Obtaining and Using Meaningful Tobacco Control Policy Measures

National Conference on Tobacco OR HealthBoston, Massachusetts

December 11, 2003

Gary Giovino

Roswell Park Cancer Institute

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

Price

Smoke-free Air

Treatment

CounterMarketing

Components of Smoking Vaccine

Conceptual Model of Factors Influencing Trends in Adolescent

Smoking – United States, 1975-2001

0

5

10

15

20

25

30

35

40

45

1975 1977 1979 1981 1983 1985 1987 1989 1991 1993 1995 1997 1999 2001YEAR

PE

RC

EN

T

Data Source: Institute for Social Research, University of Michigan, Monitoring the Future Surveys

Smoke-free Air

0

5

10

15

20

25

30

35

40

45

5019

60

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

NU

MB

ER

OF

ST

AT

ES

ExtensiveModerateBasicNominal

Restrictiveness Of State Laws Regulating Smoking

In Public Places – U.S., 1960-2003*

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

Sources: ALA’s SLATI, CDC’s STATE system, the MayaTech Corp., and the Roswell Park Cancer Institute.

0

5

10

15

20

25

30

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

YEAR

NU

MB

ER

OF

ST

AT

ES

Priv WS, restaurants, & bars S-FRestaurants & bars S-FPrivate WS & restaurants S-FPrivate worksites smoke freeRestaurants smoke free2+ sites smoke free1 site smoke free

1415 15

18 19 19 2021

2425 26

27

29

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 StatesNevada 34.3 51.0 + 48.7Kentucky 30.4 61.8 +103.4Hawaii 47.2 62.4 + 32.1

Percent of Employed Persons who Work in Smoke-free Work Places: United States and Selected States, 1992-1993 and 2001/2002

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

0

50

100

150

200

250

300

350

400

450

11:4

1 P

M

11:4

6 P

M

11:5

1 P

M

11:5

6 P

M

12:0

1 A

M

12:0

6 A

M

12:1

1 A

M

12:1

6 A

M

12:2

1 A

M

12:2

6 A

M

12:3

1 A

M

12:3

6 A

M

12:4

1 A

M

12:4

6 A

M

12:5

1 A

M

12:5

6 A

M

1:01

AM

1:06

AM

1:11

AMR

es

pir

ab

le S

us

pe

nd

ed

Pa

rtic

les

(μ

g/m

3 o

f P

M2

.5)

July 18th Normal Smoking Night

July 23rd Limited Smoking Night

July 24th New Law in Effect at Midnight,Smoking Stops

Air Quality Over Time in a Western New York Bar

-97.6%

-80.4%

-98.3%

-84.0%

-86.0%

-89.3%

-84.2%-94.8%

-96.2%

-90.8%

-72.9%

-95.4%

-98.1%

-97.6%

0

200

400

600

800

1,000

1,200

1,400

1,600

Re

sp

ira

ble

Su

sp

en

de

d P

art

icle

s (

μg

/m3 o

f P

M2.

5)

Before July 24th, 2003Average = 412 μg/m3

After July 24th, 2003Average = 34 μg/m3

Change in Air Quality in Western New York Bars and Restaurants After Implementation of the New York State

Clean Indoor Air Law

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

89

73

96

84

01020304050

60708090

100

All Restaurants Bars Bowling Overall

Per

cen

Price

20.030.040.050.060.070.080.090.0

100.0110.0120.0130.0140.0150.0

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

Tot

al T

ax for

a P

ack of Cig

arettes (C

ents)

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

Note: Tax and price of cigarettes were adjusted for inflation; Price of cigarettes included generic cigarettes.

r2 = 0.942

ß = 0.723

P < 0.001

N = 51

NY

KY

CA

VA

HI AK

Cigarette Taxes and Prices, 1970-2003

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50

$3.00

$3.50

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

Price Increase

Quitting

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

Reduction in prevalence

???

No effect

Adapted from: International Tobacco Control Policy Survey Overview, Geoff Fong, PhD, 2002.

88+% of NYS’s Population is Within 40 Miles of a Lower or Untaxed Cigarette

Source.

38

0 0 0 1

56

21

131

0

20

40

60

80

100

Phone Internet Another State IndianReservation

ConvenienceStore

%

NYS Rest of the US

Usual Source of Cigarettes: NYS vs. the Rest of the US -- Fall 2002.

ITC Question: “Where do you buy most of your cigarettes? … ”Source: International Tobacco Control Policy Evaluation Survey

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

5551

78

0

20

40

60

80

100

%

Overall Erie County Niagara County

Percent of Smokers who Report Regularly Buying their Cigarettes at Indian Reservations,

Erie/Niagara Counties, 2002/3.

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

Michigan

$0.00

$0.50

$1.00

$1.50

$2.00

$2.50R

eal P

rice

($)

ACCRA

TI

Scanner

Possession, Use, & Purchase Laws

PUP PUP LawsLaws:: Possession, use, and purchase (PUP) laws Possession, use, and purchase (PUP) laws

are are youth access tobacco control policies that youth access tobacco control policies that penalize minors, themselves, for penalize minors, themselves, for

possessing, possessing, using, and/or purchasing using, and/or purchasing tobacco products tobacco products

Recent trends indicate a sharp increase in Recent trends indicate a sharp increase in the the number of state PUP laws:number of state PUP laws:

1988: 17 states had enacted at least one 1988: 17 states had enacted at least one PUP law PUP law 2003: 45 states had enacted at least one 2003: 45 states had enacted at least one PUP lawPUP law

There is little empirical data on the There is little empirical data on the effectiveness of such lawseffectiveness of such laws

PUP State Enforcement IndexPUP State Enforcement Index:: Max total score – Max total score – 35 pts.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)

STATE ENFORCEMENT STATE ENFORCEMENT MEASURE MEASURE

PUP Local Enforcement IndexPUP Local Enforcement Index:: Max total score – Max total score – 15 pts.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)

LOCAL ENFORCEMENT LOCAL ENFORCEMENT MEASURE MEASURE

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