The value of studying supply chains for tobacco control

Introduction: Tobacco control research and advocacy has yet to capitalise on understanding the tobacco industry supply chain. The objective of this narrative review is to expose the processes, actors and supporting industries involved in tobacco production, laying the groundwork to expand the scope of tobacco control beyond the transnational tobacco companies (TTCs). Methods: We reviewed 69 academic articles (2013 to 2019) and five tobacco industry journal issues. Results: We identify six major processes in tobacco production: farming, primary processing of the leaf, secondary processing into products such as cigarettes, packaged product, use by smokers, and decay. Supply chain actors include seed and plant retailers, farmers, leaf processors, wholesalers, brokers and middlemen, manufacturers, retailers, smokers and refuse collectors with considerable variation in intermediate actors by location. Supporting industries supply additives, machinery, packaging, logistics, marketing, and research and development (R&D). Conclusions: This expanded understanding of the supply chain can enable wider appreciation of the various incentives and risks of being involved in the industry, as well as how profit and power is accrued and distributed among participants, all of which is important information to feed into tobacco control policies. Researchers and campaigners seeking to design effective policy preventing the expansion of this industry and the health harms it produces, need to look beyond the TTCs to identify under-exploited leverage points along the entire tobacco supply chain

The relationship between housing tenure and health: does ontological security play a role?

Previous research in the UK and elsewhere has found that housing tenure (i.e. whether the dwelling is owned or rented) predicts mortality and morbidity. This thesis aims to explain whether ontological security (a long term tendency to believe things are reliable and secure as opposed to threatening) is more likely to be associated with owner occupation, and therefore whether it helps to explain the observed association with tenure and health.For the purposes of this study ontological security was operationalised as being formed of three components: protection, autonomy and prestige. A scale was devised to measure ontological security arising from the home through these three components. This scale was included in a postal survey that also included questions on health, housing area, psychological and sociodemographic characteristics. The postal survey was sent to a random sample of adults in the West of Scotland and nearly 300 completed questionnaires were returned.I found that ontological security was associated with owner occupation but not independently of features of housing. Ontological security was not independently related to housing tenure itself. Owner occupiers reported more ontological security from their homes because their homes were in better condition, situated in better areas and of higher value than social renters. Ontological security appeared to be related to health particularly through psychological characteristics. Other reasons for the associations between tenure and health were that owners were on average younger and richer than social renters.This study suggests that social meaning per se may not be health damaging, but that social rented homes might put their occupants at greater health risk because they are in poorer condition, located in more poorly resourced and problem ridden areas and of lower status. These features of social renting may also be observed in other countries (e.g. USA)

Perceptions of cigarette pack inserts promoting cessation and dissuasive cigarettes among young adult smokers in the UK: a cross-sectional online survey

Objectives To explore young adult smokers’ perceptions of cigarette pack inserts promoting cessation and cigarettes designed to be dissuasive. Design Cross-sectional online survey. Setting UK. Participants The final sample was 1766 young adult smokers, with 50.3% male and 71.6% white British. To meet the inclusion criteria, participants had to be 16–34 years old and smoke factory-made cigarettes. Primary and secondary outcome measures Salience of inserts, perceptions of inserts as information provision, perceptions of inserts on quitting, support for inserts and perceived appeal, harm and trial of three cigarettes (a standard cigarette, a standard cigarette displaying the warning ‘Smoking kills’ and a green cigarette). Results Half the sample indicated that they would read inserts with three-fifths indicating that they are a good way to provide information about quitting (61%). Just over half indicated that inserts would make them think more about quitting (53%), help if they decided to quit (52%), are an effective way of encouraging smokers to quit (53%) and supported having them in all packs (55%). Participants who smoked factory-made cigarettes and other tobacco products (compared with exclusive factory-made cigarette smokers), had made a quit attempt within the last 6 months (compared with those that had never made a quit attempt) or were likely to make a successful quit attempt in the next 6 months (compared with those unlikely to make a quit attempt in the next 6 months) were more likely to indicate that inserts could assist with cessation. Multivariable logistic regression modelling suggested that compared with the standard cigarette, the cigarette with warning (adjusted OR=17.71; 95% CI 13.75 to 22.80) and green cigarette (adjusted OR=30.88; 95% CI 23.98 to 39.76) were much less desirable (less appealing, more harmful and less likely to be tried). Conclusions Inserts and dissuasive cigarettes offer policy makers additional ways of using the pack to reduce smoking

Longitudinal evaluation of the impact of standardised packaging and Minimum Excise Tax on tobacco sales and industry revenue in the UK

BACKGROUND: Standardised packaging for factory-made cigarettes (FM) and roll-your-own tobacco (RYO), and a minimum excise tax (MET) were fully implemented in the UK in May 2017 following a 12-month transition period. This paper is the first to examine effects on tobacco sales volumes and company revenues. METHODS: Analysis of UK commercial supermarket and convenience store electronic point of sale data on tobacco sales. FM and RYO products' data (May 2015–April 2018) yielded 107 572 monthly observations. Expected values from additive mixed modelling were used to calculate trends in: (1) volumes of tobacco sold overall, by cigarette type (FM and RYO) and by seven market segments; and (2) company net revenues. A 10-month period (June 2015–March 2016) before the transition to standardised packs was compared with a 10-month period after the introduction of the MET and full implementation of standardised packs (June 2017–March 2018). RESULTS: Postimplementation, the average monthly decline in stick sales was 6.4 million (95% CI 0.1 million to 12.7 million) sticks faster than prelegislation, almost doubling the speed of decline. Sales of cheap FM brands, previously increasing, plateaued after implementation. Company monthly net revenues declined from a stable £231 million (95% CI £228 million to £234 million), prelegislation, to £198 million (95% CI £191 million to £206 million) in April 2018. CONCLUSIONS: The concurrent introduction of standardised packaging and MET in the UK was associated with significant decline in sales and in tobacco industry revenues, and the end of the previous growth in cheap cigarette brands that appeal to young and price conscious smokers

Extended impacts of climate change on health and wellbeing

Anthropogenic climate change is progressively transforming the environment despite political and technological attempts to reduce greenhouse gas emissions to tackle global warming. Here we propose that greater insight and understanding of the health-related impacts of climate change can be gained by integrating the positivist approaches used in public health and epidemiology, with holistic social science perspectives on health in which the concept of ‘wellbeing’ is more explicitly recognised. Such an approach enables us to acknowledge and explore a wide range of more subtle, yet important health-related outcomes of climate change. At the same time, incorporating notions of wellbeing enables recognition of both the health co-benefits and dis-benefits of climate change adaptation and mitigation strategies across different population groups and geographical contexts. The paper recommends that future adaptation and mitigation policies seek to ensure that benefits are available for all since current evidence suggests that they are spatially and socially differentiated, and their accessibility is dependent on a range of contextually specific socio-cultural factors.<br/

Views from the coalface:what do English Stop Smoking Service personnel think about E-cigarettes?

The UK Stop Smoking Services (SSS) are a source of information and advice on e-cigarettes for smokers and thus it is important to understand the knowledge of, and attitudes towards, e-cigarettes held by stop smoking practitioners. The datasets were English SSS quarterly monitoring returns (n = 207,883) and an online survey of English SSS practitioners, managers, and commissioners between 26th November and 15th December 2014 (n = 1801). SSS monitoring data suggested 2% of clients were using e-cigarettes to quit with SSS and that clients using e-cigarettes had similar quit rates to clients using Varenicline. Most SSS personnel are waiting for licenced e-cigarettes to become available before they will recommend them to clients. However, less than a quarter view e-cigarettes as “a good thing”. Managers and commissioners were more positive than practitioners. SSS personnel working for the NHS (hospitals and GP surgeries) were less positive about e-cigarettes than those employed elsewhere. E-cigarettes were cited as the most important reason for the recent decline in service footfall. Thus dissemination of information about e-cigarettes needs to be examined and services should address their stance on e-cigarettes with some urgency.</p

Wellbeing impacts of city policies for reducing greenhouse gas emissions

To mitigate climate change, city authorities are developing policies in areas such as transportation, housing and energy use, to reduce greenhouse gas emissions. In addition to their effects on greenhouse gas emissions, these policies are likely to have consequences for the wellbeing of their populations for example through changes in opportunities to take physical exercise. In order to explore the potential consequences for wellbeing, we first explore what ‘wellbeing’ is and how it can be operationalised for urban planners. In this paper, we illustrate how wellbeing can be divided into objective and subjective aspects which can be measured quantitatively; our review of measures informs the development of a theoretical model linking wellbeing to policies which cities use to reduce greenhouse gas emissions. Finally, we discuss the extent to which the links proposed in the conceptual model are supported by the literature and how cities can assess wellbeing implications of policies.</p