Brett R. Loomis

Declines in Hospital Admissions for Acute Myocardial Infarction in New York State After Implementation of a Comprehensive Smoking Ban

OBJECTIVESnReductions in exposure to environmental tobacco smoke have been shown to attenuate the risk of cardiovascular disease. We examined whether the 2003 implementation of a comprehensive smoking ban in New York State was associated with reduced hospital admissions for acute myocardial infarction and stroke, beyond the effect of moderate, local and statewide smoking restrictions, and independent of secular trends.nnnMETHODSnWe analyzed trends in county-level, age-adjusted, monthly hospital admission rates for acute myocardial infarction and stroke from 1995 to 2004 to identify any association between admission rates and implementation of the smoking ban. We used regression models to adjust for the effects of pre-existing smoking restrictions, seasonal trends in admissions, differences across counties, and secular trends.nnnRESULTSnIn 2004, there were 3813 fewer hospital admissions for acute myocardial infarction than would have been expected in the absence of the comprehensive smoking ban. Direct health care cost savings of

A Comprehensive Examination of the Influence of State Tobacco Control Programs and Policies on Youth Smoking

56 million were realized in 2004. There was no reduction in the number of admissions for stroke.nnnCONCLUSIONSnHospital admission rates for acute myocardial infarction were reduced by 8% as a result of a comprehensive smoking ban in New York State after we controlled for other relevant factors. Comprehensive smoking bans constitute a simple, effective intervention to substantially improve the publics health.

Point of purchase cigarette promotions before and after the Master Settlement Agreement: exploring retail scanner data

OBJECTIVESnWe examined the influence of tobacco control policies (tobacco control program expenditures, smoke-free air laws, youth access law compliance, and cigarette prices) on youth smoking outcomes (smoking susceptibility, past-year initiation, current smoking, and established smoking).nnnMETHODSnWe combined data from the 2002 to 2008 National Surveys on Drug Use and Health with state and municipality population data from the US Census Bureau to assess the associations between state tobacco control policy variables and youth smoking outcomes, focusing on youths aged 12 to 17 years. We also examined the influence of policy variables on youth access when these variables were held at 2002 levels.nnnRESULTSnPer capita funding for state tobacco control programs was negatively associated with all 4 smoking outcomes. Smoke-free air laws were negatively associated with all outcomes except past-year initiation, and cigarette prices were associated only with current smoking. We found no association between these outcomes and retailer compliance with youth access laws.nnnCONCLUSIONSnSmoke-free air laws and state tobacco control programs are effective strategies for curbing youth smoking.

The association of retail promotions for cigarettes with the Master Settlement Agreement, tobacco control programmes and cigarette excise taxes

Background: Evidence indicates that point of purchase (POP) advertising and promotions for cigarettes have increased since the Master Settlement Agreement (MSA). Retail promotions have the potential to offset the effects of cigarette tax and price increases and tobacco control programmes. Objective: To describe the trend in the proportion of cigarette sales that occur as part of a POP promotion before and after the MSA. Design: Scanner data were analysed on cigarette sales from a national sample of grocery stores, reported quarterly from 1994 through 2003. The proportion of total cigarette sales that occurred under any of three different types of POP promotions is presented. Results: The proportion of cigarettes sold under a POP promotion increased notably over the sample period. Large increases in promoted sales are observed following implementation of the MSA and during periods of sustained cigarette excise tax increases. Conclusions: The observed pattern of promoted cigarette sales is suggestive of a positive relationship between retail cigarette promotions, the MSA, and state cigarette tax increases. More research is needed to describe fully the relationship between cigarette promotions and tobacco control policy.

Influence of Tobacco Displays and Ads on Youth: A Virtual Store Experiment

Background: Retail stores are the primary medium for marketing cigarettes to smokers in the US. The prevalence and characteristics of cigarette retail advertising and promotions have been described by several investigators. Less is known about the proportion of cigarette sales occurring as part of a retail promotion and about the effects of tobacco control policies on cigarette promotions. Objective: To estimate the effect of the Master Settlement Agreement (MSA), state tobacco control programme funding and cigarette taxes on retail promotions for cigarettes in supermarkets in the US. Outcome measures: Proportion of cigarette sales occurring under a retail promotion and the value of multipack promotions (eg, buy one pack, get one pack free) and cents-off promotions, measured using scanner data in supermarkets from 50 retail market areas from 1994 to 2004. Results: Promoted cigarette sales have increased significantly since the MSA (p<0.01), and are higher in market areas with high tobacco control programme funding (p<0.01) and high cigarette tax (p<0.01). The value of a multipack promotion is higher since the MSA (p<0.01) and in market areas with high cigarette tax (p<0.01). The value of a cents-off promotion is negatively related to the MSA (p<0.01), with mixed results for tobacco control programme funding (p<0.05), and is unassociated with tax. Conclusions: Higher promoted cigarette sales and increased promotional values in market areas with strong tobacco control policies, compared with market areas with weaker tobacco control policies, may partially offset the decline in smoking achieved in those areas.

Influence of Point-of-Sale Tobacco Displays and Graphic Health Warning Signs on Adults: Evidence From a Virtual Store Experimental Study

OBJECTIVE: To examine the potential impact of banning tobacco displays and ads at the point of sale (POS) on youth outcomes. METHODS: An interactive virtual convenience store was created with scenarios in which the tobacco product display at the POS was either openly visible (status quo) or enclosed behind a cabinet (display ban), and tobacco ads in the store were either present or absent. A national convenience sample of 1216 youth aged 13 to 17 who were either smokers or nonsmokers susceptible to smoking participated in the study. Youth were randomized to 1 of 6 virtual store conditions and given a shopping task to complete in the virtual store. During the shopping task, we tracked youth’s attempts to purchase tobacco products. Subsequently, youth completed a survey that assessed their perceptions about the virtual store and perceptions about the ease of buying cigarettes from the virtual store. RESULTS: Compared with youth in the status quo condition, youth in the display ban condition were less aware that tobacco products were for sale (32.0% vs 85.2%) and significantly less likely to try purchasing tobacco products in the virtual store (odds ratio = 0.30, 95% confidence interval = 0.13−0.67, P < .001). Banning ads had minimal impact on youth’s purchase attempts. CONCLUSIONS: Policies that ban tobacco product displays at the POS may help reduce youth smoking by deterring youth from purchasing tobacco products at retail stores.

Influence of Retail Cigarette Advertising, Price Promotions, and Retailer Compliance on Youth Smoking-Related Attitudes and Behaviors:

OBJECTIVESnWe tested the impact of banning tobacco displays and posting graphic health warning signs at the point of sale (POS).nnnMETHODSnWe designed 3 variations of the tobacco product display (open, enclosed [not visible], enclosed with pro-tobacco ads) and 2 variations of the warning sign (present vs absent) with virtual store software. In December 2011 and January 2012, we randomized a national convenience sample of 1216 adult smokers and recent quitters to 1 of 6 store conditions and gave them a shopping task. We tested for the main effects of the enclosed display, the sign, and their interaction on urge to smoke and tobacco purchase attempts.nnnRESULTSnThe enclosed display significantly lowered current smokers (Bu2009=u2009-7.05; 95% confidence interval [CI]u2009=u2009-13.20, -0.91; Pu2009<u2009.05) and recent quitters (Βu2009=u2009-6.00, 95% CIu2009=u2009-11.00, -1.00; Pu2009<u2009.01) urge to smoke and current smokers purchase attempts (adjusted odds ratiou2009=u20090.06; 95% CIu2009=u20090.03, 0.11; Pu2009<u2009.01). The warning sign had no significant main effect on study outcomes or interaction with enclosed display.nnnCONCLUSIONSnThese data show that POS tobacco displays influence purchase behavior. Banning them may reduce cues to smoke and unplanned tobacco purchases.

Association of indoor smoke-free air laws with hospital admissions for acute myocardial infarction and stroke in three states.

CONTEXTnExposure to retail tobacco marketing is associated with youth smoking, but most studies have relied on self-reported measures of exposure, which are prone to recall bias.nnnOBJECTIVEnTo examine whether exposure to retail cigarette advertising, promotions, and retailer compliance is associated with youth smoking-related outcomes using observational estimates of exposure.nnnDESIGNnData on retail cigarette advertising and promotions were collected from a representative sample of licensed tobacco retailers in New York annually since 2004. County-level estimates of retail cigarette advertising and promotions and retailer compliance with youth access laws were calculated and linked to the New York Youth Tobacco Survey, administered to 54,671 middle and high school students in 2004, 2006, and 2008. Regression models examined whether cigarette advertising, promotions, and retailer compliance were associated with youths awareness of retail cigarette advertising, attitudes about smoking, susceptibility to smoking, cigarette purchasing behaviors, and smoking behaviors.nnnRESULTSnLiving in counties with more retail cigarette advertisements is associated with youth having positive attitudes about smoking (odds ratio [OR] = 1.10, 95% confidence interval [CI] = 1.03-1.19, P < .01). Living in counties with more retail cigarette promotions is associated with youth current smoking (OR = 1.57, 95% CI = 1.01-2.44, P < .05). Living in counties with higher retailer compliance with youth access laws is associated with higher odds of youth being refused cigarettes when attempting to buy in stores (OR = 1.12, 95% CI = 1.01-1.25, P < .05) and lower odds of retail stores being youths usual source of cigarettes (OR = 0.88, 95% CI = 0.80-0.97, P < .01).nnnCONCLUSIONSnStrong retailer compliance programs and policies that eliminate cigarette advertising and promotions may help reduce youth smoking.

Do Increases in Cigarette Prices Lead to Increases in Sales of Cigarettes with High Tar and Nicotine Yields

Objective. To examine whether comprehensive smoke-free air laws enacted in Florida, New York, and Oregon are associated with reductions in hospital admissions for acute myocardial infarction (AMI) and stroke. Methods. Analyzed trends in county-level, age-adjusted, hospital admission rates for AMI and stroke from 1990 to 2006 (quarterly) for Florida, 1995 to 2006 (monthly) for New York, and 1998 to 2006 (monthly) for Oregon to identify any association between admission rates and passage of comprehensive smoke-free air laws. Interrupted time series analysis was used to adjust for the effects of preexisting moderate local-level laws, seasonal variation in hospital admissions, differences across counties, and a secular time trend. Results. More than 3 years after passage of statewide comprehensive smoke-free air laws, rates of hospitalization for AMI were reduced by 18.4% (95% CI: 8.8–28.0%) in Florida and 15.5% (95% CI: 11.0–20.1%) in New York. Rates of hospitalization for stroke were reduced by 18.1% (95% CI: 9.3–30.0%) in Florida. The few local comprehensive laws in Oregon were not associated with reductions in AMI or stroke statewide. Conclusion. Comprehensive smoke-free air laws are an effective policy tool for reducing the burden of AMI and stroke.

Trends in Cigarette Advertising, Price-Reducing Promotions, and Policy Compliance in New York State Licensed Tobacco Retailers, 2004 to 2015

We used scanner data on cigarette prices and sales collected from supermarkets across the United States from 1994 to 2004 to test the hypothesis that cigarette prices are positively correlated with sales of cigarettes with higher tar and nicotine content. During this period the average inflation-adjusted price for menthol cigarettes increased 55.8%. Price elasticities from multivariate regression models suggest that this price increase led to an increase of 1.73% in sales-weighted average tar yields and a 1.28% increase in sales-weighted average nicotine yields for menthol cigarettes. The 50.5% price increase of nonmenthol varieties over the same period yielded an estimated increase of 1% in tar per cigarette but no statistically significant increase in nicotine yields. An ordered probit model of the impact of cigarette prices on cigarette strength (ultra-light, light, full flavor, unfiltered) offers an explanation: As cigarette prices increase, the probability that stronger cigarette types will be sold increases. This effect is larger for menthol than for nonmenthol cigarettes. Our results are consistent with earlier population-based cross-sectional and longitudinal studies showing that higher cigarette prices and taxes are associated with increasing consumption of higher-yield cigarettes by smokers.