Restricting supply of tobacco products to pharmacies: a scoping review.

OBJECTIVE: We synthesised the published literature on proposals to restrict tobacco supply to pharmacies, covering (1) policy concept/rationale/attempts, (2) policy impact and implementation and (3) policy and research recommendations. DATA SOURCES: We searched eight databases (PubMed, CINAHL, Scopus, Web of Science, Embase, IPA, ProQuest and OATD) for publications with at least an English-language abstract. We searched reference lists of included publications manually. STUDY SELECTION: One author screened all publications, and a second author reviewed a 10% subset. We focused on approaches to restrict the supply of tobacco products to pharmacies, without any restrictions on study design, location, participants or publication date. DATA EXTRACTION: Data extraction adhered to the JBI Scoping Review Methodology and Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. DATA SYNTHESIS: We included 18 publications. Among the 13 studies conducted in specific geographical contexts, 8 were from Aotearoa/New Zealand. Most publications (n=8) focused on effectiveness domains, indicating potential reductions in retailer density, smoking prevalence, disease burden, cost and increased opportunities for cessation advice. Seven explored policy acceptability among experts, pharmacists and people who smoke. Publications noted that pharmacy-only supply aligns with other programmes involving pharmacists, such as needle exchange programmes, but conflicts with efforts to phase out tobacco sales from the US and Canadian pharmacies. CONCLUSIONS: Progress in tobacco retailing policy (eg, licensing, retailer incentives) and research (eg, assessment of policy equity and durability, application in other geographical contexts) are needed before a pharmacy-only tobacco supply model would be feasible.

Will Australia's tightened prescription system reduce nicotine vaping among young people?

BACKGROUND: Australia introduced a prescription only policy for e-cigarettes in 2011 to prevent uptake among youth while allowing smokers to access e-cigarettes for cessation. This is one of the restrictive forms of regulation for e-cigarettes recommended by the World Health Organisation. AIMS: To assess whether the policy has prevented e-cigarette youth uptake and facilitated smokers' access to e-cigarettes for cessation; and to examine a proposed toughening of the policy. METHODS: An analysis of survey and administrative data on e-cigarette use and smoking and a critical analysis of the contents of submissions to parliamentary inquiries into the policy. RESULTS: E-cigarette use among youth and young adults has increased steeply since 2016 but very few of these products have been obtained through the prescription system, because medical authorities discourage their use. A policy change in 2021 to increase the prescription of e-cigarettes has not reduced e-cigarette use among youth and only marginally increased rates of prescribing. Australian policy makers have nonetheless tightened the prescription system by banning any use of e-cigarettes unless prescribed by a doctor and dispensed by a pharmacist. IMPLICATIONS: Australia's tightened prescription policy for e-cigarettes may reduce adolescent vaping but at the risk of reducing smokers' access to e-cigarettes and increasing the size of the illicit market for combustible cigarettes and e-cigarettes. A more effective policy would allow vapes to be sold as consumer products by licensed tobacconists under regulations that require prior product approval, plain packaging, bans on their promotion and enforced age restrictions on purchases.

Designing observational studies for credible causal inference in addiction research-Directed acyclic graphs, modified disjunctive cause criterion and target trial emulation.

Randomized controlled trials (RCTs) are considered the gold standard for causal inference. With a sufficient sample size, randomization removes confounding up to the time of randomization and allows the treatment effect to be isolated. However, RCTs may have limited generalizability and transportability and are often not feasible in addiction research due to ethical or logistical constraints. The importance of observational studies from real-world settings has been increasingly recognized in research on health. This paper provides an overview of modern approaches to designing observational studies that enable causal inference. It illustrates three key techniques, Directed Acyclic Graphs (DAGs), modified Disjunctive Cause Criterion and Target Trial Emulation, and discusses the strengths and limitations of their applications.