Tobacco price and use following California Proposition 56 tobacco tax increase

Background California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017. Methods Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011–2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a “synthetic” California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted. Results The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. Conclusion Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.

Tobacco use among School-going Adolescents in Comoros: A Secondary Analysis of the 2015 Comoros Global Youth Tobacco Survey.

BackgroundTobacco use among adolescents has long term adverse health consequences, especially during adulthood. Currently, little is known about tobacco use behaviour among adolescents in Comoros. Our study aims to estimate the prevalence and identify key factors associated with tobacco use among adolescents in Comoros using the 2015 Comoros Global Youth Tobacco Survey data.MethodsNational cross-sectional survey data of 2,810 eligible school-going adolescents aged between 11-17 years were analysed. Complex sample logistic regression analyses to determine the correlates of current cigarette smoking and current use of non-cigarette tobacco products.ResultsThe overall prevalence of current cigarette smoking was 14.3% [males (18.5%), females (9.9%)]. The prevalence of current use of non-cigarette tobacco products was 5.8% [males (6.7%), females (4.9%)]. Being male (AOR=2.23;95%CI:1.38-3.59), exposure secondhand smoke within (AOR=3.869;95%CI:2.835-5.280)) and outside their home (AOR= 1.514; 95%CI: 1.100-2.084) and exposure to tobacco industry promotion (AOR=2.986; 95%CI:2.246-3.969) were predictors of current tobacco use among adolescents. Similarly, Exposure to tobacco industry promotion (AOR=.2.669;95%CI:1.610-4.425) were associated with non-cigarette tobacco use. Adolescents exposed to anti-smoking education in schools were less likely to use non-cigarette tobacco (AOR=0.523;95% CI:0.311-0.881) than those not exposed to anti-smoking education in schools.ConclusionOne in seven school-going adolescents smoke cigarettes, and approximately one in 20 school-going adolescents use non-cigarette tobacco products in Comoros. Exposure to secondhand smoke within and outside the home and exposure to tobacco industry promotion were associated with tobacco use in school-going adolescents in Comoros. Our findings suggest the need for adolescent-friendly gender-sensitive tobacco interventions, including strengthening existing tobacco control laws to prevent and reduce tobacco use among school-going adolescents in Comoros.

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.

Patterns of non-cigarette tobacco and nicotine use among current cigarette smokers and recent quitters: Findings from the 2020 ITC Four Country Smoking and Vaping Survey

Introduction This study explores patterns of use of non-cigarette tobacco and nicotine products among adult cigarette smokers and recent ex-smokers. Along with cigarette smoking status we explore differences as a function of countries with different product regulations, gender and age. Methods Data came from the ITC Four Country Smoking and Vaping Wave 3 Survey conducted between February-June 2020. The analytic sample consisted of 9112 current cigarette smokers (at least monthly) and 1184 recent ex-smokers (quit cigarettes ≤ 2 years) from Australia, Canada, England, and the US. Respondents were asked about their cigarette smoking and current use of the following non-cigarette products: combustible tobacco (cigars, cigarillos, pipe, waterpipe); non-combustible tobacco (smokeless tobacco, and heated tobacco products (HTPs)); and non-tobacco nicotine products (nicotine vaping products (NVPs), nicotine replacement therapy (NRT), and nicotine pouches)). Results Overall, NVPs (13.7%) and NRT (10.9%) were the most reported nicotine products used, followed by cigars (5.3%), cigarillos (4.2%), and HTPs (3.5%). More than 21% current and recent ex-smokers of cigarettes reported using a non-tobacco nicotine product and non-combustible product, with respondents in England reporting the highest levels of use (>26%). Males, younger respondents, and current non-daily cigarette smokers were more likely to use non-cigarette nicotine products. Notably, 11.6% of ex-cigarette smokers were using other combustible tobacco. Conclusion Considerable percentages of current cigarette smokers and ex-smokers use non-cigarette nicotine products, and there are unexpectedly high levels of use of other combustible products by those recent ex-smokers of cigarettes which is concerning and has important implications for definitions of smoking cessation. Implications The tobacco product market has evolved to include new products which add to existing non-cigarette tobacco products creating a much more diverse nicotine market. This brief report provides a snapshot of use of various combustible and non-combustible nicotine containing products among current cigarette smokers and recent ex-smokers in four western countries. Our results indicate that use of non-cigarette tobacco and nicotine products among these cigarette smokers and recent ex-smokers is not low, particularly among males, younger and non-daily cigarette smokers. Use of other combustible tobacco among respondents that recently quit cigarette smoking is concerning and has important implications for definitions of smoking cessation. Increased emphasis on researching non-cigarette nicotine product use is warranted in tobacco control generally and smoking cessation in particular.

Changes in cigarillo availability following implementation of a local flavoured tobacco sales restriction

IntroductionProvidence, Rhode Island (RI) was among the first US jurisdictions to enact a policy (effective 3 January 2013) restricting the retail sale of non-cigarette tobacco products with a characterising flavour other than the taste or aroma of tobacco, menthol, mint or wintergreen. We used scanner data to assess the impact of this sales restriction on retail availability of cigarillos, flavoured and otherwise, in Providence and a rest-of-state (ROS) comparison area.MethodsEvery unique cigarillo product—each indicated by a universal product code (UPC)—available for sale in RI from January 2012 to December 2016 was assigned to an exclusive flavour-name category (tobacco; explicit or concept flavour; or menthol/mint) based on characteristics in the scanner dataset and, as necessary, information from online websites. We calculated weekly unique cigarillo UPC counts and market share by flavour category and used difference-in-difference regression to assess prepolicy and postpolicy changes in counts and share in Providence relative to ROS.ResultsThe prepolicy to postpolicy decrease in the number of unique cigarillo products available in Providence was 28.64 (±5.83) UPCs greater than the comparable decrease in ROS (p<0.05). The prepolicy to postpolicy increase in the number of unique concept-named flavoured cigarillo products in Providence was 6.08 (±2.31) UPCs greater than the increase in ROS (p<0.05). The postpolicy market share of concept-named flavoured cigarillos was higher in Providence (27.32%, ±1.77) than ROS (12.67%, ±1.67) (p<0.05).ConclusionsAfter policy implementation, Providence consumers were exposed to fewer cigarillo UPCs but a greater variety and proportion of concept-named flavoured cigarillos in the retail marketplace.

HPLC Analysis of Aflatoxin B1 Contamination of Local and Foreign Brands of Cigarette Tobacco Popularly Consumed in Niger State North-Central Nigeria

Under favorable growth conditions, fungi produced aflatoxins. Aflatoxin B1 (AFB1) categorized as a carcinogen is the most toxic and subject of regulation in foods and feeds in many countries. AFB1 contamination has been reported in a wide range of products including cigarette tobacco due to improper processing and storage conditions. This research aim at determining the concentration load of AFB1 mycotoxin in brands of cigarette tobacco commonly consumed in Lapai and Minna metropolis of Niger State Nigeria. Thirty-six (36) brands of cigarette tobacco were purchased in open markets in Minna and Lapai towns of Niger state, Nigeria. Residual AFB1 was extracted from the sample using standard procedures. HPLC analysis was used for the mycotoxin quantification. The result showed that all cigarette samples produces AFB1 with a concentration of 302 µg/mL and 18 µg/mL as the highest and lowest AFB1 concentration respectively for the local – Nigeria brands compared to 166 µg/mL and 8 µg/mL AFB1 concentration observed for the foreign brands. The findings from this study provide sufficient levels of contamination to pose significant health hazard for the consumer of the tobacco. Careful processing and storage is therefore advocated to eliminate or reduce the mycotoxin contamination of the cigarette brands.

Radiological risk assessment of some consumed cigarettes and hookah in Iraq

The main purposes of the research are to assess the radiological risk due to smoking cigarettes and hookah and their impacts on the people health. Radon levels were measured in 28 consumed brands of cigarettes and 10 brands of hookah consumed Iraq using CR-39 solid state nuclear track detectors (SSNTDs). The results showed that the 222Rn concentration in cigarette tobacco samples ranged from 138.9 to 781.2 Bqm-3 with average value of 318.0 Bqm-3. The radon concentrations emerged from 11brands of the investigated samples was significantly higher than the recommended value. While, its concentration in hookah ranged from 633.6 Bqm-3 to 416.6 Bqm-3 with average value of 509.5 Bqm-3. The Potential Alpha Energy Concentration (PAEC) in terms of (WL) units, Exposure to radon progeny (EP), and the annual effective dose (AED) in terms of (mSv/y) units were also obtained. Lung cancer cases per year per million people (CPPP) are also evaluated with an average value of 144.4 per million people. The result indicates that the average values of PAEC, EP and AED were within the recommended range values given by UNSCEAR, NCRP and ICRP respectively. The radioactive impact of smoking is considered as a risk factor for lung cancer.

A Longitudinal Study of Exposure to Tobacco-Related Toxicants and Subsequent Respiratory Symptoms Among U.S. Adults with Varying E-cigarette Use Status

Background The link between e-cigarette use and subsequent development of respiratory diseases remains an open question. Aims and Methods A subset of a probability sample of U.S. adults from the Population Assessment of Tobacco and Health Study Waves 1 and 2 were selected for biospecimen analysis (n = 4614). Subjects were divided into three mutually exclusive groups at baseline: nonusers (n = 2849), exclusive e-cigarette users (n = 222), and poly e-cigarette/tobacco users (n = 1,543). Geometric mean concentrations of baseline biomarkers from five classes of harmful and potentially harmful constituents were reported. Multivariable linear regressions were conducted to examine the relationship between baseline biomarkers and subsequent respiratory symptoms among user groups. Results Baseline exclusive e-cigarette users (33.6%[confidence interval, CI: 26.7% to 41.4%]) and poly e-cigarette/tobacco users (50.8%[CI: 47.4% to 54.2%]) had higher prevalence of subsequent respiratory symptoms than nonusers (21.7%[19.2% to 24.4%]). As compared with nonusers, poly e-cigarette/tobacco users had higher concentrations in clinically relevant biomarkers at baseline than exclusive e-cigarette users. Among poly e-cigarette/tobacco users, baseline nicotine metabolites (TNE2, cotinine), tobacco-specific nitrosamine (NNAL), PAH (1-NAP, 3-FLU), and volatile organic compound (N-Acetyl-S-(2-carboxyethyl)-l-cysteine, N-acetyl-S-(2-cyanoethyl)-l-cysteine) were significantly higher among those reporting subsequent respiratory symptoms than those who did not. Among exclusive e-cigarette users, baseline NNAL was significantly higher among those reporting subsequent respiratory symptoms than those who did not. Within subjects with subsequent respiratory symptoms, NNAL was 2.5 times higher in exclusive e-cigarette users (10.7[6.5 to 17.5]) and 63.4 times higher in poly e-cigarette/tobacco users (199.6[176.7 to 225.4]) than nonusers (3.1[2.4 to 3.9]). Conclusions E-cigarette use is associated with higher concentrations of known tobacco-related toxicants and risks of subsequent respiratory symptoms than nonusers. Poly e-cigarette/tobacco users exhibit higher risk than exclusive e-cigarette users. Implications This longitudinal study identified positive associations between baseline urinary biomarkers of exposure to tobacco-related toxicants and increased risks of subsequent respiratory symptoms across varying e-cigarette use groups. E-cigarette use is associated with increased exposure to known tobacco-related toxicants, and certain toxicant exposure increases the risk of respiratory symptoms.