Cigarette taxes and smoking participation: evidence from recent tax increases in Canada

Association of cigarette excise taxes and clean indoor air laws with change in smoking behavior in the United States: a Markov modeling analysis

The rates of cigarette smoking in the United States have declined over the past few decades in parallel with increases in cigarette taxes and introduction of more stringent clean indoor air laws. Few longitudinal studies have examined association of taxes and clean indoor air policies with change in smoking nationally. This study examined the association of state and local cigarette taxes and clean indoor laws with change in smoking status of 18,499 adult participants of the longitudinal 2010-2011 Tobacco Use Supplement of the Current Population Survey over a period of 1 year. Every $1 increase in cigarette excise taxes was associated with 36% higher likelihood of stopping smoking among regular smokers. We found no association between clean indoor air laws and smoking cessation nor between taxes and clean indoor air laws with lower risk of smoking initiation. Cigarette taxes appear to be effective anti-smoking policies. Some state and local governments do not take full advantage of this effective policy measure.

Quantile regression of tobacco tax pass-through in the UK 2013-2019. How have manufacturers passed through tax changes for different tobacco products?

BACKGROUND

The effectiveness of tax increases relies heavily on the tobacco industry passing on such increases to smokers (also referred to as 'pass-through'). Previous research has found heterogeneous levels of tax pass-through across the market segments of tobacco products available to smokers. This study uses retail sales data to assess the extent to which recent tax changes have been passed on to smokers and whether this varies across the price distribution.

METHODS

We use panel data quantile regression analysis on Nielsen commercial data of tobacco price and sales in the UK from January 2013 to March 2019 combined with official UK tax rates and inflation to calculate the rate of tax pass-through for factory made (FM) cigarettes and roll your own (RYO) tobacco.

RESULTS

Following increases in the specific tax payable on tobacco, we find evidence of overshifting across the price distribution for both FM and RYO. The rate of the overshift in tax increased the more expensive the products were. This was consistent for FM and RYO. Additionally, our findings suggest that the introduction of standardised packaging was not followed by changes in how the tobacco industry responded to tax increases.

CONCLUSIONS

Following the repeated introduction of increases in specific tobacco tax as well as standardised packaging, we show that the tobacco industry applies techniques to keep the cheapest tobacco cheaper relative to the more expensive products when passing on tax increases to smokers.

Education-smoking gradient and upstream health policies: comparing Generation X with millennials

Purpose

Over the years, many upstream health policies have sought to reduce smoking across populations. While smoking has been substantially reduced, the effects of these policies on education-smoking gradient remain unclear. The present paper compares the education-smoking gradient among the Generation X and the millennials, who grew up with different types of upstream policies.

Design/methodology/approach

The study relies on regression analysis. The data are from the Canadian Tobacco, Alcohol and Drugs Survey of 2017, with the sample restricted to those born between 1965 and 1995.

Findings

At the zero-order, the education-smoking gradient has not significantly flattened from Generation X to millennials. And, accounting for the channels of impact of education on smoking does not substantially change this pattern.

Social implications

The implications for health inequalities associated with socioeconomic status, and tobacco consumption reduction policies, are discussed.

Originality/value

This paper is the first study of the kind using Canadian data.

Tobacco Price Increase and Successful Smoking Cessation for Two or More Years in Japan

INTRODUCTION

Assessing long-term smoking cessation after tobacco price increases is more valuable than short-term cessation as smokers often relapse after temporary cessation. We investigated whether tobacco price increases were associated with long-term smoking cessation and whether the association differed according to demographic, socioeconomic, and behavioral factors, using a national longitudinal survey of middle-aged individual-level data from 10 waves, every November from 2005 to 2014.

METHODS

Temporary and long-term at least 1 year (1y+) or 2 years (2y+) quitters were defined by smoking in any one wave and quitting in the subsequent two or three waves in a discrete-time design. November 2006 (after July 11% increase) and November 2010 (after October 37% increase) were used as proxy variables for price increases. Generalized estimating equation models adjusted for demographic, socioeconomic, and behavioral covariates, and analyses stratified by these covariates were performed to estimate the association between price increases and smoking cessation.

RESULTS

Of 43 630 smokers aged 50-65, 7.7%, 5.6%, and 5.2% of smokers quit temporarily, for at least 1 year and at least 2 years, respectively. 2y+ quitters significantly increased in November 2005-November 2008 (adjusted odds ratio = 1.23, 95% confidence interval: 1.06-1.43) and November 2009-November 2012 (adjusted odds ratio = 1.85, 95% confidence interval = 1.57-2.16). In stratified analyses, higher prices were associated with 2y+ quitters in all subgroups with some exceptions, including participants who smoked 21-30 cigarettes per day and those aged 60-65.

CONCLUSIONS

Increasing tobacco prices may be effective in promoting long-term smoking cessation in various subgroups among middle-aged Japanese adults.

IMPLICATIONS

Few longitudinal studies have examined the effect of a tobacco price increase on long-term smoking cessation. In a national longitudinal survey of middle-aged Japanese from 10 waves, the 37% tobacco price increase was found to be a trigger for successful smoking cessation for two or more years. Price increases were significantly associated with 2y+ smoking cessation in most demographic, behavioral, and socioeconomic subgroups. Results indicate that higher tobacco prices may be effective for long-term smoking cessation in almost all subgroups. Raising tobacco taxes and prices may be one of the most effective strategies for promoting long-term smoking cessation.

New views on endothelial dysfunction in gestational hypertension and potential therapy targets

The placenta has vital roles in metabolite exchange, fetal growth, and pre-eclampsia (PE). In this review, we discuss the pathogenesis of hypertension in pregnancy, focusing on four major theories to explain PE, discussing endothelial roles in those theories. We focus in particular on the roles of nitric oxide (NO) and prostacyclin (PGI₂) in placental endothelium, and propose new hypotheses for the influence and mechanisms of endothelial NO and PGI₂ signaling pathways in PE.

The effects of cigarette price and the amount of pocket money on youth smoking initiation and intensity in Canada

OBJECTIVES

To investigate the price and income elasticities of adolescent smoking initiation and intensity to determine the extent to which increased pocket money leads to greater smoking among youth, and whether higher taxes can mitigate this effect.

METHODS

We used the 2012/2013 Canadian Youth Smoking Survey including students in grades 7-12. The multivariable logistic regression was used to examine the probability of smoking initiation, and a linear regression to examine the smoking intensity determined by province-level prices of cigarettes, pocket money, and a vector of individual characteristics, including age, sex, race, and school-related and psychosocial factors.

RESULTS

Of respondents, 28.8% have tried cigarette smoking. More than 90% of these initiated smoking between age 9 and 17. Male smokers consumed a higher average number of whole cigarettes daily than did females. The price elasticity of smoking initiation and intensity for youth in the full sample were - 1.13 and - 1.02, respectively, which means that a 10% increase in price leads to an 11.3% reduction in initiation and a 10.2% reduction in intensity. The income elasticity of smoking initiation and intensity for youth in the full sample were 0.07 and 0.06, respectively, which means that a 10% increase in income leads to a 0.7% increase in initiation and a 0.6% increase in intensity.

CONCLUSION

Economic measures such as taxation that raise the price of cigarettes may be a useful policy tool to limit smoking initiation and intensity.

The contribution of excise cigarette taxes on the decline in youth smoking in Canada during the time of the Federal Tobacco Control Strategy (2002-2012)

OBJECTIVES

To evaluate the impact of changes in cigarette taxes on smoking for youths aged 15-18 in Canada during the time of the Federal Tobacco Control Strategy (FTCS).

METHODS

We used a difference-in-differences framework and leveraged the variation in cigarette taxes across Canada and over time. We used regression models with province and year fixed effects, and individual-level and provincial-level covariates on 2002-2012 data from the Canadian Tobacco Use Monitoring Survey.

RESULTS

Tax increases generally did not affect smoking outcomes. Each increase of CAD $1.00 (adjusted to year 2000 dollars) in excise cigarette taxes per package of 20 was associated with a 0.2 percentage point (95% CI: -1.8; 2.2) change in smoking prevalence, and a change of 0.3 in mean cigarettes smoked in the past week (95% CI: -1.2; 1.8).

CONCLUSION

From 2002 to 2012, smoking prevalence and mean smoking frequency were in steady decline among youths in Canada. This decline, however, was evident even among provinces with stable or decreasing cigarette tax levels. Tobacco taxes have mostly increased since the 1980s, and so, tax levels were already quite high by the launch of the FTCS. Province fixed effects and common temporal changes accounted for 83.7% of the variation in smoking prevalence. We derived similar results for smoking frequency. The cumulative tax increase during our study period was at least $1.00 for only three provinces. Thus, our findings suggest that factors driving down tobacco use among youths in all provinces appear to outweigh any impact of small tax increases at already high tax levels.

An Empirical Analysis of the Association Between Cigarette Smoking and Participation in the Supplemental Nutrition Assistance Program

PURPOSE

To examine the association between smoking and participation in Supplemental Nutrition Assistance Program (SNAP) among low-income families.

DESIGN

A quasi-experimental design using pooled cross-sectional data from the Bureau of Labor Statistics' Consumer Expenditure Diary Survey.

SETTING

A national, representative sample of US households from 2005 through 2012.

PARTICIPANTS

A total of 19 395 low-income households.

MEASURES

US poverty thresholds were used, in conjunction with household income, to create a sample of families at 130% of the federal poverty level and below. Expenditures on cigarettes and self-reported enrollment in SNAP were used to measure smoking behavior and program participation, respectively.

ANALYSIS

Estimation of a maximum likelihood model was used to predict the probability of smoking given participation in SNAP.

RESULTS

The SNAP participation among low-income households was associated with a 30% ( P < .01) increase in the likelihood of a household containing at least 1 smoker, relative to low-income non-SNAP households. Among smokers, SNAP households do not spend more money on tobacco products than non-SNAP households.

CONCLUSION

Given the strong association found between SNAP participation and smoking, connecting program participants who smoke to effective smoking cessation programs could be an effective tool in reducing the prevalence of smoking among the low-income population. States have a unique opportunity to use SNAP-Education programs to integrate tobacco prevention and cessation into curriculum for direct client impact.

Age-period-cohort analysis of smoking prevalence among young adults in Korea

OBJECTIVES:

Smoking prevalence among Korean men in their thirties is substantially high (approximately 50%). An in-depth analysis of smoking trends among young adults in their twenties is necessary to devise antismoking policies for the next 10 years. This study aimed to identify the contributions of age, period, and birth cohort effects on smoking prevalence in young adults.

METHODS:

Subjects comprised 181,136 adults (83,947 men: 46.3%; 97,189 women: 53.7%) aged 19 to 30 years from the 2008-2013 Korea Community Health Survey. Smoking prevalence adjusted with reference to the 2008 population was applied to the age-period-cohort (APC) model to identify the independent effects of each factor.

RESULTS:

For men, smoking prevalence rapidly escalated among subjects aged 19 to 22 years and slowed down among those aged 23 to 30 years, declined during 2008 to 2010 but stabilized during 2011 to 2013, and declined in birth cohorts prior to 1988 but stabilized in subjects born after 1988. However, in APC models, smoking prevalence increased with age in the 1988 to 1991 birth cohort. In this birth cohort, smoking prevalence at age 19 to 20 years was approximately 24% but increased to 40% when the subjects turned 23 to 24 years. For women, smoking prevalence was too low to generate consistent results.

CONCLUSIONS:

Over the past six years and in recent birth cohorts, smoking prevalence in adults aged 19 to 30 years has declined and is stable. Smoking prevalence should be more closely followed as it remains susceptible to an increase depending on antismoking policies or social conditions.

Beyond excise taxes: a systematic review of literature on non-tax policy approaches to raising tobacco product prices

Objective

Raising the price of tobacco products is considered one of the most effective ways to reduce tobacco use. In addition to excise taxes, governments are exploring other policies to raise tobacco prices and minimise price dispersion, both within and across price tiers. We conducted a systematic review to determine how these policies are described, recommended and evaluated in the literature.

Data sources

We systematically searched six databases and the California Tobacco Control library for English language studies or reports, indexed on or before 18 December 2013, that included a tobacco keyword (eg, cigarette), policy keyword (eg, legislation) and a price keyword (eg, promotion). We identified 3067 abstracts.

Study selection

Two coders independently reviewed all abstracts and identified 56 studies or reports that explicitly described a public policy likely to impact the retail price of tobacco products through non-tax means.

Data extraction

Two coders independently identified tobacco products targeted by policies described, recommendations for implementing policies and empirical assessments of policy impacts.

Data synthesis

The most prevalent non-tax price policies were price promotion restrictions and minimum price laws. Few studies measured the impact of non-tax policies on average prices, price dispersion or disparities in tobacco consumption, but the literature includes suggestions for crafting policies and preparing for legal challenges or tobacco industry opposition.

Conclusions

Price-focused evaluations of well-implemented non-tax price policies are needed to determine whether they can deliver on their promise to raise prices, reduce price dispersion and serve as an important complement to excise taxes.

The influence of estimated retail tobacco sale price increase on smokers' smoking habit in Jiangxi province, China: a cross-sectional study

Introduction

China is the biggest tobacco producer and consumer in the world. Raising cigarette taxes and increasing tobacco retail prices have been prove as effective strategies to reduce tobacco consumption and the prevalence of smoking in western countries. But in China, it is uncertain how an increase of cigarette retail price will influence the tobacco consumption.

Methods

From April to July, 2012, we selected 4025 residents over 15 years by a three stage random sampling in four cities, Jiangxi Province, China. We conducted interviews of their current smoking habits and how they would change their smoking behavior if tobacco retail prices increase.

Results

Overall, the prevalence of smoking is 27 % (47 % for male, 3.1 % for female). 15 % of smokers have tried to quit smoking in the past but all relapsed (168/1088), and over 50 % of current smokers do not want to quit, The average cigarette price per pack is 1.1 USD (range = 0.25-5.0). If retail cigarette prices increases by 50 %, 45 % of smokers say they will smoke fewer cigarettes, 20 % will change to cheaper brands and 5 % will attempt to quit smoking. Smokers who have intention to quit smoking are more sensitive to retail cigarette price increase. With retail cigarette price increases, more smokers will attempt to quit smoking.

Conclusion

Chinese smokers will change their smoking habits if tobacco retail prices increase. Consequently the Chinese government should enact tobacco laws which increase the retail cigarette price. The implementation of new tobacco laws could result in lowering the prevalence of smoking. Meanwhile, price increase measures need to apply to all cigarette brands to avoid smokers switching cigarettes to cheaper brands.

Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review

BACKGROUND AND AIMS

There is strong evidence about which tobacco control policies reduce smoking. However, their equity impact is uncertain. The aim was to assess the effectiveness of population-level interventions/policies to reduce socioeconomic inequalities in adult smoking.

METHODS

Systematic review of studies of population-level interventions/policies reporting smoking-related outcomes in adults of lower compared to higher socioeconomic status (SES). References were screened and independently checked. Studies were quality assessed. Results are presented in a narrative synthesis. Equity impact was assessed as: positive (reduced inequality), neutral (no difference by SES), negative (increased inequality), mixed (equity impact varied) or unclear.

RESULTS

117 studies of 130 interventions/policies were included: smokefree (44); price/tax (27); mass media campaigns (30); advertising controls (9); cessation support (9); settings-based interventions (7); multiple policies (4). The distribution of equity effects was: 33 positive, 36 neutral, 38 negative, 6 mixed, 17 unclear. Most neutral equity studies benefited all SES groups. Fourteen price/tax studies were equity positive. Voluntary, regional and partial smokefree policies were more likely to be equity negative than national, comprehensive smokefree policies. Mass media campaigns had inconsistent equity effects. Cigarette marketing controls were equity positive or neutral. Targeted national smoking cessation services can be equity positive by achieving higher reach among low SES, compensating for lower quit rates.

CONCLUSIONS

Few studies have assessed the equity impact of tobacco control policy/interventions. Price/tax increases had the most consistent positive equity impact. More research is needed to strengthen the evidence-base for reducing smoking inequalities and to develop effective equity-orientated tobacco control strategies.

Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review

Background. Policymakers need estimates of the impact of tobacco control (TC) policies to set priorities and targets for reducing tobacco use. We systematically reviewed the independent effects of TC policies on smoking behavior. Methods. We searched MEDLINE (through January 2012) and EMBASE and other databases through February 2009, looking for studies published after 1989 in any language that assessed the effects of each TC intervention on smoking prevalence, initiation, cessation, or price participation elasticity. Paired reviewers extracted data from studies that isolated the impact of a single TC intervention. Findings. We included 84 studies. The strength of evidence quantifying the independent effect on smoking prevalence was high for increasing tobacco prices and moderate for smoking bans in public places and antitobacco mass media campaigns. Limited direct evidence was available to quantify the effects of health warning labels and bans on advertising and sponsorship. Studies were too heterogeneous to pool effect estimates. Interpretations. We found evidence of an independent effect for several TC policies on smoking prevalence. However, we could not derive precise estimates of the effects across different settings because of variability in the characteristics of the intervention, level of policy enforcement, and underlying tobacco control environment.

The association between workplace smoking bans and self-perceived, work-related stress among smoking workers

Background

There is substantial empirical evidence on the benefits of smoking bans; however, the unintended consequences of this anti-smoking measure have received little attention. This paper examines whether workplace smoking bans (WSB's) are associated with higher self-perceived, work-related stress among smoking workers.

Methods

A longitudinal representative sample of 3,237 individuals from the Canadian National Population Health Survey from 2000 to 2008 is used. Work-related stress is derived from a 12-item job questionnaire. Two categories of WSB's, full and partial, are included in the analysis, with no ban being the reference category. Analysis also controls for individual socio-demographic characteristics, health status, provincial and occupational fixed-effects. We use fixed-effects linear regression to control for individual time-invariant confounders, both measured and unmeasured, which can affect the relationship between WSB's and work-related stress. To examine the heterogeneous effects of WSB's, the analysis is stratified by gender and age. We check the robustness of our results by re-estimating the baseline specification with the addition of different control variables and a separate analysis for non-smokers.

Results

Multivariate analysis reveals a positive and statistically significant association between full (β = 0.75, CI = 0.19-1.32) or partial (β = 0.69, CI = 0.12-1.26) WSB's, and the level of self-perceived, work-related stress among smoking workers compared to those with no WSB. We also find that this association varies by gender and age. In particular, WSB's are significantly associated with higher work stress only for males and young adults (aged 18-40). No statistically significant association is found between WSB's and the level of self-perceived work-related stress among non-smoking workers.

Conclusion

The results of this study do not imply that WSB's are the main determinant of self-perceived, work-related stress among smokers but provides suggestive evidence that these may be positively related.

The effect of job stress on smoking and alcohol consumption

This paper examines the effect of job stress on two key health risk-behaviors: smoking and alcohol consumption, using data from the Canadian National Population Health Survey. Findings in the extant literature are inconclusive and are mainly based on standard models which can model differential responses to job stress only by observed characteristics. However, the effect of job stress on smoking and drinking may largely depend on unobserved characteristics such as: self control, stress-coping ability, personality traits and health preferences. Accordingly, we use a latent class model to capture heterogeneous responses to job stress. Our results suggest that the effects of job stress on smoking and alcohol consumption differ substantially for at least two "types" of individuals, light and heavy users. In particular, we find that job stress has a positive and statistically significant impact on smoking intensity, but only for light smokers, while it has a positive and significant impact on alcohol consumption mainly for heavy drinkers. These results provide suggestive evidence that the mixed findings in previous studies may partly be due to unobserved individual heterogeneity which is not captured by standard models.