Tobacco Product Use Among Adults - United States, 2019.

Cigarette smoking remains the leading cause of preventable disease and death in the United States (1). The prevalence of current cigarette smoking among U.S. adults has declined over the past several decades, with a prevalence of 13.7% in 2018 (2). However, a variety of combustible, noncombustible, and electronic tobacco products are available in the United States (1,3). To assess recent national estimates of tobacco product use among U.S. adults aged ≥18 years, CDC analyzed data from the 2019 National Health Interview Survey (NHIS). In 2019, an estimated 50.6 million U.S. adults (20.8%) reported currently using any tobacco product, including cigarettes (14.0%), e-cigarettes (4.5%), cigars (3.6%), smokeless tobacco (2.4%), and pipes* (1.0%).† Most current tobacco product users (80.5%) reported using combustible products (cigarettes, cigars, or pipes), and 18.6% reported using two or more tobacco products.§ The prevalence of any current tobacco product use was higher among males; adults aged ≤65 years; non-Hispanic American Indian/Alaska Native (AI/AN) adults; those whose highest level of educational attainment was a General Educational Development (GED) certificate; those with an annual household income <$35,000; lesbian, gay, or bisexual (LGB) adults; uninsured adults and those with Medicaid; those with a disability; or those with mild, moderate, or severe generalized anxiety disorder. E-cigarette use was highest among adults aged 18-24 years (9.3%), with over half (56.0%) of these young adults reporting that they had never smoked cigarettes. Implementing comprehensive, evidence-based, population level interventions (e.g., tobacco price increases, comprehensive smoke-free policies, high-impact antitobacco media campaigns, and barrier-free cessation coverage), in coordination with regulation of the manufacturing, marketing, and sale of all tobacco products, can reduce tobacco-related disease and death in the United States (1,4). As part of a comprehensive approach, targeted interventions are also warranted to reach subpopulations with the highest prevalence of use, which might vary by tobacco product type.

How Is Exposure to Tobacco Outlets Within Activity Spaces Associated With Daily Tobacco Use Among Youth? A Mediation Analysis.

INTRODUCTION: We investigated associations between exposure to tobacco outlets within activity spaces and daily tobacco use, and whether exposure to adults or peers using tobacco mediate these relationships. METHODS: We used Geographic Ecological Momentary Assessment data over 14 days from 85 youth aged 16-20 years in eight mid-sized California city areas. Tobacco outlet addresses and global positioning systems locations were geocoded and activity spaces were constructed by joining sequential points. We assessed daily number of tobacco outlets within 50 or 100 m of activity space polylines and number of minutes participants were within 50 or 100 m of tobacco outlets each day; daily use of tobacco; and whether participants saw (1) adults and (2) people their age (peers) using tobacco each day. RESULTS: Controlling for demographics, results of multilevel structural equation models showed no association between number of tobacco outlets within 50 m of polylines and tobacco use (probit regression coefficient: 0.01, p = .82). However, we found evidence of an indirect effect (p = .001) through daily exposure to peers using tobacco. Specifically, greater number of tobacco outlets within 50 m of polylines was positively associated with seeing peers use tobacco (probit regression coefficient: 0.10, p < .001). In turn, seeing peers use tobacco was positively associated with tobacco use on that day (probit regression coefficient: 2.23, p < .001). Similar results were found for number of tobacco outlets within 100 m of polylines. CONCLUSIONS: Exposure to tobacco outlets within activity spaces affects youth tobacco use through daily exposure to peers who use tobacco. IMPLICATIONS: Using real-time-ordered data, this article examines whether exposure to adults and peers using tobacco mediate associations between exposure to tobacco outlets within activity spaces and daily tobacco use among youth. Results suggest that exposure to tobacco outlets within activity spaces affects daily tobacco use through exposure to peers who use tobacco. These findings provide additional significant support for policy makers who are considering regulating the number and density of tobacco retailers and point to the importance of interventions focused on peer tobacco use and youths' daily environments to reduce tobacco use.

Assumption of Risk and the Role of Health Warnings Labels in the United States.

INTRODUCTION: This article provides historical context for understanding how the cigarette industry have manipulated language used in health warning labels (HWLs) to protect them in litigation. METHODS: Review of previously secret internal business records from 1964 discussing the role HWLs on cigarettes. Review of the legal challenges made by cigarette manufacturers surrounding HWLs as mandated in the 2009 Family Smoking Prevention and Tobacco Control Act and the language in corrective statements ordered by US Department of Justice. RESULTS: Within days after the Surgeon General's Advisory Committee issued its 1964 Report the cigarette companies plotted how they could use HWLs on cigarettes as a defense in future litigation. Industry lawyers discussed drafting legislation that would preempt other government agencies from requiring HWLs on cigarette containers and in cigarette advertising with language mirroring the key findings of the Surgeon General's Advisory Committee report. In July 1965, Congress did pass legislation which mandated a single watered-down cigarette pack HWL which excluded cigarette advertising, just as industry lawyers had recommended. Subsequent HWL laws passed by Congress in 1969 and 1984 along with the more recent history of manufacturers opposing updated graphic HWLs and corrective statements reflects a consistent and continuing effort by cigarette companies to insulate themselves from taking responsibility for harms caused by smoking. CONCLUSION: Beginning in the mid-1960s and continuing even through today, lawyers working on behalf of cigarettes companies have worked to manipulate the language of consumer warnings to focus responsibility for the harms caused by smoking on smokers. IMPLICATIONS: In tobacco litigation, juries should be informed about the industry's coordinated effort to draft legislation and water down the original caution statements proposed on cigarette containers and in advertising even though Congress ultimately is responsible for the law that was enacted. In addition, even though the 1992 Supreme Court decision in the Cipollone case preempted post-1969 failure to warm claims against cigarette makers, this protection does not apply on pre-1969 warning claims where the evidence shows that cigarette companies understood they were selling a defective product that when used as intended would harm their customers. Thus, those initiating smoking before 1969 and subsequently harmed by cigarettes can hold cigarette makers responsible for their failure to warn them about health risks.

Content analysis of tobacco in episodic programming popular among youth and young adults.

BACKGROUND: While evidence exists supporting a causal relationship between exposure to tobacco content in movies and youth smoking, research is limited on the prevalence and impact of tobacco content in episodic programming aired on television (TV) and online streaming platforms. The purpose of this study was to analyse episodic programming popular among young people to estimate the prevalence of tobacco imagery. METHODS: An online survey of participants aged 15-24 years (n=750) recruited from an existing panel was used to gauge viewership of episodic programming aired on Netflix, broadcast TV and cable TV. Two trained coders independently watched the entire 2015/2016 and 2016/2017 seasons of 14 programmes aired on a streaming platform, Netflix, and across broadcast and cable TV. The coding scheme was based on existing methods which involve documenting both the type of tobacco product featured and, if applicable, user information. RESULTS: Eighty-six per cent of Netflix programmes and 86% of broadcast and cable TV programmes had at least one occurrence of tobacco. Netflix programmes had more total occurrences (n=1185) compared with the broadcast or cable programmes (n=482). Most of the tobacco occurrences included cigarettes being actively used by a character. CONCLUSIONS: Given the high prevalence of tobacco use found in these entertainment channels, the level of exposure to tobacco use among youth and young adults is very concerning and is serving to circumvent the restrictions of tobacco advertising on broadcast TV. Further research is needed to understand the influence of this exposure on smoking behaviour.

Effect of menthol cigarette and other menthol tobacco product bans on tobacco purchases in the RTI iShoppe virtual convenience store.

OBJECTIVE: To test how a potential US ban of menthol products or replacement with 'green' products and ads could influence tobacco purchases. METHODS: US adult menthol smokers (N=1197) were recruited via an online panel and randomly assigned to complete a shopping task in one of four versions (experimental conditions) of the RTI iShoppe virtual store: (1) no ban, (2) replacement of menthol cigarettes and ads with green replacement versions, (3) menthol cigarette ban and (4) all menthol tobacco product ban. Logistic regressions assessed the effect of condition on tobacco purchases. RESULTS: Participants in the menthol cigarette ban (OR=0.67, 95% CI 0.48 to 0.92) and all menthol product ban conditions (OR=0.60, 95% CI 0.43 to 0.83) were less likely to purchase cigarettes of any type than participants in the no ban condition. Participants in the green replacement (OR=1.74, 95% CI 1.13 to 2.70), menthol cigarette ban (OR=3.40, 95% CI 2.14 to 5.41) and all menthol product ban conditions (OR=3.14, 95% CI 1.97 to 5.01) were more likely to purchase a cigarette brand different from their usual brand than participants in the no ban condition. CONCLUSIONS: Our findings suggest that menthol bans could have great public health impact by reducing cigarette purchases. However, tobacco marketing strategies, such as creating green (or other replacement) versions of menthol cigarettes, may undermine public health benefits of a menthol ban by prompting purchases of non-menthol cigarettes. Our findings highlight the importance of taking tobacco marketing tactics into consideration in tobacco product regulation.

Impact of Graphic Warning Messages on Intentions to Use Alternate Tobacco Products.

Graphic cigarette warnings increase quit attempts. Perceived message effectiveness and message avoidance are predictive of later quit attempts. We sought to examine whether randomized exposure to warning messages would inadvertently increase intentions to use alternate tobacco products while enhancing attempts to quit cigarettes. An online survey of 1392 adult smokers in the US asked participants to rate six randomly selected tobacco warnings (from a set of 319) on perceived effectiveness and avoidance intentions. These two indicators of message effectiveness were calculated at the message-level and then at the individual campaign-level to facilitate causal inference. After viewing a message campaign of six warning messages, participants indicated their intentions to use alternate tobacco products. Sixty-eight percent of participants reported some intention to use e-cigarettes and intentions to use other alternate tobacco products ranged from 31% to 40%. Campaigns of messages eliciting higher avoidance increased the odds of intending to use hookah (aOR: 4.32), smokeless tobacco (aOR: 4.88), and snus (aOR: 8.06), but not the intention to use electronic cigarettes. These relationships are mediated by intentions to quit smoking (all p <.05). Viewing campaigns with higher campaign-level perceived effectiveness increased the intentions to quit, which in turn increased intentions to try alternate tobacco products. Our findings increase the tobacco control community's understanding of unintended consequences of graphic tobacco warnings.

Price and income elasticities of demand for cigarette consumption: what is the association of price and economic activity with cigarette consumption in Spain from 1957 to 2016?

OBJECTIVES: Extensive empirical and theoretical studies have been devoted to analyzing the relationship between tobacco and income. The price and income elasticities of demand for cigarette consumption are the main focus of studies in this body of literature. However, few empirical studies exist that analyze how economic growth affects the cigarette market, and no one has studied the effects of economic expansions and recessions. Spain, as in the other countries of the European Union, has suffered a strong recession since 2008. Therefore, this article aims to detect if income elasticity takes different values in economic growth and recession and, in addition, to check whether price elasticity in Spain is consistent with previous studies. STUDY DESIGN: This is an observational epidemiological study. METHODS: In this article, the price and income elasticities of demand for cigarette consumption are measured for the Spanish cigarette market using time series data from 1957 to 2016 and by applying a non-linear autoregressive dynamics lag model. The novel specification proposed in this study is the determination of the possible effects of asymmetries in the economic shocks on cigarette consumption. RESULTS: Our results reveal that cigarette consumption maintains a notable asymmetric relationship. In particular, our results show that in expansion shocks, cigarette consumption increases (a 10% economic growth is associated with a 4.05% increase in cigarette consumption), whereas in recession shocks, cigarette consumption decreases dramatically, with a more pronounced pattern in recession phases than in expansion phases (a 10% economic decline is associated with a 58.16% decrease in cigarette consumption). On the other hand, price elasticity maintains the same behavior shown in the previous literature (a 10% price increase is associated with a 2% decrease in cigarette consumption). CONCLUSIONS: Higher cigarette prices are associated with decreased smoking. In addition, the economic recession helps in decreasing cigarette consumption. Therefore, it is strongly recommended that tax authorities have our results in mind before establishing health policies. If the authorities do not, it is possible that they will not obtain the expected results in terms of decreased tobacco consumption.

Community-Led Action to Reduce Menthol Cigarette Use in the African American Community.

Background. African Americans suffer a disproportionate burden of tobacco harm and researchers have posited that menthol cigarettes are a key contributor to this disparity. In 2015, a county health department and African American community-based organization (CBO) in Minnesota partnered to educate and engage the African American community on menthol and its role in tobacco-related health disparities. The following case study describes successes, challenges, and recommendations from this work. We focus on the role of a public health and community partnership in menthol policy adoption so others can more effectively implement a community-driven approach in their own communities. Methods. Interviews were conducted with local and state public health staff, leadership from the CBO, youth coordinators, and change agents-that is, leaders in the African American community recruited to educate and engage the community on menthol. Interviews were transcribed verbatim and analyzed in Atlas.ti using thematic analysis. Results. Participants identified several successes: (1) assessment data from community members helped inform policy decision making, (2) collaboration between local public health and CBO was powerful and a key to success, and (3) change agents were trusted communicators and effectively engaged and provided education to the community. Participants faced challenges related to stylistic and cultural differences in communication. Participants recommended engaging youth and incorporating cessation into the broader context of issues systemically affecting African American communities (e.g., economic inequity, police violence, incarceration). Implications. Menthol tobacco restrictions have the potential to reduce tobacco-related health inequities for African Americans. Findings highlight the role that public health and community partnerships can play in supporting this critical work to effect policy change.

State Preemption: Impacts on Advances in Tobacco Control.

CONTEXT: Policy is an effective tool for reducing the health harms caused by tobacco use. State laws can establish baseline public health protections. Preemptive legislation at the state level, however, can prohibit localities from enacting laws that further protect their citizens from public health threats. APPROACH: Preemptive state tobacco control laws were assessed using the Centers for Disease Control and Prevention's State Tobacco Activities Tracking and Evaluation System. Based on the assessments, the Centers for Disease Control and Prevention quantified the number of states with certain types of preemptive tobacco control laws in place. In addition, 4 different case examples were presented to highlight the experiences of 4 states with respect to preemption. DISCUSSION: Tracking and reporting on preemptive state tobacco control laws through the Centers for Disease Control and Prevention's State Tobacco Activities Tracking and Evaluation System provide an understanding of the number and scope of preemptive laws. Case examples from Hawaii, North Carolina, South Carolina, and Washington provide a detailed account of how preemption affects tobacco control governance at state and local levels within these 4 states.

Strategies to Reduce Illicit Trade of Regular Nicotine Tobacco Products After Introduction of a Low-Nicotine Tobacco Product Standard.

The US Food and Drug Administration is considering mandating a substantial reduction in the nicotine level of cigarettes and possibly other combusted tobacco products to render them minimially addictive. This would likely result in several public health benefits, including increased cessation, decreased progression to dependence, and reduced consumption of combusted tobacco products. However, findings from clinical trials of reduced-nicotine cigarettes suggest that many smokers consuming low nicotine-content cigarettes sought out regular nicotine-content cigarettes, even when they were asked to only smoke free low-nicotine cigarettes. If this policy were implemented without ensuring that cessation treatments and appealing alternative products (e.g., e-cigarettes) were readily available, some consumers would be likely to seek banned regular nicotine-content combusted tobacco products from illicit sources: retail, online, and individuals. Left unchecked, this illicit market could undermine the public health benefits of the policy. We describe supply and demand factors in an illicit market. Informed by the literature on controlling Internet tobacco sales and reducing illicit trade in low-cost cigarettes when there are price differentials, we recommend tracking and tracing products and greater surveillance and enforcement efforts to minimize illicit trade in normal nicotine products under a low-nicotine tobacco product standard.

A Qualitative Analysis of Selected Stakeholders' Viewpoints on Tobacco Control in Nigeria.

Nigeria is a signatory to the Framework Convention on Tobacco Control. However, tobacco control efforts have been fraught with challenges. These challenges cannot be presumed to be independent of tobacco industry manipulation. We examined submissions and viewpoints from prominent tobacco control stakeholders across social, administrative, and political strata to identify convergence with tobacco industry viewpoints. We illustrate how these convergences pose a threat to effective tobacco control in Nigeria. A thematic analysis of stakeholder viewpoints was conducted on submissions to the national assembly during the Tobacco Control Bill public hearings and various industry documents. Areas of convergence with tobacco industry narratives were then explored. Significant convergence in views was observed between government agencies, social groups, and the tobacco industry. These were for narratives on constitution of a National Tobacco Control Committee, use of automated vending machines, designation of smoking areas, report to regulatory agencies, and negative effect of tobacco control on trade and poverty. There was evidence of tobacco industry interference in tobacco control efforts, which manifested in some prominent tobacco control stakeholders adopting the narratives of the tobacco industry. We advocate a constant watchfulness over the activities of these stakeholders and a proactive engagement with evidence-based antitobacco dialogue.

FCTC followed by accelerated implementation of tobacco advertising bans.

OBJECTIVES: We sought to evaluate changes in countries' enacting advertising bans after the effect of ratifying the WHO Framework Convention on Tobacco Control (FCTC). METHODS: We compared adoption of advertising bans on five areas (TV and radio, print media, billboards, point-of-sale, sponsorship) in countries that did versus did not ratify the FCTC, accounting for years since the ratification of the Convention. RESULTS: On average, passage of complete advertising bans accelerated after FCTC ratification. The development was strongest among lower middle-income countries. Lack of state capacity was associated with lower likelihood of countries implementing complete advertising bans. Implementation of complete advertising bans slowed after 2007. CONCLUSIONS: Implementation of FCTC Article 13 was followed by increased progress towards complete advertising bans, but progress is incomplete, especially among low-income countries. Low-income countries need comprehensive support to implement FCTC as part of a broad effort to reinvigorate progress on global implementation of the FCTC. Enforcing complete bans requires constant monitoring and attacking of tobacco industry efforts to circumvent them.

Prices for Tobacco and Nontobacco Products in Pharmacies Versus Other Stores: Results From Retail Marketing Surveillance in California and in the United States.

OBJECTIVES: To examine disparities in the price of tobacco and nontobacco products in pharmacies compared with other types of stores. METHODS: We recorded the prices of Marlboro, Newport, the cheapest cigarettes, and bottled water in a random sample of licensed tobacco retailers (n = 579) in California in 2014. We collected comparable data from retailers (n = 2603) in school enrollment zones for representative samples of US 8th, 10th, and 12th graders in 2012. Ordinary least squares regressions modeled pretax prices as a function of store type and neighborhood demographics. RESULTS: In both studies, the cheapest cigarettes cost significantly less in pharmacies than other stores; the average estimated difference was $0.47 to $1.19 less in California. We observed similar patterns for premium-brand cigarettes. Conversely, bottled water cost significantly more in pharmacies than elsewhere. Newport cost less in areas with higher proportions of African Americans; other cigarette prices were related to neighborhood income and age. Neighborhood demographics were not related to water prices. CONCLUSIONS: Compared with other stores, pharmacies charged customers less for cigarettes and more for bottled water. State and local policies to promote tobacco-free pharmacies would eliminate an important source of discounted cigarettes.

Tobacco Product Use Among Adults - United States, 2013-2014.

While significant declines in cigarette smoking have occurred among U.S. adults during the past 5 decades, the use of emerging tobacco products* has increased in recent years (1-3). To estimate tobacco use among U.S. adults aged ≥18 years, CDC and the Food and Drug Administration (FDA) analyzed data from the 2013-2014 National Adult Tobacco Survey (NATS). During 2013-2014, 21.3% of U.S. adults used a tobacco product every day or some days, and 25.5% of U.S. adults used a tobacco product every day, some days, or rarely. Despite progress in reducing cigarette smoking, during 2013-2014, cigarettes remained the most commonly used tobacco product among adults. Young adults aged 18-24 years reported the highest prevalence of use of emerging tobacco products, including water pipes/hookahs and electronic cigarettes (e-cigarettes). Furthermore, racial/ethnic and sociodemographic differences in the use of any tobacco product were observed, with higher use reported among males; non-Hispanic whites, non-Hispanic blacks, and non-Hispanics of other races(†); persons aged <45 years; persons living in the Midwest or South; persons with a General Educational Development (GED) certificate; persons who were single/never married/not living with a partner or divorced/separated/widowed; persons with annual household income <$20,000; and persons who were lesbian, gay, or bisexual (LGB). Population-level interventions that focus on all forms of tobacco product use, including tobacco price increases, high-impact anti-tobacco mass media campaigns, comprehensive smoke-free laws, and enhanced access to help quitting tobacco use, in conjunction with FDA regulation of tobacco products, are critical to reducing tobacco-related diseases and deaths in the United States.(§).

Internet cigarette vendors make tax-free claims and sell cigarettes cheaper than retail outlets.

OBJECTIVE: This paper aims to (1) assess whether promotion of tax-free sales among Internet cigarette vendors (ICVs) changed between 2009 and 2011, (2) determine which types of ICVs are most likely to promote tax-free sales (eg, US-based, international or mixed location ICVs), and (3) compare the price of cigarettes advertised in ICVs to prices at brick-and-mortar retail outlets. METHODS: We analysed data from the 200 most popular ICVs in 2009, 2010 and 2011 to assess promotion of tax-free sales and the price of Marlboro cigarette cartons. We used Nielsen scanner data from 2009, 2010 and 2011 to measure the price of Marlboro cartons in US grocery stores. FINDINGS: The odds of ICVs claiming tax-free status were higher in 2011 than in 2009 (OR=1.58, p<0.01). Mixed location and international vendors had higher odds of promoting tax-free sales than US-based ICVs (OR=4.95 and 6.23, respectively, both p<0.001). In 2011, the average price of one Marlboro carton was $35.27 online, compared to $52.73 in US grocery stores. We estimated that in 2011, a pack-a-day smoker living in an area with high cigarette prices would save $1508 per year buying cigarettes online. CONCLUSIONS: ICVs commonly promote tax-free sales, and cigarettes are cheaper online compared to US grocery stores. Better enforcement of the Prevent All Cigarette Trafficking Act is needed to address tax-free cigarette sales among ICVs.

'Sweeter Than a Swisher': amount and themes of little cigar and cigarillo content on Twitter.

OBJECTIVE: Despite recent increases in little cigar and cigarillo (LCC) use-particularly among urban youth, African-Americans and Latinos-research on targeted strategies for marketing these products is sparse. Little is known about the amount or content of LCC messages users see or share on social media, a popular communication medium among youth and communities of colour. METHODS: Keyword rules were used to collect tweets related to LCCs from the Twitter Firehose posted in October 2014 and March-April 2015. Tweets were coded for promotional content, brand references, co-use with marijuana and subculture references (eg, rap/hip-hop, celebrity endorsements) and were classified as commercial and 'organic'/non-commercial using a combination of machine learning methods, keyword algorithms and human coding. Metadata associated with each tweet were used to categorise users as influencers (1000 and more followers) and regular users (under 1000 followers). RESULTS: Keyword filters captured over 4 372 293 LCC tweets. Analyses revealed that 17% of account users posting about LCCs were influencers and 1% of accounts were overtly commercial. Influencers were more likely to mention LCC brands and post promotional messages. Approximately 83% of LCC tweets contained references to marijuana and 29% of tweets were memes. Tweets also contained references to rap/hip-hop lyrics and urban subculture. CONCLUSIONS: Twitter is a major information-sharing and marketing platform for LCCs. Co-use of tobacco and marijuana is common and normalised on Twitter. The presence and broad reach of LCC messages on social media warrants urgent need for surveillance and serious attention from public health professionals and policymakers. Future tobacco use prevention initiatives should be adapted to ensure that they are inclusive of LCC use.

[Demand for cigarettes and tax increases in El Salvador]. / La demanda de cigarrillos y el aumento de impuestos en El Salvador.

OBJECTIVE: Analyze short- and long-term elasticities of demand for cigarettes in El Salvador as a tool for supporting recommendations on tax increases to reduce prevalence and consumption through price increases. METHODS: Demand for cigarettes in El Salvador was analyzed through an econometric time-series model using a database from El Salvador's General Directorate of Internal Taxes (DGII) and the General Directorate of Statistics and Census (DIGESTYC). The analysis period was quarterly: 2000Q1-2012Q4. The usual tests were done to prevent a spurious econometric estimation. It was found that the variables volume sales, actual sale prices, and actual per capita income exhibited first-order cointegration; this result makes it possible to use an error correction model with short- and long-term elasticity estimates. RESULTS: Only long-term elasticities were found to be statistically significant to 5%. Results show long-term price elasticity (5 quarters) of -0.9287 and income price elasticity of 0.9978. CONCLUSIONS: Absolute price elasticity is somewhat high, although it is within the levels estimated in other studies in low per-capita income countries. A tax increase from a base amount of US$1.04 per pack of 20 cigarettes to US$1.66 within three years would reduce demand by 20% to 31% and would increase tax revenues by 9% to 22%.

Higher price, fewer packs: evaluating a tobacco tax increase with cigarette sales data.

In 2013, Minnesota increased cigarette taxes by $1.75, the largest US state increase since 2000. We obtained convenience store data of cigarette sales from January 2012 to December 2013 from the Nielsen Company. Analysis revealed significantly greater year-to-year reductions in numbers of packs purchased during posttax (-12.1%) than pretax (-3.2%; P<.001) periods. The results provide contemporary evidence that, despite reduced prevalence and increased tobacco control efforts, tax increases remain an effective tobacco control strategy.

The impact of prices and taxes on the use of tobacco products in Latin America and the Caribbean.

We examined the impact of tobacco prices or taxes on tobacco use in Latin America and Caribbean countries. We searched MEDLINE, EconLit, LILACS, unpublished literature, 6 specialty journals, and reviewed references. We calculated pooled price elasticities using random-effects models. The 32 studies we examined found that cigarette prices have a negative and statistically significant effect on cigarette consumption. A change in price is associated with a less than proportional change in the quantity of cigarettes demanded. In most Latin American countries, own-price elasticity for cigarettes is likely below -0.5 (pooled elasticities, short-run: -0.31; 95% confidence interval=-0.39, -0.24; long-run: -0.43; 95% CI=-0.51, -0.35). Tax increases effectively reduce cigarette use. Lack of studies using household- or individual-level data limits research's policy relevance.