[What does the Brazilian National Health Survey have to say about the influence of cigarette spending on household income?] / O que a Pesquisa Nacional de Saúde tem a dizer sobre a influência do gasto com cigarro no rendimento domiciliar?

In a country whose indicators of population impoverishment continue to increase, it is concerning that individuals spend money to buy cigarettes instead of using this resource in actions that strengthen aspects of the well-being of their lives and that of their families. Based on the Brazilian National Health Survey conducted in 2019, the influence of spending on manufactured cigarettes on the family budget in households with at least one smoker was estimated, stratified by sociodemographic characteristics. Brazilian smokers allocated around 8% of their average per capita monthly household income to the purchase of manufactured cigarettes. The percentage of average monthly expenditure on cigarettes reached almost 10% of this income among smokers aged 15 to 24 and was even higher for those with incomplete elementary education (approximately 11%). In the North and Northeast regions of the country, this expenditure exceeded 9%. The state with the most significant impact on household income was Acre (13.6%), followed by Alagoas (11.9%), Ceará, Pará, and Tocantins (all with approximately 11%). Our findings, therefore, reinforce the importance of strengthening the implementation of effective measures, such as tax policy, to reduce the proportion of smokers. Thus, the money that individuals currently allocate to purchase cigarettes can be used to meet their basic needs, contributing to the promotion of health and improving the quality of life.

Em um Brasil no qual os indicadores de empobrecimento da população seguem aumentando, preocupa o fato de que indivíduos gastem dinheiro para comprar cigarro em vez de usarem esse recurso em ações que fortaleçam aspectos do bem-estar de suas jornadas de vida e de suas famílias. Estimou-se, a partir da Pesquisa Nacional de Saúde de 2019, a influência que o gasto com cigarro industrializado teve no orçamento familiar nos domicílios com pelo menos um fumante, estratificada por características sociodemográficas. Os fumantes brasileiros destinaram cerca de 8% do rendimento médio mensal domiciliar per capita para a compra de cigarros industrializados. O percentual do gasto médio mensal chegou a quase 10% desse rendimento, entre os fumantes de 15 a 24 anos, e foi ainda maior para aqueles com Ensino Fundamental incompleto (aproximadamente 11%). Nas regiões Norte e Nordeste do país, esse gasto ultrapassou os 9%. O estado com o maior comprometimento da renda domiciliar foi o Acre (13,6%), seguido por Alagoas (11,9%), Ceará, Pará e Tocantins (todos com aproximadamente 11%). Nossos achados reforçam, portanto, a importância de fortalecer a implementação de medidas efetivas de redução da proporção de fumantes, tal como a política tributária. Dessa forma, o dinheiro que atualmente é destinado pelos indivíduos à compra de cigarros poderá ser revertido no atendimento de suas necessidades básicas, contribuindo para a promoção da saúde e melhoria da qualidade de vida.

En un Brasil donde los indicadores de empobrecimiento de la población siguen aumentando, es preocupante el hecho de que las personas gasten dinero para comprar cigarrillo en lugar de usarlo en acciones para fortalecer los aspectos del bienestar de sus vidas y la de sus familias. A partir de la Encuesta Nacional de Salud brasileña realizada en 2019, se estimó la influencia del gasto en cigarrillo industrializado en el presupuesto familiar de los hogares donde vivía al menos un fumador, estratificado por características sociodemográficas. Los fumadores brasileños destinaron alrededor del 8% del ingreso per cápita mensual promedio del hogar para la compra de cigarrillos industrializados. El porcentaje del gasto mensual promedio en cigarrillos alcanzó casi el 10% de este ingreso entre los fumadores de 15 a 24 años y fue aún mayor para los que tenían educación primaria incompleta (aproximadamente el 11%). En el Norte y Nordeste del país, ese gasto superó el 9%. El estado con un mayor compromiso con los ingresos del hogar fue Acre (el 13,6%), seguido por Alagoas (el 11,9%), Ceará, Pará y Tocantins (todos con aproximadamente el 11%). Por lo tanto, nuestros resultados resaltan la importancia de fortalecer la implementación de medidas efectivas para reducir la proporción de fumadores, tal como la política tributaria. Así, el dinero que actualmente las personas destinan a la compra de cigarrillos podría utilizarse en la atención de sus necesidades básicas, contribuyendo a promover la salud y la mejora de la calidad de vida.

Will tobacco price increases lead more people who smoke to vape? The results from a discrete choice experiment amongst U.S. adults.

OBJECTIVE: To understand the extent to which people who smoke, people who vape and nonsmokers would switch between smoking cigarettes and vaping in response to policies (price increases, restrictions on nicotine, places, and information on addictiveness and/or health risks) aimed at decreasing tobacco use by people who smoke and vaping by nonsmokers. DESIGN: A total of 525 adults aged 18 to 88 years completed a discrete choice survey of 16 choices between two smoking/vaping alternatives. Analysis was conducted using conditional logistic regression for the entire sample and stratified by nonsmokers, people who smoke, and people who vape. RESULTS: The results suggest that most people who vape also smoke. Nonsmokers were more favorable to vaping and were concerned about long-term health risks and cost associated with vaping. Marginal analysis suggests that price increases will have only modest success in moving people who smoke to start vaping or encouraging people who vape to vape rather than use cigarettes. Nonsmokers are not very sensitive to price changes but are sensitive to information about health impacts. CONCLUSIONS: Findings indicate that increasing the price of cigarettes would lead to a limited increase in the probability of people who smoke switch to vaping. The study advances our understanding of the views of current nonsmokers toward cigarettes and vaping, suggesting that price increases and increased knowledge of addiction would likely deter nonsmokers from vaping. Changing the amount of nicotine associated with smoking would increase the probability of vaping slightly and have little impact on nonsmokers or vaping preferences, but the most significant change would come from increasing the perceptions of the risk of smoking.

Comparative assessment of implementation of Cigarette and Other Tobacco Products Act in three States of India: A pre-post study.

BACKGROUND OBJECTIVES: The Cigarette and Other Tobacco Products Act (COTPA) limits the sale of tobacco products, promotion and advertising and packaging of tobacco products in India. Periodic monitoring of the level of compliance with all sections of COTPA is obligatory to assess the effectiveness of the act. METHODS: This pre-post study aimed to assess the change in the level of compliance with different sections of COTPA in selected States. A total of 3849 and 2176 samples were assessed during the study in November 2020 and October 2021, respectively; using the EpiData Software. RESULTS: Average compliance with section 4 of COTPA was highest in Puducherry during baseline [51.88%, prevalence ratio (PR)=0.72, 95% confidence interval (CI): 0.51-1.02] and in Telangana during endline assessment (66.1%, PR=0.6, 95% CI: 0.48-0.74). A visible change with section 5 of COTPA was observed in Telangana (40.08 to 93.12%, PR=0.04, 95% CI: 0.02-0.07). Compliance with section 6a of COTPA decreased in Puducherry (81.34 to 71.83%, PR=1.84, 95% CI: 1.14-2.95) and increased for Meghalaya and Telangana. The average compliance with sections 7, 8 and 9 (for Puducherry 51.09 vs . 48.8%, Meghalaya 54.94 vs . 46.18% and Telangana 73 vs . 51.91%, respectively) decreased in all States. An increase in average compliance was observed with sections 4 and 5 ( P =0.19 and 0.11, respectively) and a decrease with sections 7, 8 and 9 ( P =0.02) of COTPA in all three States. For sections 6a ( P =0.06) and 6b ( P =0.01), a mixed response was noted. INTERPRETATION CONCLUSIONS: The findings of this study suggest that the level of compliance with sections 4 and 5 of COTPA increased because they are strictly monitored compared to sections 7-9, which are less enforced by the States. There is a need to monitor sections 7-9 (pack warning) to fulfill the objectives related to the World Health Organization (WHO) Framework Convention on Tobacco Control.

Effect of IQOS introduction on Philip Morris International cigarette sales in Spain: a Logarithmic Mean Divisa Index decomposition approach / Efecto de la introducción de IQOS en las ventas de cigarrillos de Philip Morris International en España: un enfoque de descomposición Logarithmic Mean Divisa Index

Objective: Philip Morris International, has already introduced its heated tobacco product, IQOS, in many countries and marketed it on the grounds that it is a less harmful alternative to health. The company claims that its intention is for its brand's traditional cigarette smokers to replace these with IQOS has rarely been independently tested. Method: Using time series data from September 2016 to June 2020, we analyze whether Heets sales have been accompanied by an improvement in the position of Philip Morris International in the market or if they have merely replaced lost sales of the rest of the brands sold by that tobacco company. Results: Sales of traditional cigarettes of all the brands marketed by PMI have been replaced by IQOS since the introduction of this heated tobacco product in Spain. Almost all of the variations observed in IQOS sales are due to the positioning of this product as a substitute for the range of traditional cigarettes marketed by Philip Morris International. Conclusions: As there is still no consensus that HTPs are explicitly less harmful to health, health authorities must control messages suggesting improved health outcomes thanks to HTP usage when compared to traditional cigarettes. Such messages could generate a false sense of security and lead to an increase in the consumption of tobacco. In Spain Heets in a category that has a lower tax burden than the category of traditional cigarettes. Tax authorities must consider this migration and the impact this may have on tax collection. (AU)

Objetivo: Philip Morris International ha introducido en muchos países su producto de tabaco calentado, IQOS, y lo ha comercializado con el argumento de que es una alternativa menos dañina para la salud. La compañía afirma que su intención es que los fumadores de cigarrillos tradicionales de su marca los reemplacen con IQOS. Método: Utilizando datos de series temporales de septiembre de 2016 a junio de 2020, analizamos si las ventas de Heets han ido acompañadas de una mejora en la posición de Philip Morris International en el mercado o si simplemente han sustituido a las ventas perdidas del resto de las marcas vendidas por esa compañía tabaquera. Resultados: Las ventas de cigarrillos tradicionales de todas las marcas comercializadas por Philip Morris International han sido sustituidas por IQOS desde la introducción de este producto de tabaco calentado en España. Casi todas las variaciones observadas en las ventas de IQOS se deben al posicionamiento de este producto como sustituto de la gama de cigarrillos tradicionales que comercializa Philip Morris International. Conclusiones: Como todavía no existe consenso en cuanto a que los HTP sean explícitamente menos dañinos para la salud, las autoridades sanitarias deben controlar los mensajes que sugieran mejores resultados en la salud gracias al uso de HTP en comparación con los cigarrillos tradicionales. En España se encuentran en una categoría que tiene una carga fiscal más baja que la de los cigarrillos tradicionales. Las autoridades fiscales deben considerar esta migración y el impacto que puede tener en la recaudación fiscal. (AU)

Sociodemographic Disparities in Tobacco Retailer Density in the United States, 2000-2017.

INTRODUCTION: Studies find differences in tobacco retailer density according to neighborhood sociodemographic characteristics, raising issues of social justice, but not all research is consistent. AIMS AND METHODS: This study examined associations between tobacco retailer density and neighborhood sociodemographic characteristics in the United States at four timepoints (2000, 2007, 2012, and 2017) and investigated if associations remained stable over time. Data on tobacco retailers came from the National Establishment Time-Series Database. Adjusted log-linear models examined the relationship between retailer density and census tract sociodemographic characteristics (% non-Hispanic Black [Black], % Hispanic, % vacant housing units, median household income), controlling for percentage of youth, urbanicity, and US region. To examine whether the relationship between density and sociodemographic characteristics changed over time, additional models were estimated with interaction terms between each sociodemographic characteristic and year. RESULTS: Tobacco retailer density ranged from 1.22 to 1.44 retailers/1000 persons from 2000 to 2017. There were significant, positive relationships between tobacco retailer density and the percentage of Black (standardized exp(b) = 1.05 [95% CI: 1.04% to 1.07%]) and Hispanic (standardized exp(b) = 1.06 [95% CI: 1.05% to 1.08%]) residents and the percentage of vacant housing units (standardized exp(b) =1.08 [95% CI: 1.07% to 1.10%]) in a census tract. Retailer density was negatively associated with income (standardized exp(b) = 0.84 [95% CI: 0.82% to 0.86%]). From 2000 to 2017, the relationship between retailer density and income and vacant housing units became weaker. CONCLUSIONS: Despite the weakening of some associations, there are sociodemographic disparities in tobacco retailer density from 2000 to 2017, which research has shown may contribute to inequities in smoking. IMPLICATIONS: This study examines associations between tobacco retailer density and neighborhood sociodemographic characteristics in the United States at four timepoints from 2000 to 2017. Although some associations weakened, there are sociodemographic disparities in tobacco retailer density over the study period. Research suggests that sociodemographic disparities in retailer density may contribute to inequities in smoking. Findings from this study may help identify which communities should be prioritized for policy intervention and regulation.

Cigarette Prices and Smoking Among Youth in 16 African Countries: Evidence From the Global Youth Tobacco Survey.

INTRODUCTION: African countries have among the lowest excise taxes in the world. This paper provides new evidence on the association between cigarette prices and youth smoking in 16 African countries. AIMS AND METHODS: We use Global Youth Tobacco Survey (GYTS) cross-country data from approximately 67 500 participants. The relationship between prices and youth smoking in Africa is estimated using probit models for smoking participation and generalized linear models for conditional cigarette demand. Each model is estimated using local-brand and foreign-brand cigarette prices. RESULTS: Higher prices are associated with lower demand across African countries, for both smoking prevalence and the intensity of cigarette consumption by smokers. The estimated price elasticity of participation is -0.70 [95% CI: -1.28 to -0.12] for local-brand cigarettes and -0.71 [95% CI: -0.98 to -0.44] for foreign-brand cigarettes. The price elasticity of conditional cigarette demand is -0.44 [95% CI: -0.76 to -0.12] for local brands and -0.75 [95% CI: -0.96 to -0.53] for foreign brands. The total price elasticity of demand for youth in our sample is -1.14 for local brands and -1.46 for foreign brands. CONCLUSIONS: Higher cigarette prices significantly decrease the likelihood of smoking and decrease the intensity of cigarette consumption among African youths. Increases in the excise tax that increase the retail price of cigarettes will play an important role in reducing youth tobacco use on the continent. Governments are encouraged to increase excise taxes in order to improve public health. IMPLICATIONS: Evidence on the association between cigarette prices and youth smoking in African countries is limited. The Global Youth Tobacco Survey (GYTS) was first introduced in 1999. In 2012, the Centers for Disease Control and Prevention revised the GYTS questionnaire, which removed some questions and introduced new questions into the survey. To the best of our knowledge, there are no published estimates of the relationship between cigarette prices and demand that have used this more recent individual-level GYTS data for African countries. In conducting this analysis, we add to the limited literature on the association between cigarette prices and youth smoking in Africa.

Trends in the Number and Type of Tobacco Product Retailers, United States, 2000-2017.

INTRODUCTION: Tobacco product retailers provide access to tobacco products and exposure to tobacco marketing. Without a national tobacco retailer licensing system in the United States, there are no estimates of national trends in tobacco retailer numbers and store type over time. METHODS: We developed a protocol to identify likely tobacco retailers across the United States between 2000 and 2017 using industry codes and retailer names in the annual National Establishment Time Series (NETS) database. We calculated annual counts of tobacco retailers in seven store-type categories and annual numbers of tobacco retailers that opened and closed. RESULTS: We estimate that there were 317 492 tobacco product retailers in 2000; the number grew to 412 536 in 2009 before falling to 356 074 in 2017, for a net 12% increase overall. Gas/convenience stores and grocery stores accounted for more than two thirds of all retailers. On average, new openings accounted for 8.0% of the total retailers, whereas 7.3% of retailers closed or stopped selling tobacco each year, with stronger market volatility following the Great Recession. Since 2011, there was a disproportionate reduction in tobacco-selling pharmacies and an increase in both tobacco-specialty shops and tobacco-selling discount stores. CONCLUSIONS: During two decades when smoking declined, tobacco retailer availability increased in the United States. The economic climate, corporate and public policies, and new tobacco products may all contribute to trends in tobacco retailer availability. State and local jurisdictions considering tobacco retailer policies may find retailer trend information useful for forecasting or evaluating potential policy impacts. IMPLICATIONS: This study provides historic data tracking tobacco retailers in the United States between 2000 and 2017, documenting trends that unfolded as the general economic market contracted and grew, with greater regulation of the tobacco retailer environment. These data provide a context for better understanding future changes in the tobacco retailer market. In addition, the protocol established in this study could be applied in any US-based location without tobacco retailer licensing to allow identification of stores and tracking of trends.

Banning Loose Cigarettes and Other Tobacco Products in India: A Policy Analysis.

BACKGROUND: Sale of single cigarettes (also known as singles or loosies) is a key driver for early initiation of smoking and is a leading contributor to the smoking epidemic in India. Sale of singles additionally deter implementation of tobacco control strategies of pictorial health warnings including plain packaging and defeat effective taxation and promote illicit trade. We review India's tobacco control policy responses towards banning singles and other products sold as loose tobacco and identify opportunities for future policy intervention especially in the context of the ongoing COVID-19 pandemic. METHODS: Existing national and sub-national policy documents were analyzed for their content since the inception of the tobacco control laws in the country. RESULTS: There are no effective provisions at national level to ban loose tobacco products in India. However, the implementation of multiple legislative and regulatory measures (Acts/circulars/letters/notifications/orders/court judgements) in 16 Indian states and jurisdictions provide sufficient legal framework to substantiate its complete ban pan India. While the majority of state governments have adopted state level measures, Rajasthan had issued specific directive to all the 33 districts banning loose cigarettes and other tobacco products. Himachal Pradesh introduced the most unique and comprehensive legislation, for banning the sale of cigarettes and beedis (Dated November 7, 2016). The most recent notification in the state of Maharashtra (September 24, 2020) is the first to leverage powers using a mix of national and state legislations including the legislation addressing the rapidly emerging challenge of managing COVID-19. CONCLUSION: A robust national policy which supports strong provision to deter tobacco companies, their distribution network and vendors from selling singles or loose tobacco products is urgently needed. Such policy should be backed by cautionary messaging for consumers as well. Eliminating singles and loose tobacco sale will help in blunting tobacco use prevalence besides curbing spread of infectious diseases like COVID-19 pandemic.

Tobacco price and use following California Proposition 56 tobacco tax increase.

BACKGROUND: California Proposition 56 increased cigarette excise tax by $2 per pack with equivalent increases on non-cigarette tobacco products. We estimated the changes in cigarette price, cigarette use, and non-cigarette use following the implementation of Proposition 56 in California in 2017. METHODS: Seven waves of Tobacco Use Supplements to the Current Population Survey (TUS-CPS) 2011-2019 data were used to obtain state-level aggregate self-reported outcomes, including cigarette price per pack, current and daily cigarette use, cigarette consumption per day, and current and daily use of non-cigarette tobacco products (hookah, pipe, cigar, and smokeless tobacco). A modified version of a synthetic control method was used to create a "synthetic" California that best resembled pre-policy sociodemographic characteristics and outcome trends in California while correcting time-invariant pre-policy differences. Various sensitivity analyses were also conducted. RESULTS: The implementation of Proposition 56 was associated with an increase in self-reported cigarette price per pack in California ($1.844, 95%CI: $0.153, $3.534; p = 0.032). No evidence suggested that Proposition 56 was associated with the changes in the prevalence of current or daily cigarette use, cigarette consumption per day, or the prevalence of current or daily use of non-cigarette tobacco products. CONCLUSION: Most of the cigarette tax increase following Proposition 56 in California was passed on to consumers. There is a lack of evidence that the implementation of Proposition 56 was associated with the changes in the use of cigarettes and other tobacco products such as hookah, pipe, cigar, and smokeless tobacco.

The Market for Bidis, Smokeless Tobacco, and Cigarettes in India: Evidence From Semi-Urban and Rural Areas in Five States.

Objectives: Compare the brand availability, pricing and presence of illicit products in semi-urban and rural areas in India across product types and states. Methods: In late 2017, 382 unique tobacco products were purchased from localities with populations under 50,000 in the states of Assam, Karnataka, Maharashtra, Rajasthan, and Uttar Pradesh. Brand, printed maximum retail price, price paid, tax, and health warning labels (HWLs) were used to compare the market for bidis, smokeless tobacco (SLT), and cigarettes. Results: Brand availability and pricing of SLT products was similar to cigarettes. Brand availability and pricing of bidis was consistent with having many small producers. Bidis and single serving SLT with spice mixtures were more affordable than cigarettes and SLT sold alone. 2% of SLT and 10% of cigarettes did not feature an India HWL. Conclusion: The elimination of single serving SLT packets and the removal of tax exemptions for small producers, often exploited by bidi producers, could reduce their respective affordability. State differences in illegal and illicit products could indicate a greater need for enforcement in some states.

Ability to Purchase Tobacco Products and Smoking Behavior of Cigarettes, E-cigarettes, and Heated Tobacco Products in Korean Adolescents.

Objectives: This study investigated the smoking behavior and its association with the availability of tobacco products purchases among Korean adolescents. Methods: The data of the 2019 Korea Youth Risk Behavior Survey were used (N =57,303). This study assessed 3 tobacco products: cigarettes, e-cigarettes, and heated tobacco products. Smoking behavior including lifetime, current, daily, heavy smoking, and attempting to quit and its association with the availability of tobacco products for purchase was assessed. Results: Overall, 92.9% did not try to purchase tobacco products during the past 30 days, 2.2% found it impossible to purchase, 0.8% could buy with a lot of effort, 1.7% could buy with little effort, and 2.3% could buy easily without any effort. Lifetime smokers were 13.8% (12.7% for cigarettes, 7.4% for e-cigarettes, and 4.9% for heated tobacco products). Among lifetime smokers, the current smoking rates for cigarettes, e-cigarettes, and heated tobacco products were 48.5%, 22.9%, and 19.0%, and the rates were lower in adolescents who responded that it was impossible to buy tobacco products. Among current smokers, the daily smoking rates were lower in adolescents who were found it impossible to buy tobacco products. Conclusions: The ease of access to tobacco products was associated with higher use of cigarettes, e-cigarettes, and heated tobacco products and lower attempts to quit smoking in Korean adolescents.

Effects of a Cigarette Price Increase on the Smoking Behavior of Smokers and Non-smokers.

Objectives: The government of the Republic of Korea (ie, South Korea) drastically increased cigarette prices by 80% in 2015. The exogenous regulatory change provided us with an opportunity to examine the effects of the cigarette price increase on smoking behavior. Methods: Utilizing 2011-2016 balanced panel data from the Korea Health Panel (3693 participants each year), we divided the sample into smokers and non-smokers and traced each individual's smoking behavior. Results: Overall smoking prevalence (OR = 0.476, p < .01) and daily cigarette consumption (IRR = 0.737, p < .01) were reduced after the cigarette price increase. However, although the cigarette price increase was inversely related to smokers' cigarette consumption (OR = 0.799, p < .01), we found no statistically significant impact on smoking cessation among smokers. On the other hand, the cigarette price increase was associated with decreased smoking onset among non-smokers (OR = 0.172, p < .01) and reduced cigarette consumption after they started smoking (IRR = 0.279, p < .01). Conclusions: The reduction in smoking prevalence after the increase of the cigarette price resulted from the fact that non-smokers did not start smoking rather than from a decrease in the number of existing smokers.

Commercial Tobacco Retailing in Tribal Jurisdictions: A Field Study.

Objectives: Our objective was to provide data contrasting commercial tobacco retailing in Tribal versus non-Tribal jurisdictions, in 3 states. These data may be relevant for US Food and Drug Administration regulation of Tribal retailing. Methods: With Tribal permission, observations were made on commercial tobacco advertising, product variety, pricing, and retail concept for stores within and just outside Tribal jurisdictions in areas of Arizona (AZ), California (CA), and Oklahoma (OK). Results: A total of 87 Tribal (20 AZ, 53 CA, 14 OK) and 67 (10, 43, 14) non-Tribal retailer visits were completed. There was substantial variation across tribes, with sales in AZ and most CA Tribal jurisdictions handled at convenience stores, whereas OK Tribal retailing was done mostly in specialized tobacco-specialty shops. Electronic cigarettes were ubiquitous across Tribal and non-Tribal outlets. Advertising and breadth of cigarette offerings was most extensive in the tobacco specialty retailers of Tribal OK. Surprisingly, Tribally manufactured cigarettes were found only at some CA Tribal retailers. Conclusions: Some Tribal commercial tobacco outlets actually price above their non-Tribal competitors and there is substantial variation in retailing strategy across Tribal jurisdictions. Tribal governments can continue to evaluate and reform commercial tobacco retailing so as to improve Tribal health.

Circumvention of COVID-19-related restrictions on tobacco sales by the e-cigarette industry in South Africa and comparative analyses of heated tobacco product vs combustible cigarette volume sales during 2018-2020.

As a public health measure against COVID-19, South Africa restricted the sale of "tobacco, e-cigarettes and related products" for 5 months, ending on August 17, 2020. We examined marketing activities related to novel tobacco products (e-cigarettes and heated tobacco products) during this restriction. Using web scraping, we accessed data for 2661 e-cigarette liquids marketed online by South African vendors in June 2020. We also analyzed heated tobacco product volume sales (kits) using retail scanner data from Nielsen Company. The 2661 e-cigarette liquids assessed online comprised cannabidiol liquids, 28.8%[767/2661], nicotine salts, 10.4%[276/2661], e-cigarette juice concentrates, 14.1%[376/2661], nicotine-free e-liquid, 4.0%[107/2661], and nicotine-containing e-liquid, 42.6%[1135/2661]. Cannabidiol liquids had the highest percentage of fruit (78.4%[601/767]) and tobacco flavors (9.4%[72/767]). During the restriction, many online e-cigarette vendors actively promoted cannabidiol liquid in lieu of regular e-liquid. Nielsen retail scanner data showed that volume of heated tobacco product sales in February 2020, preceding the restriction (7.76 million kits), were higher than in February 2019 (4.52 million kits). The restriction saw decreased sales of heated tobacco products; mean weekly heated tobacco product sales in the 6 weeks following the restriction (772,585 kits/week) were dramatically lower versus the 6 weeks preceding the restriction (2.26 million kits/week). Lifting the restriction saw a 131% spike in sales between the latter half of August 2020 (825,638 kits) and mid-September 2020 sales (1.90 million kits), even though total sales in September 2020 were half of what was observed in the preceding year (3.81 million units in September 2020, vs 6.33 million units, September 2019). The marketing of cannabidiol and other novel products by e-cigarette manufacturers and the tobacco industry may encourage youth use; close monitoring is required.

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.

Associations between smoking trajectories, smoke-free laws and cigarette taxes in a longitudinal sample of youth and young adults.

Cigarette smoking patterns vary within the population, with some individuals remaining never smokers, some remaining occasional users, and others progressing to daily use or quitting. There is little research on how population-level tobacco control policy interventions affect individuals within different smoking trajectories. We identified associations between tobacco control policy interventions and changes across different smoking trajectories among adolescents and young adults. Using 15 annual waves of data drawn from the National Longitudinal Survey of Youth 1997 (NLSY97), we applied a group-based trajectory model to identify associations between days smoked per month, comprehensive smoke-free laws, cigarette tax rates, and known socio-demographic risk factors for membership in different smoking trajectories. Comprehensive smoke-free laws were associated with reduced risk of initiation and reductions in days smoked per month for all trajectories other than occasional users. Higher tax rates were associated with reduced risk of initiation and days smoked for all trajectories other than established users. Overall, population-based tobacco control policies, particularly comprehensive smoke-free laws, were associated with reduced smoking. Tobacco taxes primarily reduced risk of initiation and use among never smokers, experimenters, and quitters, consistent with previous research suggesting that tobacco manufacturers lower prices after tax increases to reduce the cost of continued smoking for established users. These results provide support for expanding smoke-free laws and establishing a minimum tobacco floor price, which could improve public health by reducing the risk of initiation as well as use among occasional and established smokers.