Preventive medicine
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Preventive medicine · Feb 2023
Case ReportsAppraisal of Kenya's excisable goods management system using interrupted time series analysis: A case of cigarettes and cigars excise tax revenue.
The government of Kenya introduced the Excisable Goods Management System (EGMS) in November 2013, which is a form of Track and Trace Systems (TTSs) for excisable goods, including cigarettes and cigars. This study appraised the EGMS with a focus on its impact on cigarette and cigars excise tax revenue and possibly control of related illicit trade in Kenya. Illicit trade in cigarettes and cigars pose significant health risks owing to increased access to tobacco products, besides contributing to loss of government revenues. ⋯ The results show that the difference between the pre-intervention and post-intervention slopes of the real excise tax revenue was positive and statistically significant, suggesting a change in excise tax revenue trends. The hypothesis of an immediate level change in excise tax revenue was however not supported, possibly due to the initial implementation challenges that dampened a 'jump' in real excise tax revenue. These findings suggest that TTSs need to be complemented by sustained efforts to achieve maximum compliance levels and impact in both the short term and the long term.
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Preventive medicine · Feb 2023
Down but not defeated: Clinicians can harness the power of policy for LGBTQ+ rights.
The legal and medical rights of lesbian, gay, bisexual, transgender, queer (LGBTQ+) and other gender and sexual minority (GSM) youth are under attack in the United States. Approximately 160 anti-LGBTQ+ bills were proposed across the United States during the 2021 legislative session, with 70% of states considering at least one anti-LGBTQ+ bill. Over one hundred of the proposed bills specifically target transgender youth and have already resulted in the prohibition of nearly 85,000 13-17-year-old trans youth from participating in sports as their affirmed gender. ⋯ Conversely, the rollback of those liberties may lead to irreparable harm and preventable deaths. The consequences of anti-LGBTQ+ legislation can additionally deleteriously affect local and state economies as companies and organizations move to supportive communities. Clinicians can, and should, play an important role to engage stakeholders and advocate for LGBTQ+ inclusive policies at the institutional, local, state, and national policy level.