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ABSTRACT: INTRODUCTION: Cigarette excise tax and price increases reduce smoking consumption and prevalence. Studies have previously defined cigarette affordability internationally and have discussed its relevance as a tobacco control policy measure. This study provides the first estimates on cigarette affordability in the United States. METHODS: Cigarette affordability was defined as cigarette price in relation to individuals' income level. Three measures of cigarette affordability were estimated for U.S. states and nationally between 1970 and 2010. RESULTS: In 2010, on average, it took 1.62% of an individual's annual personal disposable income to purchase 100 packs of cigarettes in a U.S. state (relative income price). An individual who earned the equivalent of the hourly median wage in a U.S. state needed to work 21.4min in an hour to purchase a pack of cigarettes (minutes of labor, MoL50), whereas a relatively poorer individual earning the hourly 25th percentile wage needed to work 32.7min (MoL25). Cigarettes were most affordable in parts of the South and West and were least affordable in Northeastern states. While cigarette prices increased significantly between 1970 and 2008, affordability remained unchanged during this time and cigarettes may have become more affordable since the early 2000s in many states. CONCLUSIONS: Cigarette affordability in 2010 varied widely across U.S. states, a result of cigarette price increases not keeping pace with income increases in some parts of the United States, especially in Southern and Western states. In order to maximize the public health gains from cigarette tax increases, state taxation policies may consider affordability in benchmarking excise tax increases.
Nicotine & Tobacco Research 03/2013; · 2.58 Impact Factor
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Tobacco control 02/2013; · 3.85 Impact Factor
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ABSTRACT: OBJECTIVE: To analyze trends in excise taxes, real price and the affordability of cigarettes in Europe, and to examine the impact of EU wide tax policies on new member states. DESIGN: We use a sample of 37 European countries with data from 2004 to 2010. 27 countries are EU member states of which 12 joined in 2004 or 2007 (new members), while 10 non-EU countries are included as a comparison. Data is sourced from the European Commission and the Economist Intelligence Unit. RESULTS: The excise tax burden increased in all new member states between 2004 and 2010 while remaining relatively unchanged in existing member states. In 2010, the excise tax burden was higher in new (mean 63.8%) than in existing member states (mean 59.4%). Although cigarettes were significant cheaper in new member states the difference in affordability was narrower between the two groups. Excise taxes and prices rose aggressively in new member states while the increases in existing member states were smaller. While cigarettes became less affordable in most EU member states there was little difference between new and existing member states. The average annual percentage change in per-capita cigarette consumption was negative in all existing member states and in 9 of 12 new member states between 2004 and 2010, indicating declining per-capita cigarette consumption. CONCLUSIONS: Joining the EU results in significant increases in excise taxes and prices, and declines in affordability. Additionally, the structure of taxes, specifically the high excise tax floor resulted in higher taxes and prices.
Tobacco control 10/2012; · 3.85 Impact Factor
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ABSTRACT: INTRODUCTION: Article 6 of the Framework Convention on Tobacco Control commits Parties to use tax and price policies to reduce tobacco use, whereas Article 15 commits Parties to implement measures to eliminate the illicit trade in tobacco products. This paper identifies research gaps/needs, especially in low- and middle-income countries, which, if adequately addressed, would help in implementing Articles 6 and 15. METHODS: Based on a recent comprehensive review on the impact of tax and price on tobacco consumption and a summary of reviews and narratives about the illicit tobacco market, research gaps are identified. RESULTS: Countries have highly diverse research needs, depending on the stage of the tobacco epidemic, previous research and data availability, and making a ranking of research needs infeasible. Broad issues for further research are the following: (1) monitoring tobacco consumption, prices, and taxes, (2) assessing the effectiveness of the tax structure in generating revenue and reducing tobacco use, (3) strengthening the tax administration system in order to reduce tax evasion and tax avoidance, (4) improving our understanding of the political economy of tobacco tax policy, and (5) employing a multidisciplinary approach to assessing the magnitude of illicit tobacco trade.Conclusions:At a technical level, the case for increasing excise taxes to improve public health and increase government revenue is easily made, but the political and policy environment is often not supportive. In order to effectively impact policy, the required approach would typically make use of rigorous economic techniques, and be cognizant of the political economy of raising excise taxes.
Nicotine & Tobacco Research 09/2012; · 2.58 Impact Factor
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ABSTRACT: OBJECTIVE: To describe the characteristics of two primary determinants of cigarette consumption: cigarette affordability and the range of prices paid for cigarettes (and bidis, where applicable) in a set of 15 countries. From this cross-country comparison, identify places where opportunities may exist for reducing consumption through tax adjustments. DATA: Self-response data from 45,838 smokers from 15 countries, obtained from the Global Adult Tobacco Survey (GATS) 2008-2011. DESIGN: Using self-response data on individual cigarette expenditure and consumption, we construct a measure of the average cigarette price smokers pay for manufactured cigarettes (and bidis, where applicable) in 15 countries. We use these prices to evaluate cigarette affordability and the range of prices available in each country. These survey-derived measures of cigarette price and affordability are uniquely suited for cross-country comparison because they represent each country's distinctive mix of individual consumption characteristics such as brand choice, intensity of consumption, and purchasing behavior. RESULTS: In this sample of countries, cigarettes are most affordable in Russia, which has the most room for tobacco tax increase. Affordability is also relatively high in Brazil and China for cigarettes, and in India and Bangladesh for bidis. Although the affordability of cigarettes in India is relatively low, the range of cigarette prices paid is relatively high, providing additional evidence to support the call for simplifying the existing tax structure and reducing the width of price options. China has both high affordability and wide price ranges, suggesting multiple opportunities for reducing consumption through tax adjustments.
Tobacco control 08/2012; · 3.85 Impact Factor
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ABSTRACT: To assess the determinants of smoking behaviour and to estimate the impact of tobacco consumption on the consumption of other commodities by Cambodian households.
To assess the determinants of smoking in Cambodia, the authors used a logistic regression model that estimated the probability of an individual smoking, given a set of socioeconomic and demographic characteristics. A Seemingly Unrelated Regression method was used to assess the impact of tobacco consumption on the consumption of other commodities. The nationally representative 2004 Cambodia Socio-Economic Survey, collected by the National Institute of Statistics of the Ministry of Planning in Cambodia, was used for the analysis.
Smoking in Cambodia is influenced by a variety of factors such as gender, marital status, age, ethnicity, literacy, health status and perceptions about the health consequences of tobacco use. The authors found that spending on tobacco crowds out expenditures on education and clothing at the national level and expenditures on food for low- and middle-income households.
The first analysis of the study showed that increased education is associated with lower daily smoking, and the second analysis revealed that expenditures on tobacco crowds out expenditures on education. Combining these two results points to a vicious circle where low education means higher likelihood of smoking, which in turn results in lower spending on education. Such budget allocation clearly has negative intergenerational consequences.
Tobacco control 08/2011; 21(3):341-6. · 3.85 Impact Factor
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ABSTRACT: To estimate the price elasticity of cigarette demand among youth in low- and middle-income countries (LMIC).
The Global Youth Tobacco Survey was used to obtain data on the smoking behaviour of 315,353 adolescents from 17 LMIC.
Two-part model of cigarette demand with country fixed effects. The first part estimates the impact of prices on smoking participation while the second part estimates the impact of prices on the number of cigarettes smoked among current smokers. Besides controlling for individual characteristics such as Age, Gender, Parental Smoking and availability of Pocket Money, the authors control for confounding environmental factors such as anti-smoking sentiment, the prevalence of cigarette advertising and anti-tobacco media messAges, and ease of purchasing cigarettes. All countries in this study are represented with at least two observations over time, which allows us to control for unobserved country characteristics and/or policies that may influence smoking patterns within countries.
Cigarette price is an important determinant of smoking. The estimated price elasticity of smoking participation is -0.74, and the estimated price elasticity of conditional cigarette demand is approximately -1.37. The total price elasticity of cigarette demand is -2.11, implying that an increase in price of 10% would reduce youth cigarette consumption by 21.1% at the mean.
Tobacco control 07/2011; 20(6):419-24. · 3.85 Impact Factor
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ABSTRACT: By 2030, the tobacco epidemic will be responsible for over eight million deaths worldwide per year, with 80% of those deaths occurring in low-resource countries. Despite the magnitude of the problem, little is known about the funding for global tobacco control.
To estimate the amount of tobacco control funding, we created an integrated database based on information provided by tobacco control donors. We focus on resources available to low-income and middle-income countries provided as Development Assistance to Control Tobacco (DACT).
Global DACT grew from US$1.2 million in 2000 to US$44.2 million in 2009, primarily due to contributions from private philanthropies. Average annual 2000-2009 funding amounted to about US$0.003 per adult (US$0.0003 per adult in 2000 and US$0.011 per adult in 2009). DACT has been supplemented by domestic public funding that reached US$0.009 per adult in 2008. 28% of emerging and developing countries received zero DACT and 15% of those countries reported no funding at all. Out of US$21.8 billion disbursed in 2007 for health-related development assistance, DACT represented only US$0.02 billion, or 0.09%.
Since the funding for both infectious and non-communicable diseases in low-resourced countries is inadequate, the solution for global tobacco control is not to shift resources from other public health priorities, but rather to generate additional tobacco control funding. Several mechanisms to achieve this goal are proposed.
Tobacco control 06/2011; 21(5):465-70. · 3.85 Impact Factor
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ABSTRACT: To evaluate the impact of the dynamic 2007-2010 tobacco tax policy in Ukraine on cigarette prices, cigarette consumption, tobacco tax revenue and the tobacco industry's price strategy.
Using data on cigarette sales, cigarette prices, income and tobacco control policies, price elasticities of cigarette demand in Ukraine were estimated using two methods. Annual data were used to generate point price elasticity estimates, while monthly data were used in a two-step Engle-Granger procedure.
The point price elasticity estimate is data sensitive and ranges from -0.11 to -0.62, centring around -0.32. The regression model estimates a long-run price elasticity of -0.28. Cigarette consumption fell by 13% in 2009 and 15% in 2010 while the tax revenue increased by US$700 million and by US$500 million in 2009 and 2010, respectively, compared to the previous year. Tax increases have changed the tobacco industry's price strategy from one of shielding consumers from the impact of smaller tax hikes in 2007-2008, to one of increasing industry net-of-tax prices, after recent, larger tax increases.
The higher real tobacco excise taxes of 2009 and 2010 have significantly reduced tobacco consumption in Ukraine, resulting in encouraging public health and fiscal gains. It will be important for cigarette prices/taxes to keep pace with inflation and income growth for this impact to be sustained.
Tobacco control 06/2011; 21(4):429-35. · 3.85 Impact Factor
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ABSTRACT: Given the impact of higher tobacco prices on smoking cessation, we studied the role of future cigarette prices on forming expectation about smoking behavior.
Using a random sample of 9,058 adult cigarette smokers from the United States, Canada, Australia, and the United Kingdom collected in 2002, we examined predictors of what smokers say they will do in response to a hypothetical 50% increase in the price they paid for their last cigarette purchase. A series of regression analyses examined factors associated with intentions that have a positive impact on health, that is, intentions to quit and/or to consume fewer cigarettes.
The quit and/or smoke less intentions were more pronounced among those who lived in areas with higher average cigarette prices and who paid higher prices for their brand of choice during the last purchase. The magnitude of the price increase is a more important predictor of an intention to quit/smoke less compared with the average cigarette price.
The availability of alternative (cheaper) cigarette sources may reduce but would not eliminate the impact of higher prices/taxes on smokers' expected behavior that has been linked to actual quit intentions and quitting in follow-up surveys.
Nicotine & Tobacco Research 03/2011; 13(6):419-25. · 2.58 Impact Factor
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ABSTRACT: To quantify the impact of tobacco use and the related medical expenditure on poverty in India.
Tobacco expenditure and associated medical expenditure attributable to tobacco use were subtracted from the household monthly consumption expenditure in order to derive an appropriate measure of household disposable income. The 2004 National Sample Survey, a nationally representative survey of Indian households, was used to estimate the true level of poverty.
Our estimates indicate that accounting for direct expenditure on tobacco would increase the rural and the urban poverty rates by 1.5% (affecting 11.8 million people) and 0.72% (affecting 2.3 million people), respectively. Similarly, the out-of-pocket costs of tobacco-attributable medical care result in 0.09% higher poverty rates in rural areas (affecting 0.7 million people) and in 0.07% higher poverty rates in urban locations (affecting 0.23 million people).
Tobacco consumption impoverishes roughly 15 million people in India. Hence tobacco control measures would not only improve public health, but would also reduce poverty in India.
Tobacco control 02/2011; 20(5):349-52. · 3.85 Impact Factor
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ABSTRACT: To assess the impact of a tobacco control law adopted in Albania in 2007 and to estimate the share of illicit cigarettes on the market.
Comparative analysis of two waves of a nationally representative household survey, one conducted before the new law went into effect and the other after 2 years. Official sales data were contrasted with the consumption estimate based on the survey.
Smoking prevalence, quit attempts, exposure to cigarette advertising, exposure to second-hand smoke, total cigarette consumption, share of illicit packs among packs possessed by smokers.
Despite the adoption of strong smoke-free policies and adverting restrictions, smoking prevalence in Albania has risen. The increase in prevalence has been driven by higher smoking rates among females (18.9% in 2007 vs 29.3% in 2009) and young adults (23.2% in 2007 vs 38.5% in 2009 among 18-19 year olds). Self-reported exposure to second-hand smoke and cigarette advertising have been reduced since 2007. The majority of respondents are still exposed to second-hand smoke and more than half are exposed to tobacco advertising. Nevertheless, there are signs that the consumption of illicit cigarettes is declining.
The impacts of smoke-free policies and an advertising ban have been limited due to lack of enforcement and failure to adopt a comprehensive set of tobacco control measures. These measures should include sizeable and regular tobacco tax increases in excess of the general level of inflation and income growth. The decline in the share of illicit cigarettes should improve the effectiveness of the cigarette tax policy.
Tobacco control 12/2010; 19(6):463-8. · 3.85 Impact Factor
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ABSTRACT: To examine the importance of cigarette prices in influencing smoking cessation and the motivation to quit.
We use longitudinal data from three waves of the International Tobacco Control Policy Evaluation Survey (ITC). The study contrasts smoking cessation and motivation to quit among US and Canadian smokers and evaluates how this relationship is modified by cigarette prices, nicotine dependence and health knowledge. Different price measures are used to understand how the ability to purchase cheaper cigarettes may reduce the influence of prices. Our first model examines whether cigarette prices affect motivation to quit smoking using Generalized Estimating Equations to predict cessation stage and a least squares model to predict the change in cessation stage. The second model evaluates quitting behavior over time. The probability of quitting is estimated with Generalized Estimating Equations and a transition model to account for the 'left-truncation' of the data.
US and Canada.
4352 smokers at Wave 1, 2000 smokers completing all three waves.
Motivation to quit, cigarette prices, nicotine dependence and health knowledge.
Smokers living in areas with higher cigarette prices are significantly more motivated to quit. There is limited evidence to suggest that price increases over time may also increase quit motivation. Higher cigarette prices increase the likelihood of actual quitting, with the caveat that results are statistically significant in one out of two models. Access to cheaper cigarette sources does not impede cessation although smokers would respond more aggressively (in terms of cessation) to price increases if cheaper cigarette sources were not available.
This research provides a unique opportunity to study smoking cessation among adult smokers and their response to cigarette prices in a market where they are able to avoid tax increases by purchasing cigarettes from cheaper sources. Higher cigarette prices appear to be associated with greater motivation to stop smoking, an effect which does not appear to be mitigated by cheaper cigarette sources. The paper supports the use of higher prices as a means of encouraging smoking cessation and motivation to quit.
Addiction 11/2010; 106(3):609-19. · 4.31 Impact Factor
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ABSTRACT: This paper estimates the impact of cigarette prices on youth smoking in lower-income countries using data from the Global Youth Tobacco Survey (GYTS). Country-level heterogeneity is addressed with fixed effects and by directly controlling for confounding environmental factors such as local anti-smoking sentiment, cigarette advertising, anti-smoking media messages, and compliance with youth access restrictions. We find that cigarette price is an important determinant of both smoking participation and conditional demand. The estimated price elasticity of participation is -0.63. The likelihood of participation decreases with anti-smoking sentiment and increases with exposure to cigarette advertising. The estimated price elasticity of conditional cigarette demand is approximately -1.2. Neither anti-smoking sentiment, cigarette advertising, nor access restrictions have an impact on the intensity of smoking among current smokers, but exposure to anti-smoking media may reduce the number of cigarettes smoked.
National Bureau of Economic Research, Inc, NBER Working Papers. 01/2010;
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ABSTRACT: Tobacco use prevalence in Europe is characterized by large disparities, with Western nations reporting smoking rates generally below 25%, while Eastern nations have smoking rates usually above 30%. Albania provides a distressing case study for Eastern Europe in which the exposure to the West after the fall of the communist regime dramatically increased the availability of Western-type cigarettes, while adoption of counterbalancing tobacco control measures lagged far behind. Results based on the representative Albanian Adult Tobacco Survey (AATS) conducted in 2007 suggest that smoking is a major problem, with a 64% smoking prevalence among Albanian men. It is becoming an increasingly greater concern among women, whose smoking prevalence more than doubled since 1990, reaching 19% in 2007. Young women living in urban areas are particularly susceptible to tobacco use; about one-third of them reported that they smoke. About 85% of current smokers smoke daily and with very high intensity, which further increases their risk of dying of smoking-attributable diseases. Smoking and secondhand exposure kill about 3,800 Albanians per year, about one-fifth of all deaths in the country. In addition, tobacco use imposes opportunity costs on Albanian households, which spent $358.6 million on cigarettes in 2007, or about 6% of the gross domestic product (GDP). To reduce the health and economic burden caused by tobacco use, the Albanian government should implement and enforce evidence-based tobacco control policies such increasing cigarette taxes; promoting cessation, particularly via the health care system; and enacting stricter clean indoor air laws.
Central European journal of public health 01/2009; 16(4):182-8.
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ABSTRACT: The Albania SimSmoke simulation model is used to examine the effects of tobacco control policies. The model is used to consider the projected trends in smoking prevalence and associated smoking-attributable deaths in the absence of new policies, and then to examine the effect of new policies that are consistent with the Framework Convention for Tobacco Control (FCTC) on these outcomes. The model shows that significant inroads to reducing smoking prevalence and premature mortality can be achieved through tax increases. Acomprehensive strategy to further reduce smoking rates should include a media campaign complete with programs to publicize and enforce clean air laws, a comprehensive cessation treatment program, strong health warnings, advertising bans, and youth access laws. Besides presenting the benefits of a comprehensive tobacco control strategy, the model helps to identify important information needed for both modeling and policymaking. The effectiveness of future tobacco control policy will require proper surveillance and evaluation schemes for Albania.
Central European journal of public health 01/2009; 16(4):189-98.
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ABSTRACT: Roll-your-own (RYO) cigarette use has been subject to relatively limited research, particularly in developing countries. This paper seeks to describe RYO use in Thailand and Malaysia and relate RYO use to smokers' knowledge of the harmfulness of tobacco. Data come from face-to-face surveys with 4,004 adult smokers from Malaysia (N = 2,004) and Thailand (N = 2000), collected between January and March 2005. The prevalence of any use of RYO cigarettes varied greatly between Malaysia (17%) and Thailand (58%). In both countries, any RYO use was associated with living in rural areas, older average age, lower level of education, male gender, not being in paid work, slightly lower consumption of cigarettes, higher social acceptability of smoking, and positive attitudes toward tobacco regulation. Among RYO users, exclusive use of RYO cigarettes (compared with mixed use) was associated with older age, female gender (relatively), thinking about the enjoyment of smoking, and not making a special effort to buy cheaper cigarettes if the price goes up. Finally, exclusive RYO smokers were less aware of health warnings (RYO tobacco carries no health warnings), but even so, knowledge of the health effects of tobacco was equivalent.
Nicotine & Tobacco Research 06/2008; 10(5):907-15. · 2.58 Impact Factor
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ABSTRACT: We estimated the price and income elasticity of cigarette demand and the impact of cigarette taxes on cigarette demand and cigarette tax revenue in Malaysia. The data on cigarette consumption, cigarette prices, and public policies between 1990 and 2004 were subjected to a time-series regression analysis applying the error-correction model. The preferred cigarette demand model specification resulted in long-run and short-run price elasticities estimates of -0.57 and -0.08, respectively. Income was positively related to cigarette consumption: A 1% increase in real income increased cigarette consumption by 1.46%. The model predicted that an increase in cigarette excise tax from Malaysian ringgit (RM) 1.60 to RM2.00 per pack would reduce cigarette consumption in Malaysia by 3.37%, or by 806,468,873 cigarettes. This reduction would translate to almost 165 fewer tobacco-related lung cancer deaths per year and a 20.8% increase in the government excise tax revenue. We conclude that taxation is an effective method of reducing cigarette consumption and tobacco-related deaths while increasing revenue for the government of Malaysia.
Nicotine & Tobacco Research 12/2007; 9(11):1163-9. · 2.58 Impact Factor
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ABSTRACT: Despite the deleterious effects of smokeless tobacco use, very little is known about the effects of tobacco control policies on smokeless tobacco demand. This paper uses data extracted from the 1995-2001 National Youth Risk Behavior Surveys (YRBS) augmented with tobacco taxes, prices and policies to estimate smokeless tobacco demand equations among male high school students. The estimates indicate that higher smokeless tobacco taxes would significantly reduce the number of male students who use smokeless tobacco and the number of days smokeless tobacco users use smokeless tobacco. Moreover, smokeless tobacco products and cigarettes were found to be economic complements in consumption.
Applied Economics. 02/2007; 39(1):31-41.
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ABSTRACT: We evaluated the impact of a community-based tobacco control project that was implemented in the city of Tucson, Arizona, USA, between 1996 and 2001.
The project's goal was to reduce the prevalence of youth smoking through change in social norms at schools and in communities and workplaces. As is often the case, these community-based health promotion interventions were implemented in conjunction with other broader programmes, in this case implemented on the state level.
Taking into account state level interventions as well as changes in sociodemographic and economic environment over the course of the project (e.g. increases in cigarette prices), we measure the net effect of the intervention in terms of the number of people who quit or did not initiate smoking and by the discounted life-years gained. To establish the value of investing into community-based intervention, we calculated the real discounted cost per quit and per life-year gained of 3789 US dollars and 3942 US dollars, respectively. These compare favourably with the real cost per quit of 4270 US dollars when implementing the 1996 US Clinical Practice Guideline for smoking cessation but exceed the real cost of 2923 US dollars per discounted life-year gained when following the guideline.
A sensitivity analysis that assumed 5% programme persistence (i.e. 5% of the programme's impact would last forever in the absence of future funding for the programme), one-third would relapse and that one-third of those who quit may have quit smoking even without the programme, suggested a lower cost per discounted life-year saved of 3476 US dollars. The cost effectiveness of this project compares favourably with other tobacco control interventions.
Despite its relatively small target group, this community-based intervention was cost effective.
Applied Health Economics and Health Policy 02/2006; 5(3):167-76.
