Association of cigarette production and tobacco retailer density on secondhand smoke exposure in urban China

The primary aims of this study are to examine the associations between two key environmental factors—regional cigarette tobacco production and tobacco retail outlet density—and secondhand smoke (SHS) exposure in urban China and to explore the possible mechanisms that explain this association.MethodsA cross-sectional multistage sampling design was used to collect individual information in 21 cities in China. Environmental variables were retrieved from national databases. Multilevel logistic regression analysis was conducted to examine the associations between regional cigarette tobacco production, tobacco retail outlet density and SHS exposure. Structural equation modelling was employed to determine possible mechanisms.ResultsSHS exposure prevalence defined as daily exposure to SHS for at least 15 min/day at the time of the survey was found to be 28.1% among non-smokers (95% CI 27.1 to 29.0) across the 21 cities. The multilevel logistic regressions showed that province-level per capital cigarette production (OR: 2.72 (95% CI 1.56 to 4.76)and per GDP cigarette production(OR:1.69(95% CI 1,42,2.01), and city-level tobacco retail outlet density (OR: 2.66 (95% CI 1.63 to 4.38)) were significantly associated with SHS exposure. Moreover, results showed that these associations may be explained by the level of tobacco advertisement, which influences social norms, including attitudes and behaviours toward SHS exposure.ConclusionsFindings shed light on the role of cigarette manufacturers and retailers in producing environmental SHS pollution. To address the health and economic burden associated with SHS in China, it will be critical for the Chinese government to enact tobacco control measures consistent with the Framework Convention for Tobacco Control. Efforts should also focus on restricting the permitted density of tobacco retail outlets, and tobacco production in China.

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Retrospective Analysis of Tobacco Control Measures and Policies in China

Tobacco Regulatory Science ◽

10.18001/trs.7.4.6 ◽

2021 ◽

Vol 7 (4) ◽

pp. 295-299

Author(s):

Lian He ◽

Xiaoxin Chen ◽

Chunzi Shao

Keyword(s):

Tobacco Control ◽

Control Period ◽

Control Measures ◽

Chinese Government ◽

Consumption Tax ◽

Short Term ◽

Tax Rate ◽

Effective Role ◽

Regulatory Measures ◽

And Control

Objectives: Tobacco control measures can be divided into three types: regulatory, economic, and informational respectively. This paper focuses on the role and effect of different types of tobacco control measures during the epidemic prevention and control period in China. Conclusion: Firstly, as strong and powerful measures, economic measures can significantly reduce cigarette sales in the short term. However, the Chinese government did not adjust the cigarette consumption-tax rate during the period. Economic measures thus did not play an important role. Secondly, Due to few people in public places and workplaces, regulatory measures were "out of effect" in a short term. Therefore, there were insufficient evidence to find out whether regulatory measures are effective or not. Finally, China's tobacco production increased slightly during this period. This reflected that informational measures did not play an effective role.

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Assessing progress in protecting non-smokers from secondhand smoke

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054599 ◽

2018 ◽

Vol 28 (6) ◽

pp. 692-695 ◽

Cited By ~ 4

Author(s):

Sean Semple ◽

Will Mueller ◽

Alastair H Leyland ◽

Linsay Gray ◽

John W Cherrie

Keyword(s):

Tobacco Control ◽

Secondhand Smoke ◽

Control Strategies ◽

Geometric Mean ◽

Control Policy ◽

Population Exposure ◽

Tobit Regression ◽

Salivary Cotinine ◽

Shs Exposure ◽

Exposure Metrics

ObjectiveTo examine trends in population exposure to secondhand smoke (SHS) and consider two exposure metrics as appropriate targets for tobacco control policy-makers.DesignComparison of adult non-smokers’ salivary cotinine data available from 11 Scottish Health Surveys between 1998 and 2016.MethodsThe proportions of non-smoking adults who had measurable levels of cotinine in their saliva were calculated for the 11 time points. The geometric mean (GM) concentrations of cotinine levels were calculated using Tobit regression. Changes in both parameters were assessed for the whole period and also for the years since implementation of smoke-free legislation in Scotland in 2006.ResultsSalivary cotinine expressed as a GM fell from 0.464 ng/mL (95% CI 0.444 to 0.486 ng/mL) in 1998 to 0.013 ng/mL (95% CI 0.009 to 0.020 ng/mL) in 2016: a reduction of 97.2%. The percentage of non-smoking adults who had no measurable cotinine in their saliva increased by nearly sixfold between 1998 (12.5%, 95% CI 11.5% to 13.6%) and 2016 (81.6%, 95% CI 78.6% to 84.6%). Reductions in population exposure to SHS have continued even after smoke-free legislation in 2006.ConclusionsScotland has witnessed a dramatic reduction in SHS exposure in the past two decades, but there are still nearly one in five non-smoking adults who have measurable exposure to SHS on any given day. Tobacco control strategies globally should consider the use of both the proportion of non-smoking adults with undetectable salivary cotinine and the GM as targets to encourage policies that achieve a smoke-free future.

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Socioeconomic inequalities in secondhand smoke exposure before, during and after implementation of Quebec’s 2015 ‘An Act to Bolster Tobacco Control’

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056010 ◽

2020 ◽

pp. tobaccocontrol-2020-056010

Author(s):

Thierry Gagné ◽

Josée Lapalme ◽

Adrian E Ghenadenik ◽

Jennifer L OLoughlin ◽

Katherine Frohlich

Keyword(s):

Tobacco Control ◽

Secondhand Smoke ◽

Logistic Models ◽

Income Group ◽

Canadian Community Health Survey ◽

Socioeconomic Inequalities ◽

Control Laws ◽

Interaction Terms ◽

Shs Exposure ◽

Over Time

BackgroundTo better understand whether tobacco control policies are associated with changes in secondhand smoke (SHS) exposure across socioeconomic groups, we monitored differences in socioeconomic inequalities in SHS exposure in households and private vehicles among youth and adults before, during and after adoption of Quebec’s 2015 An Act to Bolster Tobacco Control.MethodsUsing data from the Canadian Community Health Survey, we examined the prevalence of daily exposure to SHS in households and private vehicles among youth (ages 12 to 17) and adults (ages 18+) across levels of household education and income (separately) in 2013/2014, 2015/2016 and 2017/2018. We tested differences in the magnitude of differences in outcomes over time across education and income categories using logistic models with interaction terms, controlling for age and sex.ResultsWe detected inequalities in SHS exposure outcomes at each time point, most markedly at home among youth (OR of SHS exposure among youth living in the 20% poorest households vs the 20% richest=4.9, 95% CI 2.7 to 6.2). There were decreases in SHS exposure in homes and cars in each education/income group over time. The magnitude of inequalities in SHS exposure in homes and cars, however, did not change during this period.ConclusionsThe persistence of socioeconomic inequalities in SHS exposure despite implementation of new tobacco control laws represents an increasingly worrisome public health challenge, particularly among youth. Policymakers should prioritise the reduction of socioeconomic inequalities in SHS exposure and consider the specific needs of socioeconomically disadvantaged populations in the design of future legislation.

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Impact of the WHO FCTC on non-cigarette tobacco products

Tobacco Control ◽

10.1136/tobaccocontrol-2018-054346 ◽

2018 ◽

Vol 28 (Suppl 2) ◽

pp. s104-s112 ◽

Cited By ~ 7

Author(s):

Ghazi S Zaatari ◽

Asma Bazzi

Keyword(s):

Tobacco Control ◽

Social Acceptance ◽

Public Awareness ◽

Effective Means ◽

Tobacco Product ◽

Control Measures ◽

Cigarette Tobacco ◽

Tobacco Products ◽

Many Sources ◽

Future Work

IntroductionThis paper investigates to what extent Framework Convention on Tobacco Control (FCTC) parties have successfully implemented regulatory measures against non-cigarette tobacco product (NCTP) use, considers the challenges and peculiarities in applying such regulations and proposes effective means.Data and methodsThis review was based on many sources mainly: International Legal Consortium, International Tobacco Control, Campaign for Tobacco-Free Kids, FCTC, expert group visits and published literature.Findings and conclusionThe FCTC provided a framework that applies to all forms of tobacco and this encouraged some parties to adopt control measures against NCTP and to incorporate them into their national tobacco control plans. Although a number of countries have adopted measures specifically targeted towards smokeless and waterpipe tobacco, greater global progress is needed. The strongest achievements have been in protection from exposure to tobacco smoke; controlling advertising, promotion and sponsorship; controlling sales to and by minors; education, communication and public awareness; and packaging and labelling of NCTP. Countries which adopted broad definitions of tobacco products have demonstrated encouraging trends in curbing their use. Future work should address the deep-rooted social acceptance of NCTP, the laxity in their control, their exclusion from regulations in some countries and the failure to subject them to increased taxation. Control measures should also specifically target the initiation risk to youth and adolescents and all factors that contribute to that such as banning flavourings and promotions through social media. Stronger global surveillance of NCTP use, tracking of policy implementation and evaluation of policy impact will provide important evidence to assist parties in fully implementing the FCTC to control their use.

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Relationship between childhood secondhand smoke exposure and the occurrence of hyperlipidaemia and coronary heart disease among Chinese non-smoking women: a cross-sectional study

BMJ Open ◽

10.1136/bmjopen-2020-048590 ◽

2021 ◽

Vol 11 (7) ◽

pp. e048590

Author(s):

Kewei Wang ◽

Yuanqi Wang ◽

Ruxing Zhao ◽

Lei Gong ◽

Lingshu Wang ◽

...

Keyword(s):

Diabetes Mellitus ◽

Coronary Heart Disease ◽

Heart Disease ◽

Secondhand Smoke ◽

Chinese Women ◽

Cross Sectional Study ◽

Sectional Study ◽

Cross Sectional ◽

Shs Exposure

ObjectiveThe objective of this study was to evaluate the influence of secondhand smoke (SHS) exposure during childhood on type 2 diabetes mellitus, hypertension, hyperlipidaemia and coronary heart disease among Chinese non-smoking women.MethodsIn this cross-sectional study, the SHS exposure data in childhood were obtained using a questionnaire survey. Self-reported childhood SHS exposure was defined as the presence of at least one parent who smoked during childhood.ResultsOf the 6522 eligible participants, 2120 Chinese women who had never smoked were assessed. The prevalence of SHS exposure in the entire population was 28.1% (596). SHS exposure during childhood was not significant for the standard risk factors of type 2 diabetes mellitus (p=0.628) and hypertension (p=0.691). However, SHS was positively associated with hyperlipidaemia (p=0.037) after adjusting for age, obesity, education status, physical activity, alcohol consumption, current SHS exposure status, diabetes mellitus and hypertension. In addition, childhood SHS increased the occurrence of coronary heart disease (p=0.045) among non-smokers after further adjusting for hyperlipidaemia.ConclusionSHS exposure during childhood is associated with prevalent hyperlipidaemia and coronary heart disease in adulthood among non-smoking Chinese women.

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Analysis of the illicit tobacco market in Georgia in response to fiscal and non-fiscal tobacco control measures

Tobacco Control ◽

10.1136/tobaccocontrol-2020-056404 ◽

2021 ◽

pp. tobaccocontrol-2020-056404

Author(s):

Megan Little ◽

Hana Ross ◽

George Bakhturidze ◽

Iago Kachkachishvili

Keyword(s):

Tobacco Control ◽

Household Survey ◽

Tobacco Consumption ◽

Control Measures ◽

Cigarette Consumption ◽

Control Law ◽

Excise Tax ◽

Cigarette Taxes ◽

Illicit Trade ◽

Cigarette Pack

BackgroundGeorgian illicit cigarette consumption was 1.5% in 2017. In 2018, a new tobacco control law took effect followed by a substantial cigarette excise tax increase in 2019. Research shows these policies reduce tobacco consumption, but the tobacco industry argues they increase illicit trade. There is limited evidence on this, particularly from developing countries.MethodsA panel household survey in Georgia obtained data over three waves: 2017 baseline, 2018 after the tobacco control law took effect and 2019 after taxes increased. A sample of 1578 smokers (and quitters in later waves) from five regions reported their tobacco use and were asked to present a cigarette pack in their possession. These were examined for tax stamps and health warnings to establish legality.FindingsThere was no evidence of an increase in illicit cigarette consumption in Tbilisi, Kutaisi, Akhaltsikhe or Gori in any wave. In Zugdidi, near the Russian-occupied Abkhazia, illicit cigarette consumption was increasing even prior to the tax increase, reaching 30.9% by wave 3. A country-wide shift occurred from manufactured cigarettes to roll-your-own tobacco (whose tax remained unchanged) between waves 2 and 3.ConclusionNo evidence of a country-wide increase in illicit cigarette trade was found after non-fiscal tobacco measures took effect and cigarette taxes increased. Relatively high illicit cigarette consumption in Zugdidi highlights the role of disputed territories and border administration in illicit cigarette supply. Substitution towards roll-your-own tobacco after manufactured cigarette taxes increased demonstrates the importance of equalising taxes on tobacco products to maximise public health benefits.

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Predictors of parental knowledge of tobacco effects on health and parental perceptions on tobacco control measures at household level in selected urban residential areas of Dhaka city, Bangladesh

International Journal of Health Promotion and Education ◽

10.1080/14635240.2021.1943489 ◽

2021 ◽

pp. 1-17

Author(s):

Md. Imdadul Haque ◽

Md. Rabiul Islam ◽

M Zobaer Hasan ◽

M. Mokter Ali ◽

Russell Kabir ◽

...

Keyword(s):

Tobacco Control ◽

Parental Knowledge ◽

Parental Perceptions ◽

Control Measures ◽

Dhaka City ◽

Residential Areas ◽

Household Level

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Using point-of-sale data to examine tobacco pricing across neighbourhoods in Scotland

Tobacco Control ◽

10.1136/tobaccocontrol-2019-055484 ◽

2020 ◽

pp. tobaccocontrol-2019-055484 ◽

Cited By ~ 1

Author(s):

Niamh K Shortt ◽

Helena Tunstall ◽

Richard Mitchell ◽

Emma Coombes ◽

Andy Jones ◽

...

Keyword(s):

Purchase Price ◽

Retail Outlet ◽

Point Of Sale ◽

Deprived Neighbourhoods ◽

Convenience Stores ◽

Neighbourhood Level ◽

Outlet Density ◽

Urban Rural ◽

Multivariable Regression ◽

Total Sales

ObjectivesTo assess the geographical variation in tobacco price (cigarettes and roll-your-own (RYO) tobacco) in convenience stores across Scotland and how this relates to neighbourhood income deprivation, tobacco retail outlet density and urban/rural status.MethodsTobacco price data from 124 566 shopping baskets purchased in 274 convenience stores during 1 week in April 2018 were obtained through an electronic point-of-sale system. These data were combined with neighbourhood-level measures of income deprivation, tobacco retail outlet density and urban/rural status. We examined brand price for 12 of the most popular cigarette brands and 3 RYO brands and variations in purchases by price segment; multivariable regression analysis assessed associations between area variables and tobacco price.ResultsMost stores sold tobacco in all price segments. The lowest priced subvalue brands were the most popular in all neighbourhoods but were most dominant in shops in more deprived neighbourhoods. When total sales were assessed, overall purchase price varied significantly by neighbourhood income deprivation; packets of 20 cigarettes were 50 pence (5.6%) lower and RYO 34 pence (2.7%) lower among shops in the two highest income deprivation quintiles relative to the lowest. Analysis of individual brands showed that for 3 of the 12 cigarette brands considered, average prices were 12–17 pence lower in more deprived neighbourhoods with the most popular RYO brand 15 pence lower. There was limited evidence of a relationship with tobacco retail outlet density.ConclusionAcross Scottish convenience stores, the purchase price of cigarettes and RYO was lower in more income-deprived neighbourhoods. The lower prices primarily reflect greater sales of cheap brands in these areas, rather than retailers reducing the prices of individual brands.

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To what extent and why adolescents do or do not support future tobacco control measures: a multimethod study in the Netherlands

Tobacco Control ◽

10.1136/tobaccocontrol-2017-053770 ◽

2017 ◽

Vol 27 (5) ◽

pp. 596-599 ◽

Cited By ~ 7

Author(s):

Michael Schreuders ◽

Naomi A Lagerweij ◽

Bas van den Putte ◽

Anton E Kunst

Keyword(s):

The Netherlands ◽

Tobacco Control ◽

Control Measures ◽

Price Increases ◽

Mixed Support ◽

Mixed Method Design ◽

Product Measures ◽

Group Interviews ◽

Political Leverage ◽

High Support

BackgroundIn the Netherlands, the adoption of new tobacco control measures is needed to further reduce rates of adolescent smoking. Adolescents’ support for future measures could increase the likelihood of adoption as this provides political leverage for tobacco control advocates. There is, however, scant evidence about to what extent and why adolescents support future measures. We therefore assessed adolescents’ support for a range of future measures and explored the criteria that adolescents use to underpin their support.MethodsA mixed-method design involved surveys and group interviews with fourth-year students (predominantly 15–16 years). The survey, completed by 345 adolescents, included statements about future tobacco control measures and a smoke-free future where nobody starts or continues smoking. Thereafter, 15 adolescents participated in five group interviews to discuss their support for future measures.ResultsThe survey showed that adolescents generally support a smoke-free future. They expressed most support for product measures, mixed support for smoke-free areas, ambivalent support for price increases and least support for sales restrictions. The group interviews revealed that differences in support were explained by adolescents’ criteria that future measures should: have the potential to be effective, not violate individuals’ right to smoke, protect children from pro-smoking social influences and protect non-smokers from secondhand smoke.ConclusionAdolescents’ high support for a smoke-free future does not lead to categorical support for any measure. Addressing the underlying criteria may increase adolescents’ support and therewith provide political leverage for the adoption of future measures.

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