonsusceptible to cigarette use and (2) never users of cigarettes at their first wave of PATH participation. Weighted interval-censoring survival analyses were used to prospectively estimate the age of initiation of cigarette use outcomes. Weighted interval-censoring Cox proportional hazard models were used to estimate differences in the age of initiation by sex and by race/ethnicity. Statistical analyses were performed from October 7, 2019, to May 1, 2020. Differences in the age of initiation by sex and race/ethnicity. Age of initiation of susceptibility to cigarette use, ever use, past 30-day use, and fairly regular cigarette use overall, by sex, and by race/ethnicity. A total of 15 776 youth never users and, among them, 11 022 youth who were nonsusceptible to cigarette use, were included in this study (weighted mean [SE] age, 13.5 [0.01] years; 58.6% [SE, 0.46%] non-Hispanic White; and 51.0% [SE, 0.32%] boys) and 15 776 were never users of cigarettes at their first wave of PATH participation (weighted mean [SE] age, 13.7 [0.01] years; 55.0% [SE, 0.29%] non-Hispanic White; and 51.0% [SE, 0.15%] boys). By age 18 years, among those who were nonsusceptible, 46.2% (95% CI, 44.3%-48.2%) became susceptible to cigarette use. Among never users, 24.4% (95% CI, 22.9%-25.9%) initiated ever cigarette use, 16.4% (95% CI, 15.2%-17.6%) initiated past 30-day cigarette use, and 4.3% (95% CI, 3.9%-4.8%) initiated fairly regular cigarette use. Boys had a higher risk of initiating ever (hazard ratio [HR], 1.21; 95% CI, 1.08-1.36) and past 30-day cigarette use (HR, 1.27; 95% CI, 1.10-1.47) at earlier ages compared with girls. Non-Hispanic White youth had a higher risk of an earlier age of initiation of susceptibility to cigarette use (HR, 0.77; 95% CI, 0.68-0.88), ever use (HR, 0.59; 95% CI, 0.49-0.71), past 30-day use (HR, 0.64; 95% CI, 0.52-0.77), and fairly regular cigarette use (HR, 0.25; 95% CI, 0.14-0.43) compared with non-Hispanic Black youth. The results of this cohort study suggest that, despite current interventions and existing laws, a large number of youth initiated cigarette use before the legal age to purchase tobacco products.

Do dual purchasers behave differently? An analysis of purchasing data for households that buy both alcohol and tobacco in the United Kingdom.

Dual purchasers of alcohol and tobacco are at increased health risk from the interacting health impacts of alcohol and tobacco use. They are also at financial risk from exposure to the dual financial cost of policies that increase alcohol and tobacco prices. Understanding whose alcohol and tobacco use exposes them to these health and financial risks is important for understanding the inequality impacts of control policies. This study explores the extent to which household spending on alcohol and tobacco combined varies between socio-economic groups and compares this with results for households which purchase only one of the commodities. Cross-sectional analysis of household-level alcohol and tobacco purchasing data. United Kingdom, 2012-17. A total of 26 021 households. We analysed transaction-level data from individual 14-day spending diaries in the Living Cost and Food Survey (LCFS). We used this to calculate expenditure, volumes of alcohol and tobacco purchased, and the price paid per unit of alcohol (1 unit=8g) and per stick of tobacco. This was compared with equivalized total expenditure and quintiles of equivalized household income. Prices were calibrated and pack sizes were imputed using empirical sales data from Nielsen/CGA to correct for reporting bias. Dual purchasing households spent [95% confidence interval] more on alcohol and more on tobacco than their single-purchasing counterparts. In general, lower-income households spent less on both alcohol and tobacco than higher-income households. Furthermore, dual purchasing households in the lowest income group were most exposed to potential increases in price than were other income groups, with (CI=12.41-13.15%) of their total household budget spent on alcohol and tobacco. Dual purchasers of alcohol and tobacco in the United Kingdom appear to be concentrated evenly among income groups. However, dual purchasers may experience particularly large effects from pricing policies, as they spend a substantially higher proportion of their overall household expenditure on alcohol and tobacco than do households that purchase only one of the commodities.

Prevalence of illicit tobacco use and tobacco tax avoidance in pregnancy.

BackgroundSmoking during pregnancy is associated with adverse maternal and fetal outcomes. Tobacco tax avoidance and tax evasion undermine the effectiveness of tobacco tax policies, resulting in cheaper prices for smokers and increased tobacco usage.AimsThe purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and use of illicit tobacco.MethodsProspective cohort study. Face to face interviews were conducted with 90 attendees (age range 18–42 years; mean age 28 years) of a smoking cessation antenatal clinic in a large Irish tertiary level maternity hospital. Information regarding smoking habits, quantity of tobacco smoked, and location of purchase of tobacco was collected in addition to socioeconomic details. Tobacco products were examined to establish whether these were purchased from legitimate sources.Results76.6% of women smoked 10 or fewer cigarettes per day. The mean weekly spend on tobacco was €39. Seventeen women (18.8%) smoked roll-your-own tobacco. One woman (1.1%) currently possessed a pack of illicit tobacco, while another 5.5% of participants had purchased illicit tobacco in the past. Four women (4.4%) practiced tobacco tax avoidance by purchasing tobacco abroad or in Duty Free.ConclusionsUse of illicit tobacco is low and only a minority of women engaged in tobacco tax avoidance. As the average price of tobacco in Ireland increases, weekly expenditure on tobacco products is a significant financial impact on low-income women. Smoking cessation would deliver significant financial gains in addition to health benefits.

Raising the legal age for purchase and use of tobacco to 21 years: A step towards tobacco endgame in India

BackgroundGlobally, policies to counter targeting of young people by the tobacco industry have proven to be effective and a key determinant of reducing the magnitude of tobacco epidemic. This paper presents a case for increasing the minimum legal age to access tobacco to 21 years in India. MethodWe analysed the two rounds of nationally representative Global Adult Tobacco Survey (GATS) data: GATS-1 (2009–10) and GATS-2 (2016–17). We segregated data for two categories of tobacco consumption (smokers and smokeless tobacco users) at the age of initiation (<18, 18–21 and >21 years) and analysed for their consumption patterns found during the time of the survey (current daily, current less than daily, former and ever users) from GATS-2 (2016–17). Further, we compared the projections from the sub-national level analysis for youth initiating tobacco use before 21 years and change in the prevalence of overall underage tobacco users between the two survey rounds. ResultNearly 77% of smokers and 75% smokeless tobacco users in India initiate tobacco use before or until the age of 21 years. Many large, most populous and high tobacco prevalence states had higher than national mean (14.1%) of youth initiating into tobacco use before 21 years. Overall, as compared to GATS-1, there is a perceptible increase in the prevalence of underage tobacco use in most states. ConclusionGlobal best practices and the significant number of young tobacco users in India call for increasing the age of access to tobacco from the current 18 years to 21 years. This will help in reducing the overall adult tobacco use prevalence in the longer run in India.