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Types of structural reforms to taxes: Equivalent taxation (i.e., universal rate of duty is applied per gram of tobacco); multi-rate tax structure (i.e., uses different tax rates dependent on product type or strengths (e.g., scaled volumetric taxation, strength-related tax tiers and a duty band for heated tobacco products); supplementary tax; international harmonisation (e.g., ensure factory-made and hand-rolled equivalence and minimum excise levels).
What we know: Equivalent taxation, multi-rate tax structures and supplementary taxation for tobacco are suggestive of beneficial effects (Hatchard et al., 2023). There have been moves toward equivalent taxation (per gram) structure to harmonise tobacco product duty rates, but no evaluations of the effects of harmonisation were identified in the review by Hatchard et al., (2023). Supplementary taxation, such as through a consequential impact tax on the purchase price of tobacco, appears to be an effective approach for generating additional state revenue from the taxation of tobacco products (Hatchard et al., 2023).
Examples of implemenation: Hatchard et al., (2023) cite a modelling study that indicated that a 2.5% consequential impact tax on the purchase price of tobacco could raise £0.45bn on tobacco products in the UK.
Types of identified restrictions: comprehensive tobacco marketing legislation that include that restriction of price promotions; standalone legislation that restricts price promotions on tobacco products, which could involve banning or restricting tobacco product coupons, value-added promotions (e.g., multipack discounts or cross-product promotions) and/or buy-down programmes (i.e., retailers lower prices by set amount agreed with manufacturer, tracks number of given discounts and then manufactuerer reimbuses the retailer after end of promotion period).
What we know: Approaches to restricting price promotions on tobacco products have either been part of comprehensive tobacco control legislative efforts or standalone policies targeting certain price promoting mechanisms (Golden et al., 2016). There is limited evidence of the effects of price promotion restrictions on tobacco use, but there is evidence to suggest that stronger price promotion restriction policies can decrease awareness of promotion offers, which could impact consumption and sales of tobacco (Golden et al., 2016).
Types of identified levies: levies against manufacturers or retailers of tobacco products as a percentage of revenue or profit in addition to excise duty and VAT (e.g., 15% tax on industry spend on advertising and sponsorship; 13% tax on large retailers selling alcohol and tobacco products); surcharge on corporation tax; profit-based levy; revenue-based levy (e.g., fee per stick or proportion of total sales revenue by company; filled tax revenue levy.
What we know: Real-world evidence of efficacy was noted as limited, but cited modelling results indicate potential for disincentivising industry marketing spend and raising state revenue that could be hypothecated for health purposes (Hatchard et al., 2023).
Types of identified restrictions: bans and/or restrictions to advertising, promotion and/or marketing of tobacco and/or vaping products.
What we know: Well-established evidence indicates that exposure to tobacco industry advertising can negatively impact health through increasing appeal, purchasing and/or consumption of tobacco (Brown et al., 2014a; Brown et al., 2014b; Wilson et al., 2012). Evidence supports the use of comprehensive, mandatory bans on tobacco advertising and sponsorship (Brown et al., 2014a; Brown et al., 2014b; Wilson et al., 2012). Multi-component tobacco control policy action involving increased tobacco taxes, clean indoor air laws, advertisment bans and labelling is highly cost-effective (Singh et al., 2018). There is limited but suggestive evidence of efficacy of implemented advertsing bans or restrictions on smoking prevelance, with effect direction and size influenced by the type of bans/restrictions in place and challenges around assessing the independent effects of these interventions in the real-world environment (Wilson et al., 2012). There is limited evidence on the impact of vaping marketing and adertising practice in the point-of-sale environments of vape shops and more traditional tobacco retailers (e.g., convenience stores, gas stations) on youth use of these products (O'Connell and Kephart, 2020).
Types of identified policies: training psychiatric staff to deliver smoking cessation services to those who smoke; training managers about their roles and responsibilities in responding to violations.
What we know: Matthes et al., (2023) identified five types of countermarketing activities against tobacco industry interference: exposing harmful industry practices and false claims, accessing political decision-makers, generating and using scientific evidence, use of legal tools (e.g., filing complaints) and mobilising coalitions of potential supporters. Effective examples of counterstrategies were characterised by increased public awareness of tobacco industry wrongdoing, generated community support for tobacco control measures and greater pressure on political and legal desicion-makers (Matthes et al., 2023).
Examples of implementation: Matthes et al., (2023) reports on several case examples of national and local level displays of counterstrategy activities to tackle tobacco industry interference. One cited example of evidence mobilisation at the local level can be seen within a case from California, in which the American Cancer Society conducted a survey to illustrate public support for smoke-free bars admist legal efforts by the tobacco industry to get California's smoke-free bar legislation repealed (Matthes et al., 2023).
Types of identified stakeholders: young people, community organisations, leading public figures, prominent national and international lawyers, senior religious leaders and government stakeholders.
What we know: Matthes et al., (2023) identified five types of counterstrategies activities against tobacco industry interference: exposing harmful industry practices and false claims, accessing political decision-makers, generating and using scientific evidence, use of legal tools (e.g., filing complaints) and mobilising coalitions of potential supporters. Effective examples of counterstrategies were characterised by increased public awareness of tobacco industry wrongdoing, generated community support for tobacco control measures and greater pressure on political and legal desicion-makers (Matthes et al., 2023).
Examples of implementation: Within the review from Matthes et al., (2023), there were some innovative, locally implemented approaches of engaging with citizens and communities around tobacco and smoking but no efficacy data was reported. These approaches included: pro-tobacco control coalitions collaborating with potential supporters (young people, civil society organisations, public figures, religious leaders, government stakeholders, prominent lawyers etc.); policy champion groups (example in Kansas City, Missouri (USA)) that connect different stakeholder groups including media coalitions, pbulic health agencies, policymakers and others to drive forward non-smoker rights and smoke-free policies; and development of community enforcement groups/task forces to help enforce smoke-free policies, such as the Beijing (China) Tobacco Control Association’s ‘Complaint Map’ – users can report violations of smoke-free policies via messaging app and recruit tobacco control volunteers to help respond to violations.
What we know: E-cigarettes or vapes have been classified in different ways across regulatory contexts, commonly as either general consumer products, tobacco products or medical products, which has shaped the ways subsequent regulation, policies and restrictions have and can be developed (O'Connell and Kephart, 2020).
Examples of implementation: Within the US, vapes have been defined as tobacco products in the federal context, which has dictated the types of regulatory measures available, but at the same time, there have been cases were state and local government have sought more comprehensive legislation (O'Connell and Kephart, 2020). The states of New Jersey, New Hampshire and California have developed their own definitions of vaping products in order to develop policies for restricting youth access, and Oregon has classifed e-cigarettes under 'inhalent delivery systems' (i.e., devices that can deliver nicotine or cannabinoids via vapor/aerosol to person inhaling from device) within its Indoor Clean Air Act (O'Connell and Kephart, 2020).