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March 13th, 2015:

Would raising tobacco tax in China unfairly burden the poor?

China is home to more than 300 million smokers, a substantial proportion of whom are male and low income, and who consume more than a third of the world’s cigarettes.

More than 1 million premature deaths each year in China are attributable to smoking,1 and the economic cost of smoking amounts to billions of dollars.2

Studies consistently show that raising tax on tobacco is the most cost-effective way to reduce tobacco use,3,4 yet China has so far hesitated to use such strategies in its bid to reduce tobacco use and its consequences. One of the concerns raised by the Chinese State Tobacco Monopoly Administration (STMA) is that a tax increase would lead to an unfair burden on the poor. Under the influence of the STMA, the Chinese government has kept tied tax rates on cigarettes—ie, lower rates on low-end cigarettes so as to keep them affordable for the poor, while generating revenues by taxing premium products at higher rates. However, in many countries, studies have disclosed that a tax increase along with raised tobacco product prices leads to the largest declines in smoking among the lowest income people, and that the burden of tax increase falls more heavily on higher-income consumers whose smoking behaviour changes little in response to the tax increase.5

It is in this context that the findings of a study in The Lancet Global Health6 have important implications for the tobacco tax and price policies in China, a country that has ratified WHO’s Framework Convention on Tobacco Control but has not significantly increased its tobacco excise taxes since 2009.

Stéphane Verguet and colleagues6 attempted to simulate the effect, across income quintiles, of a hypothetical tobacco price increase in China. Specifically, they estimated the health benefits (years of life gained), the additional tax revenues raised, the net financial consequences for households, and the financial risk protection provided to households caused by a 50% increase in cigarette prices through raising cigarette excise tax. Their goal is ambitious given the complex, yet not-well-understood,  mechanisms that link cigarette excise tax and various outcomes examined in this study, and the paucity of evidence to demonstrate the effectiveness of such a strategy in a rapidly changing economy like China’s, which is also the world’s largest tobacco producer and consumer.

The key contribution of this paper lies in its comprehensive exploration of the distributional consequences of increased tobacco taxation in China, a topic of significant policy and public health importance, but which few previous studies have explored. It is a Herculean effort to quantify the distributional effect of a tobacco price increase on public health, government tax revenue, and household financial soundness. While the method—extended cost-effectiveness analysis— used in this study has been validated and used in previous research, a model of such complexity inevitably involves reductions that may seem over-simplified and assumptions that are either unrealistic or not fully supported by existing evidence. For example, one of the key assumptions in this study is that the price elasticity for the low-income group is higher than that for the high-income groups. However, findings from recent studies show a disproportionate number of low-income Chinese smokers engaged in price-reducing purchase behaviours, mitigating the effect of a price increase. In fact, a recent study by ourselves (unpublished) found that the consumption elasticity of cigarettes was close to zero among low-income smokers in China, possibly due to price-reducing behaviours such as brand switching and trading down.

Additionally, the assumption that an increase in tobacco excise tax can be fully passed onto retail prices does not take into account the unique relationship between the tobacco monopoly and the government in China. The 2009 tobacco tax increase in China, for example, was shouldered by the tobacco monopoly.

Moreover, the assumption that there would not be any changes in household income and socioeconomic status after the tobacco price increase seems unrealistic given China’s rapid economic growth in the past few decades.

The increase in household income is one of the reasons that helped fuel the increase in cigarette consumption in China by increasing the affordability of cigarettes.

Employing a simplified model that encompasses various outcomes, which also requires many inputs, is a double edged sword. It can generate powerful predictions, but may also suffer badly when the model inputs are less than perfect.

That being said, the importance of the findings from this study should not be underestimated or shadowed by these potential methodological weaknesses. The key findings that a tobacco tax increase will generate huge health gains, billions of additional government tax revenue, and reduce expenditures on tobacco-related diseases, particularly for the low-income population, are of great policy, public health, and economic significance.

The paper shows that tobacco tax in China can reduce a significant proportion of the global burden of tobacco, and that tobacco tax increases are not necessarily regressive.

*Rong Zheng, Jidong Huang
School of International Trade and Economics, University of International Business and Economics, Beijing, China (RZ);
Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA (JH)

We declare no competing interests.

Copyright © Zheng et al. Open access article distributed under the terms of CC BY.

1 Peto R. Lopez AD. Future worldwide health effects of current smoking patterns. In: Everett Koop C, Pearson CE, Schwarz MR, eds. Critical issues in global health. San Francisco: Jossey-Bass, 2001: 154–61.
2 Yang L, Sung H-Y, Mao Z, et al. Economic costs attributable to smoking in China: update and an 8-year comparison, 2000–2008. Tob Control 2011; 20: 266–72.
3 WHO. WHO technical manual on tobacco tax administration. Geneva: World Health Organization, 2010.
4 Chaloupka FJ, Yurekli A, Fong GT. Tobacco taxes as a tobacco control strategy. Tob Control 2012; 21: 172–80.
5 International Agency for Research on Cancer. IARC handbooks of cancer prevention, tobacco control, volume 14: effectiveness of tax and price policies in tobacco control. Lyon: International Agency for Research onCancer, 2011.
6 Verguet S, Gauvreau CL, Mishra S, et al. The consequences of tobacco tax on household health and finances in rich and poor smokers in China: a cost-effectiveness and modelling analysis. Lancet Glob Health 2015; 3: e206–16.

The consequences of tobacco tax on household health and finances in rich and poor smokers in China

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Secondhand E-Cig Vapor Can Penetrate Paint. What Does That Mean For Your Lungs?

Jenna Birch

The emissions from e-cigarettes are just water vapor, right? Wrong.

The “vapor” emitted from an e-cig is actually not water vapor, but more like an aerosol gas, as the emissions consist of tiny particles that contain nicotine, glycerin/glycols, artificial flavorings and preservatives, among other chemicals, according to a new study from RTI International.

And the warm, humid conditions of the lungs seem to prevent these aerosol particles from evaporating — which is cause for concern. This is just one of the learnings gleaned from an expert panel that convened on Thursday to discuss the latest research in vaping.

The takeaway: E-cigarette emissions — whether you yourself are vaping or if you’re standing next to someone who is — have an immediate effect on your acute lung function.

A big concern is the size of the particles, according to Jonathan Thornburg, Ph.D., author of the study and a senior research engineer and director of Exposure and Aerosol Technology at RTI International. “They are smaller than 1,000 nanometers, 50 times smaller than the width of a human hair,” he says. “They can stay airborne for a long time, and penetrate into the deepest part of our lungs.”

The extremely minute size of the particles actually ups their penetrative powers, which is causing experts to wonder what the impacts will be for tissues inside the body. Stanton Glantz, Ph.D., professor of medicine at University of California, San Francisco and director of the UCSF Center for Tobacco Control Research and Education, says the aerosol particles emitted are so tiny they can actually seep through the paint on painted walls. If you scaled that representation to size, the pores in the paint would look something like Swiss cheese in comparison to the particle size — which might cause imminent problems.

We may see vastly different health effects result from of e-cigarette use than we do from conventional cigarettes. Because they don’t burn anything and there’s a lack of combustion, fewer cancer-causing chemicals are emitted. However, e-cig emissions are still composed of ultra-fine particles with nicotine and numerous other potentially damaging additives. “Even some of the flavorings are dangerous — like cinnamon, if you inhale it, can be quite toxic,” Glantz says. “It’s a different risk profile. Some toxicologists think it’s inappropriate to even compare e-cigarettes to tobacco cigarettes.”

Glantz thinks we may eventually discover more heart-related consequences associated with vaping. “Exposure to the ultra-fine particles inhibits blood vessels to get larger when they need to, and makes platelets sticky, which leads to more heart attacks,” he says. “The particle effects are a big factor. The oxidizing agents also oxidize cholesterol, which leads to heart disease and heart attacks.”

And that doesn’t just go for e-cig emissions. Similar health issues also might result in areas of high air pollution, too. “It’s important to understand that heart attacks are triggered,”Glantz continues. “The ultra-fine particles lead to inflammation, which can actually trigger a heart attack.”

Ultimately, when asked flat-out about safety, the panel concluded that e-cigarettes are probably not as harmful as standard cigarettes. “We know that the level of carcinogens and toxins are lower,”says Thornburg.

That said, there was no endorsement for unending use.

“They’re not as dangerous as cigarettes, but they’re not safe,”Glantz says. “You are better off not using them. The question is how much safer are they than regular cigarettes?”

To put it in better perspective, Glantz also offers this: “They are less toxic than a cigarette, but the cigarette is probably the most toxic consumer product ever designed. It’s a low bar.”

And although many ingredients are regarded as generally safe by the FDA upon ingestion, the effects upon inhalation aren’t well understood or studied, leaving a need for better clarity — especially with the prevalence of e-cigarettes taking off in recent years. Since 2007, e-cig sales have doubled each year, finally reaching the $1 billion mark in 2013.

Roughly 13 percent of adults have tried vaping, one-third of whom had never before smoked conventional cigarettes, according to Annice Kim, Ph.D., a senior social scientist in the Public Health Policy Research Program at RTI. “Eight percent of current tobacco smokers also use e-cigarettes,” says Kim, who is currently tracking vaping trends on social media and among key demographics, like kids and teens.

“The trends are alarming,” she says. “Seventeen percent of 12th graders have used e-cigarettes in the past month. To date, 40 states have prohibited e-cigarette sales to minors, but as of January 1, 2015, only four states have banned e-cigarette use in schools statewide.”

Department of Health, Hong Kong SAR, China: Tobacco Control in HK

NYU – A Global Network University

Experts have called for a ‘turbocharged’ campaign to rid the world of tobacco by 2040

Could the world be smoke-free by 2040? ‘Turbocharged’ global campaign to ban the sale of tobacco could save one billion lives, experts say .Sale of tobacco should be phased out in the next 25 years, experts say .Claim one billion deaths could be averted by the end of the century .United Nations should take a lead role in the ‘turbocharged’ campaign

By Lizzie Parry for MailOnline

Leading experts have called for a ‘turbocharged’ global campaign to make the world tobacco free by 2040.

The sale of tobacco should be phased out within the next 25 years, leading public health researchers have today said.

They claim one billion deaths from smoking could be averted by the end of the century, if action is taken now.

But a global campaign will only work with the support of governments as well as with stronger evidence-based action against the tobacco industry, they warn.

Professors Robert Beaglehole and Ruth Bonita, from the University of Auckland in New Zealand have called on the United Nations to lead efforts against the sale and consumption of tobacco.

They warn that despite the decline of smoking in the developed world, tobacco use is expected to increase in some countries over the next decade, notably in Africa and the Middle East.

With global population rising, there could still be more than a billion people smoking in 2025 unless urgent action is taken, it is claimed.

The call to arms in the fight against smoking comes in a series of articles published in the Lancet medical journal and will be launched at the World Conference on Tobacco and Health being held in Abu Dhabi, United Arab Emirates.

Professor Beaglehole, said: ‘The time has come for the world to acknowledge the unacceptability of the damage being done by the tobacco industry and work towards a world essentially free from the legal and illegal sale of tobacco products.

‘A world where tobacco is out of sight, out of mind, and out of fashion – yet not prohibited – is achievable in less than three decades from now, but only with full commitment from governments, international agencies, such as UN and WHO (World Health Organisation), and civil society.