Cigarette Prices and Smoking Experimentation among Zimbabwean children: a survival analysis of the 2014 Global Youth Tobacco Survey.

INTRODUCTION: Zimbabwe has a smoking prevalence of 11.7% among the adult population (15 years and older). Thus, in the absence of effective tobacco-control measures, the economic burden of tobacco use will be aggravated, especially considering the increasing tobacco industry activity in the country. Increasing cigarette prices is one possible strategy to reduce tobacco consumption. This study seeks to examine the relationship between cigarette prices and smoking experimentation among children in Zimbabwe, thereby expanding the evidence base for the likely impact of excise taxes on cigarette demand in low-income and middle-income countries. METHODS: A survival analysis using the Zimbabwe 2014 Global Youth Tobacco Survey data. RESULTS: A 10% increase in the price of cigarettes reduces the probability of experimenting with smoking by 9%. Also, children are more likely to experiment with smoking if they have a smoking brother or father who smokes, or see teachers who smoke. The likelihood of experimenting with smoking is higher among boys than girls and is positively associated with age. CONCLUSIONS: There is strong evidence that increasing excise taxes can play an effective role in discouraging children from experimenting with cigarette smoking. Considering the relatively low excise tax burden in Zimbabwe, the government should consider substantially increasing the excise tax burden. IMPLICATIONS: With the number of smokers in low- and middle-income countries expected to increase as the industry intensively expands its market by targeting the youth, increasing excise taxes will play a significant role in preventing children from initiating smoking and help those already using tobacco to quit. An increase in the excise tax increases the retail price of tobacco products, making them less affordable, and reduces the demand for them.

The Impact of COVID-19 Lockdown on Service Utilization Among Chronic Disease Patients in South Africa.

Introduction: Globally, the COVID-19 pandemic has brought many disruptions in health service delivery. Evidence show that the pandemic has negatively affected routine healthcare utilization such as maternal and child health services, but the literature on the effect on non-communicable diseases (NCDs) is scant in South Africa. These disruptions can have long-term health and economic implications for patients. Objective: To estimate the impact of COVID-19 lockdown on service utilization among chronic disease patients in South Africa using administrative data. Methods: Using monthly data from the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program database covering November 2018 to October 2021, we examined the effects of COVID-19 lockdown on utilization among patients receiving antiretroviral therapy (ART) medication only (ART-only), patients receiving both ART and NCD medication (ART + NCD), and patients receiving NCD medications only (NCD-only). We employed segmented interrupted time series approach to examine the changes. We stratified the analysis by socioeconomic status. Results: We found that, overall, the lockdown was associated with increased utilization of CCMDD services by 10.8% (95% CI: 3.3%-19%) for ART-only and 10.3% (95% CI: 3.3%-17.7%) for NCD-only patients. The increase in utilization was not different across socioeconomic groups. For patients receiving ART + NCD medications, utilization declined by 56.6% (95% CI: 47.6%-64.1%), and higher reductions occurred in low SES districts. Conclusion: Patients should be educated about the need to continue with utilization of disease programs during a pandemic and beyond. More efforts are needed to improve service use among patients with multi-morbidities.

Costs and cost-effectiveness of treatment setting for children with wasting, oedema and growth failure/faltering: A systematic review.

This systematic review aimed to address the existing evidence gaps, and guide policy decisions on the settings within which to treat infants <12 months of age with growth faltering/failure, and infants and children aged <60 months with moderate wasting or severe wasting and/or bilateral pitting oedema. Twelve electronic databases were searched for studies published before 10 December 2021. The searches yielded 16,709 records from which 31 studies were eligible and included in the review. Three studies were judged as low quality, whilst 14 were moderate and the remaining 14 were high quality. We identified very few cost and cost-effectiveness analyses for most of the models of care with the certainty of evidence being judged at very low or low. However, there were 17 cost and 6 cost-effectiveness analyses for the initiation of treatment in outpatient settings for severe wasting and/or bilateral pitting oedema in infants and children <60 months of age. From this evidence, the costs appear lowest for initiating treatment in community settings, followed by initiating treatment in community and transferring to outpatient settings, initiating treatment in outpatients then transferring to community settings, initiating treatment in outpatient settings, and lastly initiating treatment in inpatient settings. In addition, the evidence suggested that initiation of treatment in outpatient settings is highly cost-effective when compared to doing nothing or no programme implementation scenarios, using country-specific WHO GDP per capita thresholds. The incremental cost-effectiveness ratios ranged from $20 to $145 per DALY averted from a provider perspective, and $68 to $161 per DALY averted from a societal perspective. However, the certainty of the evidence was judged as moderate because of comparisons to do nothing/ no programme scenarios which potentially limits the applicability of the evidence in real-world settings. There is therefore a need for evidence that compare the different available alternatives.

Cost-effectiveness of dental caries prevention strategies in South African schools.

BACKGROUND: In South Africa, an estimated 85% of the population relies on the public sector for oral health services. With poor infrastructure and inadequate personnel, over 80% of children with dental caries remain untreated. To reduce this burden of disease, one key goal is to promote good oral health and address oral diseases through prevention, screening, and treatment among children. While all policies have been proven to be effective in the control and prevention of dental caries, it is unclear which of those strategies provide value for money. This study evaluated five caries preventative strategies in terms of the cost and benefits among South African school children. METHODS: The study uses a hypothetical South African population of school aged learners aged 5-15. The context and insights of the strategies utilized at the schools were informed by data from both grey and published literature. Using Markov modeling techniques, we conducted a cost-effectiveness analysis of Acidulated Phosphate Fluoride (APF) application, atraumatic restorative treatment (ART), sugar-reduction and fissure sealants. Markov model was used to depict the movement of a hypothetical patient cohort between different health states over time. We assessed both health outcomes and costs of various interventions. The health outcome metric was measured as the number of Decayed, Missing, Filled Tooth (DMFT). The net monetary benefit was then used to determine which intervention was most cost-effective. RESULTS: The results showed that school-based caries prevention strategies are cost-effective compared to the status quo of doing nothing. The average cost per learner over the 10-year period ranged from ZAR4380 to approx. ZAR7300 for the interventions considered. The total costs (including screening) associated with the interventions and health outcome (DMFT averted) were: sugar reduction (ZAR91,380, DFMT: 63,762), APF-Gel (ZAR54 million, DMFT: 42,010), tooth brushing (ZAR72.8 million, DMFT: 74,018), fissure sealant (ZAR44.63 million, DMFT: 100,024), and ART (ZAR45 million, DMFT: 144,035). The net monetary benefits achieved for APF-Gel, sugar reduction, tooth brushing, fissure sealant and ART programs were ZAR1.56, ZAR2.45, ZAR2.78, ZAR3.81, and ZAR5.55 billion, respectively. CONCLUSION: Based on the net monetary benefit, ART, fissure sealant and sugar-reduction appear to be the most cost-effective strategies for preventing caries in South Africa. In a resource-scarce setting such as South Africa, where there is no fluoridation of drinking water, this analysis can inform decisions about service packages for oral health.

Beverage industry's advertising expenditures and airtimes in South Africa from 2013 to 2019 target children and families.

With the growing burden of non-communicable diseases (NCDs), countries across the globe are finding ways to reduce the consumption of ultra-processed food and drinks including sugar-sweetened beverages (SSBs). South Africa implemented a health promotion levy (HPL) in April 2018 as one strategy to reduce sugar intake. Such efforts are frequently countered or mitigated by industry action in various ways, including through marketing and advertising strategies. To better understand trends in the extent of advertising, this paper analyses advertising expenditures and exposure of children to SSB advertisements in South Africa. Using Nielsen's monthly data on advertising expenditure before and after the introduction of the HPL, for the period January 2013 to April 2019, the results show that manufacturers spent ZAR 3683 million to advertise their products. Advertising expenditure on carbonated drinks accounted for over 60% (ZAR 2220 million) of the total expenditure on SSBs. The results also show that companies spend less in advertising powdered SSBs (an average of ZAR 0.05 million per month). Based on expenditure patterns, television (TV) was the preferred medium of advertisements, with companies prioritizing what is often considered children's and family viewing time. Urgent mandatory regulations are needed to prevent child-directed marketing.

Indirect effects of COVID-19 on maternal and child health in South Africa.

BACKGROUND: The unfinished burden of poor maternal and child health contributes to the quadruple burden of disease in South Africa with the direct and indirect effects of the COVID-19 pandemic yet to be fully documented. OBJECTIVE: To investigate the indirect effects of COVID-19 on maternal and child health in different geographical regions and relative wealth quintiles. METHODS: We estimated the effects of COVID-19 on maternal and child health from April 2020 to June 2021. We estimated this by calculating mean changes across facilities, relative wealth index (RWI) quintiles, geographical areas and provinces. To account for confounding by underlying seasonal or linear trends, we subsequently fitted a segmented fixed effect panel model. RESULTS: A total of 4956 public sector facilities were included in the analysis. Between April and September 2020, full immunisation and first dose of measles declined by 6.99% and 2.44%, respectively. In the follow-up months, measles first dose increased by 4.88% while full immunisation remained negative (-0.65%) especially in poorer quintiles. At facility level, the mean change in incidence and mortality due to pneumonia, diarrhoea and severe acute malnutrition was negative. Change in first antenatal visits, delivery by 15-19-year olds, delivery by C-section and maternal mortality was positive but not significant. CONCLUSION: COVID-19 disrupted utilisation of child health services. While reduction in child health services at the start of the pandemic was followed by an increase in subsequent months, the recovery was not uniform across different quintiles and geographical areas. This study highlights the disproportionate impact of the pandemic and the need for targeted interventions to improve utilisation of health services.

The Choice of Healthy Source of Energy for Cooking Among Households in Ghana: Does Financial Inclusion Matter?

Air pollution resulting from the use of unhealthy/unclean energy sources for cooking causes illnesses such as lung cancer, stroke, chronic obstructive pulmonary disease and ischaemic heart disease. In Ghana, each year, about 18 000 deaths are recorded due to the use of unhealthy energy sources for cooking. While financial inclusion can influence the adoption of healthy energy sources for cooking, less attention has been paid to it. This study, therefore, investigates the effect of financial inclusion on the choice of healthy source of energy for cooking among households in Ghana. Doing so reveals whether financial inclusion can be employed as a tool to decrease the use of unhealthy sources of energy for cooking in Ghana. We employ the Ghana Living Standards Survey round 7 (GLSS7) as the data source for the study whiles the binary logistic regression is used as the estimation technique. The findings show that, households with financial inclusion (using a single indicator) are more likely to choose healthy sources of energy for cooking relative to those without financial inclusion (OR = 2.52, P < .01). Moreover, the effect of financial inclusion (using a single indicator) on choosing a healthy source of energy for cooking is greater among rural households (OR = 3.18, P < .01) relative to their urban counterparts (OR = 2.27, P < .01). The findings are robust even after using a different estimation technique and a combined index of financial inclusion. Thus, in the quest to improve the use of healthy sources of energy for cooking, enhancing financial inclusion among households, could be a useful strategy.

Does the Fisher effect hold in Rwanda?

The Fisher hypothesis suggests a one-to-one link between nominal interest rate and expected inflation. The indication is that interest rate is independent of expected inflation. This paper empirically examines the Fisher effect in Rwanda using data from 2012m5 to 2020m2. We employ the Autoregressive Distributed Lag (ARDL) technique for data analysis. We find evidence of partial Fisher effect in Rwanda during the period. This indicates that changes in expected inflation are not fully absorbed in the nominal interest rate which suggests that bank deposits decline over time. Also, the findings suggest that monetary policy may not be efficient in such a circumstance and household's savings rate may suffer a decrease. Besides, the short-run results show no Fisher effect between nominal interest rate and expected inflation. This calls for great attention while fixing interest rate as a tool for monetary policy.

Effect of price on the decision to experiment with cigarette smoking among Gambian children: a survival analysis using the Gambia 2017 Global Youth Tobacco Survey data.

OBJECTIVES: To investigate the relationship between cigarette prices and smoking experimentation among children in the Gambia, and thereby expanding the evidence base of the likely impact of excise taxes on cigarette demand in low-income and middle-income countries. DESIGN: A survival analysis using the Gambia 2017 Global Youth Tobacco Survey data. SETTING: The Gambia. PARTICIPANTS: The survey sample was 12 585 youths, aged 12-17 years, but our analysis was restricted to 11 030 respondents with information on smoking status. PRIMARY AND SECONDARY OUTCOME MEASURES: Our outcome variable was smoking experimentation defined as the first time the respondent smoked (at least part of) a cigarette. RESULTS: A 1% increase in the price of cigarettes reduces the probability to experiment with smoking by 0.7%. We also found that children are more likely to experiment with smoking if they have at least one smoking parent, friends who smoke and see teachers who smoke. The probability to experiment with cigarette smoking increases with age and is higher among boys than girls. CONCLUSION: There is strong evidence that increasing excise taxes can play an effective role in discouraging children from experimenting with cigarette smoking. Considering the relatively low excise tax burden in the Gambia, the government should consider substantially increasing the excise tax burden.

Estimating the healthcare cost of overweight and obesity in South Africa.

BACKGROUND: Overweight and obesity are major risk factors for noncommunicable diseases. This presents a major burden to health systems and to society in South Africa. Collectively, these conditions are overwhelming public healthcare. This is happening when the country has embarked on a journey to universal health coverage, hence the need to estimate the cost of overweight and obesity. OBJECTIVE: Our objective was to estimate the healthcare cost associated with treatment of weight-related conditions from the perspective of the South African public sector payer. METHODS: Using a bottom-up gross costing approach, this study draws data from multiple sources to estimate the direct healthcare cost of overweight and obesity in South Africa. Population Attributable Fractions (PAF) were calculated and multiplied by each disease's total treatment cost to apportion costs to overweight and obesity. Annual costs were estimated for 2020. RESULTS: The total cost of overweight and obesity is estimated to be ZAR33,194 million in 2020. This represents 15.38% of government health expenditure and is equivalent to 0.67% of GDP. Annual per person cost of overweight and obesity is ZAR2,769. The overweight and obesity cost is disaggregated as follows: cancers (ZAR352 million), cardiovascular diseases (ZAR8,874 million), diabetes (ZAR19,861 million), musculoskeletal disorders (ZAR3,353 million), respiratory diseases (ZAR360 million) and digestive diseases (ZAR395 million). Sensitivity analyses show that the total overweight and obesity cost is between ZAR30,369 million and ZAR36,207 million. CONCLUSION: This analysis has demonstrated that overweight and obesity impose a huge financial burden on the public health care system in South Africa. It suggests an urgent need for preventive, population-level interventions to reduce overweight and obesity rates. The reduction will lower the incidence, prevalence, and healthcare spending on noncommunicable diseases.

Cigarette Prices and Smoking Experimentation in Sierra Leone: An Exploratory Study.

This study examines the effect of cigarette prices on the likelihood of experimental smoking among adolescents in Sierra Leone. The study links data from the 2017 Global Youth Tobacco Survey (GYTS) to price data covering 2008-2017 obtained from the World Health Organization (WHO). After employing duration analysis techniques, we find that increases in cigarette prices are associated with a lower probability of smoking experimentation, with an estimated price elasticity of -1.63 (CI: -.24 to -3.02). Other factors affecting an adolescent's decision to experiment with smoking are parental and friends' smoking status, gender, exposure to tobacco advertising, and income. We conclude that higher prices, through excise taxation, are important tools for controlling smoking uptake among the youth of Sierra Leone.

Effect of relative income price on smoking initiation among adolescents in Ghana: evidence from pseudo-longitudinal data.

OBJECTIVE: Many smokers initiate smoking during adolescence. Making tobacco products less affordable is one of the best ways to control tobacco use. Studies on the effect of relative income price (RIP (ie, affordability)) of cigarettes on smoking initiation are scarce in low-income and middle-income countries, especially in Sub-Saharan Africa where data are limited. The goal of this study is to examine the effect of cigarette RIP on adolescent smoking initiation in Ghana. SETTING: The study uses a pseudo-longitudinal data set constructed from the Global Youth Tobacco Surveys (GYTS (2000-2009 and 2017)) and RIP for the most sold cigarette brand in Ghana. PARTICIPANTS: The GYTS is a national survey on adolescents. PRIMARY AND SECONDARY OUTCOME: Effect of RIP on adolescent smoking initiation in Ghana. RESULTS: Using the GYTS 2000-2009 data, we find that the probability of smoking initiation falls significantly in response to a higher RIP, with an elasticity of -0.372 (95% CI -0.701 to -0.042) for the unmatched sample and -0.490 (95% CI -0.818 to -0.161) for the matched sample. The RIP elasticity for women ((-0.888) (95% CI -1.384 to -0.392) and (-0.928) (95% CI -1.434 to -0.422)) is statistically significant at 1% in both the unmatched and the matched samples, respectively, while the RIP elasticity for men is statistically insignificant in the 2000-2009 surveys. Analysis of the 2017 GYTS shows a similar outcome: a negative relationship between RIP and smoking initiation, and the results are statistically significant for both men and women, and for both matched and unmatched samples. CONCLUSION: The affordability (RIP) of cigarettes is negatively related to the probability of smoking initiation among adolescents in Ghana. Raising tobacco taxes in line with income growth would make cigarettes less affordable and dissuade adolescents from initiating smoking.

Equity impact of minimum unit pricing of alcohol on household health and finances among rich and poor drinkers in South Africa.

INTRODUCTION: South Africa experiences significant levels of alcohol-related harm. Recent research suggests minimum unit pricing (MUP) for alcohol would be an effective policy, but high levels of income inequality raise concerns about equity impacts. This paper quantifies the equity impact of MUP on household health and finances in rich and poor drinkers in South Africa. METHODS: We draw from extended cost-effectiveness analysis (ECEA) methods and an epidemiological policy appraisal model of MUP for South Africa to simulate the equity impact of a ZAR 10 MUP over a 20-year time horizon. We estimate the impact across wealth quintiles on: (i) alcohol consumption and expenditures; (ii) mortality; (iii) government healthcare cost savings; (iv) reductions in cases of catastrophic health expenditures (CHE) and household savings linked to reduced health-related workplace absence. RESULTS: We estimate MUP would reduce consumption more among the poorest than the richest drinkers. Expenditure would increase by ZAR 353 000 million (1 US$=13.2 ZAR), the poorest contributing 13% and the richest 28% of the increase, although this remains regressive compared with mean income. Of the 22 600 deaths averted, 56% accrue to the bottom two quintiles; government healthcare cost savings would be substantial (ZAR 3.9 billion). Cases of CHE averted would be 564 700, 46% among the poorest two quintiles. Indirect cost savings amount to ZAR 51.1 billion. CONCLUSIONS: A MUP policy in South Africa has the potential to reduce harm and health inequality. Fiscal policies for population health require structured policy appraisal, accounting for the totality of effects using mathematical models in association with ECEA methodology.

Determinants of willingness to accept child vaccination against malaria in Ghana.

BACKGROUND: Malaria is a public health problem in Ghana with children being one of the most vulnerable. Given this, in 2019, Ghana decided to add the first malaria vaccine (RTS, S) as part of routine immunisations for children in the near future. This study, thus, examines the determinants of malaria vaccine awareness and willingness to uptake the vaccine for children in Ghana. METHOD: The study uses data from the 2019 Ghana Malaria Indicator Survey while employing the binary logistic regression as the empirical estimation technique. RESULTS: The study finds that religion, region of residence and awareness of the malaria vaccine, influence the willingness to uptake the vaccine for children. Moreover, younger mothers (15-26 years), households in the richest wealth quintile, male-headed households and the number of children aged five years and below in a household, are found to be associated with less willingness to uptake the vaccine for children. CONCLUSION: Paying attention to awareness creation, region, religion, younger mothers (15-26 years), households in the richest wealth quintile, male-headed households and households with more children aged five years and below, can ensure optimal uptake of the malaria vaccine for children in Ghana.

Effect of cigarette prices on cigarette consumption in Ghana.

Introduction: Noncommunicable diseases are on the rise globally, with tobacco consumption being a major risk factor. Reducing tobacco consumption is an important step towards reducing the incidence and prevalence of many noncommunicable diseases. Tax and price measures have been proposed as tobacco control tools. This study investigated the link between cigarette prices and cigarette consumption in Ghana. Methods: Annual time series data for the period 1980-2016 were used. The data came from diverse sources, including WHO, World Bank, and tobacco industry documents. Dynamic Ordinary Least Squares (DOLS), cointegration techniques, and three-stage least squares (3SLS) were used to analyze the data. Results: After controlling for education, income, and population growth, we estimated that the price elasticity of cigarette demand is between -0.35 and -0.52 and statistically significant at 1% level. In the short run, the price elasticity is -0.1. Another variable that significantly reduced cigarette consumption during the period was education, with an elasticity between -1.7 and -2.7. Conclusion: Cigarette demand in Ghana is influenced by cigarette prices and education. We conclude that tobacco taxes that significantly raise retail prices of cigarettes and higher education (including health education) will help reduce cigarette consumption.

Health sector funding in Ghana: The effect of IMF conditionalities.

Purpose: This paper examines the factors influencing government health spending in Ghana with a particular focus on IMF conditionalities. Design/methodology/approach: We estimate four simultaneous equations using three-stage least squares (3SLS) estimator. The data used cover the period 1980-2014. Findings: After controlling for some other factors affecting government health spending, the results show that democracy and foreign aid significantly increase public sector health funding. IMF programs with its associated conditionalities insignificantly reduce public health spending Ghana. Originality/value: This study provides important evidence on the impact of IMF conditionalities on health sector funding in Ghana. The results will serve as guide to policymakers when negotiating for IMF credit so that such arrangements do not obstruct health sector funding.

Estimating the price elasticity of demand for cigarettes in South Africa using the Deaton approach.

OBJECTIVE: To estimate the price elasticity of demand for South Africa and thereby contribute to growing the evidence base of the likely impact of excise taxes on cigarette demand in low-income and middle-income countries. METHODS: We employ the Deaton method, using wave 5 data from the South African National Income Dynamics Study, to estimate the cigarette price elasticity for South Africa. We used a sample of 6820 households. RESULTS: Of the 6 820 households in the sample for which we had sufficient data, 1341 (19.7%) spent money on tobacco. The price elasticity of demand for cigarettes is estimated at -0.86 (95% CI -1.37 to -0.35), implying that the demand for cigarettes in South Africa declines by 8.6% for every 10% increase in price. CONCLUSION: The negative price elasticity estimate for South Africa indicates that increases in the excise tax are particularly effective in controlling cigarette consumption. However, given the presence of a significant illicit tobacco market in the country, it is important that authorities augment tax measures with strategies that curb the illicit trade in cigarettes.

Effects of foreign direct investment and trade on the prevalence of tobacco consumption in Africa: a panel study.

BACKGROUND: As African governments take measures to enhance international trade and Foreign Direct Investment (FDI) inflows, a major concern is that, these measures can make Africa more vulnerable to the strategies of the tobacco industry. This concern is based on the fact that, each year, tobacco use is estimated to be responsible for the deaths of over eight million people in the world. However, there is very little empirical evidence to refute or confirm the above concern, especially in the African context. This study therefore investigates the effects of FDI and trade on the prevalence of tobacco consumption in Africa. METHODS: Data on a sample of 31 African countries for the period, 2010-2018 are used. The system Generalised Method of Moments (GMM) regression model is employed as the empirical estimation technique. RESULTS: The findings show that, FDI and trade have negative and positive significant association with the prevalence of tobacco consumption respectively. These findings are robust even after using different specifications and indicators of FDI and trade. CONCLUSION: Rising trade (and not FDI) should be of concern to African governments in the quest to reduce the prevalence of tobacco consumption on the continent.

Socioeconomic Determinants of Smoking in the Kingdom of Saudi Arabia.

Tobacco consumption, or smoking, is a major cause of preventable morbidity and mortality worldwide, including in the Kingdom of Saudi Arabia (KSA). In order to reduce the consumption of tobacco products, it is necessary to understand the factors that drive it. However, little is known about the socioeconomic determinants of tobacco smoking in the KSA. This study, therefore, investigates the socioeconomic factors that influence tobacco smoking in the KSA. Using a national health survey, the study employs logistic and negative binomial regressions to examine the socioeconomic factors associated with smoking. Moreover, the inequality concentration indices (CIs) are used to assess inequalities in smoking. The results reveal that the smoking prevalence is 14.09% of the 8813 respondents considered in this study. The prevalence of smoking is higher among men (25.34%) than among women (1.91%). On the determinants of smoking, the logistic regression results show that higher income is associated with lower likelihood of smoking. Other factors significantly associated with current smoking status are marital status, gender, age, and region of residence. Similarly, gender, age and region of residence are significantly associated with smoking intensity. As regards the inequality analysis, at the national level, the results show that smoking is concentrated among those with higher socioeconomic status (income: CI = 0.071, p < 0.01; education: CI = 0.095, p < 0.01), but with significant regional variations. By gender disaggregation, the results also show that the income-based CIs are positive for both males and females, but statistically insignificant. Education-based CI is positive for males and significant (CI = 0.057, p < 0.05), while it is negative and insignificant for females during the study period. The findings call for targeted tobacco control measures focusing on those with higher socioeconomic status, as well as factors such as age, gender, marital status and region of residence.

The effects of tobacco taxation and pricing on the prevalence of smoking in Africa.

BACKGROUND: Tobacco use continues to kill millions of people globally, making it one of the major causes of preventable deaths. Notwithstanding, there has been a very marginal fall in the prevalence of tobacco smoking in Africa. Since taxes (hence prices) are part of the main measures suggested to decrease the demand for tobacco products, this study investigates how tobacco taxation and pricing influence the prevalence of smoking in 24 African countries. METHODS: Using panel data on 24 African countries sourced from the World Health Organization (WHO) and the World Bank databases for the period 2010 to 2016, this study employs the system Generalized Method of Moments (GMM) estimator to investigate the effects of tobacco taxation and pricing on the prevalence of smoking. The system GMM estimator is used due its ability to deal with potential endogeneity of tobacco taxation and pricing: the likelihood that the prevalence of smoking can influence tobacco taxation and pricing which may lead to biased estimates. RESULTS: Tobacco taxation and pricing have negative significant effects on the prevalence of smoking among the selected countries after controlling for growth of Gross Domestic Product (GDP) per capita, urbanization, death rate and net inflows of Foreign Direct Investment (FDI). Specifically, a percentage increase in tobacco price is found to decrease the prevalence of smoking by between 0.11 to 0.14%, while a percentage increase in tobacco tax decreases the prevalence of smoking by between 0.25 to 0.36%, all at 1% level of significance. CONCLUSION: Since tobacco taxation and pricing are found to have negative significant effects on the prevalence of smoking, the implication is that, their use can be intensified by African policy makers towards achieving the WHO Framework Convention on Tobacco Control (FCTC) recommended targets and hence decrease the prevalence of tobacco smoking in Africa. Doing so may therefore help in achieving the Sustainable Development Goal (SDG) 3.5 (prevention and treatment of substance abuse), thereby reducing the colossal number of smoking attributable deaths.