Pricing Policies of Green Dual-Channel Supply Chain with Fairness Concerns and Altruistic Preferences Based on Consumers' Environmental Awareness and Channel Preference.

Taking into consideration fairness concerns and altruistic preferences of manufacturers, this paper aims to propose a green dual-channel supply chain that incorporates consumers' environmental awareness (CEA) and channel preference. The purpose of this work is to explore and further compare the optimal outcomes in a green dual-channel supply chain in three scenarios, which are the fairness-neutrality scenario (Model N), the manufacturer is concerned with fairness scenario (Model F), and the manufacturer has altruistic preference (Model A), respectively. The game-theoretical models with different fairness preferences, comparative, and numerical analyses are used to put forward the impacts of consumers' channel preference and CEA on pricing, profits, and utilities, and to identify the differences in decisional outcomes between the three models. The results indicate that CEA always contributes to developing the green market while adversely affecting common products. Moreover, consumers' channel preferences might enable the manufacturer and retailer to enhance profitability under certain conditions. The findings also reveal that manufacturer's fairness concerns can possibly increase the demand for green products but impair the overall performance of the supply chain in general. Moreover, while the manufacturer's altruistic preference benefits the retailer's profits, it has a detrimental effect on the performance of the green supply chain. The practical implications of this research come to promote green consumption and increasing consumer awareness of environmental protection are effective ways to develop a green supply chain. It is also important to note that in order to maintain the durability and stability of the sup-ply chain, the manufacturer must maintain a moderate level of fairness preference behaviors so that downstream retailers will remain enthusiastic about establishing long-term relationships.

Drug importation: limitations of current proposals and opportunities for improvement.

Drug importation is a policy proposal to help alleviate rising pharmaceutical prices. Restrictions on drug importation stem from the Federal Food, Drug, and Cosmetic Act but authorization of importation can be made by the Health and Human Services (HHS) Secretary. During the Trump administration a number of states passed laws to develop a drug importation programs, however, none have been authorized by HHS. Limitations of these importation programs include sole reliance on Canada, exclusion of high-cost drugs like biologics, and persistent legal hazard of the Personal Importation Program. Potential revisions to current law include expansion of countries approved for importation, inclusion of biologics, and codifying protection for personal importation. Drug importation policies are not a panacea to address rising pharmaceutical prices but may blunt prices while more permanent solutions are pursued.

Early commercial experience with a newly designed balloon-expandable transcatheter heart valve: 30-day outcomes and implications of preprocedural computed tomography.

OBJECTIVES: We herein report a single-centre experience with the SAPIEN 3 Ultra balloon-expandable transcatheter aortic valve implantation (TAVI) system. METHODS: Between March 2019 and January 2020, a total of 79 consecutive patients received transfemoral TAVI using the SAPIEN 3 Ultra device. Data were retrospectively analysed according to updated Valve Academic Research Consortium-2 definitions. Detailed analysis of multislice computed tomography data was conducted to identify potential predictors for permanent pacemaker (PPM) implantation and residual paravalvular leakage (PVL) post TAVI. RESULTS: Device success and early safety were 97.5% (77/79) and 94.9% (75/79) with resulting transvalvular peak/mean pressure gradients of 21.1 ± 8.2/10.9 ± 4.4 and PVL >mild in 0/79 patients (0%). Mild PVL was seen in 18.9% (15/79) of cases. Thirty-day mortality was 2.5% (2/79). The Valve Academic Research Consortium-2 adjudicated clinical end points disabling stroke, acute kidney injury and myocardial infarction occurred in 1.3% (1/79), 5.1% (4/79) and 0% (0/79) of patients. Postprocedural PPM implantation was necessary in 7.6% (6/79) of patients. Multislice computed tomography analysis revealed significantly higher calcium amounts of the right coronary cusp in patients in need for postprocedural PPM implantation and a higher eccentricity index in patients with postinterventional mild PVL. CONCLUSIONS: First experience with this newly designed balloon-expandable-transcatheter heart valve demonstrates adequate 30-day outcomes and haemodynamic results with low mortality, low rates of PPM implantation and no residual PVL >mild. The herein-presented multislice computed tomography values with an elevated risk for PPM implantation and residual mild PVL may help to further improve outcomes with this particular transcatheter heart valve in TAVI procedures.

Vape Shop Employees: Do They Act as Smoking Cessation Counselors?

INTRODUCTION: This study examined smoking cessation advice offered by vape shop employees, as well as their perceived awareness of vaping research. AIMS AND METHODS: This cross-sectional study was conducted in 121 vape shops in the Greater Los Angeles area of Southern California in four multiethnic communities (Hispanic/Latino, African American, Korean/Asian, and non-Hispanic White). A 35-minute interview assessed the employee's tobacco product use, perceptions of vaping research, and experience advising customers to quit cigarette smoking. RESULTS: Among 121 vape shop employees surveyed, 106 (88%) reported that they provided smoking cessation advice or counseling to customers. Nearly half (45%) reported having no vaping-related research knowledge, while 30% were aware of provaping studies only. Approximately 85% of employees had quit cigarettes by switching to e-cigarettes instead, whereas 15% were dual users. Only 49% believed that vaping products contribute to nicotine addiction among youth. Those who provided advice on quitting cigarette smoking reported significantly lower knowledge of e-cigarette research than those who did not provide advice (p < .01). CONCLUSIONS: Most vape shop employees provide advice to customers who desire to quit cigarette smoking and initiate electronic cigarette use. However, they report a low level of awareness about e-cigarette research. Future research is warranted to examine the specifics of advice provided by vape shop employees. Training programs for vape shop employees and educational campaigns about evidence-based scientific findings on vaping may be beneficial. IMPLICATIONS: Almost nine out of 10 surveyed vape shop employees offered cigarette smoking cessation advice to their customers, while almost half of the retailers report not being aware of any vaping-related research studies. Providing employees with training on evidence-based cessation advice could help protect customers. Also, training programs for vape shop employees and educational campaigns about the risk of nicotine addiction could potentially increase their motivation to avoid sales to minors and to warn adults about nicotine addiction.

Youth and Young Adult Convenience Store Behaviors: Findings From Intercept Surveys.

INTRODUCTION: To inform tobacco policy and prevention efforts, we examined youth and young adult behaviors at gas-station-convenience stores and whether these behaviors varied by demographics or tobacco use. AIMS AND METHODS: Between June and July 2017, we conducted 990 intercept surveys at convenience stores in North Carolina among 16- to 25-year olds who were susceptible to or used tobacco. We used logistic regression to examine whether demographics or tobacco use predicted pumping gas, entering the store, or purchasing tobacco, gas, food, lottery tickets, or other items inside the store. RESULTS: Most participants (85.3%) reported ever using tobacco. Most visited that store at least once per week (40.3%) or once within the past month (41.2%). Just over half (55.0%) reported pumping gas at the store. Of those who went or planned to go inside (68.8%), 43.2% purchased food, 39.2% purchased gas, 33.1% purchased tobacco, and 6.8% purchased lottery tickets. Those who were aged 21-25, visited the store two to three times a week, and went inside already were more likely to purchase tobacco (all p < .05). Past 30-day cigarette, cigar, smokeless, and other tobacco uses were positively associated with purchasing tobacco (all p < .05). CONCLUSIONS: Our sample of young people who were susceptible to or ever used tobacco regularly visited gas-station-convenience stores, and one-third purchased or planned to purchase tobacco during their visit. Convenience stores appear to be an important access point for young people. Practitioners and policy makers should consider a comprehensive set of strategies to reduce access among youth and young adults. IMPLICATIONS: We conducted 990 intercept surveys among youth and young adults at gas-station-convenience stores. Among our sample of those who had ever used tobacco or were susceptible to use, most visited the store frequently and one-third purchased tobacco, particularly those who used cigarettes and cigars. Tobacco companies heavily market in convenience stores, and our results show tobacco is a product often purchased by susceptible young adults. Practitioners and policy makers should consider prioritizing efforts at convenience stores to reduce product purchase and use.

The Effects of Alcohol Warning Labels on Population Alcohol Consumption: An Interrupted Time Series Analysis of Alcohol Sales in Yukon, Canada.

OBJECTIVE: There is limited evidence that alcohol warning labels (AWLs) affect population alcohol consumption. New evidence-informed AWLs were introduced in the sole government-run liquor store in Whitehorse, Yukon, that included a cancer warning (Ca), low-risk drinking guidelines (LRDGs) and standard drink (SD) messages. These temporarily replaced previous pregnancy warning labels. We test if the intervention was associated with reduced alcohol consumption. METHOD: An interrupted time series study was designed to evaluate the effects of the AWLs on consumption for 28 months before and 14 months after starting the intervention. Neighboring regions of Yukon and Northwest Territories served as control sites. About 300,000 labels were applied to 98% of alcohol containers sold in Whitehorse during the intervention. Multilevel regression analyses of per capita alcohol sales data for people age 15 years and older were performed to examine consumption levels in the intervention and control sites before, during, and after the AWLs were introduced. Models were adjusted for demographic and economic characteristics over time and region. RESULTS: Total per capita retail alcohol sales in Whitehorse decreased by 6.31% (t test p < .001) during the intervention. Per capita sales of labeled products decreased by 6.59% (t test p < .001), whereas sales of unlabeled products increased by 6.91% (t test p < .05). There was a still larger reduction occurring after the intervention when pregnancy warning labels were reintroduced (-9.97% and -10.29%, t test p < .001). CONCLUSIONS: Applying new AWLs was associated with reduced population alcohol consumption. The results are consistent with an accumulating impact of the addition of varying and highly visible labels with impactful messages.

Chemotyping and identification of protected Dalbergiatimber using gas chromatography quadrupole time of flight mass spectrometry.

The international trade in illegally logged and environmentally endangered timber has spurred enforcement agencies to seek additional technical procedures for the identification of wood species. All Dalbergia species are listed under the Convention on International Trade in Endangered Species (CITES) which is the reason this genus was chosen for study. Multiple sources of the heartwood from different Dalbergia species were extracted and chromatographic profiles collected by gas chromatography with high resolution quadrupole Time of Flight mass spectrometry (GC/QToF). The collected data was mined to select peaks and mass ions representative of the investigated Dalbergia species, and used to develop a Microsoft Excel® template offering immediate graphical representation of the results. Using wood specimens sourced from different xylaria, this graphical fingerprint proved adept at definitive identification of Dalbergia species. The CITES Appendix I species, D. nigra, was easily distinguished from D. melanoxylon and look-alike species of other genera. Similarly, a number of other Dalbergia species were differentiated using this current approach. Kernel discrimination analysis (KDA) was applied to increase the confidence of the species identification. The mislabeling of specimens appears to be common, and the emerging technique of GC/QToF in combination with other techniques, offers improved confidence in identification. GC/QToF further provides automation, the dimension of chromatography to avoid interferences, and production of reproducible electron impact positive (EI+) spectra. The prospect of building an EI+ spectral database for future wood identification is an important feature considering the limited accessibility of authenticated wood species specimens.

Changes in roll-your-own tobacco and cigarette sales volume and prices before, during and after plain packaging legislation in the UK.

BACKGROUND: Plain packaging and minimum pack size legislation for tobacco products was introduced in the UK in May 2016, with a 1-year sell-off period until May 2017, during which both fully branded and plain packs of various sizes were legally available. This study investigates trends in prices of roll-your-own tobacco (RYO) before, during and after implementation of this legislation, and compares trends with those observed in the cigarette market. METHODS: We used Nielsen Scantrack data for the period from March 2013 to June 2018 to describe trends in UK inflation-adjusted prices and volumes of both RYO and cigarettes, and linear regression to estimate changes in prices associated with the introduction of plain packaging and the minimum pack sizes of 30 g RYO and 20 cigarettes. RESULTS: In contrast to a downward trend in cigarette sales volumes, RYO volumes rose throughout the study period. By the time plain packs accounted for 75% or more of sales, the average price of products sold in equivalent pack sizes had increased, relative to average prices in the year before implementation and with adjustment for tax changes, from 34.9 to 38.8 pence per gram for RYO (mean difference 4.26, 95% CI 3.99 to 4.53 pence, 12% increase), and from 38.6 to 41.13 pence for cigarettes (mean difference 2.53, 95% CI 2.24 to 2.83 pence, 7% increase) per cigarette. CONCLUSIONS: New legislation resulted in higher prices for RYO and manufactured cigarettes. However, sales volumes of RYO continued to increase throughout the study period, perhaps because RYO remains a less expensive means of smoking tobacco.

Is Smoking Cessation in Young Adults Associated With Tobacco Retailer Availability in Their Activity Space?

INTRODUCTION: The presence of tobacco retailers in residential neighborhoods has been inversely associated with residents' likelihood of quitting smoking. Few studies have yet explored whether this association holds when accounting for tobacco retailers found in the multiple environments where people conduct their daily activities, that is, their activity space. METHODS: We analyzed cross-sectional data from 921 young adults (18- to 25-years old) participating in the Interdisciplinary Study of Inequalities in Smoking (Montreal, Canada). Respondents self-reported sociodemographic, smoking, and activity location data. Log-binomial regression was used to estimate prevalence ratios (PRs) for the association between smoking cessation and (1) the number of tobacco retailers (counts), and (2) the distance to the closest retailer (proximity) in participants' residential neighborhood and activity space. RESULTS: Smoking cessation was positively associated with low and intermediate tertile levels of tobacco retailer counts in both the residential neighborhood and activity space, and with the furthest distance level in the activity space [PR (95% CI) = 1.21 (1.02 to 1.43)]. CONCLUSIONS: Individuals encounter resources in the course of their regular daily activities that may hamper smoking cessation. This study highlights the relevance of considering the tobacco retail environment of both individuals' residential neighborhood and activity space to understand its association with smoking cessation. IMPLICATIONS: This article contributes to the literature on the association between the tobacco retail environment and smoking cessation in young adults by moving beyond the residential neighborhood to also assess individuals' access to tobacco retailers in the multiple areas where they regularly spend time, that is, their activity space. Findings suggest that lower numbers of tobacco retailers in both the residential neighborhood and activity space, and further distance to tobacco retailers in the activity space are associated with increased smoking cessation.

Street market saleswomen: strategies for the recognition of health needs / Mujeres feriantes: estrategias para el reconocimiento de las necesidades de salud / Mulheres feirantes: estratégias para o reconhecimento das necessidades de saúde

ABSTRACT Objectives: to describe the strategies used by street market saleswomen to recognize their health needs. Methods: qualitative research, based on the Human Needs Theory. The data were collected through semi-structured interviews, with the participation of 15 street market saleswomen. Content Analysis was used to interpret the results. Results: the following categories emerged: "Potentialities and challenges for addressing health needs", which reflect changes in attitudes and practices related to socially recognized behaviors as harmful, and changes in the work process; and "Popular practices in health care", which points out therapeutic alternatives for the resolution of health problems. Final considerations: the therapeutic choices of street market saleswomen are geared towards meeting their perceived health needs. While the minority of these women recognize their more complex health needs to satisfy it, it is necessary to overcome barriers and limitations in an ongoing way in their lives.

RESUMEN Objetivos: describir las estrategias utilizadas por las mujeres feriantes, para el reconocimiento de sus necesidades de salud. Métodos: pesquisa cualitativa, fundamentada en la Teoría de las Necesidades Humanas. Se colectaron los datos en entrevistas semiestructuradas. Participaron 15 mujeres feriantes. Se interpretaron los datos a través del análisis de contenido. Resultados: emergieron dos categorías temáticas: "Potencialidades y desafíos para el enfrentamiento de las necesidades de salud", que reflejan modificaciones de actitudes y prácticas relacionadas a comportamientos socialmente perjudiciales y cambios en el proceso de trabajo; y, "Prácticas populares en la atención a la salud", que apunta alternativas terapéuticas para la resolución de problemas de salud. Consideraciones finales: se concluyó que las selecciones terapéuticas de las feriantes se vuelcan al enfrentamiento de sus necesidades de salud percibidas, y, aunque la minoría de esas mujeres reconozca sus necesidades de salud más complejas, para satisfacerlas, hay que superar barreras y limitaciones continuamente en sus vidas.

RESUMO Objetivos: descrever as estratégias utilizadas por mulheres feirantes para reconhecimento de suas necessidades de saúde. Métodos: pesquisa qualitativa, fundamentada na Teoria das Necessidades Humanas. Os dados foram coletados por meio de entrevistas semiestruturadas, com a participação de 15 mulheres feirantes. Para a interpretação dos resultados, utilizou-se a Análise de Conteúdo. Resultados: emergiram as categorias temáticas: "Potencialidades e desafios para o enfrentamento das necessidades de saúde", que reflete modificações de atitudes e práticas relacionadas a comportamentos socialmente reconhecidos como prejudiciais, e mudanças no processo de trabalho; e "Práticas populares no cuidado à saúde", que aponta alternativas terapêuticas para a resolução dos problemas de saúde. Considerações finais: evidencia-se que as escolhas terapêuticas das feirantes são voltadas para o enfrentamento de suas necessidades de saúde percebidas. Embora a minoria dessas mulheres reconheça suas necessidades de saúde mais complexas, para satisfazê-la, é necessário superar barreiras e limitações de maneira contínua em suas vidas.

The E-Cigarette Debate: What Counts as Evidence?

Two major public health evaluations of e-cigarettes-one from the National Academies of Science, Engineering, and Medicine (NASEM), the other from Public Health England (PHE)-were issued back to back in the winter of 2018. While some have read these analyses as broadly consistent, providing support for the view that e-cigarettes could play a role in smoking harm reduction, in every major respect, they come to very different conclusions about what the evidence suggests in terms of public health policy. How is that possible? The explanation rests in what the 2 reports see as the central challenge posed by e-cigarettes, which helped to determine what counted as evidence. For NASEM, the core question was how to protect nonsmokers from the potential risks of exposure to nicotine and other contaminants or from the risk of smoking combustible cigarettes through renormalization. A precautionary standard was imperative, making evidence that could speak most conclusively to the question of causality paramount. For PHE, the priority was how to reduce the burdens now borne by current smokers, burdens reflected in measurable patterns of morbidity and mortality. With a focus on immediate harms, PHE turned to evidence that was "relevant and meaningful." Thus, competing priorities determined what counted as evidence when it came to the impact of e-cigarettes on current smokers, nonsmoking bystanders, and children and adolescents. A new clinical trial demonstrating the efficacy of e-cigarettes as a cessation tool makes understanding how values and framing shape core questions and conclusive evidence imperative.

The palm oil industry and noncommunicable diseases.

Large-scale industries do not operate in isolation, but have tangible impacts on human and planetary health. An often overlooked actor in the fight against noncommunicable diseases is the palm oil industry. The dominance of palm oil in the food processing industry makes it the world's most widely produced vegetable oil. We applied the commercial determinants of health framework to analyse the palm oil industry. We highlight the industry's mutually profitable relationship with the processed food industry and its impact on human and planetary health, including detrimental cultivation practices that are linked to respiratory illnesses, deforestation, loss of biodiversity and pollution. This analysis illustrates many parallels to the contested nature of practices adopted by the alcohol and tobacco industries. The article concludes with suggested actions for researchers, policy-makers and the global health community to address and mitigate the negative impacts of the palm oil industry on human and planetary health.

Les grandes industries ne fonctionnent pas en vase clos; elles ont des effets tangibles sur la santé des individus et de la planète. Un acteur souvent négligé dans la lutte contre les maladies non transmissibles est l'industrie de l'huile de palme. Étant donné sa prédominance dans l'industrie alimentaire, l'huile de palme est l'huile végétale la plus largement produite au monde. Nous avons appliqué les déterminants commerciaux de la santé pour analyser l'industrie de l'huile de palme. Nous mettons en évidence la relation mutuellement profitable entre cette industrie et l'industrie des aliments transformés ainsi que ses effets sur la santé des individus et de la planète, et notamment des pratiques culturales néfastes liées à des maladies respiratoires, la déforestation, la diminution de la diversité biologique et la pollution. Cette analyse établit de nombreux parallèles avec la nature contestée de pratiques adoptées par les industries de l'alcool et du tabac. L'article se conclut par des propositions d'action pour que les chercheurs, les responsables politiques et la communauté mondiale de la santé examinent et atténuent les effets négatifs de l'industrie de l'huile de palme sur la santé des individus et de la planète.

Las industrias a gran escala no operan de forma aislada, sino que tienen un impacto tangible en la salud humana y del planeta. Un agente que a menudo se ignora en la lucha contra las enfermedades no contagiosas es la industria del aceite de palma. El predominio del aceite de palma en la industria del procesamiento de alimentos lo convierte en el aceite vegetal más producido del mundo. Se han aplicado los determinantes comerciales del marco de la salud para analizar la industria del aceite de palma. Cabe destacar la relación mutuamente beneficiosa de la industria con la industria de los alimentos procesados y su impacto en la salud humana y del planeta, incluidas las prácticas de cultivo perjudiciales que están relacionadas con las enfermedades respiratorias, la deforestación, la pérdida de biodiversidad y la contaminación. Este análisis ilustra muchos paralelismos con la naturaleza controvertida de las prácticas adoptadas por las industrias del alcohol y el tabaco. El artículo concluye con varias sugerencias de posibles medidas para que los investigadores, los responsables de la formulación de políticas y la comunidad mundial de la salud aborden y mitiguen los impactos negativos de la industria del aceite de palma en la salud humana y del planeta.

Evidence From Qualitative Studies of Youth About the Impacts of Tobacco Control Policy on Young People in Europe: A Systematic Review.

INTRODUCTION: A range of tobacco control policies endeavor to prevent smoking uptake in young people, yet relatively little is known about how such interventions impact young people's engagement with smoking. We reviewed existing qualitative evidence on young people and smoking in Europe to assess whether, in what ways and why young people comply with, adapt to, resist, or circumvent tobacco control policies in their respective countries. METHODS: We undertook a systematic review of academic literature presenting qualitative research from Europe on smoking and young people (11-18 years), published from 2000 to 2015. Bibliographic searches (PubMed, PsycInfo, SSCI) produced 1357 records, from which 43 relevant articles were assessed for quality and 39 included in the review. RESULTS: Most studies were from the United Kingdom (27), with a small number (one or two each) from other European countries (Denmark, Sweden, Switzerland, Belgium, Cyprus, Greece, Hungary, Ireland, and Spain). Only 16 articles (11 from United Kingdom) provided any evidence about the impacts of tobacco control policies on young people's smoking. These focused on smoke-free legislation (four), age of sale laws (four), plain packaging (three), and black market tobacco (one). CONCLUSIONS: There is very little qualitative evidence exploring the impacts of tobacco control on youth smoking in Europe. To develop more effective smoking prevention policies that take account of local political, social, and cultural contexts, more qualitative research from a wider range of European countries is needed to understand how tobacco control impacts on young people's social worlds and smoking behaviors. IMPLICATIONS: Smoking is the leading cause of premature mortality in Europe. However, there is little qualitative evidence exploring the impact of tobacco control policies on young people in Europe. Most comes from the United Kingdom and focuses on a narrow range of policies. Thus, we have a limited understanding of how and in what ways tobacco control policies reach young people, their engagement with these, and how local context affects their impact. More qualitative research is needed, from a wider range of countries and on a broader range of tobacco control policies, to strengthen the evidence-base for reducing youth smoking.

Distributional health and financial benefits of increased tobacco taxes in Colombia: results from a modelling study.

BACKGROUND: In Colombia, smoking is the second leading modifiable risk factor for premature mortality. In December 2016, Colombia passed a major tax increase on tobacco products in an effort to decrease smoking and improve population health. While tobacco taxes are known to be highly effective in reducing the prevalence of smoking, they are often criticised as being regressive in consumption. This analysis attempts to assess the distributional impact (across socioeconomic groups) of the new tax on selected health and financial outcomes. METHODS: This study builds on extended cost-effectiveness analysis methods to study the new tobacco tax in Colombia, and estimates, over a time period of 20 years and across income quintiles of the current urban population (80% of the country population), the years of life gained with smoking cessation and the increased tax revenues, all associated with a 70% relative price increase of the pack of cigarettes. Where possible, we use parameters that vary by income quintile, including price elasticity of demand for cigarettes (average of -0.44 estimated from household survey data). FINDINGS: Over 20 years, the tax increase would lead to an estimated 191 000 years of life gained among Colombia's current urban population, with the largest gains among the bottom two income quintiles. The additional annual tax revenues raised would amount to about 2%-4% of Colombia's annual government health expenditure, with the poorest quintiles bearing the smallest tax burden increase. CONCLUSIONS: The tobacco tax increase passed by Colombia has substantial implications for the country's population health and financial well-being, with large benefits likely to accrue to the two poorest quintiles of the population.

Return of cartoon to market e-cigarette-related products.

INTRODUCTION: The tobacco industry's use of cartoons to market products has been shown to be effective at increasing awareness and appeal of combustible cigarettes among youth. While the Master Settlement Agreement placed restrictions on the use of cartoons for major cigarette and smokeless (chew) tobacco brands in the USA, no such restrictions exist for electronic cigarettes (e-cigarettes). Research has shown that e-cigarette manufacturers are using cartoons to market products, but limited data exist on the extent of these practices. This study examined the extent of the use of cartoons to market e-liquids on Instagram. METHODS: Instagram posts with the hashtag #ejuice or #eliquid were collected from 3 November 2017 to 17 November 2017. Rules were established to identify Cartoon (the post contained a cartoon), Logo (the post was labelled a cartoon due to the logo) and Promo (the image of the post or accompanying text indicated it was a promotion) in the data (n=3481). RESULTS: Among all posts, 723 (20.77%) contained a Cartoon, and 479 (13.76%) were coded as a cartoon because of the Logo. In other words, 479/723 or (66.25%) of Cartoon were coded as cartoons due to the vendor's or manufacture's logo. Among all posts, 2360 (67.80%) were Promo. CONCLUSION: Findings indicate that e-cigarette companies are using cartoons to market their products and many of these companies' logos are cartoons. Empirical data are needed to determine whether cartoon marketing strategies impact perceived risk and benefits, product appeal, the intention to use and actual use of e-cigarettes.

Association of flavoured cigar regulations with wholesale tobacco volumes in Canada: an interrupted time series analysis.

INTRODUCTION: This study examines the association of Federal Canadian regulations passed in 2009 addressing flavours (excluding menthol) in small cigars with changes in cigar sales. METHODS: Quarterly wholesale unit data as reported to Health Canada from 2001 through 2016 were analysed using interrupted time series analysis. Changes in sales of cigars with and without flavour descriptors were estimated. Analyses were seasonally adjusted. Changes in the flavour types were assessed over time. RESULTS: The Federal flavour regulations were associated with a reduction in the sales of flavoured cigars by 59 million units (95% CI -86.0 to -32.4). Increases in sales of cigars with descriptors other than flavours (eg, colour or other ambiguous terms) were observed (9.6 million increase (95% CI -1.3 to 20.5), but the overall level (decline of 49.6 million units (95% CI -73.5 to -25.8) and trend of sales of cigars (6.9 million units per quarter (95% CI -8.1 to -5.7)) declined following the ban. Sensitivity analysis showed that there was no substantial difference in effect over time comparing Ontario and British Columbia, suggesting that other provincial tobacco control legislation was not associated with the changes in levels. Analyses suggested that the level change was sensitive to the specification of the date. CONCLUSION: This study demonstrates that flavour regulations have the potential to substantially impact tobacco sales. However, exemptions for certain flavours and product types may have reduced the effectiveness of the ban, indicating the need for comprehensive, well-designed regulations.

Child awareness of and access to cigarettes: impacts of the point-of-sale display ban in England.

INTRODUCTION: England introduced a tobacco display ban for shops with >280 m2 floor area ('partial ban') in 2012, then a total ban in 2015. This study assessed whether these were linked to child awareness of and access to cigarettes. METHODS: Data come from the Smoking, Drinking and Drug Use survey, an annual survey of children aged 11-15 years for 2010-2014 and 2016. Multivariate logistic regression models assessed changes in having seen cigarettes on display, usual sources and ease of access to cigarettes in shops RESULTS: During the partial display ban in 2012, 89.9% of children reported seeing cigarettes on display in the last year, which was reduced to 86.0% in 2016 after the total ban (adjusted OR 0.58, 95% CI 0.50 to 0.66). Reductions were similar in small shops (84.1% to 79.3%)%) and supermarkets (62.6% to 57.3%)%). Although the ban was associated with a reduction in the proportion of regular child smokers reporting that they bought cigarettes in shops (57.0% in 2010 to 39.8% in 2016), we did not find evidence of changes in perceived difficulty or being refused sale among those who still did. DISCUSSION: Tobacco point-of-sale display bans in England reduced the exposure of children to cigarettes in shops and coincided with a decrease in buying cigarettes in shops. However, children do not report increased difficulty in obtaining cigarettes from shops, highlighting the need for additional measures to tackle tobacco advertising, stronger enforcement of existing laws and measures such as licencing for tobacco retailers.

Philip Morris International-funded 'Foundation for a Smoke-Free World': analysing its claims of independence.

The Foundation for a Smoke-Free World was launched in September 2017 with an announced 12-year funding commitment of $1 billion from Philip Morris International (PMI). The Foundation claims that its governing documents (certificate of incorporation, bylaws and a pledge agreement) ensure that it has an independent research agenda and stringent protections from conflicts of interest. We analysed the text of these governing documents. Their provisions have multiple loopholes, particularly regarding conflicts of interest. Further, these documents cannot substitute for other important documentation such as information about PMI's internal business case for investing $1 billion in the Foundation, an unwaivable conflict of interest policy, annual disclosure statements, copies of pre-Foundation establishment correspondence between key individuals, all signed contracts or salary information, none of which, as of July 2018, the Foundation has made publicly available. Even if these were released, however, it is problematic that the Foundation's fundamental purpose was decided on and its leader selected following a tobacco company-paid, privately negotiated arrangement with the Foundation's president. It cannot be regarded as independent.

Estimating the effect of a potential policy to restrict tobacco retail availability in New Zealand.

INTRODUCTION: Reducing tobacco retailer density is suggested to be a key component of tobacco endgames. Where tobacco retail reduction policies exist, 'grandfathering' is typically used, where existing retailers are exempt from restrictions aimed at reducing outlet density. We examined the possible impact on tobacco outlet density in New Zealand of a policy preventing new retail outlets from selling tobacco, but allowing existing retail outlets to continue selling tobacco until they ceased trading or relocated. METHODS: We obtained data on numbers of tobacco outlets and the number of outlet closures recorded annually from 2006 to 2016. We calculated the mean and the lowest and highest 3-year rolling average closure rates for each type of tobacco outlet. We projected decreases in the number of tobacco outlets that would hypothetically be permitted to sell tobacco from 2020 onwards and estimated when the combined number of tobacco outlets would decline by 50% and 95%. RESULTS: Based on mean annual closure rates, the total number of tobacco outlets would decrease by 50% by 2032 and a 95% reduction could be achieved by 2072. By 2025, the number of tobacco outlets would decrease by 27%; by 2050, this reduction would reach 84%. CONCLUSION: A tobacco retail reduction policy that prevented new retail outlets from selling tobacco and grandfathered existing retailers would be unlikely to achieve New Zealand's target of a 95% reduction in tobacco outlet density within several decades of being enacted. Nonetheless, this policy could achieve a 50% reduction in tobacco retail availability in the first decade of implementation.

Innovations in counterfeiting tax stamps: a study of ultraviolet watermarks in a sample of discarded New York City packs.

OBJECTIVE: Document the use of ultraviolet watermark in counterfeit joint New York City/New York State cigarette tax stamps to assess the scale at which distributors of illegal cigarettes adapt to measures protecting the integrity of the system of tobacco tax collection. METHODS: In 2016, we collected 2357 empty discarded cigarette packs along a stratified random sample of block groups in New York City (n=114) and analysed 449 joint New York City/New York State tax stamps using long wave ultraviolet irradiation, light microscopy and taggant testers developed by the tax stamp manufacturer, Meyercord Revenue, to determine whether the tax stamps were counterfeit and how they differed from their genuine equivalent. FINDINGS: 23% (n=102) of the joint NYC/NYS tax stamps examined were counterfeit. Subsequent investigation revealed that almost two-thirds (n=58) of the counterfeit sample bore ultraviolet watermark that closely resembled genuine tax stamps in terms of fluorescence, watermark colour and wording. However, microscopic findings revealed that counterfeit tax stamps mismatched the genuine ultraviolet watermark in regards to font style and word orientation. CONCLUSION: Counterfeiters are using ultraviolet watermarks which makes it difficult to differentiate counterfeit joint New York City/New York State tax stamps from their genuine equivalent when UV irradiation is used as the sole screening tool. Innovations in counterfeiting technology may be the result of fluorescent ink being available for purchase in the mainstream market. Independent monitoring of trends in the illicit market for tobacco products is advised to keep apace of counterfeiting methods.