Classifying European cigarette consumption trajectories from 1970 to 2015

ObjectivesTo systematically code and classify longitudinal cigarette consumption trajectories in European countries since 1970.DesignBlinded duplicate qualitative coding of periods of year-over-year relative increase, plateau, and decrease of national per capita cigarette consumption and categorisation of historical cigarette consumption trajectories based on longitudinal patterns emerging from the data.Setting41 countries or former countries in the European region for which data are available between 1970 and 2015.ResultsRegional trends in longitudinal consumption patterns identify stable or decreasing consumption throughout Northern, Western and Southern European countries, while Eastern and Southeastern European countries experienced much greater instability. The 11 emergent classes of historical cigarette consumption trajectories were also regionally clustered, including a distinctive inverted U or sine wave pattern repeatedly emerging from former Soviet and Southeastern European countries.ConclusionsThe open-access data produced by this study can be used to conduct comparative international evaluations of tobacco control policies by separating impacts likely attributable to gradual long-term trends from those more likely attributable to acute short-term events. The complex, regionally clustered historical trajectories of cigarette consumption in Europe suggest that the enduring normative frame of a gently sloping downward curve in cigarette consumption can offer a false sense of security among policymakers and can distract from plausible causal mechanisms among researchers. These multilevel and multisectoral causal mechanisms point to the need for a greater understanding of the political economy of regional and global determinants of cigarette consumption.

Cigarette dependence is more prevalent and increasing among US adolescents and adults who use cannabis, 2002–2019

SignificanceCannabis use is increasing among cigarette smokers. If cannabis use is associated with cigarette dependence, a barrier to smoking cessation, this could have public health implications for tobacco control. The current study estimated the prevalence of cigarette dependence among US individuals who smoke cigarettes by cannabis use status, and investigated trends in cigarette dependence from 2002 to 2019 among cigarette smokers by cannabis use status and cigarette consumption (ie, cigarettes per day, CPD).MethodsData were drawn from the 2002–2019 annual National Survey on Drug Use and Health and included US individuals aged 12+ years who used cigarettes at least once in the past month (n=231 572). Logistic regression was used to estimate the prevalence of cigarette dependence, measured as time to first cigarette <30 min, by past-month cannabis use (no use, non-daily use, daily use), and to estimate trends in cigarette dependence from 2002 to 2019 overall and stratified by cannabis use and smoking level (light, 1–5 CPD; moderate, 6–15 CPD; heavy, 16+ CPD).ResultsAcross all levels of cigarette use, cigarette dependence was significantly more common among individuals with daily cannabis use compared with those with non-daily or no cannabis use. From 2002 to 2019, cigarette dependence increased among cigarette smokers with non-daily cannabis use, and among light and moderate cigarette smokers with no cannabis use.ConclusionsUS individuals who use both cigarettes and cannabis report a higher prevalence of cigarette dependence relative to individuals who use cigarettes and do not use cannabis at virtually all levels of cigarette consumption. Further, cigarette dependence is increasing in the USA both among those who use and do not use cannabis. Given the increase in cannabis use among those using cigarettes, efforts to elucidate the nature of the association between cannabis and cigarette dependence are needed.

Brand-switching and tobacco taxation in Vietnam

BackgroundThe government of Vietnam is embarking on a radical tobacco excise tax reform, switching from the current pure ad valorem scheme to a mixed system by adding a specific component. There have been concerns raised by state-owned tobacco companies against this initiative that switching to a mixed scheme may shift consumption away from cheaper, domestic brands to more expensive, foreign brands (produced locally by joint ventures between multinational tobacco companies and domestic firms) and to illicit cigarettes, thus impairing the domestic industry, rather than reducing cigarette consumption effectively. Unfortunately, although this concern has been one of the biggest obstacles to the tobacco tax reform in the country, no study thus far has attempted to address it due mostly to the unavailability of relevant micro-market data with detailed information on brand choice.ObjectivesThis research attempts to study cigarette brand substitution patterns and quantify the potential effect of the proposed tax structure change on cigarette brand choice to inform tax policy discussions in Vietnam.MethodsA discrete choice experiment is conducted to collect data on smokers’ stated brand choice when cigarette prices change exogenously. Combined with data on their current cigarette consumption, random parameter logit models were estimated and then used to calculate brand-level price semielasticities as well as numerically simulate the impact of tax reforms on smoking.ResultsSmokers are more likely to substitute a low-priced domestic brand with another domestic brand than either with a foreign brand or with an illicit brand, both of which are more expensive. Furthermore, the opt-out is one of the closest substitutes to low-priced brands and also the most sensitive to a change in their prices, implying that smokers of low-priced brands are more likely to buy none of the studied brands when cigarette prices increase. This provides strong suggestive evidence that they appear more likely to stop smoking when faced with higher cigarette prices. Imposing a specific tax tends to reduce the market share for both low-priced and high-priced licit brands, although the estimated market share reduction is larger for the former. In response to specific tax increases, a large share of current smokers do not intend to switch to illegal cigarette brands, but rather choose none of the experimented brands, suggesting their intention to quit. Finally, the magnitude of substitution to illicit brands tends to be negatively related to change in their prices as a result of the specific excise tax hike.ConclusionContrary to the raised concern, smokers are more likely to substitute a domestic brand with another domestic brand than with a foreign brand. Moreover, the threat of illicit trade should not be exaggerated, and there are actions that the government of Vietnam can take to mitigate the threat effectively.

The Effect of Income and Social Status on Interests are not Smoking on Active Smokers

Introduction. Smoking is a phenomenon in society that emerged as an area of interest in research within the last decade, moreover due to the high prevalence in young adults. WHO reported that in 2008, Indonesia held the 3rd position out of 10 countries with highest population and cigarette consumption worldwide. High interest of cigarette consumption due to income and social status of individuals yielded such devastating effects in every aspects of life. High cigarette consumption had caused economic and social burden that never stopped to arise. Aizen and Fishbain described that interest was a good predictor to determine behavioral aspect of cigarette smoking in individual. Planned behavior theory stated that interest or intention were the closest determinant factors of behavior. From the above explanation, there were several factors that could alter one’s interest to quit smoking viewed from income and social status aspects. This research was conducted to determine factors that influenced interest in smoking consumption, including the aspects of income and social status toward the interests of active smokers in Palembang to quit their smoking behavior. Methods: The method used was qualitative research and data were taken by observations, focus group discussion (FGD) and in-depth interview. The informants were 15 active smokers from various backgrounds in Palembang that were selected by purposive sampling technique. In FGD, out of 15 informants, 10 were taken and divided into 2 groups, and the rest 5 informants were chosen for in-depth interview. Results: Based on the three aspects of planned behavior theory, i.e. individual’s interest, subjective social norm, and behavioral control, the result showed that individual’s attitude did not influence the decision of active smokers to quit their smoking behavior, meant as not to quit but more inclined to reduce than to stop. Second, based on subjective social norm, from environment, parents, and peers, the result showed that this aspect could influence active smokers’ interest to quit smoking. Third, based on the aspect of behavioral control by individual’s income, the result showed that the income did not influence active smokers’ interest to quit smoking because they were more driven by their cravings for cigarette. Based on behavioral control by social status, the results showed that educational level and marriage status did have influence on active smokers to their smoking behavior, but not to stop, rather only to reduce. The aspect of jobs also did not have any influence on active smokers to quit their smoking behavior. Conclusion: The aspect of income and job-related social status did not have any influence on active smokers to quit their smoking behavior, while social status viewed from educational level and marriage status yielded the influence on active smokers, but more inclined to reduce than to stop.

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.

Extended cost–benefit analysis of tobacco taxation in Brazil

BackgroundBrazil has experienced a persistent and substantial reduction in the prevalence of smoking in the population since 2006 due to increased taxes on tobacco and other tobacco control policies. Despite the effectiveness of these measures, however, the socioeconomic costs of smoking are still very high. Tobacco taxation in Brazil plays an important role among the measures adopted to curb tobacco use.MethodsThe study combines data from the National Household Sample Survey of 2008 and the National Health Survey of 2013 and applies cross-section, pooled, and probit estimations, to estimate price elasticities of tobacco consumption by distinct population cohorts. The paper presents a comprehensive cost–benefit analysis resulting from a one-time tax increase on manufactured cigarettes using estimated conditional price elasticity of cigarette consumption and probability of smoking by income and age quartiles.FindingsEach 10% price increase (BRL 0.54), due to higher tobacco taxes, reduces cigarette consumption by about 5%, and for poor smokers, it would lead to net income gains by about BRL 39.00 per month (in 2019 values). The highest net income effects were observed for the younger, aged between 15 and 29 years, and for middle-aged individuals, between 40 and 59 years old. Higher tobacco taxes lead to lower medical expenses on tobacco-related diseases and a longer, healthier and more productive life. Most importantly, this policy is progressive, as its economic effects are stronger for the poorer than for the richer according to the income quartiles.ConclusionsA tax increase that rises cigarette prices generates significant social benefits by reducing tobacco spending and medical expenses on tobacco-related diseases and raising future years of life and net income. The total benefits for the individual and the society go way beyond the public finance improvement.

Dutch youth’s smoking behaviour during a partial covid-19 lockdown

Previous research found that adult smokers increased their smoking in response to the Covid-19 lockdown in spring 2020. This study explored changes in youth’s smoking during, compared to before, the partial lockdown in the Netherlands in a cross-sectional sample of 287 adolescents. Smoking prevalence increased from 4.5% to 5.2%. Cigarette consumption remained the same on school days and increased with +1.9 cigarettes per weekend day. The largest increase in cigarette consumption on weekend days was observed for adolescents who 1) did not consider smoking a risk factor for contracting Covid-19 (+4.5), 2) had smoking siblings (+4.1), and 3) had smoking friends (+2.4). Youth without smoking friends (-0.8) and who considered smoking a risk factor for Covid-19 (-0.2) decreased their cigarette consumption.

Electronic cigarettes consumption and associated factors among general population in Western Saudi Arabia

Background: In recent years, consumption of E-cigarettes has increased dramatically. Several studies have focused on the prevalence of E-cigarettes among specific groups of people, using it as a substitute to traditional cigarettes, or the participant knowledge regarding risks. This research was aimed on E-cigarettes’ prevalence and its association to several factors in the general population of Western Saudi Arabia.Design and Methods: Using an observational cross-sectional study, data were collected from (n=465) above 18 years old smokers during the survey at public attractions. A validated self-administered questionnaire acquired from previous studies was employed to insure the suitability for the general population of Jeddah Saudi Arabia. Sample size was calculated via Raosoft@ and adults of either gender were included in the study. Descriptive or inferential statistical analysis was performed using SPSS.Results: The preponderance of e-cigarette smokers used entertainment as the reason for smoking, with an average of (33.9%). Although one reason for e-cigarette consumption was to cease traditional smoking, results showed an average of (49.4%), which is the majority of those who attempted to cease traditional smoking via e-cigarette, did not succeed in quitting traditional smoking. This study also demonstrated that participant that believed that e-cigarette is beneficial had a higher chance to cease conventional smoking than who did not (32.1% versus 14.6%) which is significant (p<0.001).Conclusions: In conclusion, this study estimated the prevalence of e-cigarette consumption among the population of Jeddah, Saudi Arabia along with assessment of elements which help increase the overall e-cigarette consumption in Jeddah.

The effect of price on cigarette consumption, distribution, and sale in Tehran: a qualitative study

Background Appropriate increases in tobacco taxes and prices are an essential component of comprehensive tobacco control strategies. This study investigates factors related to the use, sale, and distribution of cigarettes in Iran, focusing on the relationship between cigarette price and its consumption. Methods This interview-based qualitative study was conducted among 20 participants, including cigarette smokers, retail shop owners, large-scale distributors, and an expert in tobacco control research. Results Seven themes were extracted from participant interviews, including the type and price of cigarette, the best time to sell cigarettes, profits from the sale of cigarette, affordability, rise in cigarette price and smokers’ reaction to it, lobbying and black-market sales of cigarettes, and the sale and distribution of cigarettes across the country. Although the price of cigarettes in Iran has shown some increases in the past decade, the timing of these increases are not predictable and the limited amount of these increases has not reduced the use of cigarettes. Following a price increase, consumers are more likely to switch from buying packets to single cigarettes, or buy a less expensive brand, then to quit. Moreover, increases in prices may encourage smokers and sellers to buy a large number of cigarettes and store them for a rainy day. Another adverse effect may be increased smuggling of illicit cigarettes to balance the pressure caused by rising prices. Conclusions Our findings highlight two important aspects concerning cigarette pricing in Iran. First is the change in the type of purchase from the whole box of cigarettes to the single stick cigarette or swapping to less expensive cigarettes. Second, increase in cigarette price (either through taxing or regular increases) could be offset by flooding smuggled cigarettes into the market. Therefore, in addition to raising cigarette prices, reducing cigarette consumption rates in Iran requires the development and effective implementation of regulatory policies to control cigarette smuggling, reduce purchasing, and subsequently curb the use of this leading cause of premature morbidity and mortality.