Smoking prevalence and attributable disease burden in 195 countries and territories, 1990–2015: a systematic analysis from the Global Burden of Disease Study 2015

IntroductionA Cochrane systematic review was undertaken to answer the question: "does legislation to ban or restrict tobacco smoking reduce exposure to secondhand smoke and smoking behaviour?"Relevance for nursingSmoking bans are environmental, population-focused approaches that aim to rReducetion in both tobacco smoking behaviours and secondhand smoke exposure. through smoking bans impact the environment and hence population health. Often bans are accompanied by education regarding the need for the ban and support services thato help smokers use the opportunity to quit or reduce their tobacco consumption. Therefore, smoking bans can be associated with the 'settings approach' to health promotion derived from the World Health Organisation's Ottawa Charter (1986). Thise Charter supports population and individual health through integrated, coordinated and multi-dimensional interventions.Study characteristicsAThis was a Cochrane systematic review was undertaken thatwhich produced a 'narrative only' synthesis of 50 studies. Studies (with reported numbers of participants) had samples ranging from of 24 to 10413 subjects. No randomised controlled trials were identified that met review inclusion criteria., Nonethelesshowever, 13 non-randomised controlled studies (quasi-experimental designs) were included; of these 7, were located in a general or workplace setting and 6six related to hospital admissions. A further 37 studies which lacked a control group but recorded data from participants pre and post intervention were also included in the review. In total, In 16 16 of reviewed studies used random sampling was used to select participants from a target population, 11 employed convenience sampling, 5five used randomly selected clusters of bars/public houses; 5five sampling methods were unclear and 2two studies utilised mixed sampling methods.No age, gender or geographic limits were placed on study samples included in the review. ReviewedIncluded studies followed participants for a minimum of six months following the ban (except for 8 studies which measured exposure to second hand smoke). Eight study authors identified that small sample size or low statistical power limited the generalisability of their research findings. No age, gender or geographic limit was placed on participants in reviewed studies. A risk of bias summary table was not included in the review; however, the reviewers note that one source of bias (blinding participants to receipt of the intervention) was not possible in any study, due to the nature of the ban interventions. Eight study authors identified that small sample size or low statistical power was a limitation to the generalisability of their research findings.The most commonly reviewed intervention was a comprehensive legislative ban on indoor smoking that was comprehensive within indoor sites (a total ban in 40 studies). An additional 10Ten ?restriction' intervention studies were also included ; these permitted which the reviewers classified as 'restrictions' as they allowed smoking within a designated area. Twenty two of the reviewed studies were conducted in workplaces, most of these (19) targeted the health of hospitality workers in bars or restaurants. The reviewed studies included bans in 13 countries, mostly the USA (17) or Scotland (8). Exposure to secondhand smoke was collectedmeasured by participants' self-report recordingof either the 'duration of exposure' or 'percentage sample exposed'. Some researchers (mostly those conducting large population studies) also took biochemical samples e.g. of saliva, to validate self-reports. Measures such as: smoking prevalence, tobacco consumption, smoking cessation, and respiratory, cardiac or sensory health outcomes were also considered by the reviewers. …

Legislative Smoking Bans for Reducing Secondhand Smoke Exposure, Smoking Prevalence and Tobacco Consumption

Many forested landscapes around the world are severely altered during mining for their rich mineral and energy reserves. Herein we provide an overview of the challenges inherent in efforts to restore mined landscapes to functioning forest ecosystems and present a synthesis of recent progress using examples from North America, Europe and Australia. We end with recommendations for further elaboration of the Forestry Reclamation Approach emphasizing: (1) Landform reconstruction modelled on natural systems and creation of topographic heterogeneity at a variety of scales; (2) Use and placement of overburden, capping materials and organic amendments to facilitate soil development processes and create a suitable rooting medium for trees; (3) Alignment of landform, topography, overburden, soil and tree species to create a diversity of target ecosystem types; (4) Combining optimization of stock type and planting techniques with early planting of a diversity of tree species; (5) Encouraging natural regeneration as much as possible; (6) Utilizing direct placement of forest floor material combined with seeding of native species to rapidly re-establish native forest understory vegetation; (7) Selective on-going management to encourage development along the desired successional trajectory. Successful restoration of forest ecosystems after severe mining disturbance will be facilitated by a regulatory framework that acknowledges and accepts variation in objectives and outcomes.

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Forest restoration following surface mining disturbance: challenges and solutions

Summary Background The WHO Framework Convention on Tobacco Control (WHO FCTC) has mobilised efforts among 180 parties to combat the global tobacco epidemic. This study examined the association between highest-level implementation of key tobacco control demand-reduction measures of the WHO FCTC and smoking prevalence over the treaty's first decade. Methods We used WHO data from 126 countries to examine the association between the number of highest-level implementations of key demand-reduction measures (WHO FCTC articles 6, 8, 11, 13, and 14) between 2007 and 2014 and smoking prevalence estimates between 2005 and 2015. McNemar tests were done to test differences in the proportion of countries that had implemented each of the measures at the highest level between 2007 and 2014. Four linear regression models were computed to examine the association between the predictor variable (the change between 2007 and 2014 in the number of key measures implemented at the highest level), and the outcome variable (the percentage point change in tobacco smoking prevalence between 2005 and 2015). Findings Between 2007 and 2014, there was a significant global increase in highest-level implementation of all key demand-reduction measures. The mean smoking prevalence for all 126 countries was 24·73% (SD 10·32) in 2005 and 22·18% (SD 8·87) in 2015, an average decrease in prevalence of 2·55 percentage points (SD 5·08; relative reduction 10·31%). Unadjusted linear regression showed that increases in highest-level implementations of key measures between 2007 and 2014 were significantly associated with a decrease in smoking prevalence between 2005 and 2015). Each additional measure implemented at the highest level was associated with an average decrease in smoking prevalence of 1·57 percentage points (95% CI −2·51 to −0·63, p=0·001) and an average relative decrease of 7·09% (−12·55 to −1·63, p=0·011). Controlling for geographical subregion, income level, and WHO FCTC party status, the per-measure decrease in prevalence was 0·94 percentage points (−1·76 to −0·13, p=0·023) and an average relative decrease of 3·18% (−6·75 to 0·38, p=0·079). This association was consistent across all three control variables. Interpretation Implementation of key WHO FCTC demand-reduction measures is significantly associated with lower smoking prevalence, with anticipated future reductions in tobacco-related morbidity and mortality. These findings validate the call for strong implementation of the WHO FCTC in the WHO's Global Action Plan for the Prevention and Control of Non-communicable Diseases 2013–2020, and in advancing the UN's Sustainable Development Goal 3, setting a global target of reducing tobacco use and premature mortality from non-communicable diseases by a third by 2030. Funding Health Canada, Canadian Institutes of Health Research, Ontario Institute for Cancer Research and Canadian Cancer Society Research Institute.

Implementation of key demand-reduction measures of the WHO Framework Convention on Tobacco Control and change in smoking prevalence in 126 countries: an association study.

We review the contemporary theory of financial intermediation. The focus is on contributions in the past 15 years or so that have advanced our understanding of why financial intermediaries exist, the credit allocation and other services they provide in spot and forward credit markets, the contractual nature and allocational consequences of the claims they issue, and the optimal design of bank regulation. Journal of Economic Literature Classification Numbers: 310, 312, and 314.

Contemporary Banking Theory

Background: Tobacco smoking is the cause of many preventable diseases and premature deaths in the UK and around the world. It poses enormous health- and non-health-related costs to the affected individuals, employers, and the society at large. The World Health Organization (WHO) estimates that, globally, smoking causes over US$500 billion in economic damage each year.
Objectives: This paper examines global and UK evidence on the economic impact of smoking prevalence and evaluates the effectiveness and cost effectiveness of smoking cessation measures.
Study selection
Search methods: We used two major health care/economic research databases, namely PubMed and the National Institute for Health Research (NIHR) database that contains the British National Health Service (NHS) Economic Evaluation Database; Cochrane Library of systematic reviews in health care and health policy; and other health-care-related bibliographic sources. We also performed hand searching of relevant articles, health reports, and white papers issued by government bodies, international health organizations, and health intervention campaign agencies.
Selection criteria: The paper includes cost-effectiveness studies from medical journals, health reports, and white papers published between 1992 and July 2014, but included only eight relevant studies before 1992. Most of the papers reviewed reported outcomes on smoking prevalence, as well as the direct and indirect costs of smoking and the costs and benefits of smoking cessation interventions. We excluded papers that merely described the effectiveness of an intervention without including economic or cost considerations. We also excluded papers that combine smoking cessation with the reduction in the risk of other diseases.
Data collection and analysis: The included studies were assessed against criteria indicated in the Cochrane Reviewers Handbook version 5.0.0.
Outcomes assessed in the review: Primary outcomes of the selected studies are smoking prevalence, direct and indirect costs of smoking, and the costs and benefits of smoking cessation interventions (eg, “cost per quitter”, “cost per life year saved”, “cost per quality-adjusted life year gained,” “present value” or “net benefits” from smoking cessation, and “cost savings” from personal health care expenditure).
Main results: The main findings of this study are as follows:
1. The costs of smoking can be classified into direct, indirect, and intangible costs. About 15% of the aggregate health care expenditure in high-income countries can be attributed to smoking. In the US, the proportion of health care expenditure attributable to smoking ranges between 6% and 18% across different states. In the UK, the direct costs of smoking to the NHS have been estimated at between £2.7 billion and £5.2 billion, which is equivalent to around 5% of the total NHS budget each year. The economic burden of smoking estimated in terms of GDP reveals that smoking accounts for approximately 0.7% of China’s GDP and approximately 1% of US GDP. As part of the indirect (non-health-related) costs of smoking, the total productivity losses caused by smoking each year in the US have been estimated at US$151 billion.
2.The costs of smoking notwithstanding, it produces some potential economic benefits. The economic activities generated from the production and consumption of tobacco provides economic stimulus. It also produces huge tax revenues for most governments, especially in high-income countries, as well as employment in the tobacco industry. Income from the tobacco industry accounts for up to 7.4% of centrally collected government revenue in China. Smoking also yields cost savings in pension payments from the premature death of smokers.
3. Smoking cessation measures could range from pharmacological treatment interventions to policy-based measures, community-based interventions, telecoms, media, and technology (TMT)-based interventions, school-based interventions, and workplace interventions.
4. The cost per life year saved from the use of pharmacological treatment interventions ranged between US$128 and US$1,450 and up to US$4,400 per quality-adjusted life years (QALYs) saved. The use of pharmacotherapies such as varenicline, NRT, and Bupropion, when combined with GP counseling or other behavioral treatment interventions (such as proactive telephone counseling and Web-based delivery), is both clinically effective and cost effective to primary health care providers.
5. Price-based policy measures such as increase in tobacco taxes are unarguably the most effective means of reducing the consumption of tobacco. A 10% tax-induced cigarette price increase anywhere in the world reduces smoking prevalence by between 4% and 8%. Net public benefits from tobacco tax, however, remain positive only when tax rates are between 42.9% and 91.1%. The cost effectiveness ratio of implementing non-price-based smoking cessation legislations (such as smoking restrictions in work places, public places, bans on tobacco advertisement, and raising the legal age of smokers) range from US$2 to US$112 per life year gained (LYG) while reducing smoking prevalence by up to 30%–82% in the long term (over a 50-year period).
6. Smoking cessation classes are known to be most effective among community-based measures, as they could lead to a quit rate of up to 35%, but they usually incur higher costs than other measures such as self-help quit-smoking kits. On average, community pharmacist-based smoking cessation programs yield cost savings to the health system of between US$500 and US$614 per LYG.
7. Advertising media, telecommunications, and other technology-based interventions (such as TV, radio, print, telephone, the Internet, PC, and other electronic media) usually have positive synergistic effects in reducing smoking prevalence especially when combined to deliver smoking cessation messages and counseling support. However, the outcomes on the cost effectiveness of TMT-based measures have been inconsistent, and this made it difficult to attribute results to specific media. The differences in reported cost effectiveness may be partly attributed to varying methodological approaches including varying parametric inputs, differences in national contexts, differences in advertising campaigns tested on different media, and disparate levels of resourcing between campaigns. Due to its universal reach and low implementation costs, online campaign appears to be substantially more cost effective than other media, though it may not be as effective in reducing smoking prevalence.
8. School-based smoking prevalence programs tend to reduce short-term smoking prevalence by between 30% and 70%. Total intervention costs could range from US$16,400 to US$580,000 depending on the scale and scope of intervention. The cost effectiveness of school-based programs show that one could expect a saving of approximately between US$2,000 and US$20,000 per QALY saved due to averted smoking after 2–4 years of follow-up.
9. Workplace-based interventions could represent a sound economic investment to both employers and the society at large, achieving a benefit–cost ratio of up to 8.75 and generating 12-month employer cost savings of between $150 and $540 per nonsmoking employee. Implementing smoke-free workplaces would also produce myriads of new quitters and reduce the amount of cigarette consumption, leading to cost savings in direct medical costs to primary health care providers. Workplace interventions are, however, likely to yield far greater economic benefits over the long term, as reduced prevalence will lead to a healthier and more productive workforce.
Conclusions: We conclude that the direct costs and externalities to society of smoking far outweigh any benefits that might be accruable at least when considered from the perspective of socially desirable outcomes (ie, in terms of a healthy population and a productive workforce). There are enormous differences in the application and economic measurement of smoking cessation measures across various types of interventions, methodologies, countries, economic settings, and health care systems, and these may have affected the comparability of the results of the studies reviewed. However, on the balance of probabilities, most of the cessation measures reviewed have not only proved effective but also cost effective in delivering the much desired cost savings and net gains to individuals and primary health care providers.

https://journals.sagepub.com/doi/pdf/10.4137/TUI.S15628

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence

Purpose




The purpose of this paper is to investigate the importance of business lending as a source of bank profits in the UK banking system. The paper also examines whether the profitability of business lending is mostly driven by heterogeneous characteristics of individual banks or whether it is affected by systematic characteristics such as bank size and ownership structure.




Design/methodology/approach




The study uses bank level data from BankScope for a total sample of 83 UK banks and building societies. The period under consideration extends from 2005 to 2009. Econometric estimation is by panel fixed effects.




Findings




Our empirical results show that business lending is a statistically significant determinant of bank profits. However, this average effect masks important systematic differences among banks. In particular, we find strong size effects: the profitability of business lending is considerable for small banks but negligible for large banks. In contrast, we could not detect any ownership effects for domestic and foreign banks. These findings persist when the occurrence of the financial crisis is accounted for.




Research limitations/implications




Interestingly, our study relates these findings to the process of financialisation. Yet, the extent of the latter and its impact on various groups of banks (i.e. large, small, domestic and foreign banks) have not been examined. Further research in this area would make an important contribution to the literature.




Practical implications




Our findings suggest that business lending is not a driving factor of profitability for large banks. One possible policy implication – which may be of interest especially to regulators and policy makers – is that capital injections into the larger banks per se are unlikely to lead to an expansion of credit to business.




Originality/value




There is very little research in the literature on the questions addressed in this paper, especially for the UK banking system. Moreover, the process of financialisation, which motivates the enquiry of this paper, is a growing area of research. Thus, the contribution of this paper is twofold.

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Business lending and bank profitability in the UK

This paper addresses the question whether business lending is still an important source of bank profits in the UK banking system. This research question is motivated by the effects of the process of financialisation. It has been argued that one of the consequences of financialisation is a dramatic change in business strategies by financial institutions, which have turned to new fields of profitability – namely, transactions in open financial markets and household/consumer lending – moving away from traditional business lending. However, the extent to which commercial banks have embraced financialisation and the contribution of business lending to bank profitability are likely to be the result of bank-specific characteristics. This paper investigates, therefore, whether the profitability of business lending is driven by bank heterogeneity or whether it is possible to identify systematic characteristics which affect it. Using bank level data from BankScope for a total sample of 83 UK banks and building societies for the period 2005-2009 and employing panel fixed effects estimation, we find very strong size effects: in particular, while business lending is a statistically significant source of bank profits, its quantitative importance varies dramatically across bank size. For large banks, business lending contributes to the rate of return on equity very little. This finding is not due to the occurrence of the financial crisis. Indeed, large size effects are found even when the financial crisis is controlled for. While we detected strong size effects, we could not detect any ownership effects. The profitability of business lending depends on whether banks are large or small, not on whether they are domestic or foreign. One possible policy implication of our findings is that capital injections into the larger banks per se are unlikely to lead to an expansion of credit to business.

Financialisation, business lending and profitability in the uk

Apart from borrower-specific factors, bank involvement with SMEs is greatly influenced by lender-specific factors and the external business environment. Here, findings show that banks that have a relatively flatter organisational structure (such as smaller banks) tend to have advantages in loan monitoring and increased loan officer discretion. However, large banks with multi-office structures find it extremely costly to invest in relationships. Banks that are largely geared towards SMEs are known to be heavily reliant on relationship lending techniques, whilst large multi-office banks tend to have advantages in economies of scale and scope because they rely on transactions-based lending and other financial management services. Regulatory factors such as enforcement of capital requirements, sectoral credit limits and monetary policies also affect the quantity and cost of loanable funds via lenders’ risk appetite, credit rationing and the credit channel, respectively. Banking consolidation also tends to affect the amount of SME lending as lending generally reduces after a merger or acquisition. The type of lending technology adopted and the lending infrastructure are also dominant factors affecting the supply of credit to SMEs.

Victor U. Ekpu

Papers

The Economic Impact of Smoking and of Reducing Smoking Prevalence: Review of Evidence

Business lending and bank profitability in the UK

Financialisation, business lending and profitability in the uk

Supply-Side Factors Affecting Bank Lending to SMEs

Determinants of Bank Involvement with SMEs