Does higher tax rate affect tobacco usage?Unravelling the nexus between tobacco regulatory control and public health concern

Objectives:Bangladesh stands as a prominent global consumer of tobacco,with alarming consequences on public health.The Global Adult Tobacco Survey reported that tobacco consumption claimed over 126000 lives in 2018,contributing to 13.5%of all deaths in the country.This study aims to explore the effectiveness of higher tax rates and tobacco use regulation as control mechanisms in mitigating tobacco consumption and health care cost burden,with a particular emphasis on its implications for public health.Methods:This study is based on the annual time series data over the period 2000-2020.The study employs the ordinary least square method to analyze the quantitative confirming the stationarity of data at level.This research uses different models to investigate individual effects and combined effects on both tobacco consumption and tobacco health care cost burden.Results:The study finds a negative relationship between tobacco tax rate and tobacco consumption.More specifically,the higher tax rate of tobacco(low(β=-0.3495),medium(β=-0.2319),high(β=-0.9033),premium(β=-0.7322),filtered(β=-0.2114),and non-filtered(β=-0.3452)categories)is significant to reduce tobacco use at 1%level of significance.The study finds similar results when it applied tobacco retail price instead of tobacco tax rate as the independent variable.Finally,the study investigates the impact on health care cost through tobacco consumption,tobacco control law,growth rate,export-import,and tobacco production.The results indicate that tobacco consumption,export-import,and tobacco production increases health care cost burden while tobacco use regulatory decreases it.By reducing tobacco consumption,higher taxes and tobacco use regulation contribute to alleviating the burden on the healthcare system,promoting healthier lifestyles,and aligning with global health objectives.Conclusions:Higher tax rate on tobacco products is necessary to increase the retail price so that tobacco users cannot consume tobacco.Specific tax and uniform tax base are needed so that tobacco users cannot switch to lower priced brands.Tobacco control laws need to revised and proper implementation should be ensured as well,to achieve the goal of tobacco free Bangladesh by 2040.Tobacco-related diseases,responsible for a significant proportion of deaths in the country,could witness a considerable decline with the successful implementation of higher tax rates and tobacco use regulation.This study provides insights that not only contribute to the economic discourse but also accentuate the broader public health benefits arising from effective tobacco taxation policies.

Findings from 2010 Global Adult Tobacco Survey: Implementation of MPOWER Policy in China

Objective To assess the implementation of five key tobacco control policies in China： protection from second-hand smoke （SHS）; offering help to quit; health warnings regarding tobacco use; the enforcement of bans on tobacco advertising, promotion, and sponsorship; and increasing tobacco taxes and prices. Methods Using 2010 Global Adults Tobacco Survey in China （GATS-China）, 10 indicators are used to assess the implementation of five key tobacco control policies of MPOWER in China. Results Overall, 63.3% and 72.7% of adultsnoticed people smoking indoor workplaces and public places, respectively. Approximately 60% of smokers were not asked about their smoking habits and approximately 67% were not advised to quit on their visit to a health worker. Sixty percent of adults noticed health warning messages on cigarette packaging and in the media in the last 30 days, 63.6% stated that they would not consider quitting. Twenty percent of respondents noticed tobacco advertising, promotion, and/or sponsorship activities in the 30 days prior to the survey. Among them, 76.3% noticed the direct advertising and 50% noticed from TV programs. Although purchasing price of one pack of cigarettes ranged from 1 to 200 RMB, 50% of current smokers （about 150 million） spent 5 RMB or less on one pack of cigarette. The expenditure on 100 packets of cigarettes represents 2% of 2009 GDP per capita. Conclusion The average score for the implementation of the 5 policies of MPOWER in China is 37.3 points, indicating tobacco control policies in China is poor and there is a large gaps from the FCTC requirements.

Supporting smoking cessation in healthcare: obstacles in scientific understanding and tobacco addiction management

Despite ongoing efforts to reduce tobacco smoking, the smoking prevalence in many countries has remained stable for years. This may be a consequence of either lack of knowledge about effective ways to reduce smoking, or failing treatment of tobacco addiction in healthcare. This study explored gaps in the current understanding of smoking cessation and the challenges facing tobacco addiction management in order to formulate recommendations for future research and healthcare practice. A narrative review was written to determine areas in which more research is needed as well as areas in which sufficient knowledge is already available. Recommendations for future research were prioritised using a Delphi-procedure. Recommendations for healthcare practice were confirmed by expert’s assessment. Smoking is not widely acknowledged as an addiction and a relatively small number of smokers ask help from a healthcare professional when trying to stop smoking. Most healthcare professionals recognise the importance of advising patients to stop smoking, but experience certain barriers to actually do this. Overall, healthcare professionals need to be convinced that tobacco smoking is an addiction and should be treated likewise. If all healthcare professionals systematically advise their patients to give up smoking, eventually more smokers will successfully stop smoking.

Tobacco Control Intervention:A Comparative Multimodal Discourse Analysis of Video Advertisements in China and Australia

Significant differences in tobacco-control initiatives and achievements between Australia and China have been witnessed in the world,despite the fact that thecountries share the Asia-pacific region and have intimate relationships.The smoking rate in Australia has been on a downward trend since the 1980s and therefore Australia has been portrayed as a“dark market”by global tobacco industry companies.However in China,cigarette smoking is the chief killer that causes deadly health risks to both direct users of tobacco and people exposed to second-hand smoke.Non-communicable diseases due to this have caused great burden to the national medical resources.As a vital intervention tool of mass media campaign,public health advertisements on tobacco-control have played an important role in influencing the cognition and behavior of recipients.This study aims to compare the strategies adopted by the advertisements in Australia and China through corpus-driven multimodal discourse analysis to conduct quantitative analysis and qualitative case study.The results of comparative analysis indicate different pathways of tobacco-control advertisements constructions in the two countries that Australian tobacco-control advertisements achieved better in terms of health communication intervention to encourage cessation among smokers and reduce smoking initiation among potential smokers at the population level.To be compared,Chinese tobacco-control advertisements placed a heavier emphasis on the health hazards caused by second-hand smoking to protect people from the attributable morbidity and mortality.From the perspective of content theme,this study argues that Chinese tobacco-control advertisements should shift the focus to the health damage of smoking to smokers which is more targeted and fundamental.From the perspective of multimodal presentations of the video advertisements,a more prominent demonstration of the health damage is recommended.Moreover,this study argues that cultural-oriented strategies should be developed in the tobacco-control advertisements if considering the cigarette sharing and gifting social phenomenon in the Chinese society.

Impact of Village-based Health Education of Tobacco Control on the Current Smoking Rate in Chinese Rural Areas

The number of smokers in Chinese rural areas is more than 200 million, which is twice that in cities. It is very significant to carry out tobacco control interventions in rural areas. We performed this community intervention study to evaluate the efficacy of village-based health education of tobacco control on the male current smoking rate in rural areas. The population of this study was the males above 15 years old from 6 villages in rural areas. The villages were randomly assigned to intervention group or control group（3 villages in each group）. Self-designed smoking questionnaire was applied. The intervention group received the village-based health education of tobacco control for one year. The primary outcome measurement was the male current smoking rate. In the baseline investigation, completed surveys were returned by 814 male residents from the control group and 831 male residents from the intervention group. The male current smoking rate in the control group and the intervention group was 61.2% and 58.5%, respectively, before intervention. There was no significant difference between these two groups（P〉0.05）. After one-year intervention, the current smoking rate in the intervention group（51.2%） was significantly lower than that in the control group（62.8%）（P〈0.001）. Our study suggested that the village-based health education of tobacco control was effective in lowering the male current smoking rate in rural areas, which could be a suitable and feasible way for tobacco control in the Chinese rural areas.

Widening socioeconomic disparity in lung cancer incidence among men in New South Wales, Australia, 1987–2011

Objective：We assessed the trends in lung cancer incidence over a 25-year period by socioeconomic groups for men in New South Wales（NSW）,Australia.Methods：Men diagnosed with lung cancer between 1987 and 2011 were divided into five quintiles according to an Index of Education and Occupation（IEO）.We assessed relative socioeconomic differences over time by calculating age-standardized incidence ratios（SIRs）by 5-year period of diagnosis,and estimated absolute differences by comparing the observed and expected numbers of cases using the highest IEO quintile as the reference.Results：Lung cancer incidence for men decreased from 1987 to 2011 for all IEO quintiles,with a greater rate of decline for men living in the highest IEO areas.Thus,the relative disparity increased significantly over the 25-year period（P=0.0006）.For example,the SIR for the lowest IEO quintile increased from 1.28 during 1987–1991 to 1.74during 2007–2011.Absolute differences also increased with the proportion of＂potentially preventable＂cases doubling from 14.5% in 1987–1991 to 30.2% in 2007–2011.Conclusions：Despite the overall decline in lung cancer incidence among men in NSW over the past 25 years,there was a significant increase in disparity across socioeconomic areas in both relative and absolute terms.

A Decision Tree Approach for Predicting Smokers’Quit Intentions

This paper presents a decision tree approach for predicting smokers＇ quit intentions using the data from the International Tobacco Control Four Country Survey. Three rule-based classification models are generated from three data sets using attributes in relation to demographics, warning labels, and smokers＇ beliefs. Both demographic attributes and warning label attributes are important in predicting smokers＇ quit intentions. The model＇s ability to predict smokers＇ quit intentions is enhanced, if the attributes regarding smokers＇ internal motivation and beliefs about quitting are included.

Price, Tax and Cigarette Smoking： Simulations of China＇s Tobacco Tax Policy

This paper explains the tobacco tax structure and cigarette pricing mechanism in China, develops a general analytical framework for analyzing the Chinese tobacco turnover tax system, and examines the effects of 2009 tobacco tax adjustment on cigarette prices and tax revenue. We find that although the tax is not the most important factor determining cigarette retail prices, the tobacco tax does significantly affect the tobacco industry＇s profits under the current tobacco monopoly system in China. Therefore, the adjustment of the tobacco excise tax in 2009 did not raise cigarette retail prices, instead government tax revenue increased. In other words, the net result of the tax adjustment was a transfer of the tobacco industry＇s profit to government tax revenues. Profit margins ultimately determine cigarette wholesale and retail prices. From the perspective of tobacco control, China needs to reform its tobacco tax system and collect taxes at the retail level to increase overall cigarette retail prices, as well as reduce the government＇s monopolization over cigarette productions and sales.

Grappling With Tobacco Control

It's reported that the British House of Commons passed a bill February 14 to ban smoking in every pub, club and indoor public space in England. The legislation is now submitted to the upper House of Lords. If passed, it will become law by mid-2007. With the ban, Britain joins Ireland, Finland, Italy, New Zealand, Norway, South Africa, Spain, Sweden and several U.S. states and cities, all of which have restricted smoking in public places in recent years.

Building Blocks for Tobacco Control

The tobacco epidemic is a global challenge demanding concerted global and national action. Recognizing that globalization is accelerating the epidemic’s spread and perceiving the limits of national action to contain a public health problem with transnational dimensions, Member States of the World Health Organization negotiated and adopted a unique public health treaty for tobacco control. Today, the WHO FCTC contains the blueprint for coordinated global action to address one of the most significant risks to health.

Implementation planning for lung cancer screening in China

Lung cancer is the leading cause of cancer-related deaths in China,with over 690000 lung cancer deaths estimated in 2018.The mortality has increased about five-fold from the mid-1970s to the 2000s.Lung cancer lowdose computerized tomography(LDCT)screening in smokers was shown to improve survival in the US National Lung Screening Trial,and more recently in the European NELSON trial.However,although the predominant risk factor,smoking contributes to a lower fraction of lung cancers in China than in the UK and USA.Therefore,it is necessary to establish Chinese-specific screening strategies.There have been 23 associated programmes completed or still ongoing in China since the 1980s,mainly after 2000;and one has recently been planned.Generally,their entry criteria are not smoking-stringent.Most of the Chinese programmes have reported preliminary results only,which demonstrated a different high-risk subpopulation of lung cancer in China.Evidence concerning LDCT screening implementation is based on results of randomized controlled trials outside China.LDCT screening programmes combining tobacco control would produce more benefits.Population recruitment(e.g.risk-based selection),screening protocol,nodule management and costeffectiveness are discussed in detail.In China,the high-risk subpopulation eligible for lung cancer screening has not as yet been confirmed,as all the risk parameters have not as yet been determined.Although evidence on best practice for implementation of lung cancer screening has been accumulating in other countries,further research in China is urgently required,as China is now facing a lung cancer epidemic.