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 Smokefree Air Counter Marketing Price Treatment
Conceptual Model of Factors Influencing Trends in Adolescent Smoking United States, 1975-2001 PERCENT 45 40 35 30 25 20 15 10 5 0 1975197719791981 198319851987 1989 1991 1993 1995199719992001 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* NUMBER OF STATES 50 45 40 35 30 25 20 15 10 5 0 Extensive Moderate Basic Nominal 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 NUMBER OF STATES 30 25 20 15 10 5 14 Priv WS, restaurants, & bars S-F Restaurants & bars S-F Private WS & restaurants S-F Private worksites smoke free Restaurants smoke free 2+ sites smoke free 1 site smoke free 18 19 15 15 19 20 21 24 25 26 27 29 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 24 th, 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
Air Quality Over Time in a Western New York Bar Respirable Suspended Particles (µg/m 3 of PM2.5) 450 400 350 300 250 200 150 100 50 0 11:41 PM 11:46 PM 11:51 PM 11:56 PM 12:01 AM 12:06 AM 12:11 AM 12:16 AM July 18th Normal Smoking Night July 23rd Limited Smoking Night July 24th New Law in Effect at Midnight, Smoking Stops 12:21 AM 12:26 AM 12:31 AM 12:36 AM 12:41 AM 12:46 AM 12:51 AM 12:56 AM 1:01 AM 1:06 AM 1:11 AM
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 PM2.5) 1,400 1,200 1,000 800 600 400 200 0-84.2% -94.8% Bar Bar -96.2% Bar -90.8% Bar -72.9% Bar -95.4% Bar -98.1% Bar Bar/Restaurant -97.6% Bar/Restaurant -89.3% Bar/Restaurant Before July 24th, 2003 Average = 412 µg/m3 After July 24th, 2003 Average = 34 µg/m3-86.0% Bar/Restaurant -84.0% Bar/Restaurant -98.3% Bar/Restaurant -80.4% -97.6% Restaurant
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 Perc 100 90 80 70 60 50 40 30 20 10 0 96 89 84 73 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 Total Tax for a Pack of Cig 150.0 140.0 130.0 120.0 110.0 100.0 90.0 80.0 70.0 60.0 50.0 40.0 30.0 20.0 KY VA CA 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. HI NY AK r 2 = 0.942 ß = 0.723 P < 0.001 N = 51
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 Quitting Reduction in prevalence Price Increase Switch to discount brands Switch to cheaper sources (e.g., Internet, Indian reservations, Freddy s van )??? More efficient smoking (e.g., smoking more of cig, deeper breaths, less time out of mouth) Possible reduction in 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 60 40 25% report buy most of their cigarettes from the Internet, phone, another state or Indian reservation 38 56 21 20 0 1 3 1 0 0 0 1 Phone Internet Another State Indian Reservation Convenience 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 80 78 % 60 40 55 51 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
$2.50 Michigan Real Price ($) $2.00 $1.50 $1.00 $0.50 $0.00 ACCRA TI Scanner 1982 1984 1986 1988 1990 1992 1994 1996 1998 2000
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 MayaTech ImpacTeen NCI & CDC Andrew Hyland - RPCI Mark Travers - RPCI Michael Cummings - RPCI Russ Sciandra -CTFNY Harlan Juster NYS DOH Price Data Frank Chaloupka UIC Sherry Emery UIC ImpacTeen Andrew Hyland RPCI Mike Cummings RPCI RTI Matthew Farrelly PUP Enforcement Cindy Tworek RPCI ImpacTeen