Association of tobacco control policies with cigarette smoking among school age youth 13 to 15 in the Philippines, 2000 - 2015

Background In 2003, the Philippines passed extensive tobacco control legislation, including minimum legal sales age (MLSA) laws, textual warning labels (TWL), and smoke-free public places (SFPP), and pricing strategies. This study examined the impact of these tobacco control policies on cigarette smoking among Filipino youth 13 to 15 years old who attended school. Methods Data from the Philippines Global Youth Tobacco Surveys were analyzed (2000, 2004, 2007, 2011, and 2015). Sample sizes ranged from 3,708 to 5,919, and response rates from 79.5% to 84.8%. Current cigarette smoking was defined as smoking cigarettes on ≥1 day in the past 30 days. Current use of other tobacco products (OTP) was defined as using tobacco products other than cigarettes on ≥1 day in the past 30 days. Annual average cigarette price was obtained for each year from Euromonitor data, and converted into 2015 Philippine pesos Tobacco control legislation (MLSA, TWL, and SFPP) was coded as all three components in effect (1) or none in effect (0, reference). Logistic regression was used to model the association of tobacco control laws with current youth cigarette smoking, adjusting for cigarette price, age, sex, and current OTP use. Results Tobacco control legislation was associated with declines in current cigarette smoking among youth (AOR: 0.65, p< 0.0001). The price of cigarettes was not significantly associated with current cigarette smoking (AOR: 1.01, p=0.2895], which is likely related to the timing and relatively limited magnitude of price increases during this period. Age, sex, and current OTP use were associated with current cigarette smoking (p< 0.0001). Conclusions The development and implementation of the 2003 tobacco control legislation was associated with decreases in current cigarette smoking among Filipino youth in school. Continued implementation and enforcement of comprehensive, evidence-based tobacco control policies can help reduce tobacco use among youths

SEM results: Direct effects for <i>Cigarette Experimentation</i> among middle and high school students, NYTS, 2012^a.

<p>SEM, Structural Equation Model</p><p>NYTS, National Youth Tobacco Survey</p><p>^a Multivariate <i>N</i> = 24,654 based on all available cases across all variables used in analyses.</p><p>^b<i>B</i> = unstandardized regression coefficient, which represents the amount of change in the dependent variable per one-unit change in the independent variable.</p><p>^c β = standardized regression coefficient, which represents the SD change in the dependent variable per SD change in the independent variable.</p><p>^d Static exposure was defined as exposure to static tobacco advertisements on the Internet, in newspaper and magazines or retail stores.</p><p>^e Perception of peer tobacco use measured by student response to the questions (1) “Out of every 10 students in your grade at school, how many do you think smoke cigarettes?” and (2) “Out of every 10 students in your grade at school, how many do you think use tobacco products other than cigarettes?”</p><p>^f TV and movie exposure was defined as exposure to tobacco use in TV and movies.</p><p>^g Household member tobacco use was defined as number of tobacco products used by a family member or those living with the respondent.</p><p>^h Experimentation was defined as having puffed on a cigarette at least once but not having smoked a total of 100 lifetime cigarettes.</p><p>SEM results: Direct effects for <i>Cigarette Experimentation</i> among middle and high school students, NYTS, 2012<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134734#t003fn003" target="_blank">^a</a>.</p

SEM results: Direct effects, <i>Susceptibility to Cigarette Use</i> among middle and high school students, NYTS, 2012^a.

<p>SEM, Structural Equation Model</p><p>NYTS, National Youth Tobacco Survey</p><p>^a Multivariate <i>n</i> = 17,188 based on all available cases across all variables used in analyses.</p><p>^b<i>B</i> = unstandardized regression coefficient which represents the amount of change in the dependent variable per one-unit change in the independent variable.</p><p>^c β = standardized regression coefficient, which represents the SD change in the dependent variable per SD change in the independent variable.</p><p>^d Static exposure was defined as exposure to static tobacco advertisements on the Internet, in newspaper and magazines or retail stores.</p><p>^e Perception of peer tobacco use measured by student response to the questions (1) “Out of every 10 students in your grade at school, how many do you think smoke cigarettes?” and (2) “Out of every 10 students in your grade at school, how many do you think use tobacco products other than cigarettes?”</p><p>^f TV and movie exposure was defined as exposure to tobacco use in TV and movies.</p><p>^g Household member tobacco use was defined as number of tobacco products used by a family member or those living with the respondent.</p><p>^h Susceptibility was defined as never tried smoking cigarettes, even 1 or 2 puffs and responded in any way other than “no” to the question, “Do you think you will smoke a cigarette in the next year?” and responded in any way other than “definitely not” to either question: “Do you think you will smoke a cigarette soon?” or “If one of your best friends would offer you a cigarette, would you smoke it?”</p><p>SEM results: Direct effects, <i>Susceptibility to Cigarette Use</i> among middle and high school students, NYTS, 2012<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134734#t002fn003" target="_blank">^a</a>.</p

Demographic characteristics of respondents susceptible to cigarette use, cigarette experimenters, and current tobacco users, NYTS, 2012.

<p>NYTS, National Youth Tobacco Survey</p><p>^a Never-smokers who are susceptible to cigarette use was defined as never tried smoking cigarettes, even one or two puffs and responded other than “definitely not” to the following questions: “Do you think you will smoke a cigarette in the next year?” and “Do you think you will smoke a cigarette soon?” and “If one of your best friends would offer you a cigarette, would you smoke it?”</p><p>^b Reported <i>n</i> based on univariate analyses with missing values excluded.</p><p>^c Cigarette experimentation was defined as having puffed on a cigarette at least once but not having smoked a total of 100 lifetime cigarettes.</p><p>^d Current tobacco use was defined as using on at least 1 day in the past 30 days any of the following tobacco products: cigarettes, cigars, smokeless tobacco, pipe, bidis, kreteks, snus, hookah, roll-your-own cigarettes, dissolvable tobacco products, electronic cigarettes, or some other new tobacco product.</p><p>Demographic characteristics of respondents susceptible to cigarette use, cigarette experimenters, and current tobacco users, NYTS, 2012.</p

SEM results: Direct effects for <i>Current Tobacco Use</i> among middle and high school students, NYTS, 2012^a.

<p>SEM, Structural Equation Model</p><p>NYTS, National Youth Tobacco Survey</p><p>^a Multivariate <i>N</i> = 24,654 based on all available cases across all variables used in analyses.</p><p>^b<i>B</i> = unstandardized regression coefficient, which represents the amount of change in the dependent variable per one-unit change in the independent variable.</p><p>^c β = standardized regression coefficient, which represents the SD change in the dependent variable per SD change in the independent variable.</p><p>^d Static exposure was defined as exposure to static tobacco advertisements on the Internet, in newspaper and magazines or retail stores.</p><p>^e Perception of peer tobacco use measured by student response to the questions (1) “Out of every 10 students in your grade at school, how many do you think smoke cigarettes?” and (2) “Out of every 10 students in your grade at school, how many do you think use tobacco products other than cigarettes?”</p><p>^f TV and movie exposure was defined as exposure to tobacco use in TV and movies.</p><p>^g Household member tobacco use was defined as number of tobacco products used by a family member or those living with the respondent.</p><p>^h Current use was defined as using on at least 1 day in the past 30 days any of the following tobacco products: cigarettes, cigars, smokeless tobacco, pipe, bidis, kreteks, snus, hookah, roll-your-own cigarettes, dissolvable tobacco products, electronic cigarettes, or some other new tobacco product.</p><p>SEM results: Direct effects for <i>Current Tobacco Use</i> among middle and high school students, NYTS, 2012<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0134734#t004fn003" target="_blank">^a</a>.</p

Direct and indirect effects of protobacco media exposure on susceptibility, experimentation, and current use.

<p>Conceptual model demonstrating the direct and indirect effects of exposure to static ads and tobacco use in TV and movies on susceptibility to smoking cigarettes, cigarette experimentation, and current tobacco use among US youth. Variables presented in rectangular boxes are observed, whereas unmeasured (latent) variables, including static ad exposure and peer tobacco use, are represented within ellipses. Straight lines with a unidirectional arrow depict direct relationships between variables. Curved lines with bidirectional arrows represent covariation between variables. Covariates that were included in the SEM analyses and tables, but not depicted in the diagram: household member tobacco use, sex, grade in school, black race/ethnicity, Hispanic race/ethnicity, and other ethnicity.</p