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Hawkins SS, Kull M, Baum CF. US state cigarette tax increases and smoke-free legislation in relation to cigarette expenditure across household socio-economic circumstances: a quasi-experimental study. Addiction 2019; 114:721-729. [PMID: 30461118 DOI: 10.1111/add.14505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2018] [Revised: 04/03/2018] [Accepted: 11/02/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND AIMS While research has focused on outcomes of tobacco control policies, less is known about the mechanisms by which policies may affect tobacco use. We estimated the associations of changes in cigarette taxes and smoke-free legislation with (1) any household cigarette expenditure and (2) the level of household expenditure on cigarettes, as well as (3) tested interactions with socio-economic circumstances. DESIGN Difference-in-differences regression models to estimate the associations between changes in US state cigarette taxes and smoke-free legislation with changes in household expenditure on cigarettes. SETTING Forty US states and District of Columbia. PARTICIPANTS From annual, cross-sectional surveys (with a longitudinal component) between 2000 and 2014, 128 138 households interviewed quarterly in the Consumer Expenditure Survey. MEASUREMENTS Dependent measures included any household cigarette expenditure, expenditure in real dollars and budget share of cigarette expenditure. Policy measures included state cigarette taxes and 100% smoke-free legislation. Covariates included respondent age, race/ethnicity, sex; household education; poverty level; family structure; and number of children and adults. FINDINGS Every $1.00 cigarette tax increase was associated with a 1.5 percentage point (-0.028, -0.002) reduction in any cigarette expenditure and an increase of 0.1% (0.1%, 0.1%) budget share and $10.11 ($8.38, $11.84) absolute expenditure. The association with absolute expenditure was stronger among smoking households above poverty level ($10.73; $8.94, $12.51) than below ($4.72; $2.37, $7.07). The enactment of smoke-free legislation was associated with $2.33 (-$4.56, -$0.10) less expenditure, but not with any expenditure (0.1%; -1.6%, 1.8%) or budget share (-0.1%; -0.1%, 0.1%). The association with absolute expenditure was stronger among households above poverty level (-$2.62; -$4.95, -$0.29) than below (-$0.34; -$4.27, $3.58) CONCLUSION: Cigarette tax increases in the United States between 2000 and 2014 may have reduced smoking prevalence due to an absolute and relative increase in household tobacco expenditure while smoke-free policies appear to have led to a reduction in expenditure. Although tax increases had a stronger impact on absolute expenditure among households above the poverty level, impact on relative expenditure was similar, and consequences for socio-economic inequalities in smoking will vary based on the broader financial situation of households.
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Affiliation(s)
| | - Melissa Kull
- Chapin Hall at the University of Chicago, Chicago, IL, USA
| | - Christopher F Baum
- Boston College, School of Social Work, Chestnut Hill, MA, USA.,Department of Economics, Boston College, Chestnut Hill, MA, USA.,German Institute for Economic Research (DIW Berlin), Berlin, Germany
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2
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Koch SF. Quasi-experimental evidence on tobacco tax regressivity. Soc Sci Med 2018; 196:19-28. [DOI: 10.1016/j.socscimed.2017.11.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 10/27/2017] [Accepted: 11/01/2017] [Indexed: 10/18/2022]
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3
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Paes NL. [Economic factors and gender differences in the prevalence of smoking among adults]. CIENCIA & SAUDE COLETIVA 2017; 21:53-61. [PMID: 26816163 DOI: 10.1590/1413-81232015211.00162015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 05/16/2015] [Indexed: 11/22/2022] Open
Abstract
This article presents a study that seeks to identify the relevant economic variables in the prevalence of smoking in a group of 37 countries. The chosen methodology was to estimate multiple linear regression using the least square approach. The econometric exercise is performed by gender, seeking to examine whether there are different motivations for cigarette smoking among the adult population of men and women. The results show that although taxation is a common element in the decision of both sexes, the decision to smoke among women is also sensitive to price and other social and cultural factors. These factors were based on the fact that women who live in countries that are part of the Organization for Economic Cooperation and Development reveal a significantly higher prevalence of cigarette consumption. The evidence presented in this study, therefore, reinforces the perception that taxation is in fact a crucial tool in the control of smoking, but in the specific case of women, higher prices and the promotion of greater equality with men, are also important.
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Affiliation(s)
- Nelson Leitão Paes
- Programa de Pós-Graduação em Economia, Centro de Ciências Sociais Aplicadas, Universidade Federal de Pernambuco, Recife, PE, Brasil,
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4
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Martire KA, Clare P, Courtney RJ, Bonevski B, Boland V, Borland R, Doran CM, Farrell M, Hall W, Iredale JM, Siahpush M, Mattick RP. Smoking and finances: baseline characteristics of low income daily smokers in the FISCALS cohort. Int J Equity Health 2017; 16:157. [PMID: 28854980 PMCID: PMC5577825 DOI: 10.1186/s12939-017-0643-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 08/10/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Financial stress is a barrier to successful smoking cessation and a key predictor of relapse. Little is known about the financial situation of low-income Australian daily smokers. This study aims to describe and investigate associations between the financial functioning, tobacco use and quitting behaviours of low income daily smokers. METHODS Low-income Australian adult smokers in the 'Financial Intervention for Smoking Cessation Among Low-income Smokers (FISCALS) randomised clinical trial completed a structured telephone questionnaire. RESULTS The median number of cigarettes typically smoked by the 1047 participants was 23 per day. The median spent on tobacco per week was AU$80. Three quarters (73.0%) reported some financial stress and 43.2% reported smoking-induced deprivation. Financial stress was significantly associated with deprivation (IRR: 1.23, 95% CI 1.21, 1.26, p < 0.001). There were no significant associations either between adjusted financial stress or deprivation and motivation to quit or certainty of quit success. CONCLUSIONS Financial stress and smoking induced deprivation were prevalent among low-income daily smokers, but they were not associated with motivation to quit. Smoking cessation interventions need to be responsive to the role financial stress plays in reducing quit attempts and increasing relapse. TRIAL REGISTRATION Australian and New Zealand Clinical trials Registry ACTRN12612000725864 6/07/2012.
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Affiliation(s)
| | - Philip Clare
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Ryan J. Courtney
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Billie Bonevski
- School of Medicine & Public Health, University of Newcastle, University Dr, Callaghan, NSW 2308 Australia
| | - Veronica Boland
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Ron Borland
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, 615 St Kilda Rd, Melbourne, VIC 3004 Australia
| | - Christopher M. Doran
- Centre for Indigenous Health Equity Research, School of Human, Health and Social Sciences, Central Queensland University, Brisbane, Australia
| | - Michael Farrell
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Wayne Hall
- Centre for Clinical Research, University of Queensland, Brisbane, Australia
| | - Jaimi M. Iredale
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
| | - Mohammad Siahpush
- College of Public Health, University of Nebraska Medical Centre, 42nd and Emile, Omaha, NE 68198 USA
| | - Richard P. Mattick
- National Drug and Alcohol Research Centre, University of NSW, Sydney, NSW 2052 Australia
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5
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The Relationship between Neighborhood Disorder, Social Networks, and Indoor Cigarette Smoking among Impoverished Inner-City Residents. J Urban Health 2017; 94:534-541. [PMID: 28560613 PMCID: PMC5533668 DOI: 10.1007/s11524-017-0170-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Impoverished urban neighborhoods tend to have higher rates of smoking and higher rates of exposure to secondhand smoke as compared to more affluent neighborhoods. Contextual factors of neighborhood disorder and social network and household composition may have an impact on indoor smoking behaviors. The TIDE study examined psychosocial factors associated with smoking behaviors among impoverished inner-city smokers in Baltimore, Maryland. Among a community-recruited sample of 413 smokers who lived with others, most (73%) reported that they or others smoked in their residence. Cohabitation with children, elderly, and those with asthma and other respiratory condition was not associated with indoor smoking. Neighborhood disorder, the proportion of social network members who smoked with the study participant, and the proportion of household members who smoked were all independently associated with smoking indoors. The study findings suggest the importance of addressing neighborhood and social network factors when developing programs for promoting indoor smoking bans as well as cessation and prevention programs.
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6
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Financial Stress and Smoking within a Large Sample of Socially Disadvantaged Australians. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14030231. [PMID: 28245612 PMCID: PMC5369067 DOI: 10.3390/ijerph14030231] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Revised: 02/05/2017] [Accepted: 02/17/2017] [Indexed: 11/16/2022]
Abstract
Financial stress is associated with fewer quit attempts and higher relapse rates. This study aimed to compare financial stress among smokers, ex-smokers and never smokers in a highly socioeconomically disadvantaged sample. The study also aimed to determine whether specific indicators of financial stress differ according to smoking status. Adult clients seeking welfare assistance from two Social and Community Service Organisation sites in New South Wales, Australia, were invited to complete a cross-sectional survey between March 2012 and December 2013. Responses to a financial stress scale, smoking status and demographics were collected. Linear and logistic regression modelling was used to examine associations between smoking status and financial stress. A total of 1463 participants completed the survey. Current smokers had significantly higher total financial stress scores than ex-smokers and non-smokers respectively. Current smokers also had higher odds of severe financial stress indicators, such as going without meals (Odds Ratio = 2.2 and 2.0), than both non-smokers and ex-smokers. Even among a highly socioeconomically disadvantaged sample with high levels of financial stress, smoking status further exacerbates experiences of deprivation. Given the relationship between financial stress, socioeconomic disadvantage and difficulty quitting, it is important to provide enhanced cessation support to smokers experiencing financial stress.
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A qualitative analysis of low income smokers' responses to tobacco excise tax increases. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2016; 37:82-89. [PMID: 27639173 DOI: 10.1016/j.drugpo.2016.08.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/08/2016] [Accepted: 08/10/2016] [Indexed: 11/22/2022]
Abstract
BACKGROUND While increasing the excise tax applied to tobacco products reduces consumption and smoking prevalence, it may also cause hardship among smokers who do not quit. We explored how smokers living on a low income respond to increasing tobacco excise taxes. METHODS Using a social justice perspective, we explored the increasing costs of tobacco with a sample of 27 adult smokers who live below the poverty line (i.e., with an income less than 60% of the median New Zealand income). Face-to-face interviews were conducted in Dunedin, New Zealand, a city with marked income differences, and were undertaken shortly after a further tobacco excise tax increase. The interview guide explored participants' smoking practices, their perceptions of excise tax as a strategy to reduce smoking prevalence, and the strategies they used to manage their tobacco needs. RESULTS We identified three key themes: depriving the poor; tobacco as a precious commodity, and desperation. While many participants described smoking as a pleasure or coping mechanism, they also saw it as a burden that they struggled to manage. Despite trying to quit, most had failed to become smokefree and felt victimised by a punitive policy system that coerced change without supporting it. They managed financial pressure by reducing their tobacco consumption but also used increasingly desperate measures, including recycling waste tobacco; participants reported feeling demeaned by measures they saw as their only option. CONCLUSION Providing intensive cessation support for lower income smokers could avoid further alienating a group already experiencing considerable disadvantage.
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Barquera S, Pedroza-Tobias A, Medina C. Cardiovascular diseases in mega-countries: the challenges of the nutrition, physical activity and epidemiologic transitions, and the double burden of disease. Curr Opin Lipidol 2016; 27:329-44. [PMID: 27389629 PMCID: PMC4947537 DOI: 10.1097/mol.0000000000000320] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE OF REVIEW There are today 11 mega-countries with more than 100 million inhabitants. Together these countries represent more than 60% of the world's population. All are facing noncommunicable chronic disease (NCD) epidemic where high cholesterol, obesity, diabetes, and cardiovascular diseases are becoming the main public health concerns. Most of these countries are facing the double burden of malnutrition where undernutrition and obesity coexist, increasing the complexity for policy design and implementation. The purpose of this study is to describe diverse sociodemographic characteristics of these countries and the challenges for prevention and control in the context of the nutrition transition. RECENT FINDINGS Mega-countries are mostly low or middle-income and are facing important epidemiologic, nutrition, and physical activity transitions because of changes in food systems and unhealthy lifestyles. NCDs are responsible of two-thirds of the 57 million global deaths annually. Approximately, 80% of these are in low and middle-income countries. Only developed countries have been able to reduce mortality rates attributable to recognized risk factors for NCDs, in particular high cholesterol and blood pressure. SUMMARY Mega-countries share common characteristics such as complex bureaucracies, internal ethnic, cultural and socioeconomic heterogeneity, and complexities to implement effective health promotion and education policies across population. Priorities for action must be identified and successful lessons and experiences should be carefully analyzed and replicated.
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Affiliation(s)
- Simon Barquera
- National Institute of Public Health, Cuernavaca, Morelos, Mexico
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9
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Atuk O, Özmen MU. Firm strategy and consumer behaviour under a complex tobacco tax system: implications for the effectiveness of taxation on tobacco control. Tob Control 2016; 26:277-283. [PMID: 27207855 DOI: 10.1136/tobaccocontrol-2015-052808] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/31/2016] [Indexed: 11/03/2022]
Abstract
BACKGROUND The current tobacco taxation scheme in Turkey, a mix of high ad valorem tax and low specific tax, contains incentives for firms and consumers to change pricing and consumption patterns, respectively. The association between tax structure and price and tax revenue stability has not been studied in detail with micro data containing price segment information. OBJECTIVES In this study, we analyse whether incentives for firms and consumers undermine the effectiveness of tax policy in reducing consumption. METHODS We calculate alternative taxation scheme outcomes using differing ad valorem and specific tax rates through simulation analysis. We also estimate price elasticity of demand using detailed price and volume statistics between segments via regression analysis. FINDINGS A very high ad valorem rate provides strong incentives to firms to reduce prices. Therefore, this sort of tax strategy may induce even more consumption despite its initial aim of discouraging consumption. While higher prices dramatically reduce consumption of economy and medium price segment cigarettes, demand for premium segment cigarettes is found to be highly price-inelastic. CONCLUSIONS The current tax scheme, based on both ad valorem and specific components, introduces various incentives to firms as well as to consumers which reduce the effectiveness of the tax policy. Therefore, on the basis of our theoretical predictions, an appropriate tax scheme should involve a balanced combination of ad valorem and specific rates, away from extreme (ad valorem or specific dominant) cases to enhance the effectiveness of tax policy for curbing consumption.
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Affiliation(s)
- Oğuz Atuk
- Research and Monetary Policy Department, Central Bank of the Republic of Turkey, Ankara, Turkey
| | - M Utku Özmen
- Research and Monetary Policy Department, Central Bank of the Republic of Turkey, Ankara, Turkey
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10
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Power J, Mallat C, Bonevski B, Nielssen O. An audit of assessment and outcome of intervention at a quit smoking clinic in a homeless hostel. Australas Psychiatry 2015; 23:528-30. [PMID: 26139703 DOI: 10.1177/1039856215593396] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE We aim to report on smoking history, mental and physical health, and the results of interventions provided by a Quit Smoking Clinic (QSC) at a Sydney homeless men's shelter. METHODS We undertook an audit of questionnaires administered during the first QSC visit and a review of outcomes of QSC clients who attended the clinic more than once. RESULTS A total of 144 men were assessed at the QSC, with mean age 45.2 years (22-71) and mean smoking duration of 29 years. About half were receiving treatment for psychotic illness, and there were high rates of other psychiatric disorders, physical illness and substance use disorder. Carbon monoxide (CO) readings were significantly higher for those smoking discarded cigarette butts. Among the subset of clients who attended the clinic more than once (n=56), only four quit for more than a month and one for a year. However, the reported number of cigarettes smoked per day was significantly lower (p=0.001), with a significant reduction in CO (p<0.008). CONCLUSIONS This study confirms the difficulty that homeless men experience in quitting smoking, but demonstrates the potential to reduce the physical and financial harm of smoking through cessation support interventions in this setting.
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Affiliation(s)
- Joseph Power
- Sydney Medical School, University of Sydney, Sydney, NSW, Australia
| | - Claire Mallat
- Matthew Talbot Hostel Clinic, Woolloomooloo, NSW, Australia
| | - Billie Bonevski
- Associate Professor and NHMRC Fellow, University of Newcastle, Newcastle, NSW, Australia
| | - Olav Nielssen
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia
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11
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Westreich D. From exposures to population interventions: pregnancy and response to HIV therapy. Am J Epidemiol 2014; 179:797-806. [PMID: 24573538 DOI: 10.1093/aje/kwt328] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Many epidemiologic studies identify contrasts between an "always-exposed" population and a "never-exposed" population. Such "exposure effects" are perhaps most valuable in discussing individual lifestyle changes, or in clinical care; they may be less valuable in estimating the potential effects of realistic public health interventions. Various methods, among them population attributable fractions and generalized impact fractions, attempt to obtain more policy-relevant estimates of "population intervention" effects, but such methods remain rare in the epidemiologic literature. Here, we describe the use of the parametric g-formula as a tool for the estimation of population intervention effects in longitudinal data. Our discussion is motivated by a previous study of the effect of incident pregnancy on time to virological failure among human immunodeficiency virus-positive women initiating antiretroviral therapy in South Africa between 2004 and 2011. We show that 1) interventional estimates of effect can be estimated in longitudinal data using the parametric g-formula and 2) exposure effects and population interventional effects can have dramatically different interpretations and magnitudes in real-world data. Epidemiologists should consider estimating interventional effects in addition to exposure effects; doing so would allow the results of epidemiologic studies to be more immediately relevant to policy-makers and to implementation science efforts.
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12
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Guillaumier A, Bonevski B, Paul C, D'Este C, Doran C, Siahpush M. Paying the price: a cross-sectional survey of Australian socioeconomically disadvantaged smokers' responses to hypothetical cigarette price rises. Drug Alcohol Rev 2013; 33:177-85. [PMID: 24350887 DOI: 10.1111/dar.12103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2013] [Accepted: 11/20/2013] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND AIMS Increases in tobacco taxation can lead to reductions in tobacco consumption and prevalence of use across social groups. However, use of price-minimisation strategies to manage current and future tobacco use and the role of financial stress is less understood. This study aimed to measure the effect of cigarette price increases on price-minimisation strategy endorsement and financial stress among socioeconomically disadvantaged smokers. DESIGN AND METHODS Community service organisation welfare recipients in NSW, Australia completed a touchscreen survey. Smoking history, financial stress, highest price to quit and responses to hypothetical cigarette price increases were assessed. RESULTS Participants were 354 smokers (response rate = 79%). Most participants received income from a government pension (95%), earned <A$300/week (55%), had not completed secondary schooling (64%), were moderately or heavily nicotine-dependent (60%), reported high financial stress (66%) and spent A$56/week on tobacco. In response to 10% and 20% hypothetical price rises, significantly more participants endorsed trying to quit in response to the larger increase scenario (P < 0.001), and fewer selected no change to their smoking (P < 0.001). Numerous price-minimisation strategies (e.g. switching to cheaper brands/products) were endorsed, but remained constant across hypothetical scenarios; level of financial stress appeared to have little influence. Smokers indicating they would not change their smoking in response to price rises had higher levels of nicotine dependence. DISCUSSION AND CONCLUSIONS Socially disadvantaged smokers endorsed numerous price-minimising strategies to maintain smoking at hypothetically increased costs. Larger cigarette price rises motivated more smokers to consider quitting, while price-resistant smokers appeared to have a more entrenched smoker status.
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Affiliation(s)
- Ashleigh Guillaumier
- School of Medicine and Public Health, University of Newcastle, Newcastle, Australia
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13
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Jones PR, Cohen MZ, McIlvain HE, Siahpush M, Scott A, Okafor K. Smoking in young adult African Americans. J Adv Nurs 2013; 70:1117-27. [DOI: 10.1111/jan.12272] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | - Marlene Z. Cohen
- College of Nursing; University of Nebraska Medical Center; Omaha Nebraska USA
| | - Helen E. McIlvain
- Department of Family Medicine; University of Nebraska Medical Center; Omaha Nebraska USA
| | - Mohammad Siahpush
- College of Public Health; University of Nebraska Medical Center; Omaha Nebraska USA
| | - Alexis Scott
- College of Nursing; University of Nebraska Medical Center; Omaha Nebraska USA
| | - Kingsley Okafor
- College of Medicine; University of Nebraska Medical Center; Omaha Nebraska USA
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Vijayaraghavan M, Messer K, White MM, Pierce JP. The effectiveness of cigarette price and smoke-free homes on low-income smokers in the United States. Am J Public Health 2013; 103:2276-83. [PMID: 24134354 DOI: 10.2105/ajph.2013.301300] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the effectiveness of state cigarette price and smoke-free homes on smoking behaviors of low-income and high-income populations in the United States. METHODS We used the 2006-2007 Tobacco Use Supplement to the Current Population Survey. The primary outcomes were average daily cigarette consumption and successful quitting. We used multivariable regression to examine the association of cigarette price and smoke-free home policies on these outcomes. RESULTS High state cigarette price (pack price ≥ $4.50) was associated with lower consumption across all income levels. Although low-income individuals were least likely to adopt smoke-free homes, those who adopted them had consumption levels and successful quit rates that were similar to those among higher-income individuals. In multivariable analysis, both policies were independently associated with lower consumption, but only smoke-free homes were associated with sustained cessation at 90 days. CONCLUSIONS High cigarette prices and especially smoke-free homes have the potential to reduce smoking behaviors among low-income individuals. Interventions are needed to increase adoption of smoke-free homes among low-income populations to increase cessation rates and prevent relapse.
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Affiliation(s)
- Maya Vijayaraghavan
- All authors are with Cancer Prevention and Control Division, Moores UCSD Cancer Center, University of California, San Diego, La Jolla
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15
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Coady MH, Chan CA, Sacks R, Mbamalu IG, Kansagra SM. The impact of cigarette excise tax increases on purchasing behaviors among New York city smokers. Am J Public Health 2013; 103:e54-60. [PMID: 23597382 DOI: 10.2105/ajph.2013.301213] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relationship between cigarette excise tax increases and tax-avoidant purchasing behaviors among New York City adult smokers. METHODS We analyzed data from the city's annual Community Health Survey to assess changes in rates of tax avoidance over time (2003-2010) and smokers' responses to the 2008 state cigarette tax increase. Multivariable logistic regression analysis identified correlates of buying more cigarettes on the street in response to the increase. RESULTS After the 2002 tax increase, the percentage of smokers engaged in tax-avoidant behavior decreased with time from 30% in 2003 to 13% in 2007. Following the 2008 tax increase, 21% of smokers reported buying more cigarettes from another person on the street. Low-income, younger, Black, and Hispanic smokers were more likely than respondents with other sociodemographic characteristics to purchase more cigarettes on the street. CONCLUSIONS To maximize public health impact, cigarette tax increases should be paired with efforts to limit the flow of untaxed cigarettes entering jurisdictions with high cigarette pack prices.
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Affiliation(s)
- Micaela H Coady
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA
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Thomas DP, Ferguson M, Johnston V, Brimblecombe J. Impact and perceptions of tobacco tax increase in remote Australian Aboriginal communities. Nicotine Tob Res 2012; 15:1099-106. [PMID: 23166311 DOI: 10.1093/ntr/nts232] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
INTRODUCTION We sought to assess the impact of a 25% tax excise rise on tobacco sales in Aboriginal communities in remote Australia and to explore local perceptions about tobacco tax rises and their impact. METHODS Tobacco sales data were collected from 18 stores in small remote Aboriginal communities from October 2009 to December 2010. Sales in the 7 months before and after the tax increase were compared. Interviews were conducted with 54 informants in 6 communities. RESULTS There was a nonsignificant 2.2% average reduction (95% CI = -5 to 10) in total tobacco sold in a store in the 7 months after the price increase compared with the 7 months before the price increase, with a large variation across the 18 stores. The magnitude of this apparent impact may have been reduced by seasonal effects. There were increased demands to share cigarettes, with a perception that there was increased reliance on those with more disposable income to purchase cigarettes for other smokers. The main reasons given for not quitting or reducing smoking were dependence, the normative nature of smoking, and the lack of support to quit. All Aboriginal interviewees supported price increases as important in reducing smoking. CONCLUSIONS The wide confidence interval around our estimated reduction in consumption means that the tax increase could have either been associated or not with a reduction in consumption. Future excise rises are supported but should be carefully monitored in Australian Indigenous populations.
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Affiliation(s)
- David P Thomas
- Menzies School of Health Research, Charles Darwin University, Darwin, Australia.
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17
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Siahpush M, Thrasher JF, Yong HH, Cummings KM, Fong GT, de Miera BS, Borland R. Cigarette prices, cigarette expenditure and smoking-induced deprivation: findings from the International Tobacco Control Mexico survey. Tob Control 2012; 22:223-6. [PMID: 22923478 DOI: 10.1136/tobaccocontrol-2012-050613] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
AIM Mexico implemented annual tax increases between 2009 and 2011. We examined among current smokers the association of price paid per cigarette and daily cigarette expenditure with smoking-induced deprivation (SID) and whether the association of price or expenditure with SID varies by income. METHODS We used data (n=2410) from three waves of the International Tobacco Control Mexico survey (ie, 2008, 2010, 2011) and employed logistic regression to estimate the association of price paid per cigarette and daily cigarette expenditure with the probability of SID ('In the last 6 months, have you spent money on cigarettes that you knew would be better spent on household essentials like food?'). RESULTS Price paid per cigarette increased from Mex$1.24 in 2008, to Mex$1.36 in 2010, to Mex$1.64 in 2011. Daily cigarette expenditure increased from Mex$6.9, to Mex$7.6 and to Mex$8.4 in the 3 years. There was no evidence of an association between price and SID. However, higher expenditure was associated with a higher probability of SID. There was no evidence that the association of price or expenditure with SID varied by income. CONCLUSION Tax increases in Mexico have resulted in smokers paying more and spending more for their cigarettes. Those with higher cigarette expenditure experience more SID, with no evidence that poorer smokers are more affected.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, 986075 Nebraska Medical Center, Omaha, NE 68198-6075, USA.
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Peretti-Watel P, L’haridon O, Seror V. Responses to increasing cigarette prices in France: How did persistent smokers react? Health Policy 2012; 106:169-76. [DOI: 10.1016/j.healthpol.2012.03.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2011] [Revised: 03/19/2012] [Accepted: 03/22/2012] [Indexed: 11/30/2022]
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Rahman MA, Mahmood MA, Spurrier N, Rahman M, Choudhury SR, Leeder S. Why Do Bangladeshi People Use Smokeless Tobacco Products? Asia Pac J Public Health 2012; 27:NP2197-209. [DOI: 10.1177/1010539512446957] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Despite scientific evidence about the harmful effects of smokeless tobacco (SLT), it is widely used in Bangladesh. This study explored perceptions about health effects of SLT use. Semistructured interviews were conducted with 1812 nonsmoking adults. About 40% of the participants were current SLT users or had used SLT in the past. Family members’ influence was the main factor for initiation. The participants believed that people continued using SLT because of addiction (52%) and as a part of their lifestyle (23%). The majority of participants (77%) did not mention any benefit, but SLT users considered it to be a remedy for toothache ( P < .05). Almost all participants mentioned that SLT was harmful and causes heart disease, cancer, and tuberculosis. Doctors’ advice was the common motivating factor to quit. Health promotion interventions should highlight the adverse effects of SLT use, which outweigh the perceived benefits, and should consider addressing the role of family in SLT initiation and use.
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Affiliation(s)
| | | | | | - Mahmudur Rahman
- Institute of Epidemiology, Disease Control and Research (IEDCR), Dhaka, Bangladesh
| | - Sohel Reza Choudhury
- National Heart Foundation Hospital & Research Institute (NHFH&RI), Dhaka, Bangladesh
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Siahpush M, Borland R, Yong HH, Cummings KM, Fong GT. Tobacco expenditure, smoking-induced deprivation and financial stress: results from the International Tobacco Control (ITC) Four-Country Survey. Drug Alcohol Rev 2012; 31:664-71. [PMID: 22404640 DOI: 10.1111/j.1465-3362.2012.00432.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS). DESIGN AND METHODS We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS. RESULTS In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS. CONCLUSIONS Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4365, USA.
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Zhu SH, Lee M, Zhuang YL, Gamst A, Wolfson T. Interventions to increase smoking cessation at the population level: how much progress has been made in the last two decades? Tob Control 2012; 21:110-8. [PMID: 22345233 PMCID: PMC3446870 DOI: 10.1136/tobaccocontrol-2011-050371] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
This paper reviews the literature on smoking cessation interventions, with a focus on the last 20 years (1991 to 2010). These two decades witnessed major development in a wide range of cessation interventions, from pharmacotherapy to tobacco price increases. It was expected that these interventions would work conjointly to increase the cessation rate on the population level. This paper examines population data from the USA, from 1991 to 2010, using the National Health Interview Surveys. Results indicate there is no consistent trend of increase in the population cessation rate over the last two decades. Various explanations are presented for this lack of improvement, and the key concept of impact = effectiveness × reach is critically examined. Finally, it suggests that the field of cessation has focused so much on developing and promoting interventions to improve smokers' odds of success that it has largely neglected to investigate how to get more smokers to try to quit and to try more frequently. Future research should examine whether increasing the rate of quit attempts would be key to improving the population cessation rate.
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Affiliation(s)
- Shu-Hong Zhu
- University of California, San Diego, La Jolla, CA 92093-0905, USA.
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Carpenter MJ, Hughes JR, Gray KM, Wahlquist AE, Saladin ME, Alberg AJ. Nicotine therapy sampling to induce quit attempts among smokers unmotivated to quit: a randomized clinical trial. ACTA ACUST UNITED AC 2012; 171:1901-7. [PMID: 22123796 DOI: 10.1001/archinternmed.2011.492] [Citation(s) in RCA: 101] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Rates of smoking cessation have not changed in a decade, accentuating the need for novel approaches to prompt quit attempts. METHODS Within a nationwide randomized clinical trial (N = 849) to induce further quit attempts and cessation, smokers currently unmotivated to quit were randomized to a practice quit attempt (PQA) alone or to nicotine replacement therapy (hereafter referred to as nicotine therapy), sampling within the context of a PQA. Following a 6-week intervention period, participants were followed up for 6 months to assess outcomes. The PQA intervention was designed to increase motivation, confidence, and coping skills. The combination of a PQA plus nicotine therapy sampling added samples of nicotine lozenges to enhance attitudes toward pharmacotherapy and to promote the use of additional cessation resources. Primary outcomes included the incidence of any ever occurring self-defined quit attempt and 24-hour quit attempt. Secondary measures included 7-day point prevalence abstinence at any time during the study (ie, floating abstinence) and at the final follow-up assessment. RESULTS Compared with PQA intervention, nicotine therapy sampling was associated with a significantly higher incidence of any quit attempt (49% vs 40%; relative risk [RR], 1.2; 95% CI, 1.1-1.4) and any 24-hour quit attempt (43% vs 34%; 1.3; 1.1-1.5). Nicotine therapy sampling was marginally more likely to promote floating abstinence (19% vs 15%; RR, 1.3; 95% CI, 1.0-1.7); 6-month point prevalence abstinence rates were no different between groups (16% vs 14%; 1.2; 0.9-1.6). CONCLUSION Nicotine therapy sampling during a PQA represents a novel strategy to motivate smokers to make a quit attempt. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT00706979.
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Affiliation(s)
- Matthew J Carpenter
- Department of Psychiatry, Hollings Cancer Center, Medical University of South Carolina, Charleston, 29425, USA.
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Dunlop SM, Cotter TF, Perez DA. Impact of the 2010 tobacco tax increase in Australia on short-term smoking cessation: a continuous tracking survey. Med J Aust 2011; 195:469-72. [PMID: 22004399 DOI: 10.5694/mja11.10074] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2023]
Abstract
OBJECTIVE To use population-level data to monitor the impact on smoking cessation activity of the April 2010 Australian tobacco tax increase. DESIGN AND SETTING The Cancer Institute NSW [New South Wales] Tobacco Tracking Survey (CITTS) is a continuous tracking telephone survey conducting about 50 interviews per week. Data from February to September in 2009 and 2010 were analysed (ie, data on people who quit smoking in the 3 months before and 5 months after the tax increase in 2010 were compared, and quitting activity over the same period in 2009 was also analysed). PARTICIPANTS Adult smokers and smokers who had stopped smoking in the previous 12 months; 2009 (n = 1604); 2010 (n = 1699). MAIN OUTCOME MEASURE Recent quitting (defined as stopping smoking or trying to quit within a 1-month period). RESULTS 22% of the sample reported that they had quit smoking in May 2010, compared with 13% in April 2010 and 12% in May 2009. Respondents interviewed in the 3 months after the tax increase (May-July) were significantly more likely to report quitting than those interviewed in the 3 months before the tax increase (odds ratio, 1.84; 95% CI, 1.26-2.69; P < 0.01). This increase in quitting activity was not sustained in the subsequent months (August-September). CONCLUSIONS The tobacco tax increase was associated with a short-term increase in the rate of smoking cessation among NSW adult smokers and recent quitters, suggesting that regular increases in tobacco tax may further encourage quitting activity.
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Affiliation(s)
- Sally M Dunlop
- Sydney School of Public Health, University of Sydney, Sydney, NSW.
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Dunlop SM, Perez D, Cotter T. Australian smokers' and recent quitters' responses to the increasing price of cigarettes in the context of a tobacco tax increase. Addiction 2011; 106:1687-95. [PMID: 21561498 DOI: 10.1111/j.1360-0443.2011.03492.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS To track smokers' responses to the increasing price of cigarettes after a tax increase, and assess socio-demographic differences in responses. DESIGN The Cancer Institute NSW's Tobacco Tracking Survey (CITTS) is a continuous tracking telephone survey. Weekly data were collected between May and September 2010. SETTINGS New South Wales, Australia. PARTICIPANTS A total of 834 smokers and 163 recent quitters (quit in last 12 months). MEASUREMENTS Responses to the price increase included smoking-related changes (tried to quit, cut down) and product-related changes (changed to lower priced brands, started using loose tobacco, bought in bulk). Recent quitters were asked how much the increasing price of cigarettes influenced them to quit. FINDINGS Overall, 47.5% of smokers made smoking-related changes and 11.4% made product-related changes without making smoking-related changes. Multinomial logistic regressions showed that younger smokers (versus older) were more likely to make product-related changes and smoking-related changes in comparison to no changes. Low- or moderate-income smokers (versus high-income) were more likely to make smoking-related changes compared to no changes. Highly addicted smokers (versus low addicted) were more likely to make product-related changes and less likely to make smoking-related changes. The proportion of smokers making only product-related changes decreased with time, while smoking-related changes increased. Recent quitters who quit after the tax increase (versus before) were more likely to report that price influenced them. CONCLUSIONS The effect of increasing cigarette prices on smoking does not appear to be mitigated by using cheaper cigarette products or sources. These results support the use of higher cigarette prices to encourage smoking cessation.
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Affiliation(s)
- Sally M Dunlop
- Sydney School of Public Health, University of Sydney, Sydney, Australia.
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