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Secondly, the survey design underlying these estimates, including survey mode and sampling method, can affect who is included in samples, potentially under- or oversampling certain populations and yielding estimates that are higher or lower than the true values.
Some definitions include additional conditions, such as a cigarette life-time threshold which, combined with different thresholds for other tobacco and nicotine products in some cases e. The public health impact of smoking and the possible effects of policies or lack thereof may be misinterpreted if these factors are not considered.
The United States is one example of a country where adult cigarette smoking prevalence estimates are affected by some of these factors. Several surveys are used to measure tobacco use among US adults. This NHIS headline figure of The NHIS headline estimate excludes people using non-cigarette combustible tobacco products.
If we consider young adults aged 18�24 years , we see that the prevalence estimate is even higher at 2. Additionally, similar to other countries, US NHIS data highlight that cigarette smoking prevalence is higher in population subgroups, including sexual minorities It is well documented that it has been increasingly difficult to recruit nationally representative survey samples in recent decades.
Thus, it is possible that the US NHIS cigarette smoking prevalence estimate is low if members of groups who are difficult to engage in survey samples are under-represented. Comparing across another data set, the NHIS cigarette smoking prevalence estimate However, asking about past-month tobacco and nicotine product use, as conducted in the NSDUH, has been documented previously to overestimate regular use [ 7 , 8 ].
Nevertheless, this difference in cigarette smoking prevalence illustrates how different methods can affect national prevalence estimates, making them difficult to compare not only across jurisdiction, but even within countries. The public health impact of combustible tobacco use in the United States is arguably distorted by headline cigarette smoking prevalence estimates because they often exclude non-cigarette combustible tobacco use, use imprecise definitions of current smoking and may be subject to other factors such as under-representation of difficult-to-engage groups.
Cross-survey and cross-national comparisons of smoking prevalence estimates, including non-cigarette combustible products, are necessary to provide meaningful information to researchers, advocates and policy-makers. Rapid changes in the tobacco and nicotine market-place and policy environment highlight further the need for surveillance measures to be harmonized, and for reporting and interpretation to be conducted carefully.
The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or the Food and Drug Administration. Author manuscript; available in PMC Aug 1. Sara C. Hitchman , 1, 2 Jennifer L. Pearson , 3, 4 and Andrea C. Villanti 3, 4, 5. Jennifer L.
Andrea C. Author information Copyright and License information Disclaimer. Copyright notice. The publisher's final edited version of this article is available at Addiction. Abstract Recent changes in the tobacco and nicotine market make it more important than ever to have valid and reliable measures of tobacco and nicotine use that capture population exposure.
This is reinforced by evidence of the industry's willingness to exaggerate the costs of regulation � and misrepresent planned factory closures 59 as a direct cost of regulation. The paper has focused on BAT. While the global market context is identical for all TTCs, there may be differences in the nature of each company's response. For example, Imperial Tobacco relies more on cheaper brands than BAT, has invested less in research and is less able to innovate; these issues could threaten its long term profitability compared with other TTCs.
The issue of harm reduction is, for example, quite different there as ST use is already well established. Finally, it has been impossible to address all of the current complexities in tobacco control policy making that emerge through industry manipulation.
A key omission is cigarette smuggling which will be addressed in a separate paper. This paper highlights the complex tensions between volume and value, cigarettes and ST, harm reduction and CSR, and how an understanding of the motives and tactics of TTCs can inform policies, avoid pitfalls in policy development and ensure prompt policy responses to emerging issues. The public health community, by actively shaping the regulatory environment, has the potential to shape the future of the cigarette and ST epidemics.
Much has been learnt from tobacco industry document research and it has proved essential to holding the tobacco industry to account. This paper illustrates the way in which more contemporary industry materials can be used to monitor and analyse both the global tobacco market and current tobacco industry actions and how this information can be used to inform public health policy development.
Once China is excluded, global cigarette volumes are already declining but that, despite this, industry profits continue to increase. This pattern is explained by the industry's pricing power�its ability to increase prices faster than volumes fall. This pricing power is a consequence of market failure and is now fundamental to the industry's long term future which is now largely reliant on value not volume growth.
Understanding this profit and value dimension is essential to understanding industry conduct and planning effective tobacco control interventions. The funders played no role in the study design, analysis and interpretation of the data, or writing of the report, or the decision to submit the article for publication.
The content is solely the responsibility of the author and does not necessarily represent the official views of the funders. Provenance and peer review Commissioned; externally peer reviewed.
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Email alerts. Article Text. Article menu. The tobacco epidemic today. Understanding the vector in order to plan effective tobacco control policies: an analysis of contemporary tobacco industry materials. Abstract This paper builds on tobacco document research by analysing contemporary materials to explore how the global tobacco market has changed, how transnational tobacco companies TTCs are responding and the implications for tobacco control. Statistics from Altmetric.
Introduction Tobacco document research has produced an important body of literature which has proved essential in holding the industry to account and informing policy development. Methods In addition to existing academic literature, the paper draws on the analysis of a variety of materials examined from onwards although some date from before that as part of efforts by the University of Bath Tobacco Control Research Group to monitor the business and marketing activities of TTCs.
Figure 1 Global cigarette consumption trends and predictions millions of sticks : � Cigarette value trends and pricing power The industry's main interest, however, is profits, and despite stagnating sales, profits continue to rise figure 2. Figure 2 Global cigarette market: per cent change in value and volume overall, and by region, � Combining volume and value maximising approaches In limited numbers of markets opportunities for volume growth remain, and while this is the case the industry will combine its long term volume and short term value profit maximising approaches.
Volume maximisation emerging markets There are three main ways that TTCs can gain volume: entering new markets, acquiring new businesses and pushing up consumption.
Figure 3 Examples of product innovation. Right person As before, 54 young people remain key to the industry, with the global drive brands all targeted at this age group.
Price and excise policy Contrary to established wisdom, it appears that the industry's pricing power is, in many countries, facilitated by tobacco excise policies 20 23 : when tobacco excise rates are high, manufacturer's profits represent only a small share of the retail price and increases in these profits, because they make relatively little contribution to the overall price rise, can be disguised as part of the tax increases.
Value maximisation: making efficiency savings Increasing efficiency�for example, by integrating the supply chain, closing factories and streamlining the brand portfolio 58 59 �is also key to profit maximisation and has helped BAT address its historical inefficiencies. The hidden agenda: cheap tobacco products Although TTC presentations to analysts barely mention the value end of the market, 64 65 in mature markets, despite the heavy marketing of premium brands, use of cheap tobacco products is growing 48 66�69 as is the use of price within the marketing mix.
The global tobacco market�smokeless tobacco While previous decades were characterised by frequent mergers and acquisitions in the cigarette sector, 17 the past few years have seen a switch in emphasis to ST and, very recently, nicotine, 79 80 as explored elsewhere in this edition. Harm reduction While harm reduction features as part of BAT's responsibility strategy, unlike other aspects of this strategy, details are rarely fleshed out 10 23 and, despite its recent investments in ST, ST is virtually absent from BAT's business plan.
Discussion Key findings This paper shows that the global cigarette market has changed in key ways. Implications for policy and practice Many of the issues outlined above can be addressed through full implementation and enforcement of the Framework Convention on Tobacco Control.
Emerging markets In emerging markets there is still potential to constrain the size of the tobacco epidemic and, through this, the industry's long term future. All markets Interventions that challenge the industry's ability to grow value are now the industry's greatest threat. Further marketing controls Product innovation is a particular concern given that it may be used to convey a misleading message of reduced risk, just as light cigarettes did in the past and, in the value segment, to undermine the impact of tax increases, and because young people remain a marketing target.
A more informed excise policy We must recognise that in high tax markets at least the industry is not opposed to price increases per se but wants this to occur via its own price increases and not via tax increases.
Price cap regulation Price cap regulation could address many of the problems identified in this paper. Addressing corporate social responsibility The paper provides further evidence that CSR must be recognised as a political activity 84 85 by indicating that BAT's ongoing focus on CSR is essential to its ability to maintain sufficient credibility to participate in policy debates. Harm reduction While evidence suggests that ST could be part of an effective harm reduction strategy, 96 97 this paper highlights the need to understand the industry dimension.
Efficiency savings and implications for impact assessments Requirements to cost the impacts of regulation on business, via business impact assessments, are growing. Limitations The paper has focused on BAT. Conclusion This paper highlights the complex tensions between volume and value, cigarettes and ST, harm reduction and CSR, and how an understanding of the motives and tactics of TTCs can inform policies, avoid pitfalls in policy development and ensure prompt policy responses to emerging issues.
What this paper adds Much has been learnt from tobacco industry document research and it has proved essential to holding the tobacco industry to account. It shows inter alia that: Once China is excluded, global cigarette volumes are already declining but that, despite this, industry profits continue to increase.
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First, of course, there is the pipe. Second, tobacco suitable to your taste. Then there are appurtenances ranging from cleaners to reamers, which your local tobacconists can tell you about. They will show you how they can help make your pipe a greater source of pleasure. With the basic equipment in hand, the neophyte needs only a little patience to acquire the art of pipe smoking. There is nothing difficult about it if you keep this in mind. The payoff in contentment, relaxation, and satisfaction is worth waiting for.
Just like a marathon runner needs to start slow and work up to the full distance, the same is true for a new pipe smoker. If you start with a quality briar pipe and a good, mild tobacco like an Sutliff brand, of course , you will have no difficulty.
Begin with a little bit the first day and go slowly to learn all the incredible pleasures and nuances pipe smoking offers. Fill the bowl of a new pipe one-half to two-thirds full, using your finger to tamp each layer firmly, but without losing the feel of springiness in the tobacco. Light the pipe evenly all around. Tamp the tobacco again and relight. Proper packing and occasional tamping will keep it lit. Smoke the first few bowlfuls slowly. Allow your pipe to cool and dry between smokes.
Remove ashes by gently slapping the bowl on the palm of your hand. Hold it by the bowl, not the stem, and avoid striking your pipe against hard objects. Although pipe smoking is an art, it is based upon science. A pipe bowl is simply a combustion chamber in which fuel is oxidized.
The intensity of oxidation burning is governed by the kind of fuel and amount of air drawn through the flue pipe stem. But I digress. There are certain categories of phrases that immediately flash warning signs to the effect that what is being said should be taken with a pinch of salt, and one such category comprises those with superlatives. It is almost impossible to imagine an instance when nobody or everybody was in favor of something.
Language matters, and, to my way of thinking, one of the problems that people who champion tobacco harm reduction have helped to create is down to the fact that they have been too willing to accept and parrot some of the extreme language and figures used by those people also involved in tobacco control but who are opposed to harm reduction.
The other smokers die of something else�perhaps of injuries caused by a drunk driver. OK, some will argue the smoking problem is not only about death but about the physical and economic costs of smokers living with medical conditions linked to their habit. But we are all prisoners of the choices we make. I doubt there are many people who reach the age of 50 without carrying some physical ailment linked to something they did when they were young.
Some footballers die at relatively young ages having suffered from dementia attributable to their playing football, but few would claim playing football kills.
Rather, we try to change the rules of the game and the equipment used to prevent brain damage�we employ harm reduction techniques. On the question of parroting figures, take the annual death toll attributed to tobacco-related diseases. Over the years, it has been increased a number of times, usually in lots of one million, so it now stands at the nicely rounded figure of 8 million.
At the same time, the World Health Organization, which has ownership of this figure, has been claiming success in its efforts to prevent the deaths attributed to tobacco. Why is this important?
Because by exaggerating the problems caused by tobacco, some sections of tobacco control have been allowed to distort the picture to such an extent that it becomes difficult to sell the idea of tobacco harm reduction.
Additionally, because too many people have, for a quiet life, gone along with the U. What we need is honesty. For instance, we need to stop lumping all combustibles together as if the consumption of cigarettes, cigars or pipe tobacco is equally risky. This cannot be the case, especially at a population level.