The effectiveness of tobacco control policies on vulnerable populations in the USA: a review

Abstract Population-level public health policies aim to improve health for the entire population. Yet, in doing so, they may unintentionally neglect vulnerable populations' specific needs, which may perpetuate social inequalities in health. As an example, tobacco control policies (e.g. media campaigns, smoke-free places, tax increases, and tobacco product regulation) have been found to significantly reduce overall smoking prevalence in many high-income countries. However, social inequalities in smoking have been increasing, with smoking prevalence being higher, notably for those of low socio-economic status (SES). Low SES individuals start smoking at younger ages, smoke more cigarettes per day, have lower cessation rates, and are exposed to more second-hand smoke than higher SES individuals. These social inequalities in smoking translate into social inequalities in health such that low SES groups carry a disproportionately heavier burden of smoking-related illnesses. Based on data from a critical discourse analysis of tobacco control policy in Quebec, Canada, as well as from a literature review of vulnerable populations' experiences with tobacco control policies, this presentation will: 1) illustrate ways in which tobacco control policies may be increasing social inequalities in smoking, including the absence of vulnerable populations who smoke from policy planning, smoking denormalization's unintended stigmatizing effects, and targeting behaviours rather than the 'causes of the cause' in policy; 2) provide ideas for future population-level policies based on a health equity approach, which includes integrating vulnerable population's voices in policy design, prioritizing vulnerable populations and health equity in policy, and shifting attention towards policies addressing social inequalities in access to social determinants (e.g. education, income, employment security, safe, clean, and affordable housing) to improve health rather than targeting behaviours, such as smoking.

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Flavoured tobacco product restrictions in Massachusetts associated with reductions in adolescent cigarette and e-cigarette use

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056159 ◽

2021 ◽

pp. tobaccocontrol-2020-056159

Author(s):

Summer Sherburne Hawkins ◽

Claudia Kruzik ◽

Michael O'Brien ◽

Rebekah Levine Coley

Keyword(s):

Tobacco Control ◽

Tobacco Use ◽

Tobacco Product ◽

County Level ◽

Cigarette Use ◽

Youth Health ◽

Control Policies ◽

Tobacco Control Policies ◽

The Usa ◽

Adolescent Tobacco Use

BackgroundIn the USA, many states do not pre-empt municipalities from enacting stricter tobacco-control policies than state or federal laws. Several municipalities in Massachusetts have passed progressive local laws aimed at reducing adolescent tobacco use. We exploited this variability to examine the associations between county-level flavoured tobacco product restrictions, tobacco 21 policies and smoke-free laws prohibiting e-cigarettes with adolescent cigarette and e-cigarette use in Massachusetts, and to assess whether policy effects varied by age.MethodsWe conducted difference-in-differences models to link changes in county-level tobacco-control policies to changes in adolescents’ use of cigarettes and e-cigarettes using 2011–2017 biennial Massachusetts Youth Health Surveys.ResultsCounties with greater implementation of flavoured tobacco product restrictions were associated with a decrease in the level of cigarette use among users (incidence rate ratio −1.56; 95% CI −2.54 to −0.58). A significant interaction (p=0.03) revealed the largest reductions among 14 and 18 year olds. Increasing flavoured tobacco product restrictions were also associated with reductions in the likelihood of e-cigarette use (OR −0.87; 95% CI −1.68 to −0.06). Increasing tobacco 21 restrictions were associated with decreases in cigarette use only among 18 year olds, while there was no evidence of associations between smoke-free laws with use of either tobacco product.ConclusionsAdolescents in Massachusetts decreased their use of cigarettes and e-cigarettes in response to local restrictions that limited the sale of flavoured tobacco products to adult-only retail tobacco stores. Local legislation can reduce adolescent tobacco use and municipalities should enact stricter tobacco-control policies when not pre-empted by state law.

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Campus tobacco control policies and cessation interventions in college students: a commentary calling for research and action to address tobacco-related health disparities

Translational Behavioral Medicine ◽

10.1093/tbm/ibaa083 ◽

2020 ◽

Author(s):

Carla J Berg ◽

Y Tony Yang ◽

Mandi L Pratt-Chapman ◽

W Douglas Evans ◽

Ana-Paula Cupertino ◽

...

Keyword(s):

College Students ◽

Health Disparities ◽

Tobacco Control ◽

Low Socioeconomic Status ◽

Research Translation ◽

Control Policies ◽

Individual Level ◽

Tobacco Control Policies ◽

Populations At Risk ◽

The Usa

Abstract Tobacco-related health disparities (TRHDs) have a significant impact on population health in the USA. Effectively preventing and controlling TRHDs among young adult populations require multiple prevention and cessation points, including within college/university contexts. This commentary addresses current campus tobacco control policies and cessation interventions for U.S. college students, with an emphasis on TRHDs and opportunities for research and research translation to reduce these disparities. This commentary is informed by literature published between 2010 and 2020 regarding (a) prevalence and impact of campus tobacco control policies; and/or (b) behavioral outcomes from cessation interventions for young adults attending colleges. Despite a doubling of college campuses adopting tobacco-free policies from 2012 to 2017, roughly two-thirds continue to operate without such policies. Few policies address alternative tobacco products (e.g., e-cigarettes, cigars/cigarillos, and hookah), and communication about and enforcement of existing policies is extremely limited. A broad range of cessation intervention strategies have targeted individuals in this age group, but with little focus on TRHDs and limited intervention dissemination. Importantly, college students representing populations at risk for TRHDs (e.g., racial/ethnic/sexual/gender minorities, low socioeconomic status) are less likely to be exposed to strong tobacco control policies or supports for cessation. There are untapped opportunities for behavioral medicine approaches to reduce TRHDs in college settings. Research findings regarding multilevel (policy, community-level, and individual-level) interventions must be translated to policy/practice in order to address tobacco use, particularly among vulnerable college student populations.

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Projecting the effects of tobacco control policies in the USA through microsimulation: a study protocol

BMJ Open ◽

10.1136/bmjopen-2017-019169 ◽

2018 ◽

Vol 8 (3) ◽

pp. e019169 ◽

Cited By ~ 6

Author(s):

Jamie Tam ◽

David T Levy ◽

Jihyoun Jeon ◽

John Clarke ◽

Scott Gilkeson ◽

...

Keyword(s):

Tobacco Control ◽

Computational Models ◽

Smoking Prevalence ◽

Smoking Initiation ◽

Control Programme ◽

Smoking History ◽

Control Policies ◽

Tobacco Control Policies ◽

Life Years ◽

The Usa

IntroductionSmoking remains the leading cause of preventable death in the USA but can be reduced through policy interventions. Computational models of smoking can provide estimates of the projected impact of tobacco control policies and can be used to inform public health decision making. We outline a protocol for simulating the effects of tobacco policies on population health outcomes.Methods and analysisWe extend the Smoking History Generator (SHG), a microsimulation model based on data from the National Health Interview Surveys, to evaluate the effects of tobacco control policies on projections of smoking prevalence and mortality in the USA. The SHG simulates individual life trajectories including smoking initiation, cessation and mortality. We illustrate the application of the SHG policy module for four types of tobacco control policies at the national and state levels: smoke-free air laws, cigarette taxes, increasing tobacco control programme expenditures and raising the minimum age of legal access to tobacco. Smoking initiation and cessation rates are modified by age, birth cohort, gender and years since policy implementation. Initiation and cessation rate modifiers are adjusted for differences across age groups and the level of existing policy coverage. Smoking prevalence, the number of population deaths avoided, and life-years gained are calculated for each policy scenario at the national and state levels. The model only considers direct individual benefits through reduced smoking and does not consider benefits through reduced exposure to secondhand smoke.Ethics and disseminationA web-based interface is being developed to integrate the results of the simulations into a format that allows the user to explore the projected effects of tobacco control policies in the USA. Usability testing is being conducted in which experts provide feedback on the interface. Development of this tool is under way, and a publicly accessible website is available athttp://www.tobaccopolicyeffects.org.

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