Association of cigarette smoking with changes in macroeconomic conditions.

This study uses data from the 1987-2022 Behavioral Risk Factor Surveillance System and state-level employment rates from the US Bureau of Labor Statistics to estimate the association between macroeconomic conditions and cigarette smoking. Our finding suggests a positive association, which constantly declined with time after the 2001 recession. We find that a one percentage point increase in the employment rate is associated with a 1.4% higher likelihood of smoking cigarettes in the overall sample but declined to 0.4% among cohorts surveyed from 2011 to 2022. We also find strong positive and heterogeneous associations among sociodemographic groups, except among Blacks and persons aged 65 years and older, among whom there is no association; however, the positive associations consistently decreased among these sociodemographic groups. Consequently, the strong positive association disappeared in several sociodemographic groups in cohorts surveyed over the last decade.

Association between cigarette sales in the USA and FDA's announcement of its intention to prohibit menthol as a characterising flavour in cigarettes.

INTRODUCTION: On 29 April 2021, the US Food and Drug Administration (FDA) announced its intention to prohibit menthol as a characterising flavour in cigarettes. METHODS: We assessed the changes in cigarette sales associated with the FDA's announcement using interrupted time series analysis based on monthly retail point-of-sale data on cigarettes from the NielsenIQ Local Trade Area (LTA) data from September 2019 to April 2022. Main outcome variables included LTA-level monthly menthol and non-menthol cigarette sales per 1000-persons. RESULTS: Monthly cigarette sales were declining before the FDA's announcement (menthol vs non-menthol: -1.68 (95% CI -1.92, -1.45) vs -3.14 (95% CI -3.33, -2.96) packs per 1000-persons). Monthly menthol cigarette sales increased immediately in May 2021 after the FDA's announcement by 6.44 packs per 1000-persons (95% CI 3.83, 9.05). Analysis stratified by LTA-level racial/ethnic compositions showed that LTAs with a relatively higher proportion of non-Hispanic Black population (>8.94%) experienced higher spike in menthol cigarette sales in May 2021 immediately after the announcement and higher post-announcement 12-month menthol cigarette sales than expected. CONCLUSIONS: Areas with a relatively higher proportion of non-Hispanic Black population are potentially at risk of experiencing increased burden of menthol cigarette consumption. Targeted community level cessation support in non-Hispanic Black majority areas may help mitigate the growing burden of menthol cigarette smoking and improve health equity. The findings of this study also suggest that FDA's prompt finalisation and enforcement of such ban may help avoid extending the increased burden of menthol cigarette consumptions in non-Hispanic Black majority areas.

Declining trend in cigarette smoking among U.S. adults over 2008-2018: A decomposition analysis.

The United States (U.S.) witnessed considerable reduction in cigarette smoking prevalence in the recent past. While the correlates of smoking prevalence and related disparities among U.S. adults are well documented, there is limited information on how this success was shared among different population sub-groups. Based on data from the National Health Interview Surveys, 2008 and 2018, representative of non-institutionalized U.S. adults (18 years and above), we applied the threefold Kitawaga-Oaxaca-Blinder linear decomposition analysis. We decomposed the trends in cigarette smoking prevalence, smoking initiation, and successful cessation into changes in population characteristics holding smoking propensities constant (compositional change), changes in smoking propensities by population characteristics holding population composition constant (structural change), and the unmeasured macro-level changes affecting smoking behavior in different population sub-groups at differential rates (residual change) to quantify the shares of population sub-groups by sex, age, race/ethnicity, education, marital status, employment status, health insurance coverage, family income, and region of residence in the overall change in smoking rates. The analysis shows that decreases in smoking propensities regardless of the changes in population composition accounted for 66.4% of the reduction in smoking prevalence and 88.7% of the reduction in smoking initiation. The major reductions in smoking propensity were among Medicaid recipients and young adults (ages 18-24 years). The 25-44-year-olds experienced moderate increase in successful smoking cessation, while the overall successful smoking cessation rate remained steady. Taken together, consistent reduction in smoking among U.S. adults by all major population characteristics, accompanied by disproportionately larger reduction in smoking propensities among the population sub-groups with initially higher smoking propensity compared to the national average, characterized the decline in overall cigarette smoking. Strengthening proven tobacco control measures with targeted interventions to reduce smoking propensities among underserved populations is key to continued success in reducing smoking overall and remedying inequities in smoking and population health.

Economic loss attributable to cigarette smoking in the USA: an economic modelling study.

BACKGROUND: Despite large geographical disparities in the prevalence of cigarette smoking across the USA, there is a paucity of state-level estimates of economic loss attributable to smoking to inform tobacco control policies at the national and state levels. We aimed to estimate the state-level economic loss attributable to cigarette smoking in the USA. METHODS: In this economic modelling study, we used a dynamic macroeconomic model of personal income per capita at the state level. Based on publicly available data on state-level income, its determinants, and smoking status for 2011-20, we first estimated the elasticity of personal income per capita with respect to the prevalence of non-smoking adults (aged ≥18 years) in the USA using a mixed-effects, generalised linear, dynamic panel data model. We used the estimated elasticity to measure the state-specific, annual, avoidable economic loss attributable to cigarette smoking in 2020 under the counterfactual 5% prevalence of cigarette smoking. We then estimated the state-specific cumulative economic loss attributable to cigarette smoking in 2020 using the coefficient of lagged income in the dynamic model. National estimates on economic loss attributable to cigarette smoking were obtained by summing state-specific estimates. FINDINGS: In the mixed-effects model, the elasticity of personal income per capita with respect to the prevalence of non-smoking adults was 0·143 (p=0·063). The estimated annual income loss per capita in 2020 ranged from US$331 in Utah to $1674 in Kentucky. The state mean population-weighted loss per capita was $1100. The annual combined loss of income and unpaid household production at the national level was $436·7 billion (equivalent to 2·1% of US gross domestic product [GDP] in 2020). The cumulative loss of income and unpaid household production was $864·5 billion (equivalent to 4·3% of US GDP in 2020). INTERPRETATION: Smoking causes substantial economic loss in the USA. Tobacco control efforts that lower the prevalence of smoking equitably can contribute considerably to improved macroeconomic performance in the short and long term by reducing health expenditures and avoiding productivity losses. FUNDING: American Cancer Society.

Effects of Prices on Youth Cigarette Smoking and Tobacco Use Initiation in Ghana and Nigeria.

Background: Population growth in the African region is set to outpace the rate of decline in smoking prevalence, leading to a projected increase in the total number of smokers. As most tobacco users initiate during their adolescent years, tobacco prevention strategies targeting youth will be particularly important. Methods: This study estimated the impact of cigarette prices on youth cigarette smoking and tobacco use initiation in Ghana and Nigeria using the Global Youth Tobacco Survey data. First, we used cross-section data and logit models to estimate the effects of prices on youth cigarette smoking. Second, we created pseudo longitudinal data and used continuous-time hazard models to evaluate the impact of cigarette prices on tobacco use initiation. Results: We found that higher cigarette prices decreased both 30-day cigarette smoking and tobacco use onset significantly in both Ghana and Nigeria. Additionally, the price elasticity of cigarette smoking and tobacco use initiation ranged from -0.44 to -1.13, and -1.04 to -3.66, respectively. Conclusions: As one of the first studies on youth tobacco consumption in Sub-Saharan Africa, this study strongly suggests that policies that increase real cigarette prices can lower both cigarette smoking and tobacco use initiation among youth in Ghana and Nigeria.