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John RM, Dauchy EP. A Quantitative Exploration of the Influence of Tobacco Use on Poverty in India. Nicotine Tob Res 2024:ntae129. [PMID: 38856040 DOI: 10.1093/ntr/ntae129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/11/2024]
Abstract
INTRODUCTION Tobacco use has a disproportionate impact on lower socioeconomic groups in India. The study quantifies the number of people who would fall under the national poverty line if the direct spending on tobacco and healthcare expenditures attributable to tobacco use were subtracted from their monthly expenditures. It also aims to estimate the extent to which tobacco use increases the probability of poverty status in India. AIMS AND METHODS We quantify the increase in poverty by multiplying the difference between headcount ratios with and without tobacco-related spending by population size. We use propensity score matching to estimate the extent to which tobacco use increases the probability of poverty. RESULTS About 18.4 million (1.5% of all Indians) are pushed into poverty due to either direct tobacco-related expenditures or tobacco-related healthcare spending. Tobacco use increases households' likelihood of being poor by 3.4%-3.7%. CONCLUSIONS With over 22% of the global poor, achieving poverty reduction goals is a significant challenge for India. We show that this challenge is accentuated by increased tobacco spending, which pushes millions of Indians into poverty. To address this, the Government of India must implement both fiscal and non-fiscal policies that regulate tobacco use and, in turn, contribute to poverty reduction in the country. IMPLICATIONS Tobacco use has a disproportionate impact on lower socioeconomic groups in India, leading to increased and deeper poverty. This paper finds that, based on existing proven measures of poverty, tobacco use accounts for an additional 18.4 million poor individuals. It also shows that tobacco use increases the likelihood of a household being classified as poor by 3.4% to 3.7%. As India is home to a significant proportion of the global poor, addressing tobacco use becomes crucial for global and domestic poverty reduction goals. Fiscal and non-fiscal policies can be used to regulate tobacco and potentially reduce poverty levels in India.
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Affiliation(s)
- Rijo M John
- Department of Social Work, Rajagiri College of Social Sciences, Kochi, India
| | - Estelle P Dauchy
- Principal Research Officer (Professor), Department of Economics, University of Cape Town, Cape Town, South Africa
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Mirzaei O, Natcher DC. Recreational tobacco consumption and food insecurity among First Nations in Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2022; 113:703-712. [PMID: 35676556 PMCID: PMC9481820 DOI: 10.17269/s41997-022-00650-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 05/06/2022] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Crowding-out effects of tobacco consumption refers to the situation in which tobacco consumption reduces a household's spending on other commodities. In this paper, we test for the crowding-out effects of recreational tobacco consumption on food expenditures among on-reserve Indigenous communities in Canada. METHODS We use data from household expenditure surveys (N=469) to investigate tobacco consumption behaviour of on-reserve households of six First Nation communities in Canada. Using conditional Engel curves, we estimate the crowding-out effects of spending on tobacco on budget share of other expenditure categories with a focus on food expenditures. RESULTS Our analysis showed that crowding-out effects of consuming tobacco on consumption of goods and services are minimal with an estimated impact of -0.00004 on the budget share of food expenditures in the remaining budget excess of expenditures on tobacco. While crowding-out effects are not statistically significant in general, the budget share of store-bought food expenditures is significantly lower (i.e. 5%) among tobacco consumer households. CONCLUSION This study sheds new light on some of the indirect impacts of recreational tobacco use and Indigenous food insecurity in Canada. This study is the first attempt to test for crowding-out effects of tobacco consumption among Indigenous populations in Canada. Our findings are important and highlight areas for substantial improvements in health and well-being outcomes given the alarming rates of food insecurity experienced by Indigenous communities in Canada.
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Affiliation(s)
- Omid Mirzaei
- Department of Economics, University of Regina, Regina, Saskatchewan, Canada.
| | - David C Natcher
- Department of Agricultural and Resource Economics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
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Nguyen MN, Nguyen AN, Bui HT, Vu LH. Impoverishing effect of tobacco use in Vietnam. Tob Control 2022; 31:tobaccocontrol-2022-057299. [PMID: 35896377 DOI: 10.1136/tc-2022-057299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 06/28/2022] [Indexed: 11/03/2022]
Abstract
BACKGROUND Tobacco consumption places a significant economic burden on households, which is particularly severe in developing countries like Vietnam. In a country where the social insurance system is weak and healthcare is often expensive, tobacco-consuming households may face a higher risk of living in poverty. Some evidence on the social consequences of tobacco consumption suggests that it might aggravate poverty and inequality in Vietnam; however, to the best of our knowledge, no research provides a reliable estimate of the impoverishing effect of tobacco use in the country thus far. OBJECTIVES This study quantifies the direct impact of tobacco use on poverty, measured by a poverty head count and the total size of the poverty gap in Vietnam in 2018. METHODS By deducting tobacco-related expenditure from the total household income, the authors recalculate the actual household disposable income and examine whether the households suffer from the state of secondary poverty. Data from the 2018 Vietnam Household Living Standards Survey were used for calculation. RESULTS (1) Total tobacco-related expenditure increased the number of poor people by 305 090 (0.31% of the country's population) in 2018. More than one-third of those impoverished people are children, who should be considered victims of adults' tobacco use. (2) Tobacco use increased the poverty gap by 0.08 percentage points from 2.20% to 2.28%. (3) The impoverishment effects of tobacco consumption vary across groups in society and appear to be more intense in rural areas, among ethnic minorities and in the two lowest quintiles of consumption. CONCLUSION This study confirms the impoverishing effect of tobacco use in Vietnam (305 090 people) and that the effects are heterogeneous across population groups. Therefore, controlling tobacco use should be a part of the broader poverty reduction strategy in Vietnam and should be wisely targeted so as to reduce poverty effectively.
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Affiliation(s)
- Minh Ngoc Nguyen
- Economics, Development and Policies Research Center, Hanoi, Vietnam
| | - Anh Ngoc Nguyen
- Economics, Development and Policies Research Center, Hanoi, Vietnam
| | - Ha Thu Bui
- Economics, Development and Policies Research Center, Hanoi, Vietnam
| | - Linh Hoang Vu
- Economics, Development and Policies Research Center, Hanoi, Vietnam
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Yang H, Chen B, Guo A, Song J, Cheng X, Jin C. Association of Householder Smoking With Poverty and the Mediating Effect of NCDs in Relatively Underdeveloped Regions in China. Front Public Health 2022; 10:858761. [PMID: 35664093 PMCID: PMC9160790 DOI: 10.3389/fpubh.2022.858761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background:Studies have not provided clear enough evidence on the direct association between cigarette smoking and poverty. This study aims to assess the association of householder smoking with near-poverty households, and the potential mediating effect of NCDs.MethodsA cross-sectional survey was conducted from November 2019 to October 2020 in relatively underdeveloped regions in China. In total, 2,409 households were investigated in areas under the jurisdiction of 24 primary health care (PHC) institutions of eight provinces. Pearson's χ2-test was performed, and multivariable logistic regression and extended probit regression models were fitted to examine the association between householder smoking and near-poverty households. Moreover, generalized structural equation modeling was used to explore the mediating effect of NCDs.ResultsAfter adjusting for all other potential confounding factors, compared with households headed by never-smokers, households headed by smokers exhibited significantly elevated risks of being near poverty, with an odds ratio of 2.01 (95% CI: 0.48–0.91). We also found that living in rural areas and having a low education level both had a negative effect on being near poverty. Additionally, NCDs had a significantly positive mediating effect, with a 31.57% effect of householder smoking on near-poverty status mediated by NCDs; the indirect effect was estimated to be 0.17 (95% CI: 0.04–0.31).ConclusionsHouseholder smoking significantly elevated the risk of the household being near poverty, and suffering NCDs had a positive mediating effect.
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Affiliation(s)
- Huimin Yang
- Department of Child Health Development, Capital Institute of Pediatrics, Beijing, China
| | - Bowen Chen
- Department of Child Health Development, Capital Institute of Pediatrics, Beijing, China
| | - Aili Guo
- Community Health Association of China, Beijing, China
| | - Jiarui Song
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Xi Cheng
- School of Social Development and Public Policy, Beijing Normal University, Beijing, China
| | - Chenggang Jin
- Research Center for Health and Social Policy, Beijing Normal University, Zhuhai, China
- *Correspondence: Chenggang Jin
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Wei H, Zhong Z, Yang L, Yao T, Huang S, Mao Z. Impact of smoking on the income level of Chinese urban residents: a two-wave follow-up of the China Family Panel Study. BMJ Open 2020; 10:e036939. [PMID: 32830114 PMCID: PMC7445347 DOI: 10.1136/bmjopen-2020-036939] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study attempts to analyse the impact of smoking on the income level of Chinese urban residents to provide a reference for creating informed regulations on cigarette smoking. DESIGN A population-based cohort study. METHOD Two waves of panel data in 2014 and 2016 from the China Family Panel Study were used. A total of 8025 urban adults were identified. The Hausman-Taylor model was used to analyse the theoretical relationship between smoking and income. RESULTS The percentage of current smokers decreased from 27.39% (2014) to 26.24% (2016), while the percentage of former smokers rose from 9.78% to 11.78%. The results from the Hausman-Taylor model showed that current smokers and former smokers are associated with statistically significant decrease in the income of urban residents of 37.70% and 44.00%, respectively, compared with that of non-smokers. After eliminating the impact of smoking on income, the poverty rate among urban residents decreased from 15.33% to 13.63%. CONCLUSIONS Smoking can significantly reduce the income of Chinese urban residents, resulting in immense negative impacts on Chinese society. Therefore, the government should raise the tax rate on tobacco, include smoking cessation treatment in medical insurance coverage, promote publicity campaigns on the awareness of tobacco hazards and encourage smokers to quit smoking early.
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Affiliation(s)
- Han Wei
- School of Management, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhigang Zhong
- School of Management, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Lian Yang
- School of Public Health, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Tingting Yao
- Institute for Health & Aging, University of California, San Francisco, San Francisco, California, USA
| | - Shiyao Huang
- School of Management, Chengdu University of Traditional Chinese Medicine, Chengdu, Sichuan, China
| | - Zhengzhong Mao
- Huaxi School of Public Health, Sichuan University, Chengdu, Sichuan, China
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Masa-ud AGA, Chelwa G, van Walbeek C. Does tobacco expenditure influence household spending
patterns in Ghana?: Evidence from the Ghana 2012/2013
Living Standards Survey. Tob Induc Dis 2020; 18:48. [PMID: 32547351 PMCID: PMC7291959 DOI: 10.18332/tid/120936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 04/19/2020] [Accepted: 04/21/2020] [Indexed: 11/24/2022] Open
Affiliation(s)
| | - Grieve Chelwa
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
| | - Corné van Walbeek
- School of Economics, University of Cape Town, Cape Town, South Africa
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Small S, Porr C, Swab M, Murray C. Experiences and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence. ACTA ACUST UNITED AC 2019; 16:385-452. [PMID: 29419622 DOI: 10.11124/jbisrir-2017-003377] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
OBJECTIVES The aim of this review was to identify and synthesize the best available evidence to address two questions: i) what is the experience of smoking during pregnancy for Indigenous women? and ii) what are the smoking cessation needs of Indigenous women who smoke during pregnancy? INTRODUCTION Smoking during pregnancy not only affects pregnant women's general health but also causes such serious problems as pre-term delivery, low birth weight, and sudden infant death. Rates of smoking during pregnancy are particularly high among Indigenous women. Learning about Indigenous women's experiences of smoking during pregnancy and associated smoking cessation needs is important to providing informed health care to them. INCLUSION CRITERIA The participants of interest were Indigenous women who smoked during a current or past pregnancy. The phenomena of interest were the experiences of smoking during pregnancy for Indigenous women and the smoking cessation needs of Indigenous women during pregnancy. The context was any community worldwide where pregnant Indigenous women live. Studies considered for this review were those in which qualitative data were gathered and analysed on the phenomena of interest, including mixed methods research. METHODS A comprehensive search was conducted for published studies in academic databases (i.e. PubMed, CINAHL, PsycINFO, Embase, Sociological Abstracts, SocINDEX, and Web of Science), unpublished studies in sources of gray literature (i.e. ProQuest Dissertations and Theses, OAIster, LILACS, MedNar, Google, Google Scholar, OpenGrey and relevant websites), and any additional studies in reference lists. Language and date limiters were not applied. The searches included all studies globally and were carried out on October 31, 2016. Studies that met the inclusion criteria were assessed for methodological quality by two reviewers independently, using the criteria of the Joanna Briggs Institute (JBI) Critical Appraisal Checklist for Qualitative Research. Descriptive details of each study accepted for this review were extracted in accordance with the elements of the JBI Data Extraction Form for Qualitative Research. The research findings that were relevant to the phenomena of interest and had participant voice were extracted from each included study and synthesized using the JBI meta-aggregative approach. The synthesized findings were assigned confidence scores in accordance with the JBI ConQual approach. RESULTS Thirteen studies were included in this review following careful consideration of the methodological quality of each study. The studies yielded a total of 116 research findings, which were grouped into 19 categories and then aggregated to form five synthesized findings. Confidence in the findings was determined to be low to very low (see ConQual Summary of Findings). CONCLUSION There is a small body of research evidence on Indigenous women's experiences of smoking during pregnancy and their smoking cessation needs. Confidence in the synthesized findings is constrained due to methodological limitations in many of the primary studies included in this review, along with mixed credibility of the research findings from across primary studies.
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Affiliation(s)
- Sandra Small
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Caroline Porr
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Michelle Swab
- Health Sciences Library, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
| | - Cynthia Murray
- School of Nursing, Memorial University of Newfoundland, St. John's, Canada.,Memorial University School of Nursing Collaboration for Evidence-Based Nursing and Primary Health Care: A Joanna Briggs Institute Affiliated Group
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Chen A, Machiorlatti M, Krebs NM, Muscat JE. Socioeconomic differences in nicotine exposure and dependence in adult daily smokers. BMC Public Health 2019; 19:375. [PMID: 30943945 PMCID: PMC6448228 DOI: 10.1186/s12889-019-6694-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 03/22/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Socioeconomic status (SES) is a major determinant of tobacco use but little is known whether SES affects nicotine exposure and the degree of nicotine dependence. METHODS The Pennsylvania Adult Smoking Study is a cross-sectional study of smoke exposure and nicotine dependence among adults conducted in central Pennsylvania between June 2012 and April 2014. The study included several measures of SES, including assessments of education and household income, as well as occupation, home ownership, health insurance, household density and savings accounts. Measurements included saliva for the nicotine metabolites cotinine (COT), 3-'hydroxycotinine (3HC) and total metabolites (COT +3HC). Puffing behavior was determined using portable smoking topography devices. RESULTS The income levels of lighter smokers (< 20 cigarettes per day) was $10,000 more than heavier smokers. Higher Fagerström Test for Nicotine Dependence scores were associated with lower income and job status, scores ranged from 5.4 in unemployed, 4.4 in blue-collar, and 3.8 in white-collar workers. In principal components analysis used to derive SES indicators, household income, number in household, and type of dwelling were the major SES correlates of the primary component. Job category was the major correlate of the second component. Lower SES predicted significantly higher adjusted total nicotine metabolite levels in the unemployed group. Job category was significantly associated with total daily puffs, with the highest level in the unemployed, followed by blue-collar workers, after adjustment for income. CONCLUSIONS Among smokers, there was a relationship between lower SES and increased nicotine dependence, cigarettes per day and nicotine exposure, which varied by job type.
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Affiliation(s)
- Allshine Chen
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th Street CHB309, Box 26901, Oklahoma City, OK 73104 USA
| | - Michael Machiorlatti
- Department of Biostatistics and Epidemiology, University of Oklahoma Health Sciences Center, 801 NE 13th Street CHB309, Box 26901, Oklahoma City, OK 73104 USA
| | - Nicolle M. Krebs
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Dr. CH69, Hershey, PA 17033 USA
| | - Joshua E. Muscat
- Department of Public Health Sciences, Penn State College of Medicine, 500 University Dr. CH69, Hershey, PA 17033 USA
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Nargis N, Zheng R, Xu SS, Fong GT, Feng G, Jiang Y, Wang Y, Hu X. Cigarette Affordability in China, 2006⁻2015: Findings from International Tobacco Control China Surveys. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16071205. [PMID: 30987255 PMCID: PMC6480272 DOI: 10.3390/ijerph16071205] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 03/27/2019] [Accepted: 03/29/2019] [Indexed: 11/24/2022]
Abstract
China is world’s largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers—50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to the detriment of public health. This study investigated whether the level and growth in cigarette affordability in China was equally shared by smokers from all demographic and socio-economic statuses (SES) and across all price tiers of cigarette brands. The data came from the urban smoker sample (≥18 years) of the International Tobacco Control China Surveys conducted in five waves over 2006–2015. Cigarette affordability was measured by Relative Income Price—percentage of per capita household income needed to purchase 100 cigarette packs of the last purchased brand. Overall and group-specific trends in affordability by age, gender, SES (e.g., income, education, and employment status), and price tiers were analyzed using generalized estimating equations method. Cigarette affordability was higher among older, female, and higher-SES smokers, and for cheaper brands. It increased overall and across all groups over time. The increase was significantly larger among younger and lower-SES smokers, a trend that poses an added challenge to tobacco control and health equity. To reduce cigarette affordability and consumption among these vulnerable groups, a uniform specific excise system should be introduced in place of the existing tiered ad valorem excise. The specific excise should be periodically adjusted to inflation and per capita income growth observed among younger and lower-SES people, who can potentially experience faster income growth than the national average. The excise tax policy can also be complimented with minimum price regulations and restrictions on price promotions.
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Affiliation(s)
- Nigar Nargis
- American Cancer Society, 555 11th Street NW, Suite 300, Washington, DC 20004, USA.
| | - Rong Zheng
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China.
| | - Steve S Xu
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada.
- Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada.
| | - Guoze Feng
- Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China.
| | - Yuan Jiang
- Chinese Center for Disease Control and Prevention (China CDC), Beijing 102206, China.
| | - Yang Wang
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China.
| | - Xiao Hu
- School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China.
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Goodchild M, Zheng R. Early assessment of China's 2015 tobacco tax increase. Bull World Health Organ 2018; 96:506-512. [PMID: 29962553 PMCID: PMC6022610 DOI: 10.2471/blt.17.205989] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/01/2018] [Accepted: 04/13/2018] [Indexed: 11/27/2022] Open
Abstract
In 2015, the Chinese government raised tobacco excise tax for the first time since 2009. Changing from previous practice, the State Tobacco Monopoly Administration raised its cigarette prices at the same time. We assessed the early impact of the 2015 tax increase on cigarette prices, sales volumes, tax revenue generation and the potential effect on prevalence of smoking in China. Between 2014 and 2016, the retail price of cigarettes increased on average by 11%, with the cheapest category of cigarette brands increasing by 20%. The average proportion of tax in the price of cigarettes rose from 51.7% to 55.7%. Annual cigarette sales decreased by 7.8%, from 127 to 117 billion packs. The increase in cigarette prices could be associated with a 0.2% to 0.6% decrease in the proportion of adults smoking, representing between 2.2 and 6.5 million fewer smokers. Tax revenues from cigarettes increased by 14%, from 740 to 842 billion Chinese yuan between 2014 and 2016, reflecting an extra 101 billion Chinese yuan in tax revenues for the government. The 2015 tax increase shows that tobacco taxation can provide measurable benefits to both public health and finance in China. The experience also highlights the potential for tobacco taxation to contribute to China's broader development targets, including the sustainable development goals and Healthy China 2030. Looking forward, this link to development can be facilitated through multisectoral research and dialogue to develop consistent cross-sectoral objectives for tobacco tax policy design and implementation.
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Affiliation(s)
- Mark Goodchild
- Department for the Prevention of Noncommunicable Diseases, World Health Organization, avenue Appia 20, 1211 Geneva 27, Switzerland
| | - Rong Zheng
- School of International Trade and Economics, University of International Business and Economics, Beijing, China
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Verguet S, Tarr G, Gauvreau CL, Mishra S, Jha P, Liu L, Xiao Y, Qiu Y, Zhao K. Distributional benefits of tobacco tax and smoke-free workplaces in China: A modeling study. J Glob Health 2018; 7:020701. [PMID: 29188029 PMCID: PMC5681709 DOI: 10.7189/jogh.07.020701] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
Background Tobacco taxation and smoke–free workplaces reduce smoking, tobacco–related premature deaths and associated out–of–pocket health care expenditures. We examine the distributional consequences of a price increase in tobacco products through an excise tax hike, and of an implementation of smoke–free workplaces, in China. Methods We use extended cost–effectiveness analysis (ECEA) to evaluate, across income quintiles of the male population (the large majority of Chinese smokers), the premature deaths averted, the change in tax revenues generated, and the financial risk protection procured (eg, poverty cases averted, defined as the number of individuals no longer facing tobacco–related out–of–pocket expenditures for disease treatment, that would otherwise impoverish them), that would follow a 75% increase in cigarette prices through substantial increments in excise tax fully passed onto consumers, and a nationwide total implementation of workplace smoking bans. Results A 75% increase in cigarette prices would avert about 24 million premature deaths among the current Chinese male population, with a third among the bottom income quintile, increase additional tax revenues by US$ 46 billion annually, and prevent around 9 million poverty cases, 19% of which among the bottom income quintile. Implementation of smoking bans in workplaces would avert about 12 million premature deaths, with a fifth among the bottom income quintile, decrease tax revenues by US$ 7 billion annually, and prevent around 4 million poverty cases, 12% of which among the bottom income quintile. Conclusions Increased excise taxes on tobacco products and workplace smoking bans can procure large health and economic benefits to the Chinese population, especially among the poor.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Gillian Tarr
- Department of Epidemiology, University of Washington, Seattle, Washington, USA
| | | | - Sujata Mishra
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Prabhat Jha
- Center for Global Health Research, Saint Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Lingrui Liu
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
| | - Yue Xiao
- China National Health Development Research Center, Beijing, China
| | - Yingpeng Qiu
- China National Health Development Research Center, Beijing, China
| | - Kun Zhao
- China National Health Development Research Center, Beijing, China
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Ngalesoni F, Ruhago G, Mayige M, Oliveira TC, Robberstad B, Norheim OF, Higashi H. Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania. PLoS One 2017; 12:e0182113. [PMID: 28767722 PMCID: PMC5540531 DOI: 10.1371/journal.pone.0182113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 07/12/2017] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Tobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost. AIMS We aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania. MATERIALS AND METHODS A cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters. RESULTS Our model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively. CONCLUSIONS Even though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government's ability to implement these interventions.
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Affiliation(s)
- Frida Ngalesoni
- Ministry of Health, Community Development, Gender, Elderly and Children, Dar es Salaam, Tanzania
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - George Ruhago
- Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania
| | - Mary Mayige
- Tanzania National Institute of Medical Research, Dar es Salaam, Tanzania
| | - Tiago Cravo Oliveira
- Institute of Health Metrics and Evaluation, Seattle, Washington, United States of America
| | - Bjarne Robberstad
- Centre for International Health, University of Bergen, Bergen, Norway
| | - Ole Frithjof Norheim
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Jumrani J, Birthal PS. Does consumption of tobacco and alcohol affect household food security? Evidence from rural India. Food Secur 2017. [DOI: 10.1007/s12571-017-0660-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Uguru NP, Mbachu C, Ibe OP, Uguru CC, Odukoya O, Okwuosa C, Onwujekwe O. Investigating male tobacco use and expenditure patterns across socio-economic groups in Nigeria. PLoS One 2015; 10:e0122021. [PMID: 25856074 PMCID: PMC4391936 DOI: 10.1371/journal.pone.0122021] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 02/06/2015] [Indexed: 11/18/2022] Open
Abstract
The magnitude of variation in economic costs of tobacco consumption among socio-economic status (SES) groups in Nigeria is unclear. Understanding the factors that influence tobacco use and expenditure among different socio-economic groups would inform decisions on interventions for tobacco control in Nigeria. Secondary data was obtained from the 2008 National demographic and health survey. Information on tobacco use and expenditure in households and individual males were extracted from the database. A total of 34,070 households and 15,846 individual males were sampled. Analysis was done using descriptive statistics and binary logistic regression analysis. Information on wealth index obtained were categorized into socio-economic quintile groups (Q1 to Q5), representing poorest to richest socio-economic groups. To estimate expenditure on cigarettes, the average cost of a stick of cigarette was obtained and multiplied with the number of sticks smoked per day. The proportion of households that use tobacco in Nigeria is 5.25% with a greater percentage (89.6%) residing in the rural areas. Prevalence of cigarette smoking in individual males is 8.59%, and the poorer SES group smoked more cigarettes (20.9%) and spent more (0.60–1.19USD) than the richest SES group. Low education level, traditional beliefs, literacy levels, SES and employment status all influence cigarette smoking in adult males. Although poor people smoked more and spent more of their income on cigarettes, other factors like educational level and traditional beliefs were found to influence practice of cigarette smoking in men. This implies that tobacco control legislation through increased taxes alone may not effectively reduce the use of tobacco and its products in Nigeria. A consolidated approach that includes behavioral change procedures, enforcing bans on tobacco advertisement and the use of strong graphic anti-tobacco messages targeted at both the poor and rich as well as the educated and uneducated need to be effected to reduce tobacco use.
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Affiliation(s)
- Nkoli P. Uguru
- Department of Preventive Dentistry, Faculty of Dentistry, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- * E-mail:
| | - Chinyere Mbachu
- Department of Community Medicine, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Ogochukwu P. Ibe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Chibuzo C. Uguru
- Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Oluwakemi Odukoya
- Department of Community Medicine, College of Medicine, University of Lagos, Lagos, Nigeria
| | - Chinenye Okwuosa
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
| | - Obinna Onwujekwe
- Health Policy Research Group, Department of Pharmacology and Therapeutics, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
- Department of Health Administration and Management, Faculty of Health Sciences and Technology, College of Medicine, University of Nigeria, Enugu Campus, Enugu, Nigeria
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Small S, Porr C, Swab M, Murray C. The experience and cessation needs of Indigenous women who smoke during pregnancy: a systematic review of qualitative evidence protocol. ACTA ACUST UNITED AC 2015. [DOI: 10.11124/01938924-201513040-00006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Verguet S, Gauvreau CL, Mishra S, MacLennan M, Murphy SM, Brouwer ED, Nugent RA, Zhao K, Jha P, Jamison DT. The consequences of tobacco tax on household health and finances in rich and poor smokers in China: an extended cost-effectiveness analysis. LANCET GLOBAL HEALTH 2015; 3:e206-16. [PMID: 25772692 DOI: 10.1016/s2214-109x(15)70095-1] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In China, there are more than 300 million male smokers. Tobacco taxation reduces smoking-related premature deaths and increases government revenues, but has been criticised for disproportionately affecting poorer people. We assess the distributional consequences (across different wealth quintiles) of a specific excise tax on cigarettes in China in terms of both financial and health outcomes. METHODS We use extended cost-effectiveness analysis methods to estimate, across income quintiles, the health benefits (years of life gained), the additional tax revenues raised, the net financial consequences for households, and the financial risk protection provided to households, that would be caused by a 50% increase in tobacco price through excise tax fully passed onto tobacco consumers. For our modelling analysis, we used plausible values for key parameters, including an average price elasticity of demand for tobacco of -0·38, which is assumed to vary from -0·64 in the poorest quintile to -0·12 in the richest, and we considered only the male population, which constitutes the overwhelming majority of smokers in China. FINDINGS Our modelling analysis showed that a 50% increase in tobacco price through excise tax would lead to 231 million years of life gained (95% uncertainty range 194-268 million) over 50 years (a third of which would be gained in the lowest income quintile), a gain of US$703 billion ($616-781 billion) of additional tax revenues from the excise tax (14% of which would come from the lowest income quintile, compared with 24% from the highest income quintile). The excise tax would increase overall household expenditures on tobacco by $376 billion ($232-505 billion), but decrease these expenditures by $21 billion (-$83 to $5 billion) in the lowest income quintile, and would reduce expenditures on tobacco-related disease by $24·0 billion ($17·3-26·3 billion, 28% of which would benefit the lowest income quintile). Finally, it would provide financial risk protection worth $1·8 billion ($1·2-2·3 billion), mainly concentrated (74%) in the lowest income quintile. INTERPRETATION Increased tobacco taxation can be a pro-poor policy instrument that brings substantial health and financial benefits to households in China. FUNDING Bill & Melinda Gates Foundation and Dalla Lana School of Public Health.
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Affiliation(s)
- Stéphane Verguet
- Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Cindy L Gauvreau
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Sujata Mishra
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Mary MacLennan
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Shane M Murphy
- Department of Global Health, University of Washington, Seattle, WA, USA
| | | | - Rachel A Nugent
- Department of Global Health, University of Washington, Seattle, WA, USA
| | - Kun Zhao
- China National Health Development Research Center, Beijing, China
| | - Prabhat Jha
- Centre for Global Health Research, St Michael's Hospital, University of Toronto, Toronto, ON, Canada
| | - Dean T Jamison
- Global Health Sciences, University of California, San Francisco, CA, USA
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Yao T, Huang J, Sung HY, Ong MK, Mao Z, Jiang Y, Fong GT, Max W. Determinants of smoking-induced deprivation in China. Tob Control 2014; 24 Suppl 4:iv35-9. [PMID: 24827978 DOI: 10.1136/tobaccocontrol-2014-051542] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 04/14/2014] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Spending on cigarettes may deprive households of other items like food. The goal of this study was to examine the prevalence of and factors associated with this smoking-induced deprivation among adult smokers in China. METHODS The data came from Waves 1-3 of the International Tobacco Control (ITC) China Survey, conducted from 2006 to 2009 among urban adults aged 18 years or older in China. We focus on the samples of current smokers from six cities (N=7981). Smoking-induced deprivation was measured with the survey question, "In the last six months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?" We examined whether sociodemographic factors, smoking intensity and price paid per pack of cigarettes were associated with smoking-induced deprivation using generalised estimating equations modelling. FINDINGS 7.3% of smokers reported smoking-induced deprivation due to purchasing cigarettes. Low-income and middle-income smokers were more likely to have smoking-induced deprivation compared with high-income smokers (adjusted OR (AOR)=2.06, 95% CI 1.32 to 2.31; AOR=1.44, 95% CI 1.10 to 1.69); smokers living in Shenyang (AOR=1.68, 95% CI 1.25 to 2.24) and Yinchuan (AOR=2.50, 95% CI 1.89 to 3.32) were more likely to have smoking-induced deprivation compared with smokers living in Beijing. Retired smokers were less likely to have smoking-induced deprivation compared with employed smokers (AOR=0.67, 95% CI 0.52 to 0.87). There was no statistically significant relationship between smoking intensity, price paid per pack of cigarettes and smoking-induced deprivation. CONCLUSIONS Our findings indicate that certain groups of smokers in China acknowledge spending money on cigarettes that could be better spent on household essentials. Tobacco control policies that reduce smoking in China may improve household living standards by reducing smoking-induced deprivation.
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Affiliation(s)
- Tingting Yao
- Institute for Health & Aging, University of California, San Francisco, California, USA Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
| | - Jidong Huang
- Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Hai-Yen Sung
- Institute for Health & Aging, University of California, San Francisco, California, USA
| | - Michael K Ong
- Division of General Internal Medicine and Health Services Research, Department of Medicine, University of California, Los Angeles, California, USA
| | - Zhengzhong Mao
- Huaxi School of Public Health, Sichuan University, Chengdu, China
| | - Yuan Jiang
- National Tobacco Control Office, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Geoffrey T Fong
- Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada Ontario Institute for Cancer Research, Toronto, Ontario, Canada School of Public Health and Health Systems, University of Waterloo, Waterloo, Ontario, Canada
| | - Wendy Max
- Institute for Health & Aging, University of California, San Francisco, California, USA
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18
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Payaud MA. Marketing Strategies at the Bottom of the Pyramid: Examples From Nestlé, Danone, and Procter & Gamble. ACTA ACUST UNITED AC 2013. [DOI: 10.1002/joe.21533] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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Hu TW, Lee AH, Mao Z. WHO Framework Convention on Tobacco Control in China: barriers, challenges and recommendations. Glob Health Promot 2013; 20:13-22. [PMID: 24297769 PMCID: PMC4041682 DOI: 10.1177/1757975913501910] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM The aim of this study was to analyze the barriers in the implementation of the Framework Convention on Tobacco Control (FCTC) in China and present recommendations on ways to address these challenges in tobacco control in China. METHODS We review the available literature on progress and explore the barriers and challenges that impede a speedier pace in the adoption of the effective tobacco control measures, and present recommendations based on in-depth knowledge of decision-making process on the implementation of FCTC in China. RESULTS The pace of progress in China is too slow. China faces intractable political, structural, economic and social barriers in tobacco control, which make the whole-hearted implementation of FCTC measures a painstaking process. DISCUSSION The authors recommend a comprehensive approach to speed up the implementation of tobacco control measures. This includes strong political leadership from the top, structural changes to the tobacco industry and government oversight of the tobacco industry, as well as advocacy and support for tobacco control from civil society at the grassroots level.
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Affiliation(s)
- Teh-Wei Hu
- 1.Center for International Tobacco Control, Public Health Institute, Oakland, CA, USA
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20
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Leung DYP, Chan SSC, Jiang CQ, Lam TH. Providing Smoking Cessation Services and Its Relationship with Knowledge and Attitudes: A Comparison of the Guangzhou and Hong Kong Nurses. ACTA ACUST UNITED AC 2011. [DOI: 10.1080/15339114.2009.9678478] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Doris Y. P. Leung
- a Department of Nursing Studies , The University of Hong Kong , Hong Kong
| | - Sophia S. C. Chan
- b Department of Nursing Studies , The University of Hong Kong , Hong Kong
| | - C. Q. Jiang
- c Guangzhou 12th Hospital , Guangzhou, China
| | - T. H. Lam
- d Department of Community Medicine , School of Public Health, The University of Hong Kong , Hong Kong
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Xin Y, Qian J, Xu L, Tang S, Gao J, Critchley JA. The impact of smoking and quitting on household expenditure patterns and medical care costs in China. Tob Control 2009; 18:150-5. [PMID: 19158112 PMCID: PMC2655040 DOI: 10.1136/tc.2008.026955] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2008] [Accepted: 01/09/2009] [Indexed: 11/11/2022]
Abstract
BACKGROUND Smoking remains very common in Chinese men, and the economic burden caused by cigarette consumption on smokers and their families may be substantial. Using a large nationally representative household survey, the third National Health Services Survey (NHSS, 2003), we estimated the economic impact of smoking on households. METHODS Smoking status of all household members (over 15 years) was collected by interview for the NHSS, and households classified into one of seven categories based on their smoking status. Information on household income and expenditure, and use of health services was also obtained. We assessed both the "direct" costs (reducing funds available for spending on other commodities such as food, education, medical care, etc, using a fractional logit model), and "indirect costs" (increasing medical expenditures, using a log-linear model). RESULTS Every five packets of cigarettes consumed per capita per month reduces household spending on other commodities, most notably on education (by about 17 yuan per capita per annum) and medical care (11 yuan). The effects are greatest among low-income rural households. Households with quitters spend substantially more on medical care than never-smoking households (64 yuan for households with two or more quitters). CONCLUSIONS If a household member smokes, there is less money available for commodities such as education and medical care. Medical care expenditure is substantially higher among households with quitters, as ill-health is the main reason for quitting smoking in China. Smoking impoverishes a substantial number of poorer rural households.
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Affiliation(s)
- Y Xin
- Institute of Health and Society, Newcastle University, Leech Building, Newcastle upon Tyne NE24HH, UK
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22
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Abstract
We created a comprehensive set of health-system performance measurements for China nationally and regionally, with health-system coverage and catastrophic medical spending as major indicators. With respect to performance of health-care delivery, China has done well in provision of maternal and child health services, but poorly in addressing non-communicable diseases. For example, coverage of hospital delivery increased from 20% in 1993 to 62% in 2003 for women living in rural areas. However, effective coverage of hypertension treatment was only 12% for patients living in urban areas and 7% for those in rural areas in 2004. With respect to performance of health-care financing, 14% of urban and 16% of rural households incurred catastrophic medical expenditure in 2003. Furthermore, 15% of urban and 22% of rural residents had affordability difficulties when accessing health care. Although health-system coverage improved for both urban and rural areas from 1993 to 2003, affordability difficulties had worsened in rural areas. Additionally, substantial inter-regional and intra-regional inequalities in health-system coverage and health-care affordability measures exist. People with low income not only receive lower health-system coverage than those with high income, but also have an increased probability of either not seeking health care when ill or undergoing catastrophic medical spending. China's current health-system reform efforts need to be assessed for their effect on performance indicators, for which substantial data gaps exist.
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Affiliation(s)
- Yuanli Liu
- Harvard School of Public Health, Boston, MA, USA.
| | | | - Jing Wu
- Ministry of Health, Beijing, China
| | - Emmanuela Gakidou
- Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, USA
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Pu CY, Lan V, Chou YJ, Lan CF. The crowding-out effects of tobacco and alcohol where expenditure shares are low: analyzing expenditure data for Taiwan. Soc Sci Med 2008; 66:1979-89. [PMID: 18313191 DOI: 10.1016/j.socscimed.2008.01.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2007] [Indexed: 11/16/2022]
Abstract
In this paper, we used data from the 2004 Survey of Family Income & Expenditure of Taiwan to show that the problem of the crowding-out effects of tobacco and alcohol in a country with low expenditure can still be serious. Most studies that have investigated this issue have focused on developing countries with a high expenditure share on tobacco or alcohol, and have often overlooked the effects in countries with a low expenditure on such goods. After controlling for the endogeneity of tobacco and alcohol expenditure, and the possibility that households with a zero expenditure on tobacco and alcohol may result from a corner solution rather than abstention, we found that the lowest income households are still most vulnerable to tobacco and alcohol expenditures despite an overall low expenditure in Taiwan. Even higher income households may suffer a lower standard of living due to such expenditure. In addition, some goods and services may be perceived differently by households with different levels of income and this may be caused by the difference in composition across broad expenditure categories. Our results suggest that the government ought to tackle the problem of smoking and drinking outside the realm of health, since these expenditures may harm the country's standard of living even when there is high income.
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Affiliation(s)
- Cheng-yun Pu
- Institute of Public Health, National Yang-Ming University, Taipei Taiwan.
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