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...on Policy Issues
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www.ProjectCork.org
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Fall 2012
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Does spending more on tobacco control programs make economic sense? An incremental benefit-cost analysis using panel data.
Chattopadhyay S; Pieper DR. Contemporary Economic Policy 30(3): 430-447, 2012. (41 refs.)
This paper presents a benefit-cost analysis of the ongoing, state-level tobacco prevention and control programs in the United States. Using state-level panel data for the years 19912007, the study applies several variants of econometric modeling approaches to estimate the state-level tobacco demand. The paper finds a statistically significant evidence of a sustained and steadily increasing long-run impact of the tobacco control program spending on cigarette demand in states. The study also shows that, if individual states follow the Best Practices funding guidelines, potential future annual benefits of the tobacco control program can be as high as 1420 times the cost of program implementation. Copyright 2012, Wiley-Blackwell.
Effects of alcohol taxes on alcohol-related disease mortality in New York State from 1969 to 2006.
Delcher C; Maldonado-Molina MM; Wagenaar AC. Addictive Behaviors 37(7): 783-789, 2012. (32 refs.)
Objective: The relationship of increased alcohol taxes to reductions in alcohol-related harm is well established. Few studies, however, have examined the effects of sudden decreases in alcohol tax rates or effects of narrow tax changes limited to specific beverage types. In the current study, we: (1) examine whether tax increases on spirits have similar effects in reducing alcohol-related disease mortality as increasing taxes on all types of alcoholic beverages simultaneously, and (2) evaluate effects of beer-specific tax decreases in New York State on mortality. Method: We used a time-series, quasi-experimental research design, including non-alcohol deaths within New York State and other states' rates of alcohol-related disease mortality for comparison. The dataset included 456 monthly observations of mortality in New York State over a 38-year period (1969-2006). We used a random-effects approach and included several other important covariates. Results: Alcohol-related disease mortality declined by 7.0% after a 1990 tax increase for spirits and beer. A spirits-only tax increase (in 1972) was not significantly associated with mortality but a data anomaly increased error in this effect estimate. Small tax decreases on beer between 1996 and 2006 had no measurable effect on mortality. Doubling the beer tax from $0.11 to $0.22 per gallon, a return to New York State's 1990 levels, would decrease deaths by an estimated 250 deaths per year. Conclusions: Excise tax increases on beer and spirits were associated with reductions in alcohol-related disease mortality. Modifying tax rates on a single beverage type does not appear to be as effective as doing so on multiple alcoholic beverages simultaneously. In New York, small decreases in beer taxes were not significantly associated with alcohol-related disease mortality. Copyright 2012, Elsevier Science.
Influencing controlled substance prescribing: Attending and resident physician use of a state prescription monitoring program.
Feldman L; Williams KS; Knox M; Coates J. Pain Medicine 13(7): 908-914, 2012. (19 refs.)
Objective. The purpose of this study is to evaluate the influence of attending physician awareness and utilization of a state prescription monitoring program on resident physician behavior. Design. Twenty-five attending physicians and 70 residents in Emergency Medicine, Internal Medicine, Neurology, Pediatrics, and Psychiatry completed an 11-item questionnaire assessing awareness and utilization of a state prescription drug monitoring program. Results. Residents who used the system had, on average, a higher proportion of supervising attendings using the system; residents required to utilize the system had the highest proportion of attendings using the system. Overall, almost 90% of the physicians who utilized the system did so due to concerns surrounding prescription drug abuse. Over one third of attending physicians reported increasing the quantity or amount of medication prescribed after utilizing the system, while no residents reported similar outcomes. Conclusions. Through the behavioral influence of supervising attending physicians, residents were significantly more likely to utilize the system. If system utilization is desired, attendings should use the system and require resident participation. Copyright 2012, Wiley-Blackwell.
Roadmap to a tobacco epidemic: Transnational tobacco companies invade Indonesia.
Hurt RD; Ebbert JO; Achadi A; Croghan IT. Tobacco Control 21(3): 306-312, 2012. (78 refs.)
Background: Indonesia is the world's fifth largest cigarette market in the world but for decades, transnational tobacco companies (TTCs) have had limited success infiltrating this market, due to their inability to compete in the kretek market. Kreteks are clove/tobacco cigarettes that most Indonesians smoke. Objective: To determine how Phillip Morris International (PMI) and British American Tobacco (BAT) have now successfully achieved a substantial market presence in Indonesia. Methods: We analyzed previously secret, tobacco industry documents, corporate reports on Indonesia operations, the Tobacco Trade press, Indonesia media, and "The Roadmap." Results: Internal, corporate documents from BAT and PMI demonstrate that they had known for decades that kreteks are highly carcinogenic. Despite that knowledge, BAT and PMI now own and heavily market these products, as well as new more westernised versions of kreteks. BAT and PMI used their successful basic strategy of keeping cigarettes affordable by maintaining the social responsibility of smoking and opposing smoke-free workplace laws but in the 21st century, they added the acquisition of and westernisation of domestic kretek manufacturers as an additional strategy. These acquisitions allowed them to assert influences on health policy in Indonesia and to grow their business under current government policy embodied in the 2007-2020 Roadmap of Tobacco Products Industry and Excise Policy which calls for increased cigarette production by 12% over the next 15 years. Conclusion: PMI and Bat have successfully entered and are expanding their share in the Indonesia cigarette market. Despite the obvious and pervasive influence of the tobacco industry on policy decisions, the Indonesian government should ratify the FCTC and implement effective legislation to reduce tobacco consumption and exposure to tobacco smoke and revise the Roadmap to protect future generations of Indonesians. Copyright 2012, BMJ Publishing.
Social media in health - what are the safety concerns for health consumers?
Lau AYS; Gabarron E; Fernandez-Luque L; Armayones M. Health Information Management Journal 41(2): 30-35, 2012. (46 refs.)
Recent literature has discussed the unintended consequences of clinical information technologies (IT) on patient safety, yet there has been little discussion about the safety concerns in the area of consumer health IT. This paper presents a range of safety concerns for consumers in social media, with a case study on YouTube. We conducted a scan of abstracts on 'quality criteria' related to YouTube. Five areas regarding the safety of YouTube for consumers were identified: (a) harmful health material targeted at consumers (such as inappropriate marketing of tobacco or direct-to-consumer drug advertising); (b) public display of unhealthy behaviour (such as people displaying self-injury behaviours or hurting others); (c) tainted public health messages (i.e. the rise of negative voices against public health messages); (d) psychological impact from accessing inappropriate, offensive or biased social media content; and (e) using social media to distort policy and research funding agendas. The examples presented should contribute to a better understanding about how to promote a safe consumption and production of social media for consumers, and an evidence-based approach to designing social media interventions for health. The potential harm associated with the use of unsafe social media content on the Internet is a major concern. More empirical and theoretical studies are needed to examine how social media influences consumer health decisions, behaviours and outcomes, and devise ways to deter the dissemination of harmful influences in social media. Copyright 2012, Health Information Management Association.
Why the Distilled Spirits Industry Council of Australia is not a credible partner for the Australian government in making alcohol policy.
Munro G. Drug and Alcohol Review 31(4): 365-369, 2012. (38 refs.)
In 2008 the Australian government increased the excise rate on ready-to-drink premixed spirits or alcopops by 70% to reduce their attraction to young people. A campaign against the decision was led by the Distilled Spirits Industry Council of Australia, whose members include representatives of the world's largest spirits producers and which aspires to partner the government in making alcohol policy. Distilled Spirits Industry Council of Australia's central thesis appeared to lack substance and sincerity: first, it promoted industry data that were evidently premature and misleading; second, it claimed ready-to-drinks were a safer alternative to the consumption of full-strength spirits because spirits pose a threat to drinkers due to their higher alcoholic content. For spirits producers to concede that drinking spirits is generically hazardous may be unprecedented and contradicts the spirits industry's long-standing opposition to the introduction of health warnings on product labels. Although that admission did not survive the resolution of the case, the effect may be profound, as it might justify the demand for greater control of the labelling and marketing of spirits, and reduce the credibility of spirits producers, and the broader alcohol industry, on matters of policy. Copyright 2012, Wiley-Blackwell.
Change is possible: The history of the international drug control regime and implications for future policymaking.
Paoli L; Greenfield VA; Reuter P. Substance Use & Misuse 47(8): 923-935, 2012. (56 refs.)
The article, based upon an extensive literature review, reconstructs and analyzes the parallel evolution of the international drug control regime and the world opiate market, assessing the impact of the former on the latter until the rise of present-day mass markets. It shows that, since its inception, the regime has focused almost entirely on matters of supply. However, that focus has not always meant "prohibition"; until 1961, the key principle of the regime was "regulation." Given the different forms drug control policy has taken in the past, the authors conclude it may be amenable to new forms in the future. Copyright 2012, Informa Healthcare.
Meta-analyses of seven of the National Institute on Drug Abuse's principles of drug addiction treatment.
Pearson FS; Prendergast ML; Podus D; Vazan P; Greenwell L; Hamilton Z. Journal of Substance Abuse Treatment 43(1): 1-11, 2012. (43 refs.)
Of the 13 principles of drug addiction treatment disseminated by the National Institute on Drug Abuse (NIDA), 7 were meta-analyzed as part of the Evidence-based Principles of Treatment (EPT) project. By averaging outcomes over the diverse programs included in the EPT, we found that 5 of the NIDA principles examined are supported: matching treatment to the client's needs, attending to the multiple needs of clients, behavioral counseling interventions, treatment plan reassessment, and counseling to reduce risk of HIV. Two of the NIDA principles are not supported: remaining in treatment for an adequate period and frequency of testing for drug use. These weak effects could be the result of the principles being stated too generally to apply to the diverse interventions and programs that exist or unmeasured moderator variables being confounded with the moderators that measured the principles. Meta-analysis should be a standard tool for developing principles of effective treatment for substance use disorders. Copyright 2012, Elsevier Science.
The science and practice of medication-assisted treatments for opioid dependence.
Pecoraro A; Ma M; Woody GE. Substance Use & Misuse 47(8): 1026-1040, 2012. (175 refs.)
This paper briefly reviews the evolution of opioid addiction treatment from humanitarian to scientific and evidence-based, the evidence bases supporting major medication-assisted treatments and adjunctive psychosocial techniques, as well as challenges faced by clinicians and treatment providers seeking to provide those treatments. Attitudes, politics, policy, and financial issues are discussed. Copyright 2012, Informa Healthcare.
The effect of comprehensive state tobacco control programs on adult cigarette smoking.
Rhoads JK. Journal of Health Economics 31(2): 393-405, 2012. (45 refs.)
This study is the second to use national survey data to assess the effect of comprehensive state tobacco control programs on adult cigarette smoking. Data are drawn from the Behavioral Risk Factor Surveillance System (1991-2006) and reveal consistent evidence that these programs have a statistically significant effect to reduce prevalence of cigarette smoking among adults. Simulations indicate that had all states spent the CDC recommended level of funding from 1991 to 2006 then cigarette smoking prevalence would have been 1.40-8.07% lower in 2006, translating to between 635,000 and 3.7 million fewer adult cigarette smokers. Copyright 2012, Elsevier Science.
Corporate image and public health: An analysis of the Philip Morris, Kraft, and Nestle Websites.
Smith E. Journal of Health Communication 17(5): 582-600, 2012. (114 refs.)
Companies need to maintain a good reputation to do business; however, companies in the infant formula, tobacco, and processed food industries have been identified as promoting disease. Such companies use their websites as a means of promulgating a positive public image, thereby potentially reducing the effectiveness of public health campaigns against the problems they perpetuate. The author examined documents from the websites of Philip Morris, Kraft, and Nestle for issue framing and analyzed them using Benoit's typology of corporate image repair strategies. All three companies defined the problems they were addressing strategically, minimizing their own responsibility and the consequences of their actions. They proposed solutions that were actions to be taken by others. They also associated themselves with public health organizations. Health advocates should recognize industry attempts to use relationships with health organizations as strategic image repair and reject industry efforts to position themselves as stakeholders in public health problems. Denormalizing industries that are disease vectors, not just their products, may be critical in realizing positive change. Copyright 2012, Taylor & Francis.
Risk assessment of gamma-hydroxybutyric acid (GHB) in the Netherlands.
van Amsterdam JGC; van Laar M; Brunt TM; van den Brink W. Regulatory Toxicology and Pharmacology 63(1): 55-63, 2012. (102 refs.)
The Dutch Minister of Health requested the Coordination point Assessment and Monitoring new drugs (CAM) to re-assess the overall risk of GHB. The present paper is a extended redraft of a state of art report used in the risk evaluation procedure. The prevalence of GHB use is low, but the relative proportion of GHB intoxications compared to other illicit drugs is high resulting in a substantial number of GHB related incidents. In recent years the number of GHB intoxications has increased because many inexperienced users seemed unaware of the potential adverse effects, like 'passing out' upon overdosing, a condition where the user is unconsciousness (or comatose) for several hours. The dependence potential of frequent GHB use is now judged by the CAM to be rather high, but users appear not well informed about this risk. In the Netherlands, last month prevalence of GHB use is relatively low (0.2%) and treatment demand is limited (524 of a total of 76,295 referrals to the addiction treatment services in 2010). So far, no public nuisance or criminality associated with GHB use has been reported. The CAM estimated the overall risk potential of GHB use as moderate to high. The Dutch Minister of Health endorsed this conclusion and decided to upgrade GHB to Schedule I (hard drugs) of the Dutch Opium Act. Copyright 2012, Elsevier Science.
What has fairness got to do with it? Tackling tobacco among Australia's disadvantaged.
O'Brien J; Salmon AM; Penman A. Drug and Alcohol Review 31(5, special issue): 723-726, 2012. (29 refs.)
Issue. While population wide smoking rates are falling steadily the rates remain high among the disadvantaged. The future we face is one where the differentials in smoking rates will continue to widen and will flow through to increased health inequalities. Approach. How best to reduce smoking rates among the disadvantaged? Alongside existing population level initiatives and social policy initiatives is an urgent need for a targeted, comprehensive approach that acknowledges the serious impact of smoking on the disadvantaged. In 2006 Cancer Council NSW embarked on a statewide, multi-component Tackling Tobacco Program to encourage and support non-government social and community services to address smoking among their clients. Key Findings. Tackling Tobacco Program results have shown that the 1600 staff from 400 organisations trained to provide smoking care can attain the knowledge and confidence to address tobacco and that clients are very receptive to receiving quit support from them. Improvements in quality of life for clients who do quit have been encouraging and the Tackling Tobacco Program has challenged assumptions and attitudes that disadvantaged people are uninterested and unable to quit. Implications. Alongside population and social policy approaches must be a serious investment in tackling smoking among the disadvantaged. Conclusions. Tackling Tobacco Program is an innovative example of how to engage disadvantaged smokers, de-normalise smoking and encourage and support quitting using familiar settings. Engaging Australia's large network of social and community services as allies in this work should be vigorously pursued. Copyright 2012, Wiley-Blackwell.
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