Why Have Tobacco Control Policies Stalled? Using Genetic Moderation to Examine Policy Impacts

Sanjay Gandhi Medical Institute, India
PLoS ONE (Impact Factor: 3.23). 12/2012; 7(12):e50576. DOI: 10.1371/journal.pone.0050576
Source: PubMed


Research has shown that tobacco control policies have helped produce the dramatic decline in use over the decades following the 1964 surgeon general's report. However, prevalence rates have stagnated during the past two decades in the US, even with large tobacco taxes and expansions of clean air laws. The observed differences in tobacco control policy effectiveness and why policies do not help all smokers are largely unexplained.
The aim of this study was to determine the importance of genetics in explaining response to tobacco taxation policy by testing the potential of gene-policy interaction in determining adult tobacco use.
A moderated regression analysis framework was used to test interactive effects between genotype and tobacco policy in predicting tobacco use. Cross sectional data of US adults from the National Health and Nutrition Examination Survey (NHANES) linked with genotype and geocodes were used to identify tobacco use phenotypes, state-level taxation rates, and variation in the nicotinic acetylcholine receptor (CHRNA6) genotype. Tobacco use phenotypes included current use, number of cigarettes smoked per day, and blood serum cotinine measurements.
Variation in the nicotinic acetylcholine receptor was found to moderate the influence of tobacco taxation on multiple measures of tobacco use. Individuals with the protective G/G polymorphism (51% of the sample) responded to taxation while others had no response. The estimated differences in response by genotype were C/C genotype: b = -0.016 se  = 0.018; G/C genotype: b = 0.014 se  = 0.017; G/G genotype: b = -0.071 se 0.029.
This study provides novel evidence of "gene-policy" interaction and suggests a genetic mechanism for the large differences in response to tobacco policies. The inability for these policies to reduce use for individuals with specific genotypes suggests alternative methods may be needed to further reduce use.

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Available from: Jason Fletcher, Aug 22, 2015
    • "In the same article, he also outlines research designs best suited to blending public policy research to capture important genetic and environment interactions. In another article, Fletcher (2012) links genotypes and geocodes with the National Health and Nutrition Examination Survey (NHANES) to use genetic data to explain heterogeneous response to tobacco taxation, and highlighting the limitations of traditional sin taxes in moderating tobacco use. Such studies are likely to proliferate as policy researchers learn how to use information from the over 300 million biospecimens stored in U.S. biobanks that are publically and privately owned (Maschke, 2008). "

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