Heydon, N.

Jalleh, Geoffrey

Kennington, K.

Lin, Chad

English

espace@Curtin

When a tax increase fails asa tobacco control policy: the ITCChina project evaluation of the2009 cigarette tax increase inChinaChina ratified the WHO FrameworkConvention on Tobacco Control (the WHOFCTC) in 2006 and thus has the obligationto increase the prices and taxes of cigarettes.In May 2009, China raised cigarette excisetaxes, which was cited by a Chinesegovernment official as a measure of FCTCimplementation.1 Researchers noticed thatcigarette retail prices in China did notchange after the 2009 tax adjustment;however, their conclusion was based onobservations but not survey data.2We used the International TobaccoControl Survey (the ITC survey) data toexamine trends in cigarette prices in Chinaafter the 2009 tax adjustment. The ITCsurvey is a prospective survey of tobacco use.Its overall objective is to measure the effectsof key tobacco control policies. In China, thefirst three waves of the ITC survey wereconducted in six cities: Beijing, Shenyang,Shanghai, Changsha, Guangzhou andYinchuan. In each city, 800 smokers and 200non-smokers were surveyed.3 To date, threewaves of the ITC China survey have beenconducted: wave 1 (April to August 2006),wave 2 (October 2007 to January 2008) andwave 3 (May to October 2009). In July 2010,a short phone survey was conducted amongthe wave 3 respondents to examine changesin cigarette prices. During each survey,smokers were asked about the brand andcost of cigarettes they bought last time.Typical brands of cigarettes were bought bythe study team via test purchases from threetypical cigarette stores in each city duringeach survey, and the retail prices of thosecigarettes were recorded. Two indicatorswere used to examine trends in cigaretteprices in the six ITC China cities: (1) theaverage self-reported cost of 18 top brands ofcigarette in the six cities (the top threebrands in each city) from 2007 to 2010 (wave2, wave 3 and the phone survey); and (2) theaverage retail prices (Yuan/pack) of 18 ciga-rette brands that have been purchased in allthe retail store surveys from 2007 to 2010.As shown in the table 1, both indicatorsremained almost unchanged during thestudy period. After adjusting for inflation,4both indicators decreased from 2007 to 2010.That is, the nominal prices of cigarettes didnot change after the tax adjustment and thereal prices of cigarettes in China decreasedfrom 2007 to 2010.Theoretically, if an increase in the ciga-rette excise tax is not transferred to cigaretteretail prices, then cigarette consumption willnot decrease. Thus, the 2009 cigarette excisetax adjustment cannot be considered asa measure of FCTC implementation at thistime. China is home to one-third of theworld’s smokers. One of the major reasonsfor the high smoking prevalence in thenation is the low price of cigarettes.2 Chinaneeds to make further progress to increasetobacco prices, as the WHO FCTC has beenin effect in China for more than 5 years.Acknowledgements The authors would like toacknowledge the Chinese Center for Disease Control andPrevention and the local CDC representatives in each cityfor their role in data collection.Qiang Li,1,2 Teh-wei Hu,3 Zhengzhong Mao,4Richard J O’Connor,5 Geoffrey T Fong,1,6Changbao Wu,7 Jingjing Zhang,2 Anne C K Quah,1Yuan Jiang21Department of Psychology, University of Waterloo,Waterloo, Ontario, Canada; 2Tobacco Control Office,Chinese Center for Disease Control and Prevention,Beijing, China; 3School of Public Health, University ofCalifornia, Berkeley, California, USA; 4Department ofHealth Economy, Sichuan University, Chengdu, China;5Department of Health Behavior, Roswell Park CancerInstitute, Buffalo, New York, USA; 6Ontario Institute forCancer Research, Toronto, Ontario, Canada;7Department of Statistics and Actuarial Science,University of Waterloo, Waterloo, Ontario, CanadaCorrespondence to Dr Yuan Jiang, Tobacco ControlOffice, Chinese Center for Disease Control andPrevention, 27 Nanwei Rd., Beijing 100050, P R China;jiangyuan88@vip.sina.comFunding The International Tobacco Control China PolicyEvaluation Project was supported by grants from the USNational Cancer Institute (R01 CA125116 and theRoswell Park Transdisciplinary Tobacco Use ResearchCenter (P50 CA111236)), Canadian Institutes of HealthResearch (79551), Chinese Center for Disease Controland Prevention and the Ontario Institute for CancerResearch. The cigarette store survey and the phonesurvey were supported by a grant from the US NIHFogarty International Center (R01-TW059938).Competing interests None.Patient consent Obtained.Ethics approval Ethics approval was provided by theResearch Ethics Board at the University of Waterloo andthe Institutional Review Boards at the China NationalCenters for Disease Control and Prevention.Contributors T-wH, ZM, GTF and YJ contributed to theconception of the study. QL, T-wH, ZM, RJO, GTF, ACKQand YJ contributed to the design of the study. QL wasinvolved in data collection. JZ contributed to thefieldwork implementation, data cleaning and along withQL, CW and YJ contributed to data analysis. QL draftedthe article and along with T-wH, ZM, RJO, GTF, CW,ACKQ and YJ revised drafts of the article.Provenance and peer review Not commissioned;externally peer reviewed.Accepted 16 November 2011Published Online First 23 December 2011Tobacco Control 2012;21:381.doi:10.1136/tobaccocontrol-2011-050111REFERENCES1. Chen J. Ministry of industry and informationtechnology stated that China earnestly implementsFCTC. Southern Metropolis Daily 28 January 2011.2. Hu TW, Mao Z, Shi J. Recent tobacco tax rateadjustment and its potential impact on tobacco controlin China. Tob Control 2009;19:80e2.3. Wu C, Thompson ME, Fong GT, et al. Methods of theInternational Tobacco Control (ITC) China Survey. TobControl 2010;19 Suppl 2:i1e5.4. China National Statistical Bureau. China StatisticalYearbook, 2010. Beijing: China Statistical Press, 2010.Western Australian smokersstrongly support regulations onthe use of chemicals andadditives in cigarettesIn Australia, almost any ingredient ispermitted in tobacco products,1 which isa situation aptly described by Dr Nigel Grayas ‘regulatory anarchy ’.2When smokers are informed that ingredi-ents such as cocoa, coffee, peppermint,sugars and other sweeteners are added tomost manufactured cigarettes3 and not just‘niche’ flavoured varieties, many expressamusement and surprise, or become shockedand angered.4 Most smokers have little orno notion that these seemingly harmlessingredients can play a deadly role by maxi-mising addiction, increasing the palatabilityof cigarettes, reducing the smell ofTable 1 Prices of cigarettes in six cities in China from 2007 to 20102007 2009 2010Average self-reported cost of18 top brands of cigarettes (Yuan/pack)7.80 7.79 7.83Real prices (in 2007 Yuan) 7.80 7.44 7.30Average retail prices of 18 cigarettebrandsthat were purchased in all the three retailstore surveys (Yuan/pack)6.26 6.40 6.28Real prices (in 2007 Yuan) 6.26 6.12 5.85(1) In total, we purchased 280 packs of cigarettes (28 brands310 packs) in 2007, 928 packs in 2009 and 713 packs in 2010.(2) Numbers of smokers who completed each wave of the International Tobacco Control China surveys were: 4627 in wave 2(2007), 4410 in wave 3 (2009) and 1190 in the phone survey (2010).This paper is freely available online under the BMJJournals unlocked scheme, see http://tobaccocontrol.bmj.com/site/about/unlocked.xhtmlTobacco Control May 2012 Vol 21 No 3 381Research letters group.bmj.com on May 16, 2012 - Published by tobaccocontrol.bmj.comDownloaded from secondhand smoke and making it harder forsmokers to quit.1 3 5The current voluntary agreement for thedisclosure of the ingredients of cigarettes,6negotiated between the Commonwealth ofAustralia Department of Health and Ageingand three major Australian tobacco compa-nies in 2000, provides a website listing theingredients in Australian cigarettes. Focusgroups with smokers suggest that thismethod of disclosure of ingredients andadditives is ineffective in communicatingsuch information.7In 2009, Cancer Council WesternAustralia’s ‘Make Smoking History’campaign focused on these seemingly innoc-uous cigarette ingredients. The campaign,which was broadcast state-wide in Septemberand October 2009, included the ‘Sugar Sugar ’television advertisement and the ‘DeceptivelyDelicious’ press advertisement.8 The adver-tising highlighted that while ingredients suchas sugar and honey can mask the bitter tasteof tobacco, the damage smoking can docannot be hidden.A post-campaign evaluation survey wasconducted between 19 and 30 October 2009using computer assisted telephone inter-viewing. Random digit dialling from theWestern Australian residential white pageswas used to achieve a sample of 200 WesternAustralian adult smokers and recent quittersaged 25e54 years. The sample consisted of70% Perth metropolitan and 30% regionalWestern Australian residents, with equalrepresentation of men and women in eachlocation. Following the completion of post-campaign survey questions, respondentswere presented with the four statements oncigarette additives listed in table 1, and askedto indicate their level of support for eachstatement.The vast majority of smokers were infavour of government regulations on thetype of chemicals and additives used in themanufacture of cigarettes (89%), and 80%were in favour of banning the use ofchemical and additives that mask the bittertaste of cigarette smoke. There was strongsupport for tobacco companies providinginformation about the contents in cigarettesand cigarette smoke (79%), and theeffects the chemicals and additives incigarettes and cigarette smoke have onsmokers (84%). Only 11% of smokers orless were opposed to each of these fourstatements.The ‘Sugar Sugar ’ campaign achieveda very high level of awareness (83%). Thedata appear to suggest that those aware ofthe campaign were more favourable towardseach of the statements. However, due to thesmall sample size, the difference betweenthose aware and unaware of the campaignwas significant for one statement only:‘governments should regulate the type ofchemicals and additives used in themanufacturing of cigarettes’ (91.0% vs77.2%, p¼0.02).Tobacco companies are highly unlikely tomodify their products to reduce the addictivenature of cigarettes.5 Hence regulation isrequired to end the use of additives thatcreate the perception that tobacco smoke ismilder, easier to inhale and more palatable,which would ultimately make cigarettes lessacceptable to smokers.9This survey reinforces the findings of theCommonwealth Department of Health andAgeing research on disclosure of cigaretteingredients,7 and demonstrates strongsupport among smokers for increased regu-lation and disclosure on the ingredientspermitted in cigarettes. It also highlights theimportance of educating smokers about theuse of additives in cigarettes and canvassingconsumer opinions to lobby for theseimportant regulations.Narelle J Heydon,1 Kelly S Kennington,1Geoffrey Jalleh,2 Chad Lin21Cancer Council Western Australia, Perth, Australia;2Centre for Behavioural Research in Cancer Control,Curtin University, Perth, AustraliaCorrespondence to Narelle Heydon, Cancer CouncilWestern Australia, 15 Bedbrook Place, Shenton Park6008, Western Australia; nheydon@cancerwa.asn.auFunding Cancer Council Western Australia contractedthe Centre for Behavioural Research in Cancer Control tocomplete this evaluation.Competing interests None.Contributors NJH drafted the first version of the article.KSK revised the article based on feedback fromreviewers. GJ and CL provided assistance in drafting thearticle, and conducted the research on behalf of CancerCouncil Western Australia.Provenance and peer review Not commissioned;externally peer reviewed.Accepted 16 November 2011Published Online First 14 December 2011Tobacco Control 2012;21:381e382.doi:10.1136/tobaccocontrol-2011-050302REFERENCES1. Chapman S. “Keep a low profile”: pesticide residue,additives, and freon use in Australian tobaccomanufacturing. Tob Control 2003;12(Suppl III):iii45e53.2. Gray N. The need for tobacco regulation. Tob Control2006;15:145.3. Bates C, Jarvis M, Connolly GN. Tobacco Additives:Cigarette Engineering and Nicotine Addiction. Action onSmoking and Health, UK, 1999. http://www.ash.org.uk/files/documents/ASH_623.pdf (accessed 17 Sep2010).4. Carter S, Chapman S. Smokers and non-smokers talkabout regulatory options in tobacco control. TobControl 2006;15:398e404. http://www.cancerwa.asn.au/prevention/tobacco/makesmokinghistory/tvcampaigns/5. Henningfield JE, Benowitz NL, Connolly GN, et al.Reducing tobacco addiction through tobacco productregulation. Tob Control 2004;13:132e5.6. Department of Health and Ageing. AustralianCigarette Ingredient Disclosure. Commonwealth ofAustralia. 2010. http://www.health.gov.au/internet/main/publishing.nsf/Content/tobacco-ingred (accessed17 Sep 2010).7. Ipsos-Eureka Social Research Institute. PublicHealth Value of Disclosed Cigarette Ingredients andEmissions Data. Prepared for the Department of Healthand Ageing. 2009. http://www.health.gov.au/internet/main/publishing.nsf/Content/phd-tobacco-phv-cig-ing-em-data (accessed 16 Sep 2010).8. Cancer Council Western Australia. Make SmokingHistory Television Campaigns, 2009. http://www.cancerwa.asn.au/prevention/tobacco/makesmokinghistory/tvcampaigns/ (accessed 16 Sep 2010).9. Sullivan D. Is an end to smoking in sight? Nextsteps toward making smoking history. In: CancerCouncil Western Australia. The Progress of TobaccoControl in Western Australia: Achievements,Challenges and Hopes for the Future. Perth, WesternAustralia: Cancer Council Western Australia,2008:129e39.Table 1 Smokers’ attitudes towards the use and disclosure of chemicals and additives incigarettesStronglyin favour In favour No opinion AgainstStronglyagainst Total% % % % % %Governments should regulate thetype of chemicals and additives usedin the manufacturing of cigarettes74 15 8 2 2 100Governments should ban the use ofchemicals and additives that maskthe bitter taste of cigarette smoke68 12 10 6 5 100Tobacco companies should providemore information to consumersabout what is in cigarettes andcigarette smoke66 13 14 6 2 100Tobacco companies should provideinformation to consumers about theeffects on smokers of the chemicalsand additives in cigarettes andcigarette smoke62 22 10 4 2 100382 Tobacco Control May 2012 Vol 21 No 3Research letters group.bmj.com on May 16, 2012 - Published by tobaccocontrol.bmj.comDownloaded from doi: 10.1136/tobaccocontrol-2011-0503022011 2012 21: 381-382 originally published online December 14,Tob Control Narelle J Heydon, Kelly S Kennington, Geoffrey Jalleh, et al. and additives in cigaretteschemicalssupport regulations on the use of Western Australian smokers strongly http://tobaccocontrol.bmj.com/content/21/3/381.2.full.htmlUpdated information and services can be found at: These include:References http://tobaccocontrol.bmj.com/content/21/3/381.2.full.html#ref-list-1This article cites 4 articles, 4 of which can be accessed free at:serviceEmail alertingthe box at the top right corner of the online article.Receive free email alerts when new articles cite this article. Sign up inNotes http://group.bmj.com/group/rights-licensing/permissionsTo request permissions go to: http://journals.bmj.com/cgi/reprintformTo order reprints go to: http://group.bmj.com/subscribe/To subscribe to BMJ go to: group.bmj.com on May 16, 2012 - Published by tobaccocontrol.bmj.comDownloaded from 

Western Australian smokers strongly support regulations on the use of chemicals and additives in cigarettes

https://espace.curtin.edu.au/bitstream/20.500.11937/18313/2/189148_71649_Western_Australian_smokers_strongly_support.pdf

Western Australian smokers strongly support regulations on the use of chemicals and additives in cigarettes

Abstract

Similar works

Full text

Available Versions

espace@Curtin