Search

Background: Albania has one of the highest smoking prevalence in Europe especially among the youth. There is a lack of evidence in Albania, as well as in most of Eastern Europe and middle-income countries, regarding the effect of price on smoking experimentation., Objective: The study aims to assess the effect of price and tobacco control policies on youth smoking experimentation in Albania., Methods: We used microdata from the Global Youth Tobacco Survey in Albania for 2004, 2009, 2015 and 2020. We constructed a pseudo-longitudinal dataset and estimated a split-population model to assess the hazard of smoking experimentation., Results: Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females (p<0.001). Being male increases the odds for smoking experimentation by more than 50% as compared with females (p<0.001), whereas females appear to be more price sensitive. Peer and parent smoking are also important determinants for smoking experimentation. Introducing penalties for smokers and legal entities violating smoke-free policies implemented in 2014 is also associated with a lower hazard of smoking experimentation., Conclusion: Price is a significant predictor of smoking experimentation among teenagers in Albania for both males and females. A combination of increasing taxes and strengthening the rule of law to control tobacco use in public spaces, in addition to public awareness campaigns targeting both youth and smoking parents, could help to significantly reduce the probability of smoking experimentation., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.)

In 2020, California passed a flavored tobacco sales restriction (FTSR), but the tobacco companies filed a referendum, and the ban will not be implemented unless approved by voters in November 2022. This study examined the percentage of the California population covered by a city FTSR and identified groups more likely to be covered. Mean demographics as well as tobacco use and control measures were compared for California cities with ( n = 93) and without ( n = 389) a FTSR, and t tests were used to examine the differences. We calculated adjusted odds ratios using logistic regression models. City FTSR policies covered 20.7% of the California population. Adjusted predictors of having a FTSR included the American Lung Association tobacco control score (odds ratio [OR] = 1.27, 95% confidence interval [CI]: [1.17, 1.38]), voting democratic (OR = 1.06, 95% CI: [1.02, 1.10]). and having a lower adult smoking prevalence (OR = 0.84, 95% CI: [0.72, 0.99]). A state-level policy would cover all populations in California.

Introduction: Within the context of the World Health Organization Framework Convention on Tobacco Control Protocol to Eliminate Illicit Trade in Tobacco Products and the impending revision of the European Union (EU) directive on tobacco excise rules we assessed whether cigarettes price is linked to being offered illicit cigarettes., Methods: We combined data being offered illicit cigarettes from the 2015 Special Eurobarometer Survey on Illicit Tobacco (N = 27,672) with area-level data on Gross Domestic Product, unemployment, perceived corruption, and sharing a border with a non-European Economic Area (non-EEA) state. We used the 2015 Weighted Average Price of cigarettes (WAP), which reflects the average price of a cigarette pack in each Member State. We assessed associations between prices and illicit trade using three-level ordered regression models., Results: About 19.6% of respondents reported ever being offered illicit cigarettes, 6.4% repeatedly. In fully adjusted models WAP was not associated with being more likely to have been offered illicit market cigarettes more often (adjusted odds ratio = 1.02, 95% confidence interval: 0.91; 1.15). Sharing a border with a non-EEA Member State was associated with increased likelihood of reporting being offered illicit cigarettes more often (1.73, 1.26; 2.39)., Conclusion: This study found no significant association between cigarette prices and reporting being offered illicit cigarettes; sharing a border with a non-EEA Member State was linked to illicit trade. This study adds to evidence that increasing prices of cigarettes are not associated with illicit trade and that the focus should remain on securing supply chains, including through features such as independent traceability systems., Implications: After adjusting for individual and regional factors, we did not identify an association between prices of cigarettes and likelihood of reporting being offered illicit cigarettes in the EU. Sharing a border with a non-EEA state, however, was associated with increased likelihood of reporting being offered illicit cigarettes more often. This study adds to evidence that increasing taxes and prices of cigarettes are not a driver of illicit trade and that policies should maintain their focus on securing the supply chain., (© The Author(s) 2020. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Even though 90% of the world's population is covered by the World Health Organization's Framework Convention on Tobacco Control, it is estimated that only one-fifth (21%) and half (49%) of the countries that ratified this convention will achieve the target of reducing tobacco use by 30 % among men and women respectively in 2025. Over the past decade, there has been an increasing trend in the use of electronic cigarettes or e-cigarettes for recreational use as well as smoking cessation. In concurrence with the increasing use of e-cigarettes among smokers of different age groups, nations have developed relevant national regulations on its sale, advertisement, packaging, product regulation, taxation, and surveillance. The countries of the Gulf Cooperation Council (GCC) region have also witnessed several legislations, at varying extent, related to the use of electronic cigarettes. However, the evidence on the use of electronic nicotine delivery systems remains scarce in the GCC region. Thus, further research on this emerging public health issue is warranted to generate the evidence necessary for the formulation of comprehensive tobacco control laws and effective prevention strategies., .

Objectives: The finalized 'Deeming Rule' extended the Food and Drug Administration (FDA) authority to regulate e-cigarettes, cigars, and other newly deemed tobacco products. We seek to assess the neighborhood characteristics associated with retail violations of sales to minors (RVSM) by tobacco product., Study Design: We collected national inspection data on tobacco retailers during August 8, 2016, and May 31, 2018, from the FDA compliance check database., Methods: A web scraping tool was applied to text mine the FDA decision letters and extract information on the tobacco product involved in RVSM. Separate logistic regression models with random effects were performed to examine the association between zip code-level neighborhood characteristics and RVSM by tobacco product., Results: Of 268,317 minor-involved compliance inspections, 35,403 (13.2%) were identified as RVSM. Among 23,352 warning letters included in the final analysis, e-cigarettes, cigars, cigarettes, and smokeless tobacco accounted for 20.0% (n = 4673), 40.4% (9439), 35.6% (8303), and 4.0% (937) of RVSM, respectively. Flavored tobacco products were abundant among underage sales. For e-cigarettes, RVSM were more likely to occur in zip codes with a larger proportion of youth population aged 10-17 years (adjusted odds ratio [AOR] = 1.17 [1.02-1.34]). A larger proportion of African Americans was associated with a higher risk of RVSM for cigars (AOR = 1.09 [1.07-1.11]) but a lower risk of RVSM for e-cigarettes (AOR = 0.90 [0.87-0.93])., Conclusions: Retail violations of underage sales for cigars and e-cigarettes are prevalent and neighborhood characteristics associated with violations differ by tobacco product. Continued inspections with tailored strategies to reduce RVSM of all tobacco products are needed., (Copyright © 2020. Published by Elsevier Ltd.)

Objectives: In 2017, one in four French 17-year-olds was a daily smoker, even though France prohibited the sale of tobacco to under-18 minors in 2009. This research aims to evaluate the retail violation rate for sale to minors (RVRms) and the associated factors., Study Design: The study design used is observational mystery shopping study., Methods: We conducted a mystery shopping study enlisting 12-year-old and 17-year-old youths in a representative sample of 527 tobacco outlets during three weeks in spring 2019. Multinomial Logit and Probit regressions were estimated on the data collected., Results: The law is not respected. Two of three sellers (65.2%) were willing to make an illegal sale to a 17-year-old minor, and almost one in 12 (8.1%) were willing to sell to a 12-year-old child attempting to buy tobacco. Illegal sales were more likely to be made by male sellers, retailing in big cities, when there were no in-shop queues, and to 17-year-old females. The absence of the mandatory enforcement poster flagging up the ban on the sale of tobacco to minors appears to be a strong factor associated with RVRm., Conclusions: These findings show that progress needs to be made to better enforce tobacco control legislation to help decrease underage smoking in France. Rate of compliance with the law could be improved by stronger enforcement measures and tougher sanctions, but also by training and the provision of age-verification tools for sellers, as demonstrated by experiments in other countries., (Copyright © 2020 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Background: From July 2013 to January 2015, the smoking ban instituted in restaurants in South Korea gradually expanded to cover all restaurants and bars, moving by size of restaurant (≤99 m2, 100-149 m2, ≥150 m2). This study measured the impacts of the smoking ban for restaurants., Methods: This study examined credit, check, or debit card sales data for every September and October from 2012 to 2015 in 711 census tracts in Seoul, South Korea. We accounted for total restaurant sales in each census tract. Our model controlled for the sales amounts for each census tract, type of restaurant, monthly business survey index, number of restaurants, daily average temperature, daily precipitation, and day of the week, and a dummy for census tract., Results: These were some positive associations with increase in total sales. However, the significance of the coefficients was not consistent over this period. Overall, our results showed no significant negative effects of smoking ban policy on restaurants., Conclusions: Smoking ban policies produced benefits in terms of health outcomes, without causing significant negative impacts on sales., Implications: Although the owners of restaurants anticipated negative impacts on sales from smoking ban policies, the results of this study suggest that restaurants experienced no negative economic impacts on sales from policies with health benefits, which suggest that it would be reasonable to promote and keep on the smoking ban. Also, it is important to apply smoking ban policy to all targets without exclusion., (© The Author(s) 2019. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved.For permissions, please e-mail: journals.permissions@oup.com.)

Introduction: Imposing policies that increase tobacco prices is a key strategy for reducing smoking prevalence, although it may result in more cigarette trafficking. In 2013, New York City (NYC) passed the Sensible Tobacco Enforcement (STE) law requiring cigarettes be sold for a minimum price of $10.50 per pack. To evaluate whether cigarette price increases changed patterns of behaviour related to cigarette tax evasion, we examined littered pack study data from 2011 and 2015., Methods: Littered cigarette packs were collected from a random sample of NYC census tracts in 2011 and 2015. The proportions of cigarette packs with proper local, known non-local, foreign or unknown, and no tax stamp were calculated. Changes in volume, source and consumption of domestically trafficked cigarettes over time were estimated., Results: In 2011, 255 packs with cellophane were collected; in 2015, 226 packs with cellophane were collected. Packs without proper local stamp increased from 60.7% in 2011 to 76.3% in 2015 (p<0.05) and those with foreign or unknown stamp increased from 11.6% in 2011 to 31.4% in 2015 (p<0.05). The percentage of domestically sourced packs attributed to domestic trafficking increased significantly from a range of 47.9% to 52.8% in 2011 to a range of 59.4% to 63.2% in 2015., Conclusion: While the trafficking rate among domestically sourced cigarettes increased between 2011 and 2015 (before and after the STE minimum price floor on cigarette packs was in place), there was a decline in total consumption of domestically trafficked cigarettes due to a significant increase in consumption of foreign-sourced cigarettes. Jurisdictions considering price measures should bolster monitoring and enforcement efforts to maximise public health impact. Given the interstate nature of cigarette trafficking in the USA, Federal intervention would be optimal., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ.)

Importance: Banning electronic cigarette (e-cigarette) sales to minors has been a key policy to protect children from e-cigarettes in the United States and Canada, but to date little is known about the outcome of such a ban., Objectives: To investigate the association of banning e-cigarette sales to minors in Canada with e-cigarette use among youths and the mechanisms through which a ban might be associated with their e-cigarette use., Design, Setting, and Participants: This quasi-experimental difference-in-differences and triple-differences study used data from the nationally representative Canadian Tobacco, Alcohol and Drugs Survey (2013-2017) and Canadian Student Tobacco, Alcohol and Drugs Survey (2014-2017). Study samples consisted of respondents aged 15 to 18 years (in difference-in-differences analysis; n = 8212) and aged 15 to 25 years (in triple-differences analysis; n = 20 934) in the Canadian Tobacco, Alcohol and Drugs Survey, and students in grades 6 to 12 (in difference-in-differences analysis; n = 78 650) in the Canadian Student Tobacco, Alcohol and Drugs Survey., Interventions: Canada's provincial bans on e-cigarette sales to youths younger than 18 or 19 years (depending on province) implemented between 2015 and 2017., Main Outcomes and Measures: The primary outcome was past 30-day e-cigarette use among youths. Secondary outcomes were difficulty of access to e-cigarettes, perception of e-cigarette harm, and use of social sources of e-cigarettes., Results: After the bans, e-cigarette use among youths increased in all provinces, but the increase was 3.1 percentage points (95% CI, 0.2-6.0; P = .04), or 79%, lower in provinces with a ban than in provinces without a ban. Youths in provinces with a ban were 2.6 percentage points (95% CI, 1.5-3.7; P = .001), or 18%, less likely to believe that regular e-cigarette use poses no harm and 6.2 percentage points (95% CI, 1.1-11.4; P = .02), or 16%, more likely to self-report greater difficulty in obtaining e-cigarettes. Among youths who reported using e-cigarettes, the likelihood of obtaining e-cigarettes from social sources was 17.3 percentage points (95% CI, 5.2 -29.4; P = .01), or 29%, higher in provinces with a ban. These findings were robust to several sensitivity analyses., Conclusions and Relevance: Banning e-cigarette sales to minors was associated with a significant reduction in the rate of increase in e-cigarette use by youths, but this policy alone could not reverse the overall increase in e-cigarette use. The findings from this study suggest that this policy should be supplemented with other measures that can reduce young people's desire to obtain e-cigarettes through social sources, such as a ban on e-cigarettes with flavors that appeal to youths and children.

Introduction: Factory-made cigarettes (FMC) and roll-your-own (RYO) tobacco have had to be produced in standardized packaging since May 20, 2016 in the United Kingdom, with a minimum pack size of 20 sticks for FMC and 30 g for RYO. Manufacturers and retailers were given a 12-month transition period., Methods: An observational study was conducted using monthly Electronic Point of Sale data from 500 small retailers in England, Scotland, and Wales, between May 2016 and May 2017. The 20 top selling tobacco products (15 FMC, 5 RYO) were monitored to observe when standardized packs were first introduced, the proportion of retailers selling each fully branded and standardized product, and the average number of monitored fully branded and standardized products sold by each retailer. The number of unique tobacco-related product codes sold by each retailer was also recorded each month., Results: Eighteen of the fully branded products continued to be sold throughout the transition period and no standardized variants were sold in the first 5 months. It was not until month eleven that the average number of standardized products sold by retailers exceeded the fully branded products. The average number of unique tobacco-related product codes sold by each retailer decreased by a third over the transition period., Conclusions: Tobacco companies used the transition period to delay the removal of fully branded products and gradually introduce standardized variants. This staggered introduction may have mitigated some of the immediate intended effects of the legislation by desensitizing consumers to new pack designs., Implications: Evaluation research from countries which have introduced standardized packaging for tobacco products is key to help inform future implementation. This is the first study to monitor the transition from fully branded to standardized products using real-time retail data. The findings demonstrate that tobacco companies delayed the introduction of standardized products and removal of fully branded packaging. Countries seeking to introduce standardized packaging should consider what length of transition is allowed, as the protracted 12-month period in the United Kingdom appeared longer than needed to transition stockholding and may have mitigated immediate intended effects by desensitizing consumers to new pack designs., (© The Author(s) 2018. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Background and Aims: The impact of tobacco control on European older adults has not been studied, despite evidence that smoking cessation at old age can bring significant life expectancy gains. Our aim was to evaluate the impact of tobacco control policies on smoking among older adults in Europe from 2004 to 2013., Design: We used longitudinal data from the Survey of Health, Ageing and Retirement in Europe (SHARE, aged 50+ years) from four waves from 2004 to 2013. We used logistic regression models with clustered standard errors to determine whether the implementation of tobacco control policies was associated with changes in smoking status. Furthermore, we studied whether these associations varied by socio-demographic characteristics. Regression coefficients were converted to changes the probability of smoking [marginal effects (ME)]., Measurements: Smoking status was the dependent variable, and the Tobacco Control Scale (TCS) was the explanatory variable, overall and by its main policy components (pricing and smoke-free policies). Covariates included age, sex, education and country and wave fixed-effects., Findings: A 10-point increase in TCS was associated with a lower probability of smoking by 1.6 percentage points [95% confidence interval (CI) = -3.208, -0.056] for those aged 50-65, but not for older Europeans. Among those with primary school or no education, the associated drop was of 1.5 percentage points (95% CI = -2.751, -0.253). By contrast, no significant relation between TCS and smoking was observed among those with high education. Higher TCS scores for pricing (ME = -0.636, 95% CI = -0.998, -0.275) and smoke-free policies (ME = -0.243, 95% CI = -0.445, -0.041) were associated with a significantly lower probability of smoking (P = 0.001 and P = 0.018, respectively)., Conclusion: Increases in tobacco taxes and smoke-free policies are significantly related with a reduction in smoking among European older adults, suggesting potential health gains for this rising share of the population. These policies may be more effective among the lowest educated., (© 2019 The Authors. Addiction published by John Wiley & Sons Ltd on behalf of Society for the Study of Addiction.)

Background: Prohibition of tobacco sales to minors is a provision of the World Health Organization Framework Convention on tobacco control. This measure is effective to reduce youth tobacco use, if the legislation adopted is properly implemented and enforced. Through the examples of France and Quebec, the objective of this study is to compare legislative frameworks prohibiting tobacco sales to minors, their enforcement, and possible impact on underage smoking., Methods: Identification of legislative instruments, reports from public health authorities, and articles addressing the focused question was performed trough Medline and Google., Results: Selling tobacco products to minors under 18 years of age has been banned by the law since 1998 in Quebec and 2009 in France. In 2011, in France for individuals aged 17, compliance with the law was 15%. In 2017 in France, 94% of 17-year-old daily smokers regularly bought their cigarettes in a tobacco store. Law enforcement controls and sanctions are non-existent. In 2013 in Quebec, 23% of underage smoking students usually bought their own cigarettes in a business. The compliance rate with the prohibition law rose from 37% in 2003 to 92.6% in 2017. An approach of underage "mystery shoppers" attempting to purchase tobacco products and dedicated inspectors has been implemented, and progressive sanctions are applied in case of non-compliance. In 2013, 12.2% of Quebec high school students and, in 2017, 34.1% of French 17 year olds reported using tobacco products in the last 30 days., Conclusion: Only an improved law enforcement, through the training of tobacco retailer's, inspections and effective deterrent penalties for non-compliance, leads to an effective legislative measure in terms of public health., (Copyright © 2019 Elsevier Masson SAS. All rights reserved.)

Background: Ninety percent of smokers report having their first whole cigarette before the age of 19. Policies, such as youth access laws, are essential to prevent youth from becoming future smokers. In Canada, the Tobacco Act prohibits retailers from furnishing tobacco products to individuals under the age of 18. These laws can only be effective when retailers comply with them. This paper investigates the effect of retailer compliance on youth smoking behavior., Methods: Data on individual smoking behavior in conjunction with provincial retailer compliance rates and cigarette prices for the years 1999-2005 were employed to examine the effects of retailer compliance on youth smoking participation and consumption., Results: Both price and retailer compliance were significant predictors of smoking participation. A large portion of participants endorsed obtaining their cigarettes through social means. Price elasticity of demand for the overall sample was estimated to be -0.54., Conclusions: Consistent with previous literature, our results found that retailer compliance is an essential component to the successful implementation of youth access laws. Given that youth access laws and retailer compliance did not quell social access to cigarettes, there is an apparent need within schools and communities to reduce the social sale of tobacco products., (© 2019, American School Health Association.)

Importance: Despite progress against tobacco sales to minors, retailers continue to violate state and federal laws and supply adolescent smokers with tobacco products. Government-sanctioned surveys underestimate the extent of the problem, and retailer associations use these data to block stricter enforcement policies., Objectives: To assess the validity of the US federal retailer violation rate (RVR) as an estimate of the proportion of retailers that sell tobacco to minors and to investigate what proportion always or almost always sells vs refuses to sell cigarettes to minors., Design, Setting, and Participants: This survey study was conducted October 6, 2012, to September 8, 2013; data were analyzed between September 28, 2017, and March 21, 2018. The setting was a suburban county adjacent to Denver, Colorado. Participants were a systematically selected, population-based cluster sample of retailers that stock cigarettes for sale. Retailers were masked to the survey., Main Outcomes and Measures: Each retailer was visited 6 times by supervised minors who attempted to purchase cigarettes at each visit. The main outcome was whether cigarettes were sold. Other measures included whether government-issued photo identification (ID) was requested as required by law, how ID was examined, and what the demographic characteristics of study minors and clerks were., Results: The sample of 201 retailers (44.8% of the 449 listed population) included convenience stores (n = 77), liquor stores (n = 63), grocery stores/supermarkets (n = 33), pharmacies (n = 17), tobacco stores (n = 7), and stand-alone gas stations (n = 4). Bars, clubs, and adult establishments were excluded. A total of 1181 purchase attempts were analyzed; 25 (2.1%) were excluded for missing data. The mean RVR across 6 rounds of checks was 18.0% (95% CI, 14.7%-21.2%) and ranged from 13.7% to 28.0% per round. Most retailers (54.7% [110 of 201]) violated at least once in 6 visits, 26.4% (53 of 201) violated at least twice, and 11.9% (24 of 201) violated half or more times. How retailers examined proof of age largely determined whether violations occurred., Conclusions and Relevance: The proportion of retailers that sold cigarettes to a minor at least once in 6 attempts was 3 times higher than the mean RVR based on a single inspection per retailer. Larger replication studies are needed. Enforcement protocols should reflect the fact that each retailer does not respond consistently when adolescents try to buy tobacco products, and many retailers are not properly validating ID that shows proof of age.

Objective: Identify the population of internet e-cigarette vendors (IEVs) and conduct content analyses of their age verification, purchase and delivery methods in 2013 and 2014., Methods: We used multiple sources to identify IEV websites, primarily complex search algorithms scanning more than 180 million websites. In 2013, we manually screened 32 446 websites, identifying 980 IEVs, selecting the 281 most popular for content analysis. This methodology yielded 31 239 websites for screening in 2014, identifying 3096 IEVs, with 283 selected for content analysis., Results: The proportion of vendors that sold online-only, with no retail store, dropped significantly from 2013 (74.7%) to 2014 (64.3%) (p<0.01), with a corresponding significant decrease in US-based vendors (71.9% in 2013 and 65% in 2014). Most vendors did little to prevent youth access in either year, with 67.6% in 2013 and 63.2% in 2014 employing no age verification or relying exclusively on strategies that cannot effectively verify age. Effective age verification strategies such as online age verification services (7.1% in 2013 and 8.5% in 2014), driving licences (1.8% in 2013 and 7.4% in 2014, p<0.01) or age verification at delivery (6.4% in 2013 and 8.1% in 2104) were rarely advertised on IEV websites. Nearly all vendors advertised accepting credit cards, and about ¾ shipping via United States Postal Service, similar to the internet cigarette industry prior to federal bans., Conclusions: The number of IEVs grew sharply from 2013 to 2014, with poor age verification practices. New and expanded regulations for online e-cigarette sales are needed, including strict age and identity verification requirements., Competing Interests: Competing interests: KMR has served as an expert consultant in litigation against tobacco companies., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Introduction: In recent years, e-cigarettes overtook cigarettes as the leading tobacco product used by US adolescents. Most states, as well as federal regulations, have added e-cigarettes to laws prohibiting tobacco products sales to minors. We tested compliance with the newer regulation among Colorado urban retail businesses, speculating that violations might be more common for e-cigarettes than smokable cigarettes., Methods: Supervised minors visited a random sample of urban businesses and sequentially attempted to purchase an e-cigarette product and cigarettes. The protocol prescribed that the same minor make both attempts in each business, separated by at least a day to minimize influence of the first result on the second result. Data were collected during May 2014-January 2015., Results: Among 238 businesses, more than one-fourth (26.1%; 95% confidence interval (CI), 18.9%-33.2%) sold at least one type of product, and 6.3% (CI, 1.8%-10.8%) sold both types. Violation rates were similar for e-cigarette products and cigarettes (17.6% vs. 14.7%, p = n.s.)., Conclusion: Enforcement to prevent retail tobacco sales to adolescents should include e-cigarette products. Dual testing of stores indicates that single visits underestimate the problem of underage tobacco sales., Implications: Adolescents can buy e-cigarettes from retail stores as easily as they buy cigarettes. Enforcement of tobacco sales laws should include e-cigarettes, and test-retest protocols are needed to estimate the true extent of the problem., (© The Author 2017. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Objective: To draw up an up-to-date scenario of compliance with the law prohibiting the sale of cigarettes to minors., Methods: We used data about youth access to cigarette purchase that were obtained through a nationwide survey conducted in 2015 among students aged 13-17 years. We estimated simple proportions of attempts to buy cigarettes, success of attempts, purchase of cigarettes on a regular basis, and purchase of cigarettes on a regular basis in a store or bar. All estimates were stratified by gender, age group, and Brazilian macro-region. Crude absolute difference and adjusted absolute difference in the proportion of smokers in each category by variable of interest were analyzed by a generalized linear model with binomial distribution and identity link function., Results: Approximately 7 in every 10 adolescent smokers attempted to buy cigarettes at least once in the 30 days prior to the survey. Of those, approximately 9 in every 10 were successful, and individuals aged 16-17 years (vs. those aged 13-15 years) were less often prevented from buying cigarettes (adjusted absolute difference, 8.1%; p ≤ 0.05). Approximately 45% of all smokers aged 13-17 years in Brazil reported buying their own cigarettes on a regular basis without being prevented from doing so, and, of those, 80% reported buying them in a store or bar (vs. from a street vendor)., Conclusions: Our findings raise an important public health concern and may contribute to supporting educational and surveillance measures to enforce compliance with existing anti-tobacco laws in Brazil, which have been disregarded.

Objective: To assess how easily minors can purchase cigarettes online and online cigarette vendors' compliance with federal age/ID verification and shipping regulations, North Carolina's 2013 tobacco age verification law, and federal prohibitions on the sale of non-menthol flavoured cigarettes or those labelled or advertised as 'light'., Methods: In early 2014, 10 minors aged 14-17 attempted to purchase cigarettes by credit card and electronic check from 68 popular internet vendors., Results: Minors received cigarettes from 32.4% of purchase attempts, all delivered by the US Postal Service (USPS) from overseas sellers. None failed due to age/ID verification. All failures were due to payment processing problems. USPS left 63.6% of delivered orders at the door with the remainder handed to minors with no age verification. 70.6% of vendors advertised light cigarettes and 60.3% flavoured, with 23.5% and 11.8%, respectively, delivered to the teens. Study credit cards were exposed to an estimated $7000 of fraudulent charges., Conclusions: Despite years of regulations restricting internet cigarette sales, poor vendor compliance and lack of shipper and federal enforcement leaves minors still able to obtain cigarettes (including 'light' and flavoured) online. The internet cigarette marketplace has shifted overseas, exposing buyers to widespread credit card fraud. Federal agencies should rigorously enforce existing internet cigarette sales laws to prevent illegal shipments from reaching US consumers, shut down non-compliant and fraudulent websites, and stop the theft and fraudulent use of credit card information provided online. Future studies should assess whether these agencies begin adequately enforcing the existing laws., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

The death toll from tobacco is staggering: it might contribute to one billion premature deaths over the course of the 21st century. In 'The case for banning cigarettes', Kalle Grill and Kristin Voigt argue that the well-being and equality benefits of a complete ban on cigarettes more than justify the restrictions on autonomy that such a ban would impose. Their argument depends on two crucial simplifications: an assumption that the ban would be effective and the restriction of the analysis to a comparison with the status quo, rather than a broader range of policy options. I argue that despite the authors' claims, these two simplifications make it impossible for their argument to 'bring into focus the fundamental normative issues' surrounding a possible cigarette ban, since they dramatically overstate the benefits and obscure the most significant costs of such a ban., Competing Interests: Competing interests: None declared., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objectives: Waterpipe tobacco smoking has received little epidemiological and policy attention in the UK despite reports of increasing prevalence alongside an anecdotally non-compliant industry. This study aimed to determine how waterpipe tobacco smoking is changing among young people in the UK, both in terms of prevalence and sociodemographic correlates of use, and to quantify the extent of illegal underage use in waterpipe-serving premises in the UK., Study Design: Repeat cross-sectional., Methods: A secondary analysis of two cross-sectional surveys (total N = 3376), conducted in 2013 and 2015 among secondary school students aged 11-16 years in Stoke-on-Trent, measured lifetime (both surveys) and regular (at least monthly; 2015 survey only) waterpipe tobacco prevalence and location of usual use. Logistic regression models measured the association between independent variables (age, sex, ethnicity, presence of free school meals, cigarette smoking status) with lifetime and regular waterpipe tobacco use, and with illegal underage use; the latter defined as usually smoking waterpipe tobacco in a waterpipe-serving premise., Results: Lifetime waterpipe tobacco prevalence remained similar in 2013 (13.7%, 95% confidence interval [CI] 12.0-15.4%) and 2015 (14.6%, 95% CI 12.8-16.4%), whereas regular use was measured at 2.9% (95% CI 2.1-3.8%) in 2015. Older, non-white, males who concurrently used cigarettes had higher odds of lifetime waterpipe tobacco use. Illegal underage use was reported among 27.1% of all regular users, correlates of which included increasing age and South Asian ethnicity. The presence of free school meals was not associated with lifetime or regular waterpipe tobacco prevalence, nor illegal underage use., Conclusions: Increased monitoring of waterpipe tobacco prevalence and patterns, including the underage policy compliance of waterpipe-serving premises, is needed to help inform policy decisions to control waterpipe tobacco use., (Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Objectives: New York City (NYC) is the first large city to increase the legal minimum age for possessing tobacco products from 18 to 21 (Tobacco 21) and establish a minimum price law to reduce smoking rates among youth. However, retailer compliance with these regulations is unknown., Methods: Youthful investigators purchased cigarettes pre and post-Tobacco 21 implementation in 92 NYC neighbourhoods. Investigators recorded whether their ID was checked, the pack's purchase price, and observed compliance with additional regulations. Multivariable OLS and Poisson regression models assess pre and post Tobacco 21 compliance with ID checks and purchase prices, controlling for retailer type, location and compliance with other laws., Results: Retailer compliance with ID checks declined from 71% to 62% (p<0.004) between periods, and holding constant other factors, compliance with ID checks and sales at legal prices declined significantly after the laws changed. Compared to chain stores, independent retailers had significantly lower compliance rates (p<0.01)., Conclusions: Several aspects of tobacco control appear to have deteriorated in NYC. Greater attention to monitoring retailer compliance with all tobacco regulations will be important for Tobacco 21 laws to be effective in reducing youth access to tobacco products., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Objectives: California and Massachusetts are the only 2 states in the United States with municipalities that have local laws prohibiting the sale of tobacco products by pharmacies. The impacts of the tobacco-free pharmacy laws remain understudied. This study aims to fill this gap by examining the association between tobacco-free pharmacy laws and smoking prevalence among adults over time in California and Massachusetts., Design: This study used a series of cross-sectional surveys. The data source for this study was the Behavioral Risk Factor Surveillance Survey for each year from 2005 to 2013., Setting: The longitudinal changes in smoking prevalence at the city or county level were estimated and comparisons were made between cities or counties with tobacco-free pharmacy laws and those without the laws., Participants: The participants used to estimate smoking prevalence were representative of adults within California and Massachusetts., Intervention: The implementation of tobacco-free pharmacy laws was considered to be the intervention in this study., Main Outcome Measures: The outcome measures were smoking prevalence among adults. Mixed-effects negative binomial models were performed primarily to examine longitudinal changes in outcome measures., Results: The prevalence of smoking decreased in both states over time. In Massachusetts, there was a statistically significant decrease in smoking prevalence among cities with tobacco-free pharmacy laws compared with those without such laws. Despite the presence of an 8.6% decrease in prevalence after the implementation of tobacco-free pharmacy laws, this reduction was not statistically significant after controlling for the negative trend in smoking rates overall and other factors., Conclusion: This study evaluated tobacco-free pharmacy laws with regard to the real-world impacts. Our findings highlight the need for future research on the effects of tobacco-free pharmacy laws with a prolonged time span and a comprehensive understanding of the law's implementation and enforcement., (Copyright © 2016 American Pharmacists Association®. Published by Elsevier Inc. All rights reserved.)

Objective: Tobacco smoking is initiated and established mostly during adolescence. The World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC) Article 16 outlines the obligation of parties to prohibit the sale of tobacco products to minors. This study examined where and how student smokers obtain cigarettes., Methods: We examined Global Youth Tobacco Survey (GYTS) data from 2009 to 2011 on cigarette access among students aged 13-15 in six sub-Saharan African countries., Results: In all countries analyzed, over 20% of student smokers obtained their cigarettes in a store or shop (52.6% in South Africa, 37.7% in Republic of Congo, 28.2% in Swaziland, 27.4% in Cote d'Ivoire, 26.9% in Ghana, and 22.6% in Uganda). In Cote d'Ivoire and South Africa, 68.9% and 68.7% of student cigarette smokers, respectively, were not refused the sale of cigarettes because of age. The percentage of students who were offered free cigarettes by a tobacco company representative ranged from 4.7% in Cote d'Ivoire to 12.1% in South Africa., Conclusions: The method of obtaining cigarettes and access to cigarettes among students varies among sub-Saharan African countries. Adopting and enforcing interventions that prevent youth from accessing tobacco products could be an effective strategy for reducing smoking initiation among youth in sub-Saharan African countries., (Copyright © 2016. Published by Elsevier Inc.)

Background: There are ∼380 000 tobacco retailers in the USA, where the largest tobacco companies spend almost $9 billion a year to promote their products. No systematic survey has been conducted of state-level activities to regulate the retail environment, thus little is known about what policies are being planned, proposed or implemented., Methods: This longitudinal study is the first US survey of state tobacco control programmes (TCPs) about retail policy activities. Surveyed in 2012 and 2014, programme managers (n=46) reported activities in multiple domains: e-cigarettes, retailer density and licensing, non-tax price increases, product placement, advertising and promotion, health warnings and other approaches. Policy activities were reported in one of five levels: no formal activity, planning or advocating, policy was proposed, policy was enacted or policy was implemented. Overall and domain-specific activity scores were calculated for each state., Results: The average retail policy activity almost doubled between 2012 and 2014. States with the largest increase in scores included: Minnesota, which established a fee-based tobacco retail licensing system and banned self-service for e-cigarettes and all other tobacco products (OTP); Oregon, Kansas and Maine, all of which banned self-service for OTP; and West Virginia, which banned some types of flavoured OTP., Conclusions: Retail policy activities in US states increased dramatically in a short time. Given what is known about the impact of the retail environment on tobacco use by youth and adults, state and local TCPs may want diversify policy priorities by implementing retail policies alongside tax and smoke-free air laws., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Background: Native American tribes, as sovereign nations, are exempt from state tobacco excise taxation, and self-govern on-reservation activity in the USA. Under Federal law, state excise taxes are owed by non-members purchasing tobacco on tribal land, but states are limited in how they enforce or collect these taxes. This study highlights the various policy approaches that states have taken to regulate tobacco sales on tribal lands given jurisdictional challenges., Methods: State laws (statutes, regulations and case law), Attorney General opinions, and revenue notices and rulings effective as of 1 January 2015 for all 50 states and the District of Columbia were compiled using Boolean searches in Lexis-Nexis and Westlaw. Laws were limited to those addressing taxation compacts or tobacco sales involving tribal entities. Master Settlement Agreement laws and non-codified tribal codes/compacts were excluded., Results: Twenty of the 34 states with tribal lands address tribal tobacco sales. Fourteen states address intergovernmental compacts: 11 are tobacco specific, and suggest or require specific provisions. Fifteen states address tribal tax stamps: 2 explicitly prohibit stamping tribally sold products, 9 stamp all products, and 4 stamp some. Prepayment of excise tax is required in 12 states: 6 on all products, 4 on products in excess of quota, and 2 on products sold by non-tribal retailers. 6 states use quotas to limit tax-free tobacco available to tribes., Conclusions: Many states with a tribal presence have no formal strategies for non-members purchasing tobacco on tribal lands. Formalising policies and harmonising tax rates may assist states in collecting tax revenue from non-tribal consumers., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.)

Introduction: In late 2012, North Dakota expanded its statewide smoke-free air law to cover all restaurants and bars in the state. Several North Dakota communities also had local ordinances that prohibited smoking in restaurants and bars prior to the statewide law. Previous work found no effect of the initial statewide law or several local laws on restaurant and bar sales., Methods: Using quarterly county-level employment data from 1990 to 2014, we examined whether the expanded statewide law or pre-existing local laws were associated with significant changes in employment in restaurants and bars in North Dakota. Separate models were estimated for restaurant and bar employment using two methods of controlling for smoke-free air law coverage., Results: We found no evidence of a significant association between employment in restaurants and bars in North Dakota and the expanded statewide law or pre-existing local laws. Prior employment levels in restaurants and bars and prevailing economic conditions were the main drivers of restaurant and bar employment, not smoke-free air laws., Conclusions: This study examines the economic impact of smoke-free air laws in North Dakota on restaurant and bar employment following the expansion of the statewide law in late 2012 to cover all restaurants and bars. We find no significant adverse effect of smoke-free air laws on restaurants and bars, consistent with results from previous studies conducted in North Dakota and throughout the United States., Implications: This study is the first to analyze the economic impact of smoke-free air laws in North Dakota on restaurant and bar employment following the 2012 expansion of the statewide law to cover all restaurants and bars. We find no evidence of a significant adverse effect of smoke-free air laws on restaurants and bars, consistent with results from previous studies conducted in North Dakota and throughout the United States. Prior employment levels and prevailing economic conditions proved to be the main drivers of restaurant and bar employment, not smoke-free air laws., (© The Author 2016. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Purpose: Policy misalignment across different sectors of government serves as one of the pivotal barriers to WHO Framework Convention on Tobacco Control (FCTC) implementation. This paper examines the logic used by government officials to justify investment incentives to increase tobacco processing and manufacturing in the context of FCTC implementation in Zambia., Methods: We conducted qualitative semistructured interviews with key informants from government, civil society and intergovernmental economic organisations (n=23). We supplemented the interview data with an analysis of public documents pertaining to the policy of economic development in Zambia., Results: We found gross misalignments between the policies of the economic sector and efforts to implement the provisions of the FCTC. Our interviews uncovered the rationale used by officials in the economic sector to justify providing economic incentives to bolster tobacco processing and manufacturing in Zambia: (1) tobacco is not consumed by Zambians/tobacco is an export commodity, (2) economic benefits outweigh health costs and (3) tobacco consumption is a personal choice., Conclusions: Much of the struggle Zambia has experienced in implementing the FCTC can be attributed to misalignments between the economic and health sectors. Zambia's development agenda seeks to bolster agricultural processing and manufacturing. Tobacco control proponents must recognise and work within this context in order to foster productive strategies with those working on tobacco supply issues. These findings are broadly applicable to the global context. It is important that the Ministry of Health monitors the tobacco policy of and engages with these sectors to find ways of harmonising FCTC implementation., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objective: Tobacco companies have made extensive efforts to build alliances against comprehensive smoke-free legislation. This article analyses the interaction between actors who opposed the development of the European Council Recommendation on smoke-free environments., Methods: Drawing on data from 200 policy documents and 32 semistructured interviews and using qualitative textual analysis and organisational network analysis, opponents' positions on, and responses to, the policy initiative, strategies to oppose the policy, and efforts to build alliances were investigated., Results: The non-binding nature of the policy, scientific evidence and clear political will to adopt EU-wide measures combined to limit the intensity of commercial sector opposition to the comprehensive EU smoke-free policy. Most tobacco companies, led by the Confederation of European Community Cigarette Manufacturers (CECCM), voiced reservations against the proposal, criticised the policy process and fought flanking measures on product regulation. However, some companies focused on instigating harm reduction debates. These divergent approaches and the reluctance of other commercial actors to demonstrate solidarity with the tobacco sector prevented the establishment of a cohesive commercial sector alliance., Conclusions: The comparatively limited opposition to EU smoke-free policy contrasts with previous accounts of tobacco industry resistance to tobacco control. While context-specific factors can partially explain these differences, the paper indicates that the sector's diminished credibility and lack of unity hampered political engagement and alliance building. Industry efforts to emphasise the benefits of smokeless tobacco during smoke-free policy debates highlight the potential of harm reduction as a gateway for tobacco companies to re-enter the political arena., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Purpose: Age limits are effective in reducing alcohol- and tobacco-related harm, however, their effectiveness depends on the extent to which they are complied with. This study aimed to investigate the effectiveness of different age verification systems (AVSs) implemented by 400 Dutch supermarkets on requesting a valid age verification (ID) and on sellers' compliance., Methods: A mixed method design was used. Compliance was measured by 800 alcohol and tobacco purchase attempts by 17-year-old mystery shoppers. To analyze the effectiveness of AVSs, logistic regression analyses were performed. Insight into facilitating and hindering factors in the purchase process was obtained by 13 interviews with supermarket managers., Results: Only a tendency toward a positive effect of the presence of the keying-on-date-of-birth AVS or ID swiper/checker was found on ID request for both alcohol and tobacco purchase attempts. The use of the keying-on-date-of-birth AVS or ID swiper/checker significantly increased the odds for compliance after an ID was requested, for both alcohol and tobacco purchase attempts. Managers indicated that ID requests and compliance could be facilitated by providing cashiers with sufficient managerial support, technical support, and regular training about the purchase process and use of the AVS., Conclusions: The usage of AVSs calculating and confirming whether the customer reached the legal purchase age for cashiers significantly increases the odds for cashiers to comply with age limits of alcohol and tobacco. Future research should gain insight into how usage of effective AVSs can be improved and explore the feasibility of implementation and effectiveness in other outlets., (Copyright © 2016 The Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.)

The Food and Drug Administration (FDA) is issuing this final rule to deem products meeting the statutory definition of "tobacco product,'' except accessories of the newly deemed tobacco products, to be subject to the Federal Food, Drug, and Cosmetic Act (the FD&C Act), as amended by the Family Smoking Prevention and Tobacco Control Act (Tobacco Control Act). The Tobacco Control Act provides FDA authority to regulate cigarettes, cigarette tobacco, roll-your-own tobacco, smokeless tobacco, and any other tobacco products that the Agency by regulation deems to be subject to the law. With this final rule, FDA is extending the Agency's "tobacco product'' authorities in the FD&C Act to all other categories of products that meet the statutory definition of "tobacco product" in the FD&C Act, except accessories of such newly deemed tobacco products. This final rule also prohibits the sale of "covered tobacco products" to individuals under the age of 18 and requires the display of health warnings on cigarette tobacco, roll-your own tobacco, and covered tobacco product packages and in advertisements. FDA is taking this action to reduce the death and disease from tobacco products. In accordance with the Tobacco Control Act, we consider and intend the extension of our authorities over tobacco products and the various requirements and prohibitions established by this rule to be severable.

Objective: Raising the tobacco sales age to 21 has gained support as a promising strategy to reduce youth cigarette access, but there is little direct evidence of its impact on adolescent smoking. Using regional youth survey data, we compared youth smoking trends in Needham, Massachusetts--which raised the minimum purchase age in 2005--with those of 16 surrounding communities., Methods: The MetroWest Adolescent Health Survey is a biennial census survey of high school youth in communities west of Boston; over 16,000 students participated at each of four time points from 2006 to 2012. Using these pooled cross-section data, we used generalised estimating equation models to compare trends in current cigarette smoking and cigarette purchases in Needham relative to 16 comparison communities without similar ordinances. To determine whether trends were specific to tobacco, we also examined trends in youth alcohol use over the same time period., Results: From 2006 to 2010, the decrease in 30-day smoking in Needham (from 13% to 7%) was significantly greater than in the comparison communities (from 15% to 12%; p<.001). This larger decline was consistent for both genders, Caucasian and non-Caucasian youth, and grades 10, 11 and 12. Cigarette purchases among current smokers also declined significantly more in Needham than in the comparison communities during this time. In contrast, there were no comparable differences for current alcohol use., Conclusions: Our results suggest that raising the minimum sales age to 21 for tobacco contributes to a greater decline in youth smoking relative to communities that did not pass this ordinance. These findings support local community-level action to raise the tobacco sales age to 21., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Objectives: The vast majority of tobacco users began before the age of 21. Raising the tobacco sales age to 21 has the potential to reduce tobacco use initiation and progression to regular smoking. Our objective was to assess the level of public support nationally for 'Tobacco 21' initiatives in the USA., Methods: The Social Climate Survey of Tobacco Control, a cross-sectional dual-frame survey representing national probability samples of adults was administered in 2013. Respondents were asked to state their agreement level with, 'The age to buy tobacco should be raised to 21.', Results: Of 3245 respondents, 70.5% support raising the age to buy tobacco to 21. The majority of adults in every demographic and smoking status category supported raising the tobacco sales age to 21. In multivariable analyses, support was highest among never smokers, females, African-Americans and older adults., Conclusions: This national study demonstrates broad public support for raising the sales age of tobacco to 21 and will help facilitate wide dissemination of initiatives to increase the legal purchase age at national, state and local levels. Increasing public awareness about the susceptibility and rapid addiction of youth to nicotine may further increase public support for raising the tobacco sale age to 21., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Most smokers become addicted to tobacco products before they are legally able to purchase these products. We systematically reviewed the literature on protocols to assess underage purchase and their ecological validity. We conducted a systematic search in May 2015 in PubMed and PsycINFO. We independently screened records for inclusion. We conducted a narrative review and examined implications of two types of legal authority for protocols that govern underage buy enforcement in the United States: criminal (state-level laws prohibiting sales to youth) and administrative (federal regulations prohibiting sales to youth). Ten studies experimentally assessed underage buy protocols and 44 studies assessed the association between youth characteristics and tobacco sales. Protocols that mimicked real-world youth behaviors were consistently associated with substantially greater likelihood of a sale to a youth. Many of the tested protocols appear to be designed for compliance with criminal law rather than administrative enforcement in ways that limited ecological validity. This may be due to concerns about entrapment. For administrative enforcement in particular, entrapment may be less of an issue than commonly thought. Commonly used underage buy protocols poorly represent the reality of youths' access to tobacco from retailers. Compliance check programs should allow youth to present themselves naturally and attempt to match the community's demographic makeup.

Introduction: Most South Asian countries are signatories to the WHO Framework Convention for Tobacco Control (FCTC). However, there is little information on the extent to which FCTC standards are effectively implemented for controlling smokeless tobacco (SLT)-used by over 250 million people in the region. We assessed the feasibility of a novel approach based on interviewing the key actors of SLT supply chain and analyzing its findings using standards set by FCTC., Methods: Using a snowball-sampling technique, we interviewed point-of-sale vendors, wholesale retailers, manufacturers, raw-tobacco retailers, and farmers involved in the supply chain of SLT in Bangladesh, Nepal, and Pakistan. Using a structured-questionnaire, participants were asked about their customer profiles; product types; marketing practices; suppliers; profit margins, awareness and adherence to legislation., Results: We recruited 72% (130/180) of all supply chain actors approached. Findings indicate several loopholes in the existing taxation, regulatory, and inspection systems. A significant proportion of smuggled and counterfeit SLT products are available in the market. Most SLT products are sold without recommended warnings, information on their ingredients, and manufacturers' details. There appear to be no restrictions on sale of SLT products to minors. On the other hand, there are also several incentives built-in the supply chain that makes tobacco farming, SLT manufacturing, and its sale a profitable business., Conclusions: Our novel approach to study SLT control was successful in identifying and interviewing actors involved in its supply chain. The analysis using FCTC could provide valuable information to policy makers and enable them to effectively regulate SLT products., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

Importance: Single cigarettes, which are sold without warning labels and often evade taxes, can serve as a gateway for youth smoking. The Family Smoking Prevention and Tobacco Control Act of 2009 gives the US Food and Drug Administration (FDA) authority to regulate the manufacture, distribution, and marketing of tobacco products, including prohibiting the sale of single cigarettes. To enforce these regulations, the FDA conducted over 335,661 inspections between 2010 and September 30, 2014, and allocated over $115 million toward state inspections contracts., Objective: To examine differences in single cigarette violations across states and determine if likely correlates of single cigarette sales predict single cigarette violations at the state level., Design: Cross-sectional study of publicly available FDA warning letters from January 1 to July 31, 2014., Setting: All 50 states and the District of Columbia., Participants: Tobacco retailer inspections conducted by FDA (n = 33 543)., Exposures for Observational Studies: State cigarette tax, youth smoking prevalence, poverty, and tobacco production., Main Outcomes and Measures: State proportion of FDA warning letters issued for single cigarette violations., Results: There are striking differences in the number of single cigarette violations found by state, with 38 states producing no warning letters for selling single cigarettes even as state policymakers developed legislation to address retailer sales of single cigarettes. The state proportion of warning letters issued for single cigarettes is not predicted by state cigarette tax, youth smoking, poverty, or tobacco production, P = .12., Conclusions and Relevance: Substantial, unexplained variation exists in violations of single cigarette sales among states. These data suggest the possibility of differences in implementation of FDA inspections and the need for stronger quality monitoring processes across states implementing FDA inspections., (© The Author 2015. Published by Oxford University Press on behalf of the Society for Research on Nicotine and Tobacco. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.)

A continued increase in the proportion of adolescents who never smoke, as well as an understanding of factors that influence reductions in smoking among this susceptible population, is crucial. The World Health Organization Framework Convention on Tobacco Control provides an appropriate structure to briefly examine Australian and New South Wales policies and programs that are influencing reductions in smoking among adolescents in Australia. This paper provides an overview of price and recent tax measures to reduce the demand for tobacco, the evolution of smoke-free environment policies, changes to tobacco labelling and packaging, public education campaigns, and restrictions to curb tobacco advertising. It also discusses supplyreduction measures that limit adolescents' access to tobacco products. Consideration is given to emerging priorities to achieve continued declines in smoking by Australian adolescents.

Background: To evaluate the effect of tobacco prices and the implementation of smoke-free legislation on smoking cessation in Spain, by educational level, across the period 1993-2012., Methods: National Health Surveys data for the above two decades were used to calculate smoking cessation in people aged 25-64 years. The relationship between tobacco prices and smoking quit-ratio was estimated using multiple linear regression adjusted for time and the presence of smoke-free legislation. The immediate as well as the longer-term impact of the 2006 smoke-free law on quit-ratio was estimated using segmented linear regression analysis. The analyses were performed separately in men and women with high and low education, respectively., Results: No relationship was observed between tobacco prices and smoking quit-ratio, except in women having a low educational level, among whom a rise in price was associated with a decrease in quit-ratio. The smoke-free law altered the smoking quit-ratio in the short term and altered also pre-existing trends. Smoking quit-ratio increased immediately after the ban - though this increase was significant only among women with a low educational level - and then decreased in subsequent years except among men with a high educational level., Conclusion: A clear relationship between tobacco prices and smoking quit-ratio was not observed in a recent period. After the implementation of smoke-free legislation the trend in the quit ratio in most of the socio-economic groups was different from the trend observed before implementation, so existing inequalities in smoking quit-ratio were not widened or narrowed., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Background: Following the passage of the Family Smoking Prevention and Tobacco Control Act in 2009, flavoured cigarettes, including clove cigarettes, were banned based on the rationale that such cigarettes appealed to youth. However, the ban on characterising flavours was not extended to cigars., Methods: This study reviewed industry documents from Kretek International, the parent company behind Djarum clove cigars, to document the changes in their marketing and production strategies following the flavour ban on cigarettes. To assess sales trends following the ban, data for clove cigar sales in the USA from 2009 to 2012 were analysed using Nielsen's Convenience Track retail scanner database. Additionally, data on tobacco imports to the USA from Indonesia were obtained from the USDA Foreign Agricultural Service's Global Agricultural Trade System for the years 2008-2012., Results: In anticipation of Food and Drug Administration's (FDA) flavour ban on cigarettes and recognising the regulatory advantages of cigars, Kretek International began developing Djarum clove cigars in 2007. Immediately following the flavour ban, sales of this product increased by more than 1400% between 2009 and 2012. During this same period, tobacco imports to the USA from Indonesia, a leader in clove tobacco production, shifted from cigarettes to almost exclusively cigars., Conclusions: Kretek International, like other tobacco manufacturers, manipulated its products following the Family Smoking Prevention and Tobacco Control Act as a way to capitalise on regulatory loopholes and replace its now banned clove cigarettes. As a result, consumption of the company's Djarum clove cigars increased exponentially in recent years., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/)

Background: Scholars who examine the efficacy of juvenile tobacco sales restrictions, especially the 1992 "Synar Amendment" that led all of fifty U.S. states to enact prohibitions on tobacco sales to minors, are notably divided as to impact on youth smoking. Some researchers claim that such policies have failed and ought to be abandoned (Craig & Boris, 2007; Etter, 2006; Glantz, 2002), while others insist that enforcement has indeed led to reduced tobacco use (DiFranza, 2011b; SAMHSA, 2011). The present study is the first to combine data on Synar violation rates from all states and years available since the amendment's implementation, assessing the connection to national rates of cigarette sales and youth smoking behavior., Methods: Using national data from the United States Substance Abuse and Mental Health Services Administration, the Tobacco Institute, and the Centers for Disease Control's Youth Risk Behavior Surveillance System across all U.S. states between 1996 and 2007, we employ hierarchical linear modeling to examine the connection between retailer Synar violations and youth smoking., Results: Controlling for state-level demographic variables, results indicate that retailer violation rates are significantly associated with greater youth smoking prevalence, as well as higher overall cigarette sales., Conclusion: While critiques of Synar policies are substantive and should be addressed, laws prohibiting the sale of tobacco to juveniles appear to have had some degree of success., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Objective: Estimates of illicit cigarette consumption are limited and the data obtained from studies funded by the tobacco industry have a tendency to inflate them. This study aimed to validate an industry-funded estimate of 35.9% for Hong Kong using a framework taken from an industry-funded report, but with more transparent data sources., Methods: Illicit cigarette consumption was estimated as the difference between total cigarette consumption and the sum of legal domestic sales and legal personal imports (duty-free consumption). Reliable data from government reports and scientifically valid routine sources were used to estimate the total cigarette consumption by Hong Kong smokers and legal domestic sales in Hong Kong. Consumption by visitors and legal duty-free consumption by Hong Kong passengers were estimated under three scenarios for the assumptions to examine the uncertainty around the estimate. A two-way sensitivity analysis was conducted using different levels of possible undeclared smoking and under-reporting of self-reported daily consumption., Results: Illicit cigarette consumption was estimated to be about 8.2-15.4% of the total cigarette consumption in Hong Kong in 2012 with a midpoint estimate of 11.9%, as compared with the industry-funded estimate of 35.9% of cigarette consumption. The industry-funded estimate was inflated by 133-337% of the probable true value. Only with significant levels of under-reporting of daily cigarette consumption and undeclared smoking could we approximate the value reported in the industry-funded study., Conclusions: The industry-funded estimate inflates the likely levels of illicit cigarette consumption., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: Transnational tobacco companies (TTCs) submitted evidence to the 2012 UK Consultation on standardised packaging (SP) to argue the policy will have detrimental economic impacts and increase illicit tobacco trade., Methods: A content analysis of the four TTC submissions to the consultation assessed the relevance and quality of evidence TTCs cited to support their arguments. Investigative research was used to determine whether the cited evidence was industry connected. Fisher's exact tests were used to compare the relevance and quality of industry-connected and independent from the industry evidence. The extent to which TTCs disclosed financial conflicts of interest (COI) when citing evidence was examined., Results: We obtained 74 pieces of TTC-cited evidence. The quality of the evidence was poor. TTCs cited no independent, peer-reviewed evidence that supported their arguments. Nearly half of the evidence was industry-connected (47%, 35/74). None of this industry-connected evidence was published in peer-reviewed journals (0/35) and 66% (23/35) of it was opinion only. Industry-connected evidence was of significantly poorer quality than independent evidence (p<0.001). COIs were not disclosed by TTCs in 91% (32/35) of cases., Conclusions: In the absence of peer-reviewed research to support their arguments, TTCs relied on evidence they commissioned and the opinions of TTC-connected third-parties. Such connections were not disclosed by TTCs when citing this evidence and were time consuming to uncover. In line with Article 5.3 of the Framework Convention on Tobacco Control and broader transparency initiatives, TTCs should be required to disclose their funding of all third-parties and any COIs when citing evidence., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Background: The tobacco industry claims that illicit cigarette trade in South Africa is high and rising. This is often used as an argument not to increase the tobacco excise tax or to regulate tobacco products., Objectives: To determine how the tobacco industry's estimates of the size of the illicit cigarette market have changed over time., Methods: Published media articles were obtained from South African Press Cuttings; published articles and press releases were sourced from the internet. The period of interest is 1990-2012., Results: Between 1990 and 2012 we found 90 newspaper articles and press statements that emphasised the tobacco industry's view on illicit trade. Articles that reported on action taken against illicit trade were excluded. Between 2006 and early 2011 the Tobacco Institute of Southern Africa, a body representing the interests of large cigarette companies, reported that South Africa's illicit cigarette market share was 20%. This share increased to 25% in late 2011 and 30% in 2012. In a 2012 presentation by Tobacco Institute of Southern Africa to National Treasury the illicit market share in 2008 was indicated as 7.9%, compared with claims in that year that the illicit market share was 20%. Industry findings that the illicit market decreased in 2007 and 2008 were not reported in the press., Conclusions: The tobacco industry has adjusted previous estimates of the illicit trade share downwards to create the impression that illicit trade is high and rising. If previous estimates by the tobacco industry were incorrect the credibility of current estimates should be questioned., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Objectives: To estimate the size of illegal tobacco trade and consumption and assess the impact of tobacco tax on the illicit tobacco market in New Zealand (NZ)., Methods: Data on the import and seizure of legal and illegal tobacco in NZ was obtained from NZ Customs. Previous literature was used to calculate interception rates of illegal tobacco being smuggled and grown in NZ. Annual tobacco returns figures, obtained via the NZ Ministry of Health, were analysed to assess the market dynamics of legal tobacco products., Results: This study found that illicit tobacco constituted 1.8-3.9% of total national tobacco consumption in NZ in 2013. This represents a minor increase compared to previous estimates from 2007-09, suggesting that tax increases enacted by the NZ Government since 2010 have had a minimal impact on encouraging the use and procurement of illicit tobacco., Conclusions: The results highlight a slight rise in small-scale tobacco smuggling through ports and mail centres. However, tobacco returns figures show that current tobacco tax policy has forced manufacturers to focus on the production of cheap legal tobacco products, directly competing with and undercutting the demand for illicit tobacco products. At the same time, locally grown illicit tobacco continues to remain a small, isolated problem and, with recent cuts in duty free tobacco allowance, it is expected that overall illicit tobacco will remain a very small proportion of total tobacco consumption in NZ., (© 2015 Public Health Association of Australia.)