How Do Price Minimizing Behaviors Impact Smoking Cessation? Findings from the International Tobacco Control (ITC) Four Country Survey

This paper examines how price minimizing behaviors impact efforts to stop smoking. Data on 4,988 participants from the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey who were smokers at baseline (wave 5) and interviewed at a 1 year follow-up were used. We examined whether price minimizing behaviors at baseline predicted: (1) cessation, (2) quit attempts, and (3) successful quit attempts at one year follow up using multivariate logistic regression modeling. A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation. Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes. Smokers who engaged in any price/tax avoidance behaviors were 28% less likely to report cessation. Persons using low/untaxed sources were less likely to quit at follow up, those purchasing cartons were less likely to make quit attempts and quit, and those using discount cigarettes were less likely to succeed, conditional on making attempts. Respondents who utilized multiple behaviors simultaneously were less likely to make quit attempts and to succeed. SES did not modify the effects of price minimizing behaviors on cessation outcomes. The data from this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at to reduce reducing smoking prevalence through price and tax increases among all SES groups

Socio-Economic Variation in Price Minimizing Behaviors: Findings from the International Tobacco Control (ITC) Four Country Survey

This paper examines how socio-economic status (SES) modifies how smokers adjust to changes in the price of tobacco products through utilization of multiple price minimizing techniques. Data come from the International Tobacco Control Policy Evaluation (ITC) Four Country Survey, nationally representative samples of adult smokers and includes respondents from Canada, the United States, the United Kingdom and Australia. Cross-sectional analyses were completed among 8,243 respondents (7,038 current smokers) from the survey wave conducted between October 2006 and February 2007. Analyses examined predictors of purchasing from low/untaxed sources, using discount cigarettes or roll-your-own (RYO) tobacco, purchasing cigarettes in cartons, and engaging in high levels of price and tax avoidance at last purchase. All analyses tested for interactions with SES and were weighted to account for changing and under-represented demographics. Relatively high levels of price and tax avoidance behaviors were present; 8% reported buying from low or untaxed source; 36% used discount or generic brands, 13.5% used RYO tobacco, 29% reported purchasing cartons, and 63% reported using at least one of these high price avoidance behaviors. Respondents categorized as having low SES were approximately 26% less likely to report using low or untaxed sources and 43% less likely to purchase tobacco by the carton. However, respondents with low SES were 85% more likely to report using discount brands/RYO compared to participants with higher SES. Overall, lower SES smokers were 25% more likely to engage in at least one or more tax avoidance behaviors compared to their higher SES counterparts. Price and tax avoidance behaviors are relatively common among smokers of all SES strata, but strategies differed with higher SES groups more likely to report traveling to a low-tax location to avoid paying higher prices, purchase duty free tobacco, and purchase by cartons instead of packs all of which were less commonly reported by low SES smokers. Because of the strategies lower SES respondents are more likely to use, reducing price differentials between discount and premium brands may have a greater impact on them, potentially increasing the likelihood of quitting

Carotid artery blowout producing massive hematemesis in the emergency department

AbstractCarotid blowout syndrome (CBS) is a rare and fatal complication which arises from patients who have been treated for head and neck cancer. The incidence of CBS is rare and not commonly seen by emergency physicians. We review a case of a 68-year-old woman with a history of laryngectomy and chemo-radiation therapy presenting with massive oral bleeding and hypotension. Her course and treatments are highlighted, literature referring to CBS are described and we reintroduce the approach of managing such a patient in the emergency department

Cigarette Excise Taxation: The Impact of Tax Structure on Prices, Revenues, and Cigarette Smoking

The main purpose of this study is to provide empirical evidence on the effects of the cigarette excise tax structure on three outcomes: cigarette prices, government revenues, and cigarette consumption. We composed cross-sectional time-series data for 21 EU countries from year 1998 to 2007 from various data resources. We provide strong evidence that the price gap between premium and low-priced brands is larger in countries with a greater share of ad valorem tax. A 10-percent raise in the share of ad valorem tax in total excise tax leads to about a 4 to 5 percent increase in the price gap, with a smaller impact in more concentrated markets. Our estimates confirm that greater instability of government tax revenues from cigarette excise taxes can be attributed to greater reliance on the ad valorem tax and such instability increases with the growth of manufacturers' market power. We also find that greater reliance on a specific tax has greater impact on cigarette smoking, but the impact diminishes with the growth of manufacturers' market power.

Anatomical Injury Clusters in Polytrauma Patients

Polytrauma is a major cause of death in young adults. The trial was to identify clusters of interlinked anatomical regions to improve strategical operational planning in the acute situation. A total of 2219 polytrauma patients with an ISS (Injury Severity Score) ≥ 16 and an age ≥ 16 years was included into this retrospective cohort study. Pearson’s correlation was performed amongst the AIS (Abbreviated Injury Scale) groups. The predictive quality was tested by ROC (Receiver Operating Curve) and their area under the curve. Independency was tested by the binary logistic regression , AIS ≥3 was taken as a significant injury. The analysis was conducted using IBM SPSS® 24.0. The highest predictive value was reached in the combination of thorax, abdomen, pelvis and spine injuries (ROC: abdomen for thorax 0.647, thorax for abdomen 0.621, pelvis for thorax 0.608, pelvis for abdomen 0.651, spine for thorax 0.617). The binary logistic regression revealed the anatomical regions thorax, abdomen pelvis and spine as per-mutative independent predictors for each other when a particular injury exceeded the AIS ≥3. The documented clusters of injuries in truncal trauma are crucial to define priorities in the polytrauma management

The Role of Lactate for Sepsis in Polytrauma Patients, a Time related Analysis using the IBM Watson Trauma Pathway Explorer®

The Watson Trauma Pathway Explorer® is an outcome prediction tool invented by the University Hospital of Zurich in collaboration with IBM®, representing an artificial intelligence application to predict the most adverse outcome scenarios in polytrauma patients: Systemic Inflammatory Respiratory Syndrome (SIRS), sepsis within 21 days and death within 72 h. The hypothesis was how lactate values woud be associated with the incidence of sepsis. Data from 3653 patients in an internal database, with ongoing implementation, served for analysis. Patients were split in two groups according to sepsis presence, and lactate values were measured at formerly defined time points from admission until 21 days after admission for both groups. Differences between groups were analyzed; time points with lactate as independent predictor for sepsis were identified. The predictive quality of lactate at 2 and 12 h after admission was evaluated. Threshold values between groups at all timepoints were calculated. Lactate levels differed from less than 2 h after admission until the end of the observation period (21 d). Lactate represented an independent predictor for sepsis from 12 to 48 h and 14 d to 21 d after admission relative to ISS levels. AUROC was poor at 2 and 12 h after admission with a slight improvement at the 12 h mark. Lactate levels decreased over time at a range of 2 [mmol/L] for 6-8 h after admission. These insights may allow for time-dependent referencing of lactate levels and anticipation of subsequent sepsis, although further parameters must be considered for a higher predictability

IBM WATSON Trauma Pathway Explorer© as a Predictor for Sepsis after Polytrauma - Is Procalcitonin Useful for Identifying Septic Polytrauma Patients?

IBM and the University Hospital Zurich have developed an online tool for predicting outcomes of a patient with polytrauma, the IBM WATSON Trauma Pathway Explorer®. The three predicted outcomes are Systemic Inflammatory Response Syndrome (SIRS) and sepsis within 21 days as well as early death within 72 hours since the admission of the patient. The validated Trauma Pathway Explorer® offers insights into the most common laboratory parameters, such as procalcitonin (PCT). Sepsis is one of the most important complications after polytrauma, which is why it is crucial to detect it early. This study aimed to examine the time-dependent relationship between PCT values and sepsis, based on the WATSON technology. A total of 3653 patients were included, and ongoing admissions are incorporated continuously. Patients were split into two groups (sepsis and non-sepsis), and the PCT value was assessed for 21 days (1, 2, 3, 4, 6, 8, 12, 24, 48 hours, and 3, 4, 5, 7, 10, 14 and 21 days). The Mann-Whitney U-Test was used to evaluate the difference between the two groups. Binary logistic regression was utilized to examine the dependency of prediction. The Closest Top-left Threshold Method provided time-specific thresholds at which the PCT level is predictive for sepsis. At p <0.05, the data were declared significant. R was used to conduct all statistical analyses. The Mann-Whitney U-test showed a significant difference in PCT values in sepsis and non-sepsis patients between 12 and 24 hours, including post-hoc analysis (p <0.05). Likewise, the p-value started to be significant between 12 and 24 hours in the binary logistic regression (p <0.05). The threshold value of PCT to predict sepsis at 24 hours is 0.7μg/l, and at 48 hours 0.5μg/l. The presented time course of PCT levels in polytrauma patients shows the PCT as a separate predictor for sepsis relatively early. Even later, during the 21-day observation period, time-dependent PCT values may be utilized as a benchmark for the early and preemptive detection of sepsis, which may reduce death from septic shock and other deadly infectious episodes

Fiscal and Policy Implications of Selling Pipe Tobacco for Roll-Your-Own Cigarettes in the United States

The Federal excise tax was increased for tobacco products on April 1, 2009. While excise tax rates prior to the increase were the same for roll-your-own (RYO) and pipe tobacco, the tax on pipe tobacco was $21.95 per pound less than the tax on RYO tobacco after the increase. Subsequently, tobacco manufacturers began labeling loose tobacco as pipe tobacco and marketing these products to RYO consumers at a lower price. Retailers refer to these products as “dual purpose" or “dual use" pipe tobacco.Data on tobacco tax collections comes from the Alcohol and Tobacco Tax and Trade Bureau. Joinpoint software was used to identify changes in sales trends. Estimates were generated for the amount of pipe tobacco sold for RYO use and for Federal and state tax revenue lost through August 2011.Approximately 45 million pounds of pipe tobacco has been sold for RYO use from April 2009 to August 2011, lowering state and Federal revenue by over$1.3 billion.Marketing pipe tobacco as “dual purpose" and selling it for RYO use provides an opportunity to avoid paying higher cigarette prices. This blunts the public health impact excise tax increases would otherwise have on reducing tobacco use through higher prices. Selling pipe tobacco for RYO use decreases state and Federal revenue and also avoids regulations on flavored tobacco, banned descriptors, prohibitions on shipping, and reporting requirements

South Korean Military Service Promotes Smoking: A Quasi-Experimental Design

∙ The authors have no financial conflicts of interest. © Copyright: Yonsei University College of Medicine 2012 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial Licens

Is treatment "intensity" associated with healthier lifestyle choices?:An application of the dose response function

Healthy lifestyle choices and doctor consultations can be substitutes or complements in the health production function. In this paper we consider the relation between the number of doctor consultations and the frequency of patient physical activity. We use a novel application of the Dose-Response Function model proposed by Hirano and Imbens (2004) to deal with treatment endogeneity under the no unmeasured confounding assumption. Our application takes account of unobserved heterogeneity and uses dynamic non-linear models for the treatment and outcome variables of interest. Using seven waves of the British Household Panel Survey, we find that higher treatment intensity and frequency of physical activity are inversely related. We show that accounting for both treatment selection and unobserved heterogeneity halves the size of this relationship. An additional doctor consultation is associated with a 0.5 percentage point reduction in the probability of undertaking vigorous physical activity. Our results hold for a sub-sample visiting the doctor for health check-ups, and are shown to be robust using instrumental variables