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Attitudes and perceptions towards increasing cigarette price: A population-based survey in Italy

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Aims and background To monitor smoking prevalence and trends of young and adult populations in Italy. Method and study design A survey on smoking was conducted during March-April 2009 on a sample of 3213 participants (1546 men and 1667 women), representative of the Italian population aged 15 years or over. Data from a simplified questionnaire were collected in an over-sample of 1010 young individuals, reaching a total of 1390 participants aged 15–24 years (713 males and 677 females). Results In 2009, 25.4% of Italians described themselves as current cigarette smokers (28.9% of men and 22.3% of women). Among young people, male smoking prevalence steadily declined from 38% in 2001 to 29% in 2009. Smoking prevalence in young females decreased from 30% in 2001 to 19% in 2008, but increased to 23% in 2009. Among both males and females aged 15–17 years, smoking prevalence was around 10%. This increased in the 18–24 year age group, with 37.6% of current smokers among males and 28.9% among females. Among young current smokers, 45.5% reported that they would reduce the number of cigarettes smoked per day, 11.1% would quit smoking, and 4.3% would switch to hand-rolled cigarettes, assuming that the minimum price of a pack of cigarettes increased to €5. Conclusions Our findings indicate that smoking prevalence has decreased over recent years, particularly in the young. Still, over one-fourth of Italian adults are smokers. An increase in cigarette price represents an effective strategy to control tobacco, particularly in the young.
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Tobacco smoke is the main cause of avoidable death in the world. While in the past smoking was a typical characteristic of male population, with the passing time it has increasingly involved female population. The 2008 data show that female smokers are 17.9% of the Italian population. The increase in the number of female smokers caused on one hand the increase of uncommon illness in females such as lung cancer, on the other the increase of pathologies correlated with pregnancy time such as infertility, miscarriages and premature births.
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Objective Raising the price of tobacco products is considered one of the most effective ways to reduce tobacco use. In addition to excise taxes, governments are exploring other policies to raise tobacco prices and minimise price dispersion, both within and across price tiers. We conducted a systematic review to determine how these policies are described, recommended and evaluated in the literature. Data sources We systematically searched six databases and the California Tobacco Control library for English language studies or reports, indexed on or before 18 December 2013, that included a tobacco keyword (eg, cigarette), policy keyword (eg, legislation) and a price keyword (eg, promotion). We identified 3067 abstracts. Study selection Two coders independently reviewed all abstracts and identified 56 studies or reports that explicitly described a public policy likely to impact the retail price of tobacco products through non-tax means. Data extraction Two coders independently identified tobacco products targeted by policies described, recommendations for implementing policies and empirical assessments of policy impacts. Data synthesis The most prevalent non-tax price policies were price promotion restrictions and minimum price laws. Few studies measured the impact of non-tax policies on average prices, price dispersion or disparities in tobacco consumption, but the literature includes suggestions for crafting policies and preparing for legal challenges or tobacco industry opposition. Conclusions Price-focused evaluations of well-implemented non-tax price policies are needed to determine whether they can deliver on their promise to raise prices, reduce price dispersion and serve as an important complement to excise taxes.
Article
To monitor smoking prevalence and trends of young and adult populations in Italy. METHOD AND STUDY DESIGN: A survey on smoking was conducted during March-April 2009 on a sample of 3213 participants (1546 men and 1667 women), representative of the Italian population aged 15 years or over. Data from a simplified questionnaire were collected in an over-sample of 1010 young individuals, reaching a total of 1390 participants aged 15-24 years (713 males and 677 females). In 2009, 25.4% of Italians described themselves as current cigarette smokers (28.9% of men and 22.3% of women). Among young people, male smoking prevalence steadily declined from 38% in 2001 to 29% in 2009. Smoking prevalence in young females decreased from 30% in 2001 to 19% in 2008, but increased to 23% in 2009. Among both males and females aged 15-17 years, smoking prevalence was around 10%. This increased in the 18-24 year age group, with 37.6% of current smokers among males and 28.9% among females. Among young current smokers, 45.5% reported that they would reduce the number of cigarettes smoked per day, 11.1% would quit smoking, and 4.3% would switch to hand-rolled cigarettes, assuming that the minimum price of a pack of cigarettes increased to € 5. Our findings indicate that smoking prevalence has decreased over recent years, particularly in the young. Still, over one-fourth of Italian adults are smokers. An increase in cigarette price represents an effective strategy to control tobacco, particularly in the young.
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In their interesting paper, Joossens and Raw1 showed that, over the last decade, Italy, Spain and the United Kingdom reduced at least part of the illicit trade in tobacco products. In particular, in Italy smuggling had accounted for 10% to 30% of cigarette sales in the early 1990s.1–3 Available information suggests that this phenomenon had substantially decreased one decade later. Using data from a relatively large population-based Italian survey we found that in 2004 cigarette smuggling accounted for less than 5% of total tobacco.3 As previously shown,2 4 this reduction has been confirmed by annual variations of sales in areas more or less affected by smuggling, and by data on annual seizures …
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Italy was the first large country to ban smoking in all indoor public places, including restaurants and bars. The aim of this study was to quantify, 3 years after the law came into force, the effects of the smoking ban in terms of observance of the legislation and change of habits. Data were considered from four representative surveys on smoking, conducted between 2005 and 2008 on a total of 12 245 individuals (5906 men and 6339 women) aged 15 years or over. In 2008, more than 80% of Italians (more than 90% in northern Italy) had the perception that the smoking ban was respected in bars/cafes and restaurants, despite a slight reduction since 2005. In all the surveys combined, 75% of the Italian population reported that the smoking ban was respected in workplaces. Overall, approximately 10% of Italians reported that, after the implementation of the tobacco regulation, they went to bars/cafes and restaurants more frequently, and approximately 7% less frequently, than before. The study shows that in Italy the smoke-free legislation did not affect the business of restaurants and bars, and remains widely respected 3 years after the law came into force.
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To analyse the variation in demand for tobacco according to price of cigarettes across the European region. Cross-sectional study. All the 52 countries of the European region. For each European country, data were collected on annual per adult cigarette consumption (2000), smoking prevalence (most recent), retail price of a pack of local and foreign brand cigarettes (around 2000), the gross domestic product adjusted by purchasing power parities, and the adult population (2000). Price elasticity of demand for cigarettes (that is, the change in cigarette consumption according to a change in tobacco price) across all the European countries, estimated by double-log multiple linear regression. Controlling for male to female prevalence ratio, price elasticities for consumption were -0.46 (95% confidence interval (CI) -0.74 to -0.17) and -0.74 (95% CI -1.13 to -0.35) for local and foreign brand, respectively. The inverse relation between cigarette price and consumption was stronger in countries not in the European Union (price elasticity for foreign brand cigarettes of -0.8) as compared to European Union countries (price elasticity of -0.4). The result that, on average, in Europe smoking consumption decreases 5-7% for a 10% increase in the real price of cigarettes strongly supports an inverse association between price and cigarette smoking.
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To examine the differential associations of cigarette retail marketing practices on youth smoking uptake. Analyses from annual, nationally representative, cross-sectional surveys of 8th, 10th, and 12th graders in the United States. The February 1999 through June 2003 Monitoring the Future surveys involved 109,308 students and data on retail cigarette marketing collected from 966 communities in which the students reside, as part of the Bridging the Gap Initiative: Research Informing Practice and Policy for Healthy Youth Behavior. A total of 26,301 students were selected for this study. Point-of-sale advertising, promotions, prices, and placement. Using a smoking uptake measure to account for stages that identify the process by which adolescents begin smoking, we calculated odds ratios and confidence intervals through generalized ordered logit analyses, with weighted data that controlled for demographic and socioeconomic characteristics and accounted for clustering at the community level. Higher levels of advertising, lower cigarette prices, and greater availability of cigarette promotions were associated with smoking uptake. Advertising increased the likelihood of youth initiating smoking, price increased the likelihood of smoking at most levels of uptake, and availability of promotions increased the likelihood that youth will move from experimentation to regular smoking. Cigarette retail marketing practices increase the likelihood of smoking uptake. These findings suggest that specific restrictions on retail cigarette marketing may reduce youth smoking.
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The Chinese National People's Congress ratified the WHO Framework Convention on Tobacco Control (FCTC) on 27 August 2005, signaling China's commitment to implement tobacco control policies and legislation consistent with the treaty. This study was designed to examine attitudes towards four WHO FCTC measures among Chinese urban residents. In a cross-sectional design study, survey data were collected from two Chinese urban cities involving a sample of 3,003 residents aged 15 years or older. Through a face-to-face interview, respondents were asked about attitudes toward four tobacco control measures developed by the WHO FCTC. Data on the four dependent measures were analyzed using multivariate logistic regression analyses. Using descriptive statistics, potential change in smoking behavior that smokers might make in response to increasing cigarette prices is also reported. 81.8% of the respondents in the study sample supported banning smoking in public places, 68.8% favored increasing the cigarette tax, 85.1% supported health warnings on cigarette packages, and 85.7% favored banning tobacco advertising. The likelihood to support these measures was associated with gender, educational level, and personal income. Smokers were less likely to support these measures than non-smokers, with decreased support expressed by daily smokers compared to occasional smokers, and heavy smokers compared to light smokers. The proportion of switching to cheaper cigarette brands, decreasing smoking, and quitting smoking altogether with increased cigarette prices were 29.1%, 30.90% and 40.0% for occasional smokers, respectively; and 30.8%, 32.7% and 36.5% for daily smokers, respectively. Results from this study indicate strong public support in key WHO FCTC measures and that increases in cigarette price may reduce tobacco consumption among Chinese urban residents. Findings from this study have implications with respect to policymaking and legislation for tobacco control in China.
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In spite of gradual increases in tobacco price and the introduction of laws supporting various anti-tobacco measures, the proportion of smokers in Japan's population is still higher than in other developed nations. To understand what information and individual characteristics drive smokers to attempt to quit smoking. These determinants will help to realise effective tobacco control policy as a base for understanding of cessation behaviour. Discrete choice experiments on a total of 616 respondents registered at a consumer monitoring investigative company. The effect of price is greater on smokers with lower nicotine dependence. For smokers of moderate and low dependency, short term health risks and health risks caused by passive smoking have a strong impact, though the existence of penalties and long term health risks have little influence on smokers' decisions to quit. For highly dependent smokers, non-price attributes have little impact. Furthermore, the effects of age, sex and knowledge are also not uniform in accounting for smoking cessation. Determinants of smoking cessation vary among levels of nicotine dependency. Therefore, how and what information is provided needs to be carefully considered when counselling smokers to help them to quit.
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Tax increases are the single most effective intervention to reduce demand for tobacco (tax increases that raise the real price of cigarettes by 10% would reduce smoking by about 4% in high income countries and by about 8% in low income or middle income countries). Tax comprises about two thirds of retail price of cigarettes in most high income countries but is less than half of the total price on avenge in lower income countries. Improvements in the quality and extent of information, comprehensive bans on tobacco advertising and promotion, prominent warning labels, restrictions on smoking in public places, and increased access to nicotine replacement treatments are effective in reducing smoking. Reducing the supply of tobacco is not effective in reducing tobacco consumption. Comprehensive tobacco control policies are unlikely to harm economies.
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Changes in cigarette price have had an appreciable impact on smoking consumption in several countries. We analysed the price elasticity of demand for cigarettes in Italy over the period 1970-2001. A 1% increase in price of cigarettes led to a 0.30% decline in smoking prevalence and to a 0.43% decline in cigarette consumption. The present analyses confirm the existence of an inverse association between price and prevalence/consumption of cigarettes in Italy, and indicate that economic aspects may have important public health implications in tobacco control.
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The authors examined factors related to public support for cigarette taxes: smoking behavior, attitudes about other tobacco control policies, and sociodemographic factors. The authors regressed referendum voting outcomes on sociodemographic characteristics of Massachusetts' 351 towns. Logistic regressions on the surveys of Massachusetts adults (N = 14,000+) showed support for hypothetical tax increases to be related to respondents' smoking status, support for other tobacco control policies, and sociodemographic characteristics. Average educational attainment, probably acting as a proxy for nonsmoking prevalence, strongly predicted town-level support for Massachusetts' 1992 cigarette tax referendum. Survey respondents' support for hypothetical further increases was strongest if tax proceeds were earmarked for tobacco control or health purposes and if the individual was a nonsmoker and favored other tobacco control policies. For an earmarked tax, support was stronger among younger persons, females, persons with higher education, racial/ethnic minorities, and smokers with children. The high nationwide proportion of nonsmokers means that tobacco tax proposals can obtain strong voter support, but only if tax revenues are clearly earmarked for tobacco control and similar uses. Individual- and town-level characteristics can identify likely concentrations of support. Because attitudes toward tobacco control are only partly linked to smoking status, education campaigns may make a difference.
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Limited information is available on the role of smuggling and of perceived influence of cigarette price on tobacco consumption in Italy. To elucidate the issues, we included specific questions in a survey on smoking in Italy. Between March and April 2004, we conducted a survey on 3050 individuals aged 15 or over, representative of the general adult Italian population. The questionnaire included the estimate of the role of various channels of cigarette distribution and information on the self-reported perception of influence of prices on cigarette consumption in the young. Among current smokers, 85.6% bought cigarettes from tobacco shops, 7.5% from vending machines, and 6.9% from other channels of distribution, including smuggling, and internet (plus offered cigarettes). Overall, 35.9% of ever smokers (37.9% of males and 32.8% of females) reported that the prices had an intermediate to high influence on cigarette consumption in the young. Younger and less educated smokers were not more prone to report an influence of prices. These data indicate that in Italy smuggling now covers a limited proportion of cigarette sales, while cigarette prices have a substantial influence on tobacco consumption in the young.
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To quantify the implementation of tobacco control policies at country level using a new Tobacco Control Scale and to report initial results using the scale. A questionnaire sent to correspondents in 30 European countries, using a scoring system designed with the help of a panel of international tobacco control experts. The 30 countries are ranked by their total score on the scale out of a maximum possible score of 100. Only four countries (Ireland, United Kingdom, Norway, Iceland) scored 70 or more, with an eight point gap (most differences in scores are small) to the fifth country, Malta, on 62. Only 13 countries scored above 50, 11 of them from the European Union (EU), and the second largest points gap occurs between Denmark on 45 and Portugal on 39, splitting the table into three groups: 70 and above, 45 to 62, 39 and below. Ireland had the highest overall score, 74 out of 100, and Luxembourg was bottom with 26 points. However even Ireland, much praised for their ban on smoking in public places, did not increase tobacco taxes in 2005, for the first time since 1995. Although the Tobacco Control Scale has limitations, this is the first time such a scale has been developed and applied to so many countries. We hope it will be useful in encouraging countries to strengthen currently weak areas of their tobacco control policy.
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We analyzed the postal surveys conducted by Japanese Cancer Association (JCA) in 2004 and 2006. This survey aimed to assess JCA members' behavior and their attitudes toward patients who are smokers, smoking cessation, and their responsibilities. In the 2006 version, questions were added about hope for various approaches related to smoking and health and the attitudes as medical experts when treating patients. JCA members' smoking rate was 5.9% in 2004 and 9.0% in 2006. Current smokers were significantly more likely than never or former smokers to disagree or have no opinion with most activities about smoking control such as 'raising the price of tobacco' and 'labeling health warnings describing the harmful effects of tobacco in large letters with clarity for easier reading', while most members including smokers agree to ban smoking while walking, to educate general people about tobacco and health, to provide an environment where children cannot get tobacco and the information about tobacco and health. Smoking rate among JCA members were less than that of general populations, and most of them are in favor of promoting tobacco control activities.
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A clinical practice guideline for smoking cessation was released in Italy in 2002, but to date little is known about the implementation of these recommendations among primary care physicians. The objectives of this study were to estimate the prevalence of receiving physician-delivered advice to quit smoking and to determine what factors were related to the receipt of advice among adult Italian smokers. The data were collected as part of the Italian 2004-2006 adult tobacco surveys (analyzed in 2007), conducted by DOXA, the Italian branch of the Gallup International Association, and representative of the population aged>or=18 years. Each year smokers were asked whether they had received advice to quit smoking from their family physician during the previous year. Demographic, socioeconomic, tobacco-related, and physician-related variables were examined for their association with the receipt of advice. A logistic regression model was then fit to the data to determine which variables were related to receiving advice to quit smoking. Overall, 22% of smokers reported receiving advice to quit smoking from their physician in the previous year. Less likely to receive advice to quit were smokers who: were single (compared to divorced, widowed, or separated); lived in the South; had a higher level of education; were lighter smokers; had no previous quit attempts; and had physicians who likely smoked. The data suggest that Italian physicians are not advising smokers to quit at a high rate. Future research should focus on methods that encourage physicians to counsel smokers to quit during a patient-provider encounter.
Price and consumption of tobacco in Italy over the last three decades
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