Support for and potential impacts of key Smokefree 2025 strategies among Maori who smoke.

AIM: The recently passed Smokefree Environments and Regulated Products (Smoked Tobacco) Amendment Act has the potential to profoundly reduce smoking prevalence and related health inequities experienced among Maori. This study examined support for, and potential impacts of, key measures included within the legislation. METHOD: Data came from Wave 1 (2017-2019) of the Te Ara Auahi Kore longitudinal study, which was conducted in partnership with five primary health organisations serving Maori communities. Participants were 701 Maori who smoked. Analysis included both descriptive analysis and logistic regression. RESULTS: More Maori participants supported than did not support the Smokefree 2025 (SF2025) goal of reducing smoking prevalence to below 5%, and the key associated measures. Support was greatest for mandating very low nicotine cigarettes (VLNCs). Participants also believed VLNCs would prompt high rates of quitting. Participants who had made more quit attempts or reported less control over their life were more likely to support VLNCs. CONCLUSION: There was support for the SF2025 goal and for key measures that could achieve it. In particular, VLNCs may have significant potential to reduce smoking prevalence among Maori. As part of developing and implementing these measures it will be important to engage with Maori who smoke and their communities.

When people do not 'Zol': Reduced emergency centre attendance of patients with chronic obstructive pulmonary disease during coronavirus disease 2019 lockdown with the accompanying tobacco sales ban in South Africa.

The coronavirus disease 2019 (COVID-19) pandemic has spread throughout the world, with devastating effects of the virus as well as the repercussions of the resulting 'lockdowns'. South Africa went into a national lockdown in March 2020 to mitigate the impact of the virus. This included a ban on the sales of tobacco and electronic cigarette products. The ban has been a highly contentious issue in South Africa, discussed worldwide, which has drawn many criticisms. The prevalence rate of smoking in South Africa was around 21.5%, with the Western Cape province having a prevalence rate of 39%. We compared the number of chronic obstructive pulmonary disease (COPD) presentations at a large regional referral hospital in the Western Cape province from January to August 2019 with the same period in 2020. Electronic emergency centre data showed a reduction of 69.28% in COPD presentations. To control for some confounders for the same period, we also reviewed patients presenting with urinary tract infections, which showed only a 30.60% reduction. This notable reduction in COPD presentations reduced service pressure of emergency centre and most likely benefitted patients' health. Further research and policies are needed to ensure ongoing reduction in the prevalence of smoking.

Statewide Prevalence of Smoke-Free and Vape-Free Homes, by Tobacco Product Use, Minnesota, 2018.

INTRODUCTION: Securing clean indoor air laws is a major tobacco control accomplishment of the past 15 years. The public quickly adopted and supported such policies both in public and private spaces. Clean indoor air is now threatened by the emergence of e-cigarettes. E-cigarette aerosol contains nicotine, heavy metals, and carcinogens, and the long-term effect of secondhand exposure is unknown. Surveillance is necessary to track voluntary rules on smoking and vaping in the home. METHODS: The Minnesota Adult Tobacco Survey (MATS) is a series of cross-sectional, random-digit-dial telephone surveys on smoking, vaping, and other tobacco-related behaviors, attitudes, and beliefs among Minnesota adults. MATS measured voluntary smoke-free rules in the home in 2014 (N = 9,304) and measured both smoke-free and vape-free home rules in 2018 (N = 6,055). RESULTS: The prevalence of smoke-free home rules among Minnesota adults in 2018 was 91.5% (95% CI, 90.5%-92.5%), up slightly from 89.3% (95% CI, 88.4%-90.2%) in 2014. In comparison, 84.0% (95% CI, 82.7%-85.3%) reported vape-free home rules. Although 70.0% (95% CI, 66.0%-73.0%) of smokers in 2018 reported smoke-free home rules, only 23.3% (95% CI, 15.0%-31.6%) of e-cigarette users reported vape-free home rules. Living with children younger than 18 years significantly increased the odds of having smoke-free and vape-free home rules. CONCLUSION: Although widespread adoption of voluntary smoke-free and vape-free home rules demonstrates a positive change in social norms, most e-cigarette users allow vaping in their homes, including those who live with children younger than 18. Tracking voluntary smoke-free and vape-free home rules and efforts to encourage them are important to improve the public's health.

Prevalence and determinants of current cigarette smoking and secondhand smoking among Greek adolescents: the Global Youth Tobacco Survey (GYTS) 2013 study.

OBJECTIVES: Smoking prevalence in Greece is considered high within the European Union and the collection of evidence on tobacco use among adolescents is of vital importance in order to develop effective smoking prevention and cessation programmes. DESIGN: Cross-sectional. SETTING: Greece. PRIMARY AND SECONDARY OUTCOME MEASURES: Global Youth Tobacco Survey (GYTS) is a national representative, paper-and-pencil, cross-sectional, school-based study of students at ages 13-15 years. The survey employed a multistage cluster sample design with schools selected proportional to enrolment size. Finally, 4618/5127 students aged 13-15 years participated in the survey. The school response rate was 98.1%, the student response rate was 90.1% and the overall response rate was 88.4%. RESULTS: The prevalence of current cigarette smoking was estimated at 10.1% (10.4% in GYTS 2005) and of exposure to secondhand smoking in public places at 67.4% (94.1% in GYTS 2005). The vast majority of the adolescents (82.1%) supported the banning of smoking inside enclosed public places. Most of the current smokers (90.8%) were not prevented/refused purchase because of their age according to existing law. Multivariate analysis showed that peer influence (OR=48.32; 95% CI 36.2 to 64.48), pocket money (OR=2.63; 95% CI 1.28 to 3.41), increasing age (OR=2.35; 95% CI 1.63 to 3.39) and low educational level of father (OR=2.82; 95% CI 1.7 to 4.68) were risk factors independently associated with current cigarette smoking. CONCLUSIONS: Despite the existence of strict laws related to tobacco control, exposure to secondhand smoking among Greek students remained high even when compared with GYTS in 2005. This is likely a result of weak enforcement, what is really missing is the enforcement of the related legislation.

Ban on menthol-flavoured tobacco products predicts cigarette cessation at 1 year: a population cohort study.

OBJECTIVES: The province of Ontario, Canada, banned the use of menthol-flavoured tobacco products as of 1 January 2017. The long-term impact of a menthol ban on smoking behaviour has not been previously evaluated. METHODS: Population cohort study with baseline survey conducted September-December 2016 and follow-up January-August 2018 among residents of Ontario, Canada, 16 years old and over who reported current smoking (past 30 days) at baseline survey and completed follow-up (n=913) including 187 reporting smoking menthol cigarettes daily, 420 reported smoking menthol cigarettes occasionally, and 306 were non-menthol cigarette smokers. Relative rates of making a quit attempt and being a non-smoker at follow-up were estimated with Poisson regression controlling for smoking and demographic characteristics at baseline. RESULTS: At follow-up, 63% of daily menthol smokers reported making a quit attempt since the ban compared with 62% of occasional menthol smokers and 43% of non-menthol smokers (adjusted relative rate (ARR) for daily menthol smokers compared with non-menthol smokers: 1.25; 95% CI 1.03 to 1.50). At follow-up, 24% of daily menthol smokers reported making a quit since the ban compared with 20% of occasional menthol smokers and 14% of non-menthol smokers (ARR for daily menthol smokers compared with non-menthol smokers: 1.62; 95% CI 1.08 to 2.42). CONCLUSIONS: The study found higher rates of quitting among daily and occasional menthol smokers in Ontario 1 year after the implementation of a menthol ban compared with non-menthol smokers. Our findings suggest that restrictions on menthol may lead to substantial improvements in public health.

Effect of IQOS introduction on cigarette sales: evidence of decline and replacement.

BACKGROUND: Philip Morris International, one of the largest transnational cigarette manufacturers, has heavily invested in its new heated tobacco product, IQOS, marketing it aggressively as a less harmful alternative to cigarette smoking. The company's assertions that the product replaces cigarettes in a market have never been independently tested. The objective of this study is to determine whether introduction of IQOS affected cigarette sales in a large economy. DATA AND METHODS: Using 2014 to 2018 monthly retailer panel data from Japan, we analyse whether different dates of IQOS introduction across Japan's regions are reflected in the patterns of cigarette sales in those regions. A series of placebo models are estimated to test if events other than IQOS introduction could have better explained the observed trends in cigarette sales. RESULTS: Cigarette sales begin to substantially decline at the time of the introduction of IQOS in each of 11 Japanese regions (Chow tests p<0.001). IQOS introduction, which varied across regions, better predicted the timing of cigarette sales decline than any one time applied to all regions simultaneously (a national-level exogenous shock) and than nearly all possible rearrangements of the true IQOS introduction months among the regions (exact permutation test's p value from 0.02 to 0.13, depending on the study approach). CONCLUSIONS: The introduction of IQOS likely reduced cigarette sales in Japan. The net population health impact, however, cannot be assessed without resolving several key uncertainties related to the direct harms of IQOS and the precise patterns of both smoking and IQOS use.

Not Quite the Rule, But No Longer the Exception: Multiple Tobacco Product Use and Implications for Treatment, Research, and Regulation.

The patterns of tobacco product use in the United States have changed during the past several decades. Currently, a large proportion of tobacco users report using multiple tobacco products (MTPs). The prevalence of MTP use varies significantly by cigarette smoking frequency, as well: nearly half (46.9%) of all non-daily smokers report using other tobacco products within the past 30 days. Despite this, much of extant tobacco dependence treatment efforts, tobacco regulatory science research, and tobacco product research, in general, has focused largely on single product use (ie, cigarette smoking). To effectively design interventions and model the potential impact of regulations on tobacco products aimed at reducing tobacco use, as well as effectively study tobacco users, it is essential to consider actual use patterns in the population of tobacco users. Implications: MTP use is increasingly common in the United States. This commentary highlights the impact that MTP use has for efforts to treat tobacco dependence, tobacco regulatory science efforts, as well as on tobacco research, in general.

E-Cigarettes: A Disruptive Technology? An Analysis of Health Actors' Positions on E-Cigarette Regulation in Scotland.

Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health.

Investigation of number of replicate measurements required to meet cigarette smoke chemistry regulatory requirements measured under Canadian intense smoking conditions.

There has been increased interest in recent years in regulatory reporting of cigarette smoke toxicants. There is a great deal of diversity in current regulatory standards around the world in terms of the identities of regulated toxicants, and the number of replicate analyses stipulated for their measurement. Furthermore, analytical methods developed collaboratively by several organisations and intended for regulatory analysis generally differ in their recommended replicate numbers to those stipulated by regulators. In view of these inconsistencies, we undertook an exercise to examine the most appropriate numbers of replicates required for regulatory analysis of cigarette smoke toxicants. A one-point-in-time sampling exercise was undertaken of the German cigarette market, with 161 brands sampled and analysed in a single laboratory using Canadian Intense smoking conditions. Seven replicate measurements were made for each analyte and product, other than nicotine, CO and nicotine-free dry particulate matter for which eight replicate measurements were made. After confirming the absence of order of analysis effects, a variety of statistical tests (such as group assessment, paired comparisons, linear regression models and ratio analysis) were conducted examining mean values, SDs and CVs to identify the role of numbers of analytical replicates on data quality. The statistical analysis showed no difference in mean values for any of the 18 toxicants irrespective of replicate numbers (between 3 and 7 or 8). The large majority of analytes showed no difference in data variability with replicate number; but some very small differences (much lower than within product variability) were observed for a minority of compounds. Similarly, paired analysis showed no significant differences between mean values obtained using different replicate numbers in most cases, apart from very low differences (<5%) for a small number. Linear regression analysis showed correlations around 96 to 98% (other than crotonaldehyde at 91%) between values obtained with 3 vs 7 replicates. Similarly, per product mean value ratio analysis showed 95% consistency between values obtained with 3 and 7 replicates. We therefore conclude that three replicates is sufficient for precise determination of cigarette mainstream smoke toxicant emissions, and that use of 7 replicates as stipulated in some regulator jurisdictions does not offer any greater accuracy or precision.

Cancer mortality attributable to cigarette smoking in 2005, 2010 and 2015 in Qingdao, China.

INTRODUCTION: Cigarette smoking is among the most important public health concerns worldwide and the leading preventable cause of illness and death associated with cancer, chronic obstructive pulmonary disease (COPD) and cardiovascular disease (CVD). Although Qingdao, China implemented smoking control measures in 2007 and smoke-free legislation in 2013, smoking-attributable cancer mortality remains at a high level. The present study aimed to facilitate changes in policy-making, intervention implementation, monitoring and evaluation by estimating and comparing the burden of smoking-attributable cancers in Qingdao during 2005, 2010 and 2015. METHODS: This study used the disease list from the Global Burden of Disease (GBD) study to quantify the burden of smoking-related cancer. Sex and age-specific smoking-attributable mortality data were collected from the Qingdao Municipal Center for Disease Control and Prevention using an online reporting system. The population-attributable fractions (PAFs) of smoking and smoking-attributable cancer mortality in 2005, 2010 and 2015 were estimated using the smoking impact ratio (SIR) and relative risks (RRs) and by multiplying the smoking-attributable fraction by total cancer mortality, respectively. RESULTS: The numbers of smoking-attributable cancer deaths increased from 2484 in 2005 to 2999 in 2010 and 4148 in 2015, with corresponding PAFs of 26.41%, 25.76% and 29.13%, respectively. The PAFs were higher among men (vs. women) for all cancers except cervical cancer. In 2005, lung, liver, esophageal and stomach cancers were most frequently associated with smoking-associated cancer mortality, and lung cancer had the greatest PAF, followed by nasopharyngeal, oral and esophageal cancers. Similar patterns were observed in 2010 and 2015. In 2015, 1 in 3 and 1 in 5 cancer deaths in men and women, respectively, were attributable to smoking, and 95% of these deaths were associated with lung, liver, esophageal or stomach cancer. Over time, downward and upward trends in smoking-attributable cancer deaths were respectively observed among people younger than and older than 50 years. CONCLUSIONS: The smoking-attributable cancer burden in Qingdao remains considerable, despite the implementation of tobacco control and smoke-free measures. Tobacco control efforts should remain a major public health priority.

Impact of the Spanish smoking legislation among smokers: A longitudinal study with biomarkers in Barcelona (Spain).

BACKGROUND: The aim of this study is to assess the impact of the Spanish tobacco control legislation on smoking behavior and salivary cotinine concentration among smokers. METHODS: We used data from a longitudinal study, before (2004-2005) and after (2013-2014) the implementation of the two national smoking bans (in 2006 and 2011), in a representative sample of adults (≥16 years old) from Barcelona (Spain). We only analyzed a subsample of continuing smokers (n = 116). We conducted a survey on smoking behavior and obtained saliva sample for cotinine analyses. For this report, we analyzed a subsample of continuing smokers (n = 116). We calculated geometric means (GM). RESULTS: Among continuing smokers, salivary cotinine concentration significantly increased by 28.7% (GM from 91.7 ng/ml to 117.3 ng/ml, p = 0.015) after the implementation of the two Spanish smoke-free bans. Nonetheless, no pattern of change was observed in the self-reported number of cigarettes smoked daily. CONCLUSIONS: Our study shows a significant increase in the salivary cotinine concentration among adult continuing smokers after both Spanish legislations. This increase could be due to differences in smoking topography (increase in the depth of inhalation when smoking) along with changes in the type of tobacco smoked (increase in smoking roll-your-own cigarettes or mixed use of roll-your-own and manufactured cigarettes). Our results suggest the need to extend tobacco control policies, focusing on the reduction of use of any type of tobacco product and implementing better treatment to help smokers stop smoking.

Is prevalence of e-cigarette and nicotine replacement therapy use among smokers associated with average cigarette consumption in England? A time-series analysis.

OBJECTIVES: Many smokers use e-cigarettes and licensed nicotine replacement therapy (NRT), often in an attempt to reduce their cigarette consumption. We estimated how far changes in prevalence of e-cigarette and NRT use while smoking were accompanied by changes in cigarette consumption at the population level. DESIGN: Repeated representative cross-sectional population surveys of adults aged 16+ years in England. METHODS: We used Autoregressive Integrated Moving Average with Exogeneous Input (ARIMAX) modelling of monthly data between 2006 and 2016 from the Smoking Toolkit Study. Prevalence of e-cigarette use and NRT use in current smokers, and specifically for smoking reduction and temporary abstinence, were input variables. Mean daily cigarette consumption was the dependent variable. Analyses involved adjustment for mass media expenditure and tobacco-control policies. RESULTS: No statistically significant associations were found between changes in use of e-cigarettes (ß -0.012, 95% CI -0.026 to 0.002) or NRT (ß 0.015, 95% CI -0.026 to 0.055) while smoking and daily cigarette consumption. Neither did we find clear evidence for an association between e-cigarette use (ß -0.010, 95% CI -0.025 to 0.005 and ß 0.011, 95%-0.027 to 0.004) or NRT use (ß 0.006, 95%-0.030 to 0.043 and ß 0.022, 95%-0.020 to 0.063) specifically for smoking reduction and temporary abstinence, respectively, and changes in daily cigarette consumption. CONCLUSION: If use of e-cigarettes and licensed NRT while smoking acted to reduce cigarette consumption in England between 2006 and 2016, the effect was likely very small at a population level.

The relationship between cigarette taxes and child maltreatment.

Prior research suggests that income and child maltreatment are related, but questions remain about the specific types of economic factors that affect the risk of maltreatment. The need to understand the role of economics in child welfare is critical, given the significant public health costs of child maltreatment. One factor that has been overlooked is regressive taxation. This study addresses this need by examining whether state-level changes in cigarette tax rates predict changes in state-level child maltreatment rates. The results of both a fixed effects (FE) and a fixed effects instrumental variables (FE-IV) estimator show that increases in state cigarette tax rates are followed by increases in child abuse and neglect. An additional test finds that increases in the sales tax (another tax deemed to be regressive) also predict increases in child maltreatment rates. Taken as a whole, the findings suggest that regressive taxes have a significant effect on the risk of child maltreatment.

The Impact of Implementing Tobacco Control Policies: The 2017 Tobacco Control Policy Scorecard.

The Tobacco Control Scorecard, published in 2004, presented estimates of the effectiveness of different policies on smoking rates. Since its publication, new evidence has emerged. We update the Scorecard to include recent studies of demand-reducing tobacco policies for high-income countries. We include cigarette taxes, smoke-free air laws, media campaigns, comprehensive tobacco control programs, marketing bans, health warnings, and cessation treatment policies. To update the 2004 Scorecard, a narrative review was conducted on reviews and studies published after 2000, with additional focus on 3 policies in which previous evidence was limited: tobacco control programs, graphic health warnings, and marketing bans. We consider evaluation studies that measured the effects of policies on smoking behaviors. Based on these findings, we derive estimates of short-term and long-term policy effect sizes. Cigarette taxes, smoke-free air laws, marketing restrictions, and comprehensive tobacco control programs are each found to play important roles in reducing smoking prevalence. Cessation treatment policies and graphic health warnings also reduce smoking and, when combined with policies that increase quit attempts, can improve quit success. The effect sizes are broadly consistent with those previously reported for the 2004 Scorecard but now reflect the larger evidence base evaluating the impact of health warnings and advertising restrictions.

In Their Own Words: Young Adults' Menthol Cigarette Initiation, Perceptions, Experiences and Regulation Perspectives.

Background: Menthol cigarettes are disproportionately used by young people and have been called smoking starter products. However, limited qualitative research exists on young adults' perceptions of and experiences with these products, with much of it based on document reviews of the tobacco industry's research. Methods: We conducted six focus groups with young adult (ages 18-24) menthol smokers in New Jersey (half with black smokers) between December 2014 and March 2015. Participants were asked open-ended questions about their menthol smoking initiation, preference reasons, substitution behaviors, and perceptions of menthol cigarette risks and regulation. Results: Participants' menthol cigarette initiation and preference were influenced by their perceived popularity, brand recognition, taste, smoothness, satisfaction and access (including as "loosies," typically available for Newport). Some believed menthol cigarettes were less harmful than non-menthol cigarettes when initiating smoking. Many currently believed menthol cigarettes were more harmful because they contained extra "additives," were stronger (ie, requiring fewer cigarettes to feel satisfied), and/or based on hearsay. Many had tried new brand Camel Crush, which was perceived to be especially minty, fun, and attractive for newer smokers. While some used non-menthol cigarettes when menthols were unavailable, many said they would never or almost never substitute. Many acknowledged a menthol cigarettes ban would likely help them quit smoking, even though they did not support the idea. Conclusions: Menthol cigarette initiation is influenced by an interplay of multiple factors including their sensory properties, marketing, perceived popularity and availability. The FDA should continue to pursue closing this flavored cigarette loophole. Implications: In this first qualitative study of menthol cigarette use among young adults, we found further evidence that menthol cigarettes can act as starter products because they are perceived as easier to smoke and taste and smell better than non-menthol cigarettes. We also add to the literature in finding that menthol cigarettes are perceived by young people who smoke menthol cigarettes as delivering satisfaction with fewer cigarettes, being accessible as "loosies", and being popular among their peers. Many did not understand the reasons behind a potential menthol ban. Any future regulation of menthol cigarettes should include a public educational campaign to support buy-in.

Tobacco control in California compared with the rest of the USA: trends in adult per capita cigarette consumption.

BACKGROUND: In the 1990s, California led the USA in state-level tobacco control strategies. However, after 2000, California lost ground on cigarette taxes, although it maintained higher levels of smoke-free homes among smokers. METHODS: Trends in per capita cigarette consumption were assessed through taxed sales data and from self-report in repeated national cross-sectional surveys. Linear regressions identified changes in trends after year 2000 separately for California and the rest of the USA. Using data from each state, a linear regression tested the association between different tobacco control strategies and per capita consumption. Change in self-reported per capita consumption was partitioned into contributions associated with initiation, quitting and reduction in cigarette consumption level. RESULTS: Both taxed cigarette sales and per capita consumption declined rapidly in the USA from 1985 to 2015. Declines were particularly fast in California before 2000 but slowed thereafter. In 2014, per capita consumption in California was 29.4 packs/adult/year, but 90% higher in the rest of the USA. Modelling state-level data, every $1 increase in cigarette taxes reduced consumption by 4.8 (95% CI 2.9 to 6.8) packs/adult/year. Every 5% increase in the proportion of smokers with smoke-free homes reduced consumption by 8.0 (95% CI 7.0 to 8.9) packs/adult/year. The different patterns in California and the rest of the USA are at least partially explained by these two variables. The slow down in per capita consumption in California can be attributed to changes in initiation, quitting and especially smokers reducing their consumption level. CONCLUSIONS: Tobacco control strategies need to be continually updated to maintain momentum towards a smoke-free society.

The Association Between State Value-Added Taxes and Tobacco Use in India-Evidence From GATS and TCP India Survey.

Introduction: State value-added taxes (VAT) on tobacco products have been increased significantly in recent years in India. Evidence on how these VATs were associated with smoking is highly needed. Methods: State bidi and cigarette VAT rates were linked to Global Adult Tobacco Survey (GATS) India 2009-2010 and Tobacco Control Policy (TCP) India Survey waves 1 (2010-2011) and 2 (2012-2013), respectively. These linked data were used to analyze the associations between bidi VAT rates and bidi smoking, between cigarette VAT rates and cigarette smoking, and between the two VAT rates and dual use of bidis and cigarettes. Weighted logistic regressions were employed to examine GATS cross-sectional data, whereas generalized estimating equations (GEE) were employed to examine longitudinal TCP data. We further stratified the analyses by gender. Results: A 10% increase in cigarette VAT rates was associated with a 6.5% (p < .001) decrease in dual use of cigarettes and bidis among adults and a 0.9% decrease (p < .05) in cigarette smoking among males in TCP; and with a 21.6% decrease (p < .05) in dual use among adults and a 17.2% decrease (p < .001) in cigarette smoking among males in GATS. TCP analyses controlling for state fixed effects are less likely to be biased and indicate a cigarette price elasticity of -0.44. As female smoking prevalence was extremely low, these associations were nonsignificant for females. Conclusions: Higher state cigarette VAT rates in India were significantly associated with lower cigarette smoking and lower dual use of cigarettes and bidis. Increasing state VAT rates may significantly reduce smoking in India. Implications: Both Global Adult Tobacco Survey and Tobacco Control Policy (TCP) India datasets suggest that higher state cigarette value-added tax rates were significantly associated with lower male cigarette smoking and lower dual use of cigarettes and bidis among all adults in India. TCP analyses indicate a cigarette price elasticity of -0.44. As shown in this study, state tobacco taxes in the current taxation system are likely effective in reducing smoking. Given this, a future central goods and service tax (GST) system could consider keeping states' authority in implementing local tobacco taxes or designing a GST system that is equally or more effective in reducing tobacco use.

Impact of US smoke-free air laws on restaurants and bars by employer size: a panel study.

OBJECTIVES: Thirty states have smoke-free air laws that ban smoking in restaurants and bars, covering nearly two-thirds of the US population. It is well established that these laws generally have a null or positive economic impact on restaurants and bars. However, all establishments in a geographic area are usually treated as a homogeneous group without considering the potential for differential effects by establishment characteristics. This study uses variation in smoke-free air laws over time to estimate their impact on employment in restaurants and bars with a focus on potential differences by employer size (number of employees). A two-pronged approach with a national-level and state-level analysis is used to take advantage of more granular data availability for a single state (North Carolina). DESIGN: Observational study using panel data. SETTING: 1) US, 2) North Carolina INTERVENTIONS: Smoke-free air laws. OUTCOME MEASURES: State-level accommodation and food services employment for all 50 states and District of Columbia from 1990 through 2014 (Quarterly Census of Employment and Wages); county-level restaurant and bar employment in North Carolina from 2001 through 2014 (North Carolina Department of Commerce). RESULTS: There is no evidence of a redistributive effect of smoke-free air laws on restaurant and bar employment by employer size. CONCLUSION: The lack of a redistributive effect is an important finding for policy-makers considering implementation or expansion of a smoke-free air law to protect employees and patrons from the dangers of exposure to secondhand smoke.

The effect of taxation and regulation on cigarette smoking: Fresh evidence from Turkey.

Enacting Law No 5247 in May 2008, Turkey has initiated crucial anti-tobacco policies in the last decade. This paper aims to reveal on the effect of anti-tobacco policies such as excise taxes and regulations on cigarette smoking. To this aim, I empirically investigate the long-term dynamics of demand for cigarettes in Turkey through the OLS estimation strategy under various scenarios and models. Using monthly and quarterly data that cover the pre- and post- anti-smoking policy periods, I estimate demand elasticities and compare the pre- and post- taxation and regulation terms. The results presented in the paper confirm that taxation and regulation have affected the long-term dynamics of demand for cigarettes. The price and income elasticities of demand for cigarettes are significantly higher than the previous literature on Turkey. Demand elasticities have increased on average in the anti-tobacco policies period.