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Canadian Journal of Public Health

, Volume 97, Issue 4, pp 310–315 | Cite as

What Are the Effects of Tobacco Policies on Vulnerable Populations?

A Better Practices Review
  • Lorraine GreavesEmail author
  • Joy Johnson
  • Joan Bottorff
  • Susan Kirkland
  • Natasha Jategaonkar
  • Melissa McGowan
  • Lucy McCullough
  • Lupin Battersby
Article

Abstract

Methods: A better practices review model was used to assess the strength of studies published between 1990 and 2004 that examined the effects of these tobacco policies on the three vulnerable populations of interest. A total of 72 studies were assessed and 42 judged medium or high strength. A gender-based and diversity analysis was applied to assess the differential impacts on females and males and/or diverse characteristics within these populations. Intended and unintended consequences were examined.

Findings: Few studies assessed the potential or differential effects of tobacco policies on the three selected populations. In these, it was difficult to disentangle the effects of each policy in a comprehensive tobacco control environment, and there is need for improved indicators and greater attention to sex and gender analysis.

Conclusions: Research is required to measure the intended and unintended impacts of tobacco policies on populations vulnerable to tobacco use. There are problems in assessing these studies that could be resolved with more precise indicator development. An equity-based framework for assessing the effects of tobacco policies is needed that is conceptually linked to health determinants and inequities. The article concludes with a set of recommendations for research, evaluation, policy and ethics arising from this review.

Background: While comprehensive tobacco policies have reduced the prevalence of smoking in Canada, some groups remain vulnerable to tobacco use and display high rates of smoking. This article reviews three types of tobacco policies - tax and price, smoking location restrictions and sales restrictions - and examines the consequences for Aboriginal people, youth and low-income people.

MeSH Terms

Tobacco policy gender low-income population adolescent Indigenous population 

Résumé

Contexte: Les politiques antitabac intégrées ont réduit la prévalence du tabagisme au Canada, mais certains groupes demeurent vulnérables et affichent des taux de tabagisme élevés. Notre article examine trois types de politiques antitabac (les politiques fiscales et de prix, les politiques de restriction des lieux où il est permis de fumer, et les politiques de restriction des ventes de tabac) et leurs conséquences pour les Autochtones, les jeunes et les personnes à faible revenu.

Méthode: Nous avons utilisé un modèle d’examen des pratiques exemplaires pour évaluer la qualité des études publiées entre 1990 et 2004 portant sur les effets de ces politiques antitabac sur les trois populations vulnérables qui nous intéressent. En tout, nous avons évalué 72 études, dont 42 ont été jugées de qualité moyenne ou bonne. Au moyen d’une analyse de la diversité et de l’égalité, nous avons évalué les répercussions différentes sur les femmes et les hommes et/ou les diverses caractéristiques dans ces populations. Les conséquences prévues et imprévues ont été examinées.

Constatations: Peu d’études évaluent les effets possibles ou différents des politiques antitabac sur les trois populations sélectionnées. Dans ces études, il a été difficile de démêler les effets de chaque politique dans le cadre général de la lutte contre le tabagisme; de plus, il faudrait trouver de meilleurs indicateurs et accorder plus d’attention à l’analyse selon le sexe et à celle des rapports entre les sexes.

Conclusions: Il faudrait pousser la recherche pour mesurer les répercussions prévues et imprévues des politiques antitabac sur les populations vulnérables au tabagisme. Les problèmes d’évaluation des études publiées pourraient être résolus avec des indicateurs plus précis. Il faudrait un cadre d’évaluation des effets des politiques antitabac qui soit fondé sur l’égalité et qui soit conceptuellement lié aux déterminants de la santé et aux inégalités sur le plan de la santé. À la fin de l’article, nous formulons un ensemble de recommandations pour la recherche, l’évaluation, les politiques et les questions éthiques découlant de notre examen.

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References

  1. 1.
    Health Canada. The national strategy: Moving forward. The 2003 progress report on tobacco control. Ottawa, ON: Ministry of Health, 2003.Google Scholar
  2. 2.
    CTUMS. Canadian tobacco use monitoring survey: Summary of results for 2004. Ottawa: Health Canada: Tobacco Control Programme, 2004.Google Scholar
  3. 3.
    Barbeau EM, Leavy-Sperounis A, Balbach ED. Smoking, social class, and gender: What can public health learn from the tobacco industry about disparities in smoking? Tobacco Control 2004;13(2):115–20.PubMedPubMedCentralGoogle Scholar
  4. 4.
    Graham H, Der G. Patterns and predictors of tobacco consumption among women. Health Educ Res 1999;14(5):611–18.PubMedGoogle Scholar
  5. 5.
    Sorensen G, Barbeau E, Hunt MK, Emmons K. Reducing social disparities in tobacco use: A social-contextual model for reducing tobacco use among blue-collar workers. Am J Public Health 2004;94(2):230–39.PubMedPubMedCentralGoogle Scholar
  6. 6.
    Health Canada. 2000–2002 Report on tobacco control. On target. An update. Ottawa: Ministry of Health, 2003.Google Scholar
  7. 7.
    CTUMS. Canadian tobacco use monitoring survey: Summary of results for 2003. Ottawa: Health Canada: Tobacco Control Programme, 2003.Google Scholar
  8. 8.
    Connor SE, Cook RL, Herbert MI, Neal SM, Williams JT. Smoking cessation in a homeless population: There is a will, but is there a way? J Gen Intern Med 2002;17:369–72.PubMedPubMedCentralGoogle Scholar
  9. 9.
    Sachs-Ericsson N, Wise E, Debrody CP, Paniucki HB. Health problems and service utilization in the homeless. J Health Care for the Poor and Underserved 1998;10(4):443–52.Google Scholar
  10. 10.
    Snyder LD, Eisner MD. Obstructive lung disease among the urban homeless. CHEST 2004;125:1719–25.PubMedGoogle Scholar
  11. 11.
    Ogilvie D, Petticrew M. Reducing social inequalities in smoking: Can evidence inform policy? A pilot study. Tobacco Control 2004;13(2):129–31.PubMedPubMedCentralGoogle Scholar
  12. 12.
    Graham H, Kelly MP. Health inequalities: Concepts, frameworks, and policy. Briefing Paper. London: NHS, Health Development Agency, 2004.Google Scholar
  13. 13.
    World Health Organization. WHO framework convention on tobacco control. Geneva: WHO, 2003.Google Scholar
  14. 14.
    Greaves L, Johnson J, Bottorff J, Kirkland S, Jategaonkar N, McGowan M, et al. Reducing Harm: A Better Practices Review of Tobacco Policy and Vulnerable Populations. Vancouver, BC: BC Centre of Excellence for Women’s Health, 2004.Google Scholar
  15. 15.
    CTCRI. Better solutions for complex problems: Description of a model to support better practices for health. Ottawa: CTCRI, 2002.Google Scholar
  16. 16.
    Status of Women Canada. Gender-based analysis: A guide for policy-making. Ottawa: Status of Women Canada, 1996 (revised 1998). Available online at: http://www.swc-cfc.gc.ca/pubs/gbaguide/index_e.html (Accessed May 6, 2003).Google Scholar
  17. 17.
    Health Canada. Exploring concepts of gender and health. Ottawa: Minister of Public Works and Government Services Canada, 2003.Google Scholar
  18. 18.
    Gemson DH, Moats HL, Watkins BX, Ganz ML, Robinson S, Healton E. Laying down the law: Reducing illegal tobacco sales to minors in central Harlem. Am J Public Health 1998;88(6):936–39.PubMedPubMedCentralGoogle Scholar
  19. 19.
    Jason LA, Ji PY, Anes MD, Birkhead SH. Active enforcement of cigarette control laws in the prevention of cigarette sales to minors. JAMA 1991;266(22):3159–61.PubMedGoogle Scholar
  20. 20.
    Jason LA, Billows WD, Schnopp-Wyatt DL, King C. Long-term findings from Woodridge in reducing illegal cigarette sales to older minors. Evaluation & the Health Professions 1996;19(1): 3–13.Google Scholar
  21. 21.
    Jason L, Billows W, Schnopp-Wyatt D, King C. Reducing the illegal sales of cigarettes to minors: Analysis of alternative enforcement schedules. J Appl Behav Anal 1996;29(3):333–44.PubMedPubMedCentralGoogle Scholar
  22. 22.
    Jason LA, Berk M, Schnopp-Wyatt DL, Talbot B. Effects of enforcement of youth access laws on smoking prevalence. Am J Community Psychol 1999;27(2):143–60.PubMedGoogle Scholar
  23. 23.
    Landrine H, Klonoff EA, Reina-Patton A. Minors’ access to tobacco before and after the California STAKE Act. Tobacco Control 2000;9(Suppl 2):II15–17.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Ma GX, Shive S, Tracy M. The effects of licensing and inspection enforcement to reduce tobacco sales to minors in Greater Philadelphia, 1994–1998. Addict Behav 2001;26(5):677–87.PubMedGoogle Scholar
  25. 25.
    Rigotti NA, DiFranza JR, Chang Y, Tisdale T, Kemp B, Singer DE. The effect of enforcing tobacco-sales laws on adolescents’ access to tobacco and smoking behavior. N Engl J Med 1997;337(15):1044–51.PubMedGoogle Scholar
  26. 26.
    DiFranza JR, Coleman M. Sources of tobacco for youth communities with strong enforcement of youth access laws. Tobacco Control 2001;10(4):323–28.PubMedPubMedCentralGoogle Scholar
  27. 27.
    Klonoff EA, Landrine H, Alcaraz R. An experimental analysis of sociocultural variables in sales of cigarettes to minors. Am J Public Health 1997;87(5):823–26.PubMedPubMedCentralGoogle Scholar
  28. 28.
    Castrucci BC, Gerlach KK, Kaufman NJ, Orleans CT. Adolescents’ acquisition of cigarettes through noncommercial sources. J Adolesc Health 2002;31(4):322–26.PubMedGoogle Scholar
  29. 29.
    Farrelly MC, Evans WN, Sfekas AE. The impact of workplace smoking bans: Results from a national survey. Tobacco Control 1999;8(3):272–77.PubMedPubMedCentralGoogle Scholar
  30. 30.
    Gilpin EA, Stillman FA, Hartman AM, Gibson JT, Pierce JP. Index for US state tobacco control initial outcomes. Am J Epidemiol 2000;152(8):727–38.PubMedGoogle Scholar
  31. 31.
    Jeffery RW, Kelder SH, Forster JL, French SA, Lando HA, Baxter JE. Restrictive smoking policies in the workplace: Effects on smoking prevalence and cigarette consumption. Prev Med 1994;23(1):78–82.PubMedGoogle Scholar
  32. 32.
    Farkas AJ, Gilpin EA, White MM, Pierce JP. Association between household and workplace smoking restrictions and adolescent smoking. JAMA 2000;284(6):717–22.PubMedGoogle Scholar
  33. 33.
    Wakefield MA, Chaloupka FJ, Kaufman NJ, Orleans CT, Barker DC, Ruel EE. Effect of restrictions on smoking at home, at school, and in public places on teenage smoking: Cross sectional study. BMJ 2000;321(7257):333–37.PubMedPubMedCentralGoogle Scholar
  34. 34.
    Proescholdbell RJ, Chassin L, MacKinnon DP. Home smoking restrictions and adolescent smoking. Nicotine & Tobacco Res 2000;2(2):159–67.Google Scholar
  35. 35.
    Norman GJ, Ribisl KM, Howard-Pitney B, Howard KA. Smoking bans in the home and car: Do those who really need them have them? Prev Med 1999;29(6 Pt 1):581–89.PubMedGoogle Scholar
  36. 36.
    Lewit EM, Hyland A, Kerrebrock N, Cummings KM. Price, public policy, and smoking in young people. Tobacco Control 1997;6(Suppl 2):S17–S24.PubMedPubMedCentralGoogle Scholar
  37. 37.
    Ashley MJ, Northrup DA, Ferrence R. The Ontario ban on smoking on school property: Issues and challenges in enforcement. Can J Public Health 1998;89(4):229–32.PubMedGoogle Scholar
  38. 38.
    Northrup DA, Ashley MJ, Ferrence R. The Ontario ban on smoking on school property: Perceived impact on smoking. Can J Public Health 1998;89(4):224–28.PubMedGoogle Scholar
  39. 39.
    Pickett W, Northrup DA, Ashley MJ. Factors influencing implementation of the legislated smoking ban on school property in Ontario. Prev Med 1999;29(3):157–64.PubMedGoogle Scholar
  40. 40.
    Tubman JG, Soza Vento R. Principal and teacher reports of strategies to enforce anti-tobacco policies in Florida middle and high schools. J School Health 2001;71(6):229–35.PubMedGoogle Scholar
  41. 41.
    Farkas AJ, Gilpin EA, Distefan JM, Pierce JP. The effects of household and workplace smoking restrictions on quitting behaviours. Tobacco Control 1999;8(3):261–65.PubMedPubMedCentralGoogle Scholar
  42. 42.
    Bottorff JL, Kalaw C, Johnson JL, Chambers N, Stewart M, Greaves L, Kelly M. Unravelling smoking ties: How tobacco use is imbedded in couple interactions. Research in Nursing and Health 2005;28(4):316–28.PubMedGoogle Scholar
  43. 43.
    Greaves L. Smoke Screen: Women, Smoking and Social Control. Halifax, NS: Fernwood; UK: Scarlet Press, 1996.Google Scholar
  44. 44.
    Johnson CC, Myers L, Webber LS, Boris NW. Profiles of the adolescent smoker: Models of tobacco use among 9th grade high school students: Acadiana Coalition of Teens against Tobacco (ACTT). Prev Med 2004;39(3):551–58.PubMedGoogle Scholar
  45. 45.
    Alexander C, Piazza M, Mekos D, Valente T. Peers, schools, and adolescent cigarette smoking. J Adolesc Health 2001;29(1):22–30.PubMedGoogle Scholar
  46. 46.
    Chapman S, Haddad S, Sindhusake D. Do workplace smoking bans cause smokers to smoke “harder”? Results from a naturalistic observational study. Addiction 1997;92(5):607–10.PubMedGoogle Scholar
  47. 47.
    Chaloupka FJ. The impact of proposed cigarette price increases. Health Science Analysis Project, 1998 (Policy Analysis No. 9), 1–18.Google Scholar
  48. 48.
    Hamilton VH, Levinton C, St-Pierre Y, Grimard F. The effect of tobacco tax cuts on cigarette smoking in Canada. CMAJ 1997;156(2):187–91.PubMedPubMedCentralGoogle Scholar
  49. 49.
    Biener L, Aseltine RH, Jr., Cohen B, Anderka M. Reactions of adult and teenaged smokers to the Massachusetts tobacco tax. Am J Public Health 1998;88(9):1389–91.PubMedPubMedCentralGoogle Scholar
  50. 50.
    Biener L, Harris JE, Hamilton W. Impact of the Massachusetts tobacco control programme: Population based trend analysis. BMJ 2000;321(7257):351–54.PubMedPubMedCentralGoogle Scholar
  51. 51.
    Chaloupka FJ, Wechsler H. Price, tobacco control policies and smoking among young adults. J Health Economics 1997;16(3):359–73.Google Scholar
  52. 52.
    Dedobbeleer N, Beland FT, Contandriopoulos AP, Adrian M. Gender and the social context of smoking behaviour. Soc Sci Med 2004;58(1): 1–12.PubMedGoogle Scholar
  53. 53.
    Farrelly MC, Pechacek T, Chaloupka F. The impact of tobacco control program expenditures on aggregate cigarette sales: 1981–2000. J Health Economics 2003;22(5):843.Google Scholar
  54. 54.
    Glied S. Youth tobacco control: Reconciling theory and empirical evidence. J Health Economics 2002;21(1):117–35.Google Scholar
  55. 55.
    Laugesen M, Swinburn B. New Zealand’s tobacco control programme 1985–1998. Tobacco Control 2000;9(2):155–62.PubMedPubMedCentralGoogle Scholar
  56. 56.
    Tauras JA, O’Malley PM, Johnston LD. Effects of price and access laws on teenage smoking initiation: A national longitudinal analysis. ImpacTeen and Youth, Education & Society 2001;44.Google Scholar
  57. 57.
    Wasserman J, Manning WG, Newhouse JP, Winkler JD. The effects of excise taxes and regulations on cigarette smoking. J Health Economics 1991;10(1):43–64.Google Scholar
  58. 58.
    Borren P, Sutton M. Are increases in cigarette taxation regressive? Health Economics 1992;1(4):245–53.PubMedGoogle Scholar
  59. 59.
    Farrelly MC, Bray JW, Pechacek T, Woollery T. Response by adults to increases in cigarette prices by sociodemographic characteristics. Southern Economic J 2001;68(1):156–65.Google Scholar
  60. 60.
    Stephens T, Pederson LL, Koval JJ, Macnab J. Comprehensive tobacco control policies and the smoking behaviour of Canadian adults. Tobacco Control 2001;10(4):317–22.PubMedPubMedCentralGoogle Scholar
  61. 61.
    Wilson N, Thomson G. Tobacco taxation and public health: Ethical problems, policy responses. Soc Sci Med 2005;61:649–59.PubMedGoogle Scholar
  62. 62.
    Manske S, Maule C, O’Connor S, Lovato C, Harvey D. A call for action to support best practices in evaluation of comprehensive tobacco control evaluation strategies. Chron Dis Can 2003;24(1):32–37.Google Scholar

Copyright information

© The Canadian Public Health Association 2006

Authors and Affiliations

  • Lorraine Greaves
    • 1
    Email author
  • Joy Johnson
    • 2
  • Joan Bottorff
    • 3
  • Susan Kirkland
    • 4
  • Natasha Jategaonkar
    • 1
  • Melissa McGowan
    • 1
  • Lucy McCullough
    • 1
  • Lupin Battersby
    • 1
  1. 1.British Columbia Centre of Excellence for Women’s HealthBC Women’s HospitalVancouverCanada
  2. 2.School of NursingUniversity of British ColumbiaVancouverCanada
  3. 3.Faculty of Health and Social DevelopmentUniversity of British Columbia OkanaganCanada
  4. 4.Dept. of Community Health and EpidemiologyDalhousie UniversityHalifaxCanada

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