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									Obtaining and Using Meaningful
Tobacco Control Policy Measures

               Gary Giovino
        Roswell Park Cancer Institute

 National Conference on Tobacco OR Health
           Boston, Massachusetts
            December 11, 2003
          Outline of Presentation

• Conceptual models
• Smoke-free air
   – Legislative coding
   – Environmental measures of RSPs
   – Observational study
• Price
   – Data sources
   – Tax avoidance behaviors
• Possession, use, purchase laws & enforcement
• Summary and lessons learned
Components of Smoking Vaccine
              Conceptual Model of Factors
            Influencing Trends in Adolescent
           Smoking – United States, 1975-2001
           45
           40
           35
           30
 PERCENT




           25
           20
           15
           10
            5
            0
                1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001
                                               YEAR

Data Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys
Smoke-free Air
Restrictiveness Of State Laws Regulating Smoking
      In Public Places – U.S., 1960-2003*
                       50
                                          Extensive
                       45                 Moderate
                                          Basic
                       40                 Nominal
    NUMBER OF STATES




                       35
                       30
                       25
                       20
                       15
                       10
                        5
                        0
                            1960
                                   1964

                                            1970
                                            1971
                                            1972
                                            1973
                                            1974
                                            1975
                                            1976
                                            1977
                                            1978
                                            1979
                                            1980
                                            1981
                                            1982
                                            1983
                                            1984
                                            1985
                                            1986
                                            1987
                                            1988
                                            1989
                                            1990
                                            1991
                                            1992
                                            1993
                                            1994
                                            1995
                                            1996
                                            1997
                                            1998
                                            1999
                                            2000
                                            2001
                                            2002
                                            2003
                                                       YEAR

     Sources: 1989 Surgeon General’s Report, ALA’s SLATI, CDC’s STATE system, MayaTech
     Corporation, Roswell Park Cancer Institute. Note: Includes the District of Columbia;
     * 2003 data are represented for the first three quarters of the year.
                   Smoke-Free Air Legislation in the 50 States and the
                    District of Columbia -- United States, 1991-2003
                   30                                                                                              29
                               Priv WS, restaurants, & bars S-F                                              27
                               Restaurants & bars S-F                                                 26
                               Private WS & restaurants S-F                                    25
                   25          Private worksites smoke free                             24
                               Restaurants smoke free
                               2+ sites smoke free                              21
NUMBER OF STATES




                               1 site smoke free                  19      20
                   20                                        19
                                                    18


                                   15      15
                   15    14



                   10



                    5



                    0
                        1991      1992    1993     1994    1995   1996   1997   1998   1999   2000   2001   2002   2003
                                                                         YEAR

Sources:                   ALA’s SLATI, CDC’s STATE system, the MayaTech Corp., and the Roswell Park Cancer Institute.
 Percent of Employed Persons who Work in
 Smoke-free Work Places: United States and
 Selected States, 1992-1993 and 2001/2002
                             92/93 (%)             01/02 (%) % Change
National                       47.4                  72.1                   + 52.2
High States
      Utah                     67.0                  86.9                   + 29.7
      Mass.                    48.2                  82.0                   + 70.0
      Maine                    56.4                  81.5                   + 44.5
Low States
      Nevada                   34.3                  51.0                  + 48.7
      Kentucky                 30.4                  61.8                  +103.4
      Hawaii                   47.2                  62.4                  + 32.1
   Source: : NCI Tobacco Use Supplement to the Current Population Survey Series. In 2001-02
   CDC joined NCI in co-sponsoring the Supplement.
           Information Sources

• Legislative Coding:
   – ImpacTeen: http://www.ImpacTeen.org/tobaccodata.htm
   – CDC STATE:
     http://www2.cdc.gov/nccdphp/osh/state/index.htm
   – ALA SLATI: http://slati.lungusa.org/
   – ANR: http://www.no-smoke.org/advo.html
• Model Laws:
   – ANR: http://www.no-smoke.org/advo.html
   – TALC: http://talc.phlaw.org/cgi-bin/pubcgi/publications.cgi
      • (Technical Assistance Legal Center)
  Indoor Air Quality Monitoring
• The air quality in various Western New York venues
  was measured before and after the implementation of
  the New York State Clean Indoor Air Law
• The air in 18 venues allowing smoking, including 7
  bars, 7 restaurants, 2 bowling alleys, a pool hall and a
  bingo hall, was sampled in the month before the law
  and again within three months after the law went into
  effect on July 24th, 2003
• Air sampling before and after the law was done on the
  same day of the week and at approximately the same
  time of day
 Measuring Fine Particles in the Air
• TSI SidePak AM510
  Personal Aerosol Monitor
• The concentration of
  respirable suspended
  particles (RSP), or
  particles small enough to
  be easily inhaled deep into
  the lungs, was used as an
  indicator of air quality
• This instrument measures
  and records in memory the
  real-time concentration of
  RSP’s
       Respirable Suspended Particles (μg/m3 of PM2.5)




           0
               50
                    100
                          150
                                200
                                      250
                                            300
                                                                                         350
                                                                                                                                 400
                                                                                                                                                                        450




11:41 PM
11:46 PM
11:51 PM
11:56 PM
12:01 AM
12:06 AM
12:11 AM
12:16 AM
12:21 AM
12:26 AM
12:31 AM
12:36 AM
                                              Smoking Stops




12:41 AM
12:46 AM
12:51 AM
12:56 AM
                                                                                                                                       July 18th Normal Smoking Night

                                                                                               July 23rd Limited Smoking Night




 1:01 AM
 1:06 AM
                                              July 24th New Law in Effect at Midnight,




 1:11 AM
                                                                                                                                                                              Air Quality Over Time in a Western New York Bar
 Change in Air Quality in Western New York Bars and
Restaurants After Implementation of the New York State
                 Clean Indoor Air Law
                                                    1,600
Respirable Suspended Particles (μg/m 3 of PM 2.5)




                                                                                                                                             Before July 24th, 2003
                                                                      -96.2%
                                                    1,400                                                                                    Average = 412 μg/m3
                                                                                                                                             After July 24th, 2003
                                                    1,200                                                                                    Average = 34 μg/m3

                                                    1,000


                                                     800
                                                                                                -98.1%
                                                                                         -95.4%                                     -86.0%
                                                     600
                                                                                                           -97.6%
                                                               -94.8%       -90.8%
                                                     400 -84.2%                                                                                               -98.3%
                                                                                                                                                                                     -97.6%
                                                                                                                       -89.3%
                                                     200
                                                                                   -72.9%
                                                                                                                                                 -84.0%                    -80.4%
                                                       0




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  Smoke-free Air Observational
             Study
• Observations in a random sample of 259
  hospitality venues throughout New York
  State before and after the implementation of
  the statewide SFA law in July 2003
• Restaurants, Bars, and Bowling Facilities
• Measured compliance and other tobacco use
  indicators
         Compliance Rates One Month
            After NY State CIAA
                                          96
         100
                     89
          90                                        84

          80                     73

          70

          60
Percen




          50

          40

          30

          20

          10

           0

               All Restaurants   Bars   Bowling   Overall
Price
Total Tax for a Pack of Cigarettes (1) and Average Price of a Pack of
              Cigarettes (2) in the United States, 2001

                                                                                                                                    r2 = 0.942
                                             150.0                                                                    NY
                                                                                                                                    ß = 0.723
                                             140.0                                                             HI            AK
                                                                                                                                    P < 0.001
Total Tax for a Pack of Cigarettes (Cents)



                                             130.0

                                             120.0                                                                                  N = 51
                                             110.0

                                             100.0

                                              90.0

                                              80.0

                                              70.0                     CA
                                              60.0

                                              50.0

                                              40.0

                                              30.0       KY   VA

                                              20.0

                                                 270          290    310     330     350     370     390      410      430    450
                                                          Average Price of a Pack of Cigarettes (Cents)

                                                     Note: Tax and price of cigarettes were adjusted for inflation;
                                                           Price of cigarettes included generic cigarettes.
                                                        Cigarette Taxes and Prices, 1970-2003


$3.50


$3.00


$2.50


$2.00


$1.50


$1.00


$0.50


$0.00
        1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003

                                                                                         Year




                                               State Tax Federal Tax Net of Tax Price
           Compensatory Model of Price
                    Effects

       No effect
                                                                           Reduction in
                            Quitting                                       prevalence

                            Switch to discount brands

                                                                                   ???
  Price                     Switch to cheaper sources
                            (e.g., Internet, Indian
Increase
                            reservations, “Freddy’s van”)

                            More efficient smoking (e.g.,                  Possible
                            smoking more of cig, deeper                    reduction in
                            breaths, less time out of mouth)               consumption




       Adapted from: International Tobacco Control Policy Survey Overview, Geoff Fong, PhD,
88+% of NYS’s Population is Within 40
 Miles of a Lower or Untaxed Cigarette
               Source.
Usual Source of Cigarettes: NYS vs. the
      Rest of the US -- Fall 2002.
    100
                        NYS                 Rest of the US


     80
                   25% report buy most of their cigarettes from the
     60            Internet, phone, another state or Indian reservation          56


%
                                                                            38
     40
                                                             21


     20
                               3
               1                             1
                    0              0              0               1

       0
              Phone           Internet   Another State       Indian       Convenience
                                                         Reservation         Store




    ITC Question: “Where do you buy most of your cigarettes? … ”
    Source: International Tobacco Control Policy Evaluation Survey
 Percent of Smokers who Report Regularly
Buying their Cigarettes at Indian Reservations,
       Erie/Niagara Counties, 2002/3.
     100

                                          78
     80


               55
     60                    51

 %

     40



     20



      0
           Overall   Erie County   Niagara County
Sales Taxes and Excise Taxes Not Collected Each
   Year from Current Smokers who Regularly
  Purchase Cigarettes on Indian Reservations*




     *Assuming these smokers buy 50% of the cigarettes that they smoke
     from Indian Reservations and that they smoke 15 cigarettes per day;
     NY State estimate reflects revenue lost from Erie/Niagara residents.
  Sources of Cigarette Price Data
• Secondary Data
  – Tobacco Institute/Orechowski & Walker
  – ACCRA
  – Scanner

• Primary Data
  – Store observation
  – Telephone Surveys
  – Mail Surveys
                                 Real Price ($)




       $0.00
                         $0.50
                                    $1.00
                                            $1.50
                                                    $2.00
                                                            $2.50
19
  82
19
  84
19
  86
19
  88
19
  90
                                                             Michigan




19
  92
19
  94
                          TI




19
  96
                          ACCRA

               Scanner




19
  98
20
  00
Possession, Use, & Purchase
           Laws
                  PUP Laws:
     Possession, use, and purchase (PUP) laws are
      youth access tobacco control policies that
      penalize minors, themselves, for possessing,
      using, and/or purchasing tobacco products

     Recent trends indicate a sharp increase in the
      number of state PUP laws:
       1988: 17 states had enacted at least one PUP law
       2003: 45 states had enacted at least one PUP law

There is little empirical data on the effectiveness
of such laws
               STATE ENFORCEMENT MEASURE
PUP State Enforcement Index: Max total score – 35 pts.
• Level of Enforcement: Max: 2 points (0-2 points)
• State resources provided for local enforcement: Max: 3 points
(0-3 points)

• Predominant pattern of enforcement: Max: 3 points (0-3 points)
• Typical enforcement action(s) taken when violation observed:
Max: 5 points (0-5 points)
• Number of citations issued in state past 12 months: Max: 6
points (0-5 points)
• Typical enforcement penalty/penalties when first-time
violation observed: Max: 5 points (0-5 points)
• Typical enforcement penalty/penalties for second/subsequent
violations: Max: 5 points (0-5 points)
• Publicity related to enforcement during past 12 months: Max: 6
points (0-6 points)
            LOCAL ENFORCEMENT MEASURE
PUP Local Enforcement Index: Max total score – 15 pts.
• Ordinance enforced in community: Max: 1 points (0-1 points)
• Priority of enforcement in community: Max: 4 points (0-4 points)
• Resources for effective enforcement in community: Max: 2
points (0-2 points)
• Predominant pattern of enforcement in community: Max: 2
points (0-2 points)
• Typical enforcement action(s) in community when youth or
minor is caught for tobacco possession: Max: 4 points (0-4 points)
• Parents routinely notified if youth is cited for tobacco
possession: Max: 2 points (0-2 points)
         Summary & Lessons Learned


• Policy effects depend on implementation and are
  influence by adaptive behaviors
• Legislative coding is done best with legal help – can be
  resource intensive; use existing data sources whenever
  possible
• Triangulate data
• Seek out information at the sub-state level (e.g.,
  Current Population Survey, Americans for
  Nonsmokers’ Rights Foundation, Group Against
  Smoking Pollution
                 Acknowledgments

• SFA Data                      • Price Data
  –   MayaTech                    –   Frank Chaloupka – UIC
  –   ImpacTeen                   –   Sherry Emery – UIC
  –   NCI & CDC                   –   ImpacTeen
  –   Andrew Hyland - RPCI
                                  –   Andrew Hyland – RPCI
  –   Mark Travers - RPCI
  –   Michael Cummings - RPCI     –   Mike Cummings – RPCI
  –   Russ Sciandra -CTFNY        –   RTI – Matthew Farrelly
  –   Harlan Juster – NYS DOH   • PUP Enforcement
                                  – Cindy Tworek – RPCI
                                  – ImpacTeen

								
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