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The case for gender considerate tobacco control policies in Albania.

ABSTRACT: Background:Tobacco use is a serious health concern in Albania. While the prevalence of tobacco smoking has traditionally been higher for men, the increasing prevalence of smoking for women is becoming a concern. The 2007 Tobacco Control policy mandated smoke-free indoor spaces, banned various forms of tobacco advertising, required written health warnings on packaging and levied excise taxes on cigarette sales. Since smoking behavior varies among different demographic groups, each group's response to a uniform policy will differ, blunting the effectiveness of these efforts as a result. This study examines various socioeconomic, demographic and behavioral factors affecting both the likelihood and frequency of smoking in Albanian households in order to provide insights on targeting various populations more effectively. Methods:The study utilizes data from Albanian 2008-09 and 2017-18 Demographic and Health Surveys consisting of adults aged 15-49?years. The outcome variable includes respondents' current tobacco smoking behaviour and its frequency. The exposure variables include respondents' sociodemographic and lifestyle characteristics. We use a two-level random intercept model with the two-stage residual inclusion estimation method to determine the association between outcome and exposure variables. By including a time variable, we capture the change in smoking behavior during the 2009-2018 period. We also extend the analysis by assessing the differential influence of gender on the likelihood of smoking, both by income quintiles and education. Results:The results suggest that the likelihood of smoking decreased by 23% in 2017-18 compared to 2008-09, after controlling for various socioeconomic and demographic factors. Tobacco smoking is also found to be linked to alcohol consumption, with binge drinkers 59% more likely to smoke tobacco compared to moderate drinkers. We also found significant inter-quintile and inter-educational differences in smoking practices within each gender category. While the likelihood of tobacco smoking decreases with increasing wealth and educational attainment among men, the opposite (for wealth) or more involved (for educational attainment) patterns are true among women. Conclusions:To further enhance the effectiveness of the current Tobacco Control policy, the Government of Albania should target various demographic groups (such as poor males, rich and educated females) in a differentiated fashion.

SUBMITTER: Guliani H

PROVIDER: S-EPMC7155310 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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The case for gender considerate tobacco control policies in Albania.

Guliani Harminder H Çule Monika M

Global health research and policy 20200414

<h4>Background</h4>Tobacco use is a serious health concern in Albania. While the prevalence of tobacco smoking has traditionally been higher for men, the increasing prevalence of smoking for women is becoming a concern. The 2007 Tobacco Control policy mandated smoke-free indoor spaces, banned various forms of tobacco advertising, required written health warnings on packaging and levied excise taxes on cigarette sales. Since smoking behavior varies among different demographic groups, each group's ...[more]

PMID: 32313841

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Project description:It is unclear whether the benefits of tobacco control policies extend to pregnant women and infants, especially among racial/ethnic minority and low socioeconomic populations that are at highest risk for adverse birth outcomes.To examine the associations of state cigarette taxes and the enactment of smoke-free legislation with US birth outcomes according to maternal race/ethnicity and education.Using a quasi-experimental approach, we analyzed repeated cross sections of US natality files with 16,198,654 singleton births from 28 states and Washington, DC, between 2000 and 2010. We first used probit regression to model the associations of 2 tobacco control policies with the probability that a pregnant woman smoked (yes or no). We then used linear or probit regression to estimate the associations of the policies with birth outcomes. We also examined the association of taxes with birth outcomes across maternal race/ethnicity and education.State cigarette taxes and smoke-free restaurant legislation.Birth weight (in grams), low birth weight (<2500 g), preterm delivery (<37 weeks), small for gestational age (<10th percentile for gestational age and sex), and large for gestational age (>90th percentile for gestational age and sex).White and black mothers with the least amount of education (0-11 years) had the highest prevalence of maternal smoking during pregnancy (42.4% and 20.0%, respectively) and the poorest birth outcomes, but the strongest responses to cigarette taxes. Among white mothers with a low level of education, every $1.00 increase in the cigarette tax reduced the level of smoking by 2.4 percentage points (-0.0024 [95% CI, -0.0004 to -0.0001]), and the birth weight of their infants increased by 5.41 g (95% CI, 1.92-8.89 g). Among black mothers with a low level of education, tax increases reduced smoking by 2.1 percentage points (-0.0021 [95% CI, -0.0003 to -0.0001]), and the birth weight of their infants increased by 3.98 g (95% CI, 1.91-6.04 g). Among these mothers, tax increases also reduced the risk of having low-birth-weight, preterm, and small-for-gestational-age babies, but increased the risk of having large-for-gestational-age babies. Associations were weaker among higher-educated black women and largely null among higher educated white women and other groups. We did not find evidence for an association of smoke-free restaurant legislation with birth outcomes.Increases in the cigarette tax are associated with improved health outcomes related to smoking among the highest-risk mothers and infants. Considering that US states increase cigarette taxes for reasons other than to improve birth outcomes, these findings are welcome by-products of state policies.

Project description:IntroductionSmokeless tobacco (ST) was consumed by 356 million people globally in 2017. Recent evidence shows that ST consumption is responsible for an estimated 652 494 all-cause deaths across the globe annually. The WHO Framework Convention on Tobacco Control (FCTC) was negotiated in 2003 and ratified in 2005 to implement effective tobacco control measures. While the policy measures enacted through various tobacco control laws have been effective in reducing the incidence and prevalence of smoking, the impact of ST-related policies (within WHO FCTC and beyond) on ST use is under-researched and not collated.Methods and analysisA systematic review will be conducted to collate all available ST-related policies implemented across various countries and assess their impact on ST use. The following databases will be searched: Medline, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Scopus, EconLit, ISI Web of Science, Cochrane Library (CENTRAL), African Index Medicus, LILACS, Scientific Electronic Library Online, Index Medicus for the Eastern Mediterranean Region, Index Medicus for South-East Asia Region, Western Pacific Region Index Medicus and WHO Library Database, as well as Google search engine and country-specific government websites. All ST-related policy documents (FCTC and non-FCTC) will be included. Results will be limited to literature published since 2005 in English and regional languages (Bengali, Hindi and Urdu). Two reviewers will independently employ two-stage screening to determine inclusion. The Effective Public Health Practice Project's 'Quality Assessment Tool for Quantitative Studies' will be used to record ratings of quality and risk of bias among studies selected for inclusion. Data will be extracted using a standardised form. Meta-analysis and narrative synthesis will be used.Ethics and disseminationPermission for ethics exemption of the review was obtained from the Centre for Chronic Disease Control's Institutional Ethics Committee, India (CCDC_IEC_06_2020; dated 16 April 2020). The results will be disseminated through publications in a peer-reviewed journal and will be presented in national and international conferences.Prospero registration numberCRD42020191946.

Project description:ImportanceTobacco smoking is still responsible for more than 6 million preventable deaths annually, most of which occur in low- and middle-income countries. South American countries, Chile in particular, endure some of the highest cigarette smoking prevalence rates globally. Despite the lack of any meaningful increases in cigarette taxes (the most effective tobacco control measure) between 1999 and 2014, cigarette prices in Chile increased sharply almost entirely driven by British American Tobacco (BAT).ObjectiveTo examine the associations between cigarette prices and nonprice tobacco control policies targeted at youth introduced in 2006 (Law 20105) and smoking onset among Chilean youths.Design, setting, and participantsThis study used data from 8 waves of a large national school survey of urban communities in Chile conducted between October and December in 2001, 2003, 2015, 2007, 2009, 2011, 2013, and 2015 and discrete-time hazard models. Data analysis was performed from May 2017 to January 2019.ExposuresPrices, advertising, and retail restrictions.Main outcomes and measuresSmoking onset (the transition between never smoking and smoking) in youth.ResultsIn this study of 181 624 survey respondents in 8751 Chilean secondary schools, higher prices (own-price elasticity [percentage change in quantity demanded in response to a 1% change in price], -0.40; 95% CI, -0.45 to -0.36) and the tobacco control policies enacted in 2006 (hazard ratio, 0.83; 95% CI, 0.81-0.85) were associated with lower hazards of starting smoking. The study found that an increase in real prices of 58.6% and the introduction of Law 20105 were associated with similar lower hazards of starting smoking (hazard ratio, 0.83; 95% CI, 0.81-0.85); in comparison, between 1999 and 2017, inflation-adjusted cigarette prices increased by 206%.Conclusions and relevanceThe findings suggest that higher prices initiated by BAT and the tobacco control policies enacted by the Ministry of Health in 2006 were associated with lower hazards of starting smoking in Chilean youth. Large cigarette tax increases may be a strategy that can be used to help reduce smoking among youths in Chile.

Project description:IntroductionEconomic evaluations of tobacco control policies targeting adolescents are scarce. Few take into account real-world, large-scale implementation costs; few compare cost-effectiveness of different policies across different countries. We assessed the cost-effectiveness of five tobacco control policies (nonschool bans, including bans on sales to minors, bans on smoking in public places, bans on advertising at points-of-sale, school smoke-free bans, and school education programs), implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal.MethodsCost-effectiveness estimates were calculated per country and per policy, from the State perspective. Costs were collected by combining quantitative questionnaires with semi-structured interviews on how policies were implemented in each setting, in real practice. Short-term effectiveness was based on the literature, and long-term effectiveness was modeled using the DYNAMO-HIA tool. Discount rates of 3.5% were used for costs and effectiveness. Sensitivity analyses considered 1%-50% short-term effectiveness estimates, highest cost estimates, and undiscounted effectiveness.FindingsNonschool bans cost up to €253.23 per healthy life year, school smoking bans up to €91.87 per healthy life year, and school education programs up to €481.35 per healthy life year. Cost-effectiveness depended on the costs of implementation, short-term effectiveness, initial smoking rates, dimension of the target population, and weight of smoking in overall mortality and morbidity.ConclusionsAll five policies were highly cost-effective in all countries according to the World Health Organization thresholds for public health interventions. Cost-effectiveness was preserved even when using the highest costs and most conservative effectiveness estimates.ImplicationsEconomic evaluations using real-world data on tobacco control policies implemented at a large scale are scarce, especially considering nonschool bans targeting adolescents. We assessed the cost-effectiveness of five tobacco control policies implemented in 2016 in Finland, Ireland, the Netherlands, Belgium, Germany, Italy, and Portugal. This study shows that all five policies were highly cost-effective considering the World Health Organization threshold, even when considering the highest costs and most conservative effectiveness estimates.

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The case for gender considerate tobacco control policies in Albania.

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The case for gender considerate tobacco control policies in Albania.

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