Article

Do cigarette prices motivate smokers to quit? Evidence from the ITC survey

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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.

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... There is mounting evidence that smokers would be more responsive to price increases if there were fewer opportunities to obtain cheap tobacco. 1,[10][11][12] Disadvantaged smokers are more likely to use cheap tobacco, [13][14][15][16] so its availability may also contribute to the widening socioeconomic disparities associated with smoking. The present study therefore aims to track cheap tobacco sources and use among adult smokers in the United Kingdom between 2002 and 2014 via changes in product type, purchase source, and prices paid and to identify the implications for tobacco tax policy. ...
... 29 In 2009, a program to tackle illicit tobacco in the north of England was also launched, which placed an emphasis on reducing the demand for illicit tobacco, and this was also evaluated as largely meeting its aims. 30 Availability and use of cheap tobacco is associated with reduced smoking cessation, [11][12][13]31 underlining the importance of understanding the sources and types of cheap tobacco and the incentives underpinning their use. Research to date has indicated that RYO use in the United Kingdom is increasing, 18 particularly among younger smokers, 32 and between 2006 and 2009, the market share of discount FM brands increased significantly in the United Kingdom while their prices remained largely unchanged. ...
... To be included in the study, participants had to be current smokers, so our procedure meant that quitters were progressively excluded from the analysis. However, the missing data analysis also suggested that users of cheap tobacco (who are less likely to quit [11][12][13]31 ) were more likely to be excluded. Thus, these two effects balance each other to some extent. ...
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Introduction: Raising tobacco prices is the most effective population-level intervention for reducing smoking, but this is undermined by the availability of cheap tobacco. This study monitors trends in cheap tobacco use among adult smokers in the UK between 2002-2014 via changes in product type, purchase source, and prices paid. Methods: Weighted data from 10 waves of the International Tobacco Control policy evaluation study were used. This is a longitudinal cohort study of adult smokers with replenishment; 6169 participants provided 15812 responses. Analyses contrasted 1) product type: roll-your-own (RYO) tobacco, factory made packs (FM-P), and cartons (FM-C); 2) purchase source: UK store-based sources (e.g. supermarkets, convenience stores) with non-UK/ non-store sources representing tax avoidance/ evasion (e.g. outside the UK, duty free, informal sellers); and 3) prices paid (inflation-adjusted to 2014 values). Generalised Estimating Equations tested linear changes over time. Results: 1) RYO use increased significantly over time as FM decreased. 2) UK store-based sources constituted approximately 80% of purchases over time, with no significant increases in tax avoidance/ evasion. 3) Median RYO prices were less than half that of FM, with FM-C cheaper than FM-P. Non-UK/ non-store sources were cheapest. Price increases of all three product types from UK store-based sources from 2002 - 2014 were statistically significant, but not substantial. Wide (and increasing for FM-P) price ranges meant each product type could be purchased in 2014 at prices below their 2002 medians from UK store-based sources. Conclusions: Options exist driving UK smokers to minimise their tobacco expenditure; smokers do so largely by purchasing cheap tobacco products from UK stores. Implications: The effectiveness of price increases as a deterrent to smoking is being undermined by the availability of cheap tobacco such as roll-your-own tobacco and cartons of packs of factory-made cigarettes. Wide price ranges allowed smokers in 2014 to easily obtain cigarettes at prices comparable to 12 years prior, without resorting to tax avoidance or evasion. UK store-based sources accounted for 80% or more of all tobacco purchases between 2002-2014, suggesting little change in tax avoidance or evasion over time. There was a widening price range between the cheapest and most expensive factory-made cigarettes.
... 12 Evidence indicates that the availability of cheap tobacco reduces motivation to quit and quit success. [54][55][56][57][58][59] Our work, to date, had used repeat crosssectional data to examine cheap cigarette use in the UK and could therefore not directly determine the impact that tax and industry price changes had on smokers' behaviour. Two US studies 40,60 found mixed results: one 60 found smokers using cheaper FM cigarettes were less likely than those using premium brands to quit or reduce smoking between 1988 and 1993, and the second, more recent, study 40 found no direct association between use of cheap FM brands or RYO tobacco in 2009 and quitting outcomes in 2010. ...
... To be included in the study, participants had to be current smokers, so our procedure meant that quitters were progressively excluded from the analysis. However, the missing data analysis also suggested that users of cheap tobacco (who other research has shown may be less likely to quit [54][55][56]59 ) were more likely to be excluded. Thus, it is possible that these two effects balance each other to some extent. ...
... Internal industry documents confirm that the TI is particularly fearful of sudden, large tax increases and evidence indicates that sudden, large price increases are most associated with quit attempts. 59,247,248 Findings 4 and 5 therefore lend further weight to the benefit of sudden, large tax increases. Consideration should be given to interlinked options: (1) implementing intermittent larger tax increases on top of the tax escalator; (2) making the timing of such tax increases unpredictable and with little notice so that industry has no time to game the system; and (3) limiting the number of times per year that the industry is able to change its prices. ...
Article
Background Increasing tobacco prices through taxation is very effective for reducing smoking prevalence and inequalities. For optimum effect, understanding how the tobacco industry and smokers respond is essential. Tobacco taxation changes occurred in the UK over the study period, including annual increases, a shift in structure from ad valorem to specific taxation and relatively higher increases on roll-your-own tobacco than on factory-made cigarettes. Objectives Understanding tobacco industry pricing strategies in response to tax changes and the impact of tax on smokers’ behaviour, including tax evasion and avoidance, as well as the effect on smoking inequalities. Synthesising findings to inform how taxation can be improved as a public health intervention. Design Qualitative analysis and evidence synthesis (commercial and Nielsen data) and longitudinal and aggregate cross-sectional analyses (International Tobacco Control Policy Evaluation Project data). Setting The UK, from 2002 to 2016. Data sources and participants Data were from the tobacco industry commercial literature and retail tobacco sales data (Nielsen, New York, NY, USA). Participants were a longitudinal cohort (with replenishment) of smokers and ex-smokers from 10 surveys of the International Tobacco Control Policy Evaluation Project (around 1500 participants per survey). Main outcome measures (1) Tobacco industry pricing strategies, (2) sales volumes and prices by segments over time and (3) smokers’ behaviours, including products purchased, sources, brands, consumption, quit attempts, success and sociodemographic differences. Review methods Tobacco industry commercial literature was searched for mentions of tobacco products and price segments, with 517 articles extracted. Results The tobacco industry increased prices on top of tax increases (overshifting), particularly on premium products, and, recently, the tobacco industry overshifted more on cheap roll-your-own tobacco than on factory-made cigarettes. Increasingly, price rises were from industry revenue generation rather than tax. The tobacco industry raised prices gradually to soften impact; this was less possible with larger tax increases. Budget measures to reduce cheap product availability failed due to new cheap factory-made products, price marking and small packs. In 2014, smokers could buy factory-made (roll-your-own tobacco) cigarettes at real prices similar to 2002. Exclusive roll-your-own tobacco and mixed factory-made cigarettes and roll-your-own tobacco use increased, whereas exclusive factory-made cigarette use decreased, alongside increased cheap product use, rather than quitting. Quitting behaviours were associated with higher taxes. Smokers consumed fewer factory-made cigarettes and reduced roll-your-own tobacco weight over time. Apparent illicit purchasing did not increase. Disadvantaged and dependent smokers struggled with tobacco affordability and were more likely to smoke cheaper products, but disadvantage did not affect quit success. Limitations Different for each data set; triangulation increased confidence. Conclusions The tobacco industry overshifted taxes and increased revenues, even when tax increases were high. Therefore, tobacco taxes can be further increased to reduce price differentials and recoup public health costs. Government strategies on illicit tobacco appear effective. Large, sudden tax increases would reduce the industry’s ability to manipulate prices, decrease affordability and increase quitting behaviours. More disadvantaged, and dependent, smokers need more help with quitting. Future work Assessing the impact of tax changes made since 2014; changing how tax changes are introduced (e.g. sudden intermittent or smaller continuous); and tax changes on tobacco initiation. Funding This project was funded by the National Institute for Health Research (NIHR) Public Health Research programme and will be published in full in Public Health Research ; Vol. 8, No. 6. See the NIHR Journals Library website for further project information.
... Of all the MPOWER measures, increasing price through higher taxes is the single most effective way to encourage tobacco users to quit and prevent children from starting to smoke (25). Of all European countries, the Czech Republic has among the lowest cigarette prices, due to low excise taxes (26)(27). While low cigarette prices decrease the demand for illegal or contraband cigarettes, cheaper prices are associated with high smoking rates, and greater uptake among youth. ...
... While low cigarette prices decrease the demand for illegal or contraband cigarettes, cheaper prices are associated with high smoking rates, and greater uptake among youth. Higher cigarette prices are particularly effective in encouraging cessation and motivate smokers to quit, particularly young people and those living in poverty (26)(27)(28). Over time, simple and effectively implemented tax structures decrease tobacco consumption (25). ...
Article
Objectives: Smoking is the leading cause of premature mortality and morbidity. The aim of this study was to provide the first national description of organizational capacity and involvement in tobacco control (TC) measures outlined by the WHO Framework Convention on Tobacco Control (FCTC) within the Czech Republic. Methods: Data were collected in a national cross-sectional survey of all 14 organizations engaged in TC activities within the Czech Republic. Organizational capacity (defined as skills, supports, partnerships, resources, and leadership) to implement TC activities, and level of involvement in key FCTC measures were assessed and compared across organizations. Results: Despite the high economic costs of tobacco use, few organizations were involved in TC activities. 50% of all organizations involved in TC activities were non-government or non-profit organizations. Less than one third of organizations reported having a sufficient number of staff or adequate funding to work effectively. Skills for chronic disease prevention (CDP) practice including assessment, identifying relevant practices, developing and implementing initiatives were rated more favourably than skills to evaluate these activities. Level of involvement was ranked highest for activities that focused on creation of smoke-free environments and lowest for activities that focused on raising taxes and sales to minors. Organizations tended to be more involved in individual, rather than population-level prevention strategies. Inadequate funding, insufficient number of staff dedicated to working on TC, and lack of political will were major barriers. Conclusions: This paper provides the first national description of organizational capacity and level of involvement in FCTC measures within the Czech Republic.
... 9 25-27 Evidence indicates that the availability of cheap tobacco reduces motivation to quit and quit success. [28][29][30] This strategy is therefore likely to be driving inequalities in smoking and negating the intended benefits of tobacco taxation. [18][19][20] ...
... Given that sudden large price rises are most associated with quit attempts, 28 61 62 this pricing strategy and the consequent ongoing availability of cheap tobacco could reduce the incentive for price conscious smokers to quit. [28][29][30] As such smokers are socioeconomically disadvantaged, 9 this is likely to significantly exacerbate inequalities: [14][15][16][17] UK data from October 2016 show smoking prevalence remains higher among the more disadvantaged (23.7%) compared with the more affluent (14.3%). 63 As smoking is the leading cause of health inequalities 64 this has significant implications. ...
Article
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Objective Taxation equitably reduces smoking, the leading cause of health inequalities. The tobacco industry (TI) can, however, undermine the public health gains realised from tobacco taxation through its pricing strategies. This study aims to examine contemporary TI pricing strategies in the UK and implications for tobacco tax policy. Design Review of commercial literature and longitudinal analysis of tobacco sales and price data. Setting A high-income country with comprehensive tobacco control policies and high tobacco taxes (UK). Participants 2009 to 2015 Nielsen Scantrak electronic point of sale systems data. Main outcome measures Tobacco segmentation; monthly prices, sales volumes of and net revenue from roll-your-own (RYO) and factory-made (FM) cigarettes by segment; use of price-marking and pack sizes. Results The literature review and sales data concurred that both RYO and FM cigarettes were segmented by price. Despite regular tax increases, average real prices for the cheapest FM and RYO segments remained steady from 2013 while volumes grew. Low prices were maintained through reductions in the size of packs and price-marking. Each year, at the point the budget is implemented, the TI drops its revenue by up to 18 pence per pack, absorbing the tax increases (undershifting). Undershifting is most marked for the cheapest segments. Conclusions The TI currently uses a variety of strategies to keep tobacco cheap. The implementation of standardised packaging will prevent small pack sizes and price-marking but further changes in tax policy are needed to minimise the TI’s attempts to prevent sudden price increases.
... Although some studies have shown that the availability and use of cheap tobacco (including roll-your-own) is associated with lower success rates, other studies have found no such effects [16][17][18][19]. ...
... There is substantial evidence for the association between these population-level tobacco control policies and quitting activities. The introduction of a smoking ban in July 2007 was associated with a significant temporary increase in the percentage of smokers attempting to stop [36], and the change in the minimum age of sale of cigarettes in October 2007 resulted in a greater fall in prevalence in [16][17] year-olds [37]. Pictorial health warnings on product packaging introduced in October 2008 have been shown to promote smoking cessation [38]. ...
Article
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Aims: To quantify associations between the success of smoking quit attempts and factors that have varied across 2007-2018 at a population level. Design: Time series analysis using ARIMAX modelling. Setting and participants: Data were aggregated from 54,847 past-year smokers taking part in the Smoking Toolkit Study which involves monthly repeated cross-sectional household surveys of individuals aged 16+ in England. Measurements: The input series were: 1) attempts at smoking reduction using a) e-cigarettes and b) nicotine replacement therapy (NRT); 2) use during a quit attempt of a) e-cigarettes, b) NRT over-the-counter, c) medication on prescription and d) face-to-face behavioural support; 3) use of roll-your-own tobacco; 4) prevalence of a) smoking and b) non-daily smoking; 5) tobacco control mass media expenditure; 6) expenditure on smoking; 7) smoker characteristics in the form of a) high motivation to quit, b) average age, c) socio-economic status and d) cigarette consumption; 8) implementation of tobacco control policies; and 9) quit attempt rate. Findings: The licensing of NRT for harm reduction was associated with a 0.641% (95%CI 0.073 to 1.209, p=0.027) increase in the mean point prevalence of the success rate of quit attempts. For every 1% increase in the mean point prevalence of e-cigarette use and use of prescription medication during a quit attempt, the mean point prevalence of successful quit attempts increased by 0.106% (0.011 to 0.201, p=0.029) and 0.143% (0.009 to 0.279, p=0.038), respectively. For every 1% increase in the mean expenditure on tobacco control mass media, the mean point prevalence of successful quit attempts increased by 0.046% (0.001 to 0.092, p=0.046). Other associations were not statistically significant. Conclusion: In England between 2007 and 2018, licensing of nicotine replacement therapy for use in harm reduction, greater use of e-cigarettes and prescription medications during a quit attempt, and higher expenditure on tobacco control mass media were all associated with higher success rates of quit attempts.
... 9 25-27 Evidence indicates that the availability of cheap tobacco reduces motivation to quit and quit success. [28][29][30] This strategy is therefore likely to be driving inequalities in smoking and negating the intended benefits of tobacco taxation. [18][19][20] ...
... Given that sudden large price rises are most associated with quit attempts, 28 61 62 this pricing strategy and the consequent ongoing availability of cheap tobacco could reduce the incentive for price conscious smokers to quit. [28][29][30] As such smokers are socioeconomically disadvantaged, 9 this is likely to significantly exacerbate inequalities: [14][15][16][17] UK data from October 2016 show smoking prevalence remains higher among the more disadvantaged (23.7%) compared with the more affluent (14.3%). 63 As smoking is the leading cause of health inequalities 64 this has significant implications. ...
Article
Background The tobacco industry (TI) can undermine the public health gains realised from tobacco taxation through its pricing strategies. This study aims to examine contemporary TI pricing strategies in the UK and the implications for tobacco tax policy. Methods Review of commercial and TI literature, and analysis of 2009 to 2015 Nielsen Scantrak electronic point of sale systems (EPOS) data on tobacco sales and price data. The study was set in a high income country with comprehensive tobacco control policies and high tobacco taxes (UK). The main outcome measures were: tobacco price segmentation; monthly prices, sales volumes of and net revenue from roll your own and factory made (RYO and FM) cigarettes by price segment; use of price-marking; and pack sizes. Results The literature review and sales data concurred that both RYO and FM cigarettes were segmented by price into premium, mid-price and value segments, with an additional sub-value FM segment introduced in 2012. Despite regular tax increases, average real prices for RYO value and FM sub-value segments remained steady from 2013 whilst their volumes grew. The TI maintains low prices through reducing the number of cigarettes per pack, price-marking (forcing retailers to sell cheaper products at low prices) and absorbing tax increases. Each year, at the point the budget is implemented, the TI drops its revenue by up to 18 pence per pack, absorbing the tax increases (undershifting). Later in the year it gradually passes the tax increase onto consumers, effectively smoothing the price change consumers face across the year. Undershifting of taxes is most marked for the cheapest products. Conclusions The TI employs a variety of strategies to keep tobacco cheap and minimise the impact of tobacco tax increases. The implementation of standardised packaging can prevent small pack sizes and price-marking but further changes in tax policy are needed to minimise undershifting.
... The expected behavioural response was stronger with higher increase. More recently, Ross et al., [41] observed consistent results among adult smokers in the ITC Four Country Survey data. Smokers were asked how they would respond to a 50% increase in cigarette price. ...
... Hence, the stronger the level of addiction, the less likelihood the RTWs are willing to quit, given the hypothetical price increase. Ross [40] and Ross [41] stated that the magnitude of a price increase is the most important predictor of quit intentions. Table 7 revealed the results of the logit regression model. ...
Article
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Background: Psychoactive substances particularly alcohol and tobacco are the important health hazards and known risk factors for non-communicable diseases especially among transport workers and are the leading cause of preventable death in Nigeria. The goal of this study was to assess the Willingness to Quit (WTQ) psychoactive substances (cigarette and alcohol) use among Road Transport Workers (RTWs). This study also highlight the factors influencing respondent's willingness to quit psychoactive substances. Methods: A cross-sectional study was carried out among 232 RTWs in five selected major motor parks in Abeokuta. Data was collected by interview method using a pretested questionnaire. Contingent Valuation Method and Logit regression was used estimate the respondent's willingness to quit and its associated determinants. Findings: About 43% of the respondents are willing to quit for the increase in price, while 48% were willing to quit cigarette consumption if 25% increment in prices were imposed. Over one-third of the smokers reported their willingness to quit. In the study, it was found that 43% of the respondents are willing to quit with a mean amount of N450.5 (US$1.2) per pack of cigarette and mean amount of N525.5 (US$1.4) per bottle of alcohol respectively. Conclusion: The study conclude that previous attempts to quit were significantly associated with the willingness to quit smoking and drinking. This suggest non-tax policy measure of non-smoking/drinking environment with a view to seriously banning their use in public places especially in motor packs in order to achieve better psychoactive substances cessation outcomes.
... Previous studies have shown that higher tobacco prices enhance a person's motivation to quit smoking. 3) The prevalence of smoking in Korea has decreased after the implementation of the tobacco price policy, and studies have found that the increase in tobacco prices has led to the reduction of smoking rates. 4) However, no study has examined the changes in the stages of smoking cessation among smokers after the tobacco price increase in Korea. ...
... Previous studies have shown that an increase in tobacco prices has a positive effect on the prevalence of smoking. 3,4,15) The Centers for Disease Control and Prevention has estimated that a 10% increase in tobacco prices will reduce the overall tobacco consumption by 3% to 5%. 16) The Korean government had reported that the 80% increase in cigarette prices from 2,500 won to 4,500 won reduced the sale of cigarettes by 15.5% in 2015. ...
Article
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Background: In 2015, tobacco prices significantly increased in Korea as part of the government's smoking cessation policy. This study examined the changes in the stages of smoking cessation among Korean male smokers before and after the implementation of the tobacco price policy, and identified the predictors of such changes. Methods: The study population comprised 3,533 male current smokers (age ≥19 years) who participated in the Korea National Health and Nutrition Survey in 2012, 2013, 2015, and 2016. Current smokers were defined as persons who had smoked ≥100 cigarettes during their lifetime and are continuing to smoke. In accordance with the transtheoretical model, smokers were classified into the precontemplation stage (no plan to quit), contemplation stage, and preparation stage (planning to quit within 6 months). We examined the changes in the smoking cessation stages before and after the implementation of the policy. Multivariate logistic regression analysis was conducted to identify factors related to the likelihood of continuing smoking, after adjustments for potential confounders. Results: Immediately after the policy implementation, the percentage of smokers in the precontemplation stage decreased from 65.6% to 60.8% (P=0.014). However, this effect was temporary. Significant risk factors for remaining in the precontemplation stage were older age (odds ratio [OR], 1.010; 95% confidence interval [CI], 1.002-1.018; P=0.004), being in the lowest income quartile (OR, 1.226; 95% CI, 1.001-1.502; P=0.049), and manual worker or unemployed status (OR, 1.256; 95% CI, 1.036-1523; P=0.020). Conclusion: Increasing tobacco prices only temporarily change the stage of smoking cessation among Korean male smokers.
... For example, does reduced affordability lead smokers to quit smoking completely, to continue smoking but reduce their consumption, or to find cheaper sources of cigarettes? While these critically important questions are beyond the scope of this study, existing research demonstrates that some smokers do indeed quit in the face of tax increases [35][36][37][38] while others rely on price-minimization strategies [39]. ...
Article
Full-text available
Cigarette affordability measures the price smokers pay for cigarettes in relation to their incomes. Affordability can be measured using the relative income price of cigarettes (RIP), or the price smokers pay to purchase 100 packs of 20 cigarettes divided by their per capita household income. Using longitudinal data from 7046 smokers participating in the International Tobacco Control (ITC) US Survey, the purpose of this study was to test whether affordability significantly changed following the US federal tax increase implemented on 1 April 2009. This study also estimated temporal trends in affordability from 2003–2015 at state and national levels using small area estimation methods and segmented linear mixed effects regression models. RIP increased slightly during 2003–2008. This was followed by a 30% increase during 2008–2010, indicating cigarettes were less affordable after the federal tax increase. RIP continued to increase during 2010–2013 but decreased during 2013–2015, suggesting cigarettes have recently become more affordable for US smokers. State-level trends in RIP were consistent with overall national trends. Controlling for other factors, a $1 increase in the state excise tax was significantly associated with a 9% increase in RIP, indicating state taxes reduced affordability. Tax-induced price increases must keep pace with underlying economic conditions to ensure cigarettes do not become more affordable over time.
... Other studies (Ross, Blecher, Yan, & Hyland, 2011) have found higher cigarette prices contributed to the greater motivation to stop smoking and likelihood of quitting among adult smokers in the US and Canada. Our participants highlighted that cheap cigarettes contribute strongly to the high smoking prevalence in Korea and a substantial price increase would be likely to reduce smoking rates, particularly among younger people: ...
Article
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The study aims to explore how Korean male smokers living in Australia talk and feel about smoking and how they have understood and experienced tobacco control policies in Australia—including price increase, display ban, plain packaging, and graphic warning labels. A qualitative study was conducted based on in-depth face-to-face interviews with 8 Korean male smokers aged 23–40 years living in Canberra. Participants discussed social and cultural conditions in Korea under which smoking is practiced and maintained. Smoking as a means of socialising and relaxation were consistently discussed as the main reasons for continued smoking which was deeply embedded in their everyday lives as habit or part of routines. The health risks of smoking were not among the immediate or ultimate considerations influencing participants. Participants commented that price increases had affected them most but other measures had little impact on their smoking behaviours, although they acknowledged their potentials in deterring younger people. Future anti-smoking interventions in Korea should address the significant social and cultural determinants of smoking and acknowledge smokers’ own understanding of their smoking and anti-smoking measures. Appreciating smokers’ diverse representations of their own smoking and their attitudes towards health and anti-smoking measures would increase acceptance of policies and the probability that they will be successful, leading to positive outcomes.
... [14][15][16][17] This is problematic as access to cheap tobacco appears to reduce motivation for, and success in, quitting smoking. [18][19][20][21] Evidence from Ireland demonstrates that while the industry may warn governments against raising taxes, citing multiple potential adverse outcomes secondary to price increases, companies consistently increase the prices they charge for some products to maximise profit. 22 However, there is no comprehensive picture of the strategies employed by the TI across the EU, which could inform the review of the Directive. ...
Article
Background The tobacco industry (TI) can act to undermine the impact of tobacco tax increases by adopting various pricing strategies. Little is known about strategies used across the European Union (EU), except for the UK. Aim To examine pricing strategies adopted by the TI in the EU, and whether they differ by cigarette price segment, or between manufactured and roll-your-own (RYO) cigarettes. Methods This is a longitudinal analysis of commercial pricing data for manufactured and RYO cigarettes from 23 EU countries in 2006–2017. Price and revenue trends were explored. Linear regression estimated the average annual change in revenue, and linear fixed-effects panel regression models were used to explore the association between changes in median revenue (net of tax and adjusted for inflation) and tax increases in different price segments of manufactured cigarettes. Results Over the 11-year period price gaps were observed in all countries. The average annual adjusted median net revenue per pack increased in 19 of 23 countries for manufactured and RYO cigarettes. A tax increase was associated with a significant decrease of −€0.09 in adjusted median net revenue per pack (95% CI −0.16 to −0.03) in the cheap cigarette price segment, while no change was detected in the expensive cigarette price segment (−€0.05, 95% CI −0.11 to 0.01). Conclusion Across the EU, pricing strategies adopted by the TI maintained or increased price gaps and retained cheaper tobacco products in the market, diminishing the impact of tobacco tax increases. Further strengthening of tobacco taxation policy is needed to maximise public health impact.
... Sustained increases in federal, state, and local excise taxes on tobacco have been consistently shown to promote cessation among current users, prevent initiation among nonusers, and reduce tobacco consumption. 6,[30][31][32][33] Currently, federal and state excise taxes are disproportionately lower for cigars than for cigarettes. 34 Our findings indicate that the average price of a cigarette pack costs 6.0 times more than a single large cigar, 4.3 times more than a pack of 2 cigarillos, and 2.5 times more than a pack of 20 little cigars. ...
Article
Introduction: Tobacco manufacturers continue to implement a range of pricing strategies to increase the affordability and consumption of tobacco products. To demonstrate the extent of retail- and brand-level price discounts at the point of sale, this study assessed national sales trends in price-discounted cigarettes, large cigars, little cigars, and cigarillos. Methods: Retail scanner data for tobacco product sales were obtained for convenience stores (C-store) and all-other-outlets-combined (AOC) from September 25, 2011, to January 9, 2016. The proportion of price-discounted sales, average nondiscounted unit price, and average discounted unit price were examined by product category and brand. JoinPoint regression was used to assess average monthly percentage change. Results: Overall, price-discounted sales accounted for 11.3% of cigarette, 3.4% of large cigar, 4.1% of little cigar, and 3.9% of cigarillo sales. The average difference between nondiscounted and discounted prices was 25.5% (C-store) and 36.7% (AOC) for cigarettes; 11.0% (C-store) and 11.2% (AOC) for large cigars; 19.2% (C-store) and 9.6% (AOC) for little cigars; and 5.3% (C-store) and 14.7% (AOC) for cigarillos. Furthermore, price-discounted sales of top-selling tobacco brands comprised up to 36% of cigarette, 7.4% of large cigar, 7.7% of little cigar, and 4.2% of cigarillo unit sales. Conclusions: These findings highlight the use of price discounts by tobacco manufacturers to reduce the cost of cigarettes, large cigars, little cigars, and cigarillos to consumers. These sales patterns underscore the importance of sustained efforts to implement evidence-based strategies to increase prices and reduce availability and consumption of combustible tobacco in the United States. Implications: This study highlights the prevalence and provides a baseline of price-discounted cigarettes, large cigars, little cigars, and cigarillos. Surveillance of tobacco sales data, including state-level trends and additional product types, is critical for informing approaches to reduce tobacco consumption. These approaches include countering tobacco product price-discounting practices and raising and maintaining a high sales price for all tobacco products. The implementation of evidence-based population-level interventions, together with local, state, and federal regulation of tobacco products, could prevent tobacco initiation, increase tobacco cessation, and reduce overall tobacco use among US youth and adults.
... Increasing tobacco prices and taxes has become the dominant strategy to curb smoking and increase quit attempts across regions [5][6][7][8][9][10]. In the United States, price control of cigarette smoking is typically implemented through an excise tax on cigarettes. ...
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Objectives. This study aims at examining the impact of graphic pictorial warning labels on inten-tion to quit smoking and perceived harms among Chinese working-age adults (n = 661). Methods. A randomized controlled trial is utilized as the research design by comparing three scenarios: Group 1 as baseline (n = 193) and presented with real market tobacco products with text-only la-bels, Group 2 as price group and with hypothetical scenarios of manipulated prices, and Group 3 as the imaging group and with hypothetical scenarios of graphic pictorial cigarette warning la-bels. Both bivariate and multivariate analyses are utilized to determine the effectiveness of warn-ing labels. Results. Graphic pictorial cigarette warning labels are associated with stronger inten-tion to quit smoking and greater perceived harms. Smokers have a greater number of attempts if they are less nicotine dependent and express greater smoking risk perceptions. Conclusions. This study adds to the evidence that graphic pictorial warning labels are more effective than text-only labels in increasing intention to quit smoking. As China strives to achieve a reduction in smoking to meet the goal of the Healthy China 2030 initiative, this work strengthens the evidence base for policy makers, practitioners, and researchers to design low-cost warning labels on cigarette packs to promote tobacco control.
... 3,[15][16][17][18] In one example of International Tobacco Control analysis in the United States and Canada, an increase in cigarette prices led to a significant increase in the motivation of smokers to quit, and an increased likelihood of actually quitting. 19 Therefore, many policy makers have suggested that increasing cigarette prices is the best option to promote smoking cessation and increase motivation to quit, thereby reducing the smoking rate. 20 The Law on Control and Prevention of Tobacco Harm in Vietnam was passed in 2012. ...
Presentation
Background Vietnamese government is targeting at achieving tobacco control goal with 10% reduction by year 2020. In the last two decades, cigarette price in Vietnam have not been increased. According to article 6 of FCTC, raising the cigarette price is known as one of the most effective strategies to combat cigarette smoking. The aim of the study was to estimate the required price that would make smokers attempt to quit and identify the predictors of required price to quit. Methods A cross-sectional survey was conducted with a total of 820 current smokers who live in third largest city of Vietnam. A structured questionnaire was adopted from International Tobacco Control (ITC) project surve. Bayesian quantile regression and Bayes factor were applied to predict factors associate with cigarette required price. Results Out of 56% (461 people) of smokers were suggested price to quit with age range from 18 to 65 years. The median required prices to quit per pack, US $ 2.7 IQR (~2 to 4.4), increased 2.8 times (2.04 to 4.54) higher than usual price (~ US $ 1). If the required price reaches to at median price (higher 2.8 times), 56% of smokers suggested price tend to be quitting seriously. predictors of cigarette price were significantly associated with the lower required price including perceived awareness of warning label, smoke-free workplace and receiving advices from physicians. In contrast, high educations, having good health, heavy smoker and failure of quitting were significantly associated with the higher price across all quantiles. Conclusions These results suggest the potentially useful approach to setting price increase in Vietnam. Require prices have been considered various factors regarding non-tax policy and quit intention, and appropriate approach to those group with failure quitting history, high education, heavy smoker
... Drug valuation can be measured using behavioral economic demand, which refers to the quantitative association between the price of a commodity and the amount purchased (Acker & MacKillop, 2013;Hursh, 1980;MacKillop, Brown, et al., 2012). Previous research has indicated a negative association between cigarette prices and consumption (Buczkowski, Marcinowicz, Czachowski, & Piszczek, 2014;Douglas, 1998;Forster & Jones, 2001;Ross, Blecher, Yan, & Hyland, 2011). Furthermore, greater demand for cigarettes is associated with a higher number of daily cigarettes consumed MacKillop et al., 2008;Murphy, MacKillop, Tidey, Brazil, & Colby, 2011) and less sensitivity to changes in cigarette prices . ...
Article
Relationships between discounting and addictive behaviors have both state- and trait-based components. Evolutionarily driven motives may trigger risk-taking behaviors, and narratives might be used to alter the temporal window of reward valuation. The current investigation-in 2 separate studies-sought to understand the basic effects of narratives on smoking behavior by examining the effect of mating narratives on the discounting rates of cigarette smokers. Using data collected online, Study 1 (N = 132) assessed the within-individual effect of a mating narrative describing a long-term romantic relationship on rates of discounting after being randomly assigned to 1 of 2 narratives (romance or control) and Study 2 (N = 273) assessed the between-individual effect of 2 mating narratives (1 describing a long-term romantic relationship and 1 describing a short-term sexual encounter) on rates of discounting, craving, and cigarette valuation after being randomly assigned to 1 of 3 motivational narratives (romance, sex, or control). Reading the romance narrative decreased rates of discounting (i.e., increased preference for larger delayed rewards), compared to a control narrative (Studies 1 and 2). In contrast, reading the sexual narrative increased discounting (i.e., decreased preference for larger delayed rewards). Moreover, the romance narrative significantly decreased craving of cigarettes while the sexual narrative increased cigarette valuation (Study 2). These findings suggest that mating narratives may be useful in manipulating the temporal window of reward valuation, relevant for altering demand and craving, and may show potential as a component of future behavioral addiction interventions. Given the small effect sizes, replicating the study in future research will be beneficial. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... A mediano plazo: incluye a los efectos hipotéticos relacionados con disminuir el número de cigarrillos consumidos. Esta disminución fue considerada en forma proporcional a la disminución del consumo, al 75 % del exceso del riesgo de diferencia entre un tabaquista actual y un extabaquista, asumiendo que 25 % del riesgo adicional, sería eliminado cuando la persona pasa a ser un exfumador (24) . ...
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Objectives. To consider the burden of disease associated to tobacco consumption in Paraguay and to evaluate the potential economic and health effect of price increase through taxes. Materials and Methods. A Monte Carlo simulation model was designed incorporating natural history, costs, and quality of life of diseases associated to smoking for 2015. Also, several scenarios were considered for the impact of tax raises on the prevalence of smoking and fiscal collection. Results. In Paraguay, 3,354 people die every year as a consequence of smoking. Nineteen percent of deaths are due to cardiac ischemia, 15% due to stroke. 77% of deaths due to chronic obstructive pulmonary disease (COPD), and 83% of lung cancer can be attributed to smoking. These diseases in Paraguay represent an annual direct medical cost of more than 1.5 trillion PYG, while the tax collection from cigarette sales barely covers 20% of this expense. A 50% increase in the price of cigarettes via taxes could avoid 2507 deaths in ten years and generate resources by 2.4 trillion in savings in health expenses and tax of collection. Conclusions. The cost and the burden of disease associated to tobacco consumption is high in the health system in Paraguay. An increase in cigarette price through taxes could have significanthealth benefits and could offset health costs in part.
... Educational campaigns regarding the benefits of smoking cessation as well as policy interventions (e.g. taxation) may be important investments in countries where low rates of quitting intentions are reported 37,38 . For example, in Greece where intentions to quit are lowest, smoke-free public place policies are not enforced by the government 39 . ...
Article
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Introduction: There is clear evidence that the use of cessation aids significantly increases the likelihood of successful smoking cessation. The aim of this study was to examine quitting activity and use of cessation aids among smokers from various European countries. Subgroup differences were also examined for sex, income, education, and age in each country. Methods: Cross-sectional data were collected in 2016 from 10,683 smokers in eight European countries participating in the ITC Project: England (n=3,536), Germany (n=1,003), Greece (n=1,000), Hungary (n=1,000), the Netherlands (n=1,136), Poland (n=1,006), Romania (n=1,001), and Spain (n=1,001). We measured quitting activity, including quit attempts in the previous 12 months and intention to quit, use of cessation aids (i.e., medication, quitlines, internet, local services, and e-cigarettes), and whether respondents had received advice about quitting and e-cigarettes from health professionals. Results: Quit attempts were most common in England (46.3%) and least common in Hungary (10.4%). Quit intention was highest in England and lowest in Greece. Use of e-cigarettes to quit was highest in England (51.6%) and lowest in Spain (5.0%). Use of cessation aids was generally low across all countries; in particular this was true for quitlines, internet-based support, and local services. Receiving health professional advice to quit was highest in Romania (56.5%), and lowest in Poland (20.8%); few smokers received advice about e-cigarettes from health professionals. No clear differences were found for sex and income groups. Across countries, smokers with lower education reported less quitting activity. Conclusions: Quitting activity and use of cessation methods were low in most countries. Greater quit attempts and use of cessation aids were found in England, where large investments in tobacco control and smoking cessation have been made. Health professionals are important for motivating smokers to quit and promoting the effectiveness of various methods, but overall, few smokers get advice to quit.
... A few studies have shown that the availability and use of cheap tobacco (including RYO) is associated with lower rates of smoking cessation. [21][22][23] Data from the International Tobacco Control (ITC) Four-Country Survey indicated that RYO users in the UK and Australia were less likely to report an intention to quit smoking than manufactured cigarette smokers, but there was no association between RYO cigarette use and intention to quit in Canada or the USA. 14 RYO cigarette smokers in the ITC Four-Country Survey were also less likely to make a quit attempt than smokers who did not use RYO or other discounted tobacco, although this difference was not significant after adjustment for sociodemographics and heaviness of smoking. ...
Article
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Objectives Roll-your-own (RYO) cigarettes have become popular in the UK and reduce the cost of smoking, potentially mitigating the impact of tax increases on quitting. We examined whether RYO cigarette use was associated with reduced motivation to quit smoking, incidence of quit attempts and quit success. Design Cross-sectional survey. Setting England. Participants 38 590 adults who reported currently smoking or having stopped within the past 12 months. Main outcome measures Motivation to quit smoking, quit attempt in the last year, motives for quitting and quit success were regressed onto RYO cigarette use, adjusting for sociodemographic variables and level of cigarette addiction. Mediation by weekly spending on smoking was tested. Results Compared with manufactured cigarette smokers, RYO smokers had lower odds of high motivation to quit (OR=0.77, 95% CI 0.73 to 0.81) or having made a quit attempt (OR=0.87, 95% CI 0.84 to 0.91). Among those who had attempted to quit smoking, quit success did not differ by cigarette type (OR=1.00, 95% CI 0.89 to 1.12), but RYO smokers were less likely to report cost of smoking as a motive to quit (OR=0.68, 95% CI 0.61 to 0.74). Spending on smoking mediated the association between RYO use and quit attempts (β=−0.02, SE=0.003, 95% CI −0.03 to −0.02). Conclusions In England, compared with smokers of manufactured cigarettes, RYO cigarette smokers appear to have lower motivation to quit and lower incidence of quit attempts but similar success of quit attempts. The lower cost of RYO smoking appears to mediate the lower incidence of quit attempts among RYO users.
... 14, No. 10 2018 groups that possess the highest smoking prevalence in Australia (Dunlop, Perez, & Cotter, 2011). When the price of cigarette increases, young adult smoker is expected to reduce cigarette consumption, more motivated to quit smoking and have an increased likelihood of actual quitting (Ross et al., 2011). However, this ideal scenario is contrary to the reality. ...
Article
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Although cigarette smoking rate has declined consistently in the past four decades in Australia, the smoking habit remains popular among some groups. From a marketer’s vantage point, this slowed reduction portrays the less effective implementation of anti-smoking campaigns in Australia. Ideally, each anti-smoking intervention ought to break the chain of marginal utility and lead to a sharp or stepped decline of smoking prevalence. This paper explores the inadequacies of fear factored anti-smoking campaigns and some prevailing reasons why young adult smokers continue to smoke. This paper begins with a review and categorisation of the different reasons of why young adults continue to smoke. These reasons draw on addiction, stress, habit, social-economic factors, self-identity and peer pressure. The rationale for studying these anti-smoking initiatives is to evaluate if these initiatives address the issues of smoking amongst young adults. This paper is significant for formulating effective anti-smoking messages and policy developments in Australia.
... First, public expectations that cigarette prices will continue to increase may encourage more people to quit smoking, especially in countries where governments regularly increase tobacco taxes. 32 However, taxes and prices in China have not changed for at least six-years before 2015, and therefore it seems unlikely that the single increase will have altered Chinese smokers' expectations about future tax increases. Second, cigarettes in China remain very affordable, and will become more so over time due to continued growth in people's incomes. ...
Article
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In 2015, the Chinese government raised tobacco excise tax for the first time since 2009. Changing from previous practice, the State Tobacco Monopoly Administration raised its cigarette prices at the same time. We assessed the early impact of the 2015 tax increase on cigarette prices, sales volumes, tax revenue generation and the potential effect on prevalence of smoking in China. Between 2014 and 2016, the retail price of cigarettes increased on average by 11%, with the cheapest category of cigarette brands increasing by 20%. The average proportion of tax in the price of cigarettes rose from 51.7% to 55.7%. Annual cigarette sales decreased by 7.8%, from 127 to 117 billion packs. The increase in cigarette prices could be associated with a 0.2% to 0.6% decrease in the proportion of adults smoking, representing between 2.2 and 6.5 million fewer smokers. Tax revenues from cigarettes increased by 14%, from 740 to 842 billion Chinese yuan between 2014 and 2016, reflecting an extra 101 billion Chinese yuan in tax revenues for the government. The 2015 tax increase shows that tobacco taxation can provide measurable benefits to both public health and finance in China. The experience also highlights the potential for tobacco taxation to contribute to China's broader development targets, including the sustainable development goals and Healthy China 2030. Looking forward, this link to development can be facilitated through multisectoral research and dialogue to develop consistent cross-sectoral objectives for tobacco tax policy design and implementation.
... Together, these factors undermine the intended effect of tobacco tax increases. [32][33][34][35] The current cigarette excise system has been in force for decades in Bangladesh. The tiered system poses an administrative burden on the tax authority for surveillance of the declaration of brands and the tax bases. ...
Article
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Bangladesh has achieved a high share of tax in the price of cigarettes (greater than the 75% benchmark), but has not achieved the expected health benefits from reduction in cigarette consumption. In this paper we explore why cigarette taxation has not succeeded in reducing cigarette smoking in Bangladesh. Using government records over 2006–2017, we link trends in tax-paid cigarette sales to cigarette excise tax structure and changes in cigarette taxes and prices. We analysed data on smoking prevalence from Bangladesh Global Adult Tobacco Surveys to study consumption of different tobacco products in 2009 and 2017. Drawing on annual reports from tobacco manufacturers and other literature, we examine demand-and supply-side factors in the cigarette market. In addition to a growing affordability of cigarettes, three factors appear to have undermined the effectiveness of tax and price increases in reducing cigarette consumption in Bangladesh. First, the multitiered excise tax structure widened the price differential between brands and incentivized downward substitution by smokers from higher-price to lower-price cigarettes. Second, income growth and shifting preferences of smokers for better quality products encouraged upward substitution from hand-rolled local cigarettes (bidi) to machine-made low-price cigarettes. Third, the tobacco industry’s market expansion and differential pricing strategy changed the relative price to keep low-price cigarettes inexpensive. A high tax share alone may prove inadequate as a barometer of effective tobacco taxation in lower-middle income countries, particularly where the tobacco tax structure is complex, tobacco products prices are relatively low, and the affordability of tobacco products is increasing.
... 3,[15][16][17][18] In one example of International Tobacco Control analysis in the United States and Canada, an increase in cigarette prices led to a significant increase in the motivation of smokers to quit, and an increased likelihood of actually quitting. 19 Therefore, many policy makers have suggested that increasing cigarette prices is the best option to promote smoking cessation and increase motivation to quit, thereby reducing the smoking rate. 20 The Law on Control and Prevention of Tobacco Harm in Vietnam was passed in 2012. ...
Article
Full-text available
Introduction: Raising the price of cigarettes is one of the most effective strategies to reduce cigarette smoking. The Vietnamese government is working toward the tobacco control goal of a 10% reduction in smoking prevalence by 2020. However, cigarette prices in Vietnam have not increased in the last two decades. The aim of this study was to estimate what cigarette prices would make smokers attempt to quit smoking, and to identify predictors of the price to quit and the intention to quit. Methods: A cross-sectional survey was conducted with 822 male current smokers in Da Nang, Vietnam. A structured questionnaire was adapted from the International Tobacco Control project survey. Bayesian quantile regression was applied to predict factors associated with expected cigarette price. Results: Fifty-six percent of smokers suggested a price to quit. Their median suggested price to quit per pack, 62 000 VND (2.8 USD), was 2.8 times higher than the actual current price, 22 000 VND (1.01 USD). Suggesting a lower price to quit was significantly associated with awareness of warning labels and smoke-free policies. In contrast, being a heavy smoker was significantly associated with a higher suggested price to quit across all quantiles. Conclusions: There may be sufficient room to increase cigarette prices in Vietnam. The price to quit is associated with various factors, including non-pricing policies. Implications: Evidence suggests that a steep increase in cigarette prices, setting a high minimum tax, and introducing a large specific tax, which are policy-induced price increases that can raise prices substantially in Vietnam, are preferable strategies. In addition to increasing price and taxes, the government should also strengthen non-pricing policies.
... [5] Increasing the prices of tobacco products has been found to provide greater motivation to quit; but at the same time, an inverse relationship between motivation to quit and dependence has been documented. [19] The present study reported a significant association between high dependence and occupation requiring travel suggesting that occupational stress might play an important role in tobacco consumption. Patients with occupations such as auto rickshaw driver and cab driver consistently keep tobacco quid ("Mawa") in their mouths to suppress their appetite and to have better concentration on the road while driving. ...
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Background: There is a paucity of data on smokeless tobacco (SLT) use in Bhavnagar city of western India. This research attempts to find out the dependence and willingness to quit SLT use. Materials and Methods: This was a hospital‑based cross‑sectional study conducted in a tertiary care government hospital on a calculated sample size of 258 SLT users in the year 2017. The patients were recruited from ear‑nose‑throat (ENT) and dental outpatient department (OPD). The tobacco dependence was assessed using “Fagerstrom Test for Nicotine Dependence‑SLT” and willingness to quit was assessed on a Likert scale of 1–10. Results: Among the 258 SLT users, 20% were highly dependent on SLT and 61% had low willingness to quit tobacco. “Mawa” was the most common (60%) chewed form of tobacco. Illiterate patients were three times more likely and patients whose occupation required traveling were 2.4 times more likely to develop high dependence for SLT than their counterparts. Patients living in the joint family were 2.7 times more likely to develop high dependence than patients living in a nuclear family. Conclusion: There is a need for the introduction of tobacco cessation interventions in ENT and dental OPD of tertiary care hospitals of western India.
... Educational campaigns regarding the benefits of smoking cessation as well as policy interventions (e.g. taxation) may be important investments in countries where low rates of quitting intentions are reported 37,38 . For example, in Greece where intentions to quit are lowest, smoke-free public place policies are not enforced by the government 39 . ...
Article
Full-text available
INTRODUCTION: There is clear evidence that the use of cessation aids significantly increases the likelihood of successful smoking cessation. The aim of this study was to examine quitting activity and use of cessation aids among smokers from various European countries. Subgroup differences were also examined for sex, income, education, and age in each country. // METHODS: Cross-sectional data were collected in 2016 from 10683 smokers in eight European countries participating in the ITC Project: England (n=3536), Germany (n=1003), Greece (n=1000), Hungary (n=1000), the Netherlands (n=1136), Poland (n=1006), Romania (n=1001), and Spain (n=1001). We measured quitting activity, including quit attempts in the previous 12 months and intention to quit, use of cessation aids (i.e. medication, quitlines, internet, local services, e-cigarettes), and whether respondents had received advice from health professionals about quitting and e-cigarettes. // RESULTS: Quit attempts were most common in England (46.3%) and least common in Hungary (10.4%). Quit intention was highest in England and lowest in Greece. Use of e-cigarettes to quit was highest in England (51.6%) and lowest in Spain (5.0%). Use of cessation aids was generally low across all countries; in particular this was true for quitlines, internetbased support, and local services. Receiving health professional advice to quit was highest in Romania (56.5%), and lowest in Poland (20.8%); few smokers received advice about e-cigarettes from health professionals. No clear differences were found for sex and income groups. Across countries, smokers with lower education reported less quitting activity. // CONCLUSIONS: Quitting activity and use of cessation methods were low in most countries. Greater quit attempts and use of cessation aids were found in England, where large investments in tobacco control and smoking cessation have been made. Health professionals are important for motivating smokers to quit and promoting the effectiveness of various methods, but overall, few smokers get advice to quit.
... Raising the price of tobacco products is considered one of the most effective ways to reduce consumption (Chaloupka, Straif, & Leon, 2011;Ross, Blecher, Yan, & Hyland, 2011;U.S. Department of Health and Human Services, 2014) and is a highly recommended tobacco control strategy worldwide. ...
Article
International and cross-cultural research is critical for understanding multilevel influences on health, health behaviors, and disease. A particularly relevant area of need for such research is tobacco control. The tobacco epidemic is one of the biggest public health threats globally, killing over 7 million people a year. Research critical to addressing this public health problem has leveraged variability in tobacco use, history, product market, and policies across different countries, settings, and populations, particularly in low- and middle-income countries (LMICs) where the tobacco burden is increasing. These efforts are needed in order to advance the science and inform practice and policy in various settings, including the US. Several funding agencies provide support for international research focused on tobacco control in LMICs because of the importance and implications of such research. This paper provides some concrete examples of how such research has advanced our knowledge-base and informed practice and policy globally, particularly in high-income countries including the US. Some prominent themes emphasized in this manuscript include: the development of knowledge regarding the diverse tobacco products on the market; better understanding of tobacco use and its impact among different populations; generating knowledge about the impacts including unintended consequences of tobacco control policy interventions; and better understanding tobacco industry strategies and informing advocacy efforts. In summary, international tobacco control research, particularly in LMICs, is critical in effectively and efficiently building the evidence base to advance tobacco control research, policy, and practice globally, including the US, with the ultimate goal of curbing the tobacco epidemic.
... Furthermore, the lack of data availability on the age and gender of tobacco users, due to lack of individual data, does not allow us to estimate price elasticity by age or gender. Elasticity coefficients differ in terms of age, gender and incomes, time observed, and brands [10,38]. The youth in several low-income countries is found to be more responsive to cigarette price changes than other age cohorts [39,40]. ...
Article
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This paper analyzes the determinant factors of tobacco consumption in Albania, which is one of the countries with the highest smoking prevalence in Europe. To empirically estimate the elasticity of cigarettes demand in Albania, the paper uses the Living Standard Measurement Survey (LSMS) applying Deaton's (1988) demand model. This paper estimates an Almost Ideal Demand System (AIDS), which allows disentangling quality choice from exogenous price variations using unit values from cigarette consumption. Following Deaton's model, the results suggest that the demand for tobacco is inelastic, with a price elasticity of −0.57. The price elasticity appears to be within the range of elasticity estimates frequently reported for low-and middle-income countries. The results suggest that total expenditure, household size, male-to-female ratio, and adult ratio are important determinants of tobacco demand in Albania. The increase in the tobacco price, which has been mainly driven by increased excises, has demonstrated a significant impact on reducing tobacco consumption. Consequently, the Albanian government may engage in gradual increases in excise taxes given the inelastic tobacco demand.
... undermine the effectiveness of tax and price increases in inducing smoking cessation or mitigating smoking initiation (Ross et al., 2011a;Ross et al., 2011b;Licht et al., 2011). Bangladesh has the second highest tax share in retail price of the most sold brand of cigarettes (71%) next to Thailand (78.6%) among South-East Asian countries (WHO, 2019). ...
Article
The effectiveness of tax increase in reducing tobacco use depends on the extent to which the industry passes on the tax to consumers. Evidence suggests that tobacco industry may absorb or raise the price more than the tax increase depending on the price segment of tobacco products. In this paper, we examined the industry's pricing strategy by price segment of the cigarette market in Bangladesh by observing the deviation between the market retail prices (MRP) of cigarettes faced by consumers and government recommended retail prices (RRP) used as tax base in a four-tiered ad valorem tax structure. The RRPs by brands were collected from government sources. The MRPs by brands were collected by the International Tobacco Control Bangladesh Wave 3 Survey 2011-12 and Wave 4 Survey 2014-15. Applying linear regression to the deviation of MRP from RRP by price tiers, we found MRPs were higher than RRPs for higher-price brands allowing extra profit margin from the high end while lowering the relative price of and expanding demand for cheaper brands. Bangladesh cigarette industry adopted a differential pricing strategy that undermined the intended effect of tax policy change in reducing cigarette consumption and improving public health. This pricing strategy was supported by the tiered excise tax structure which should be replaced with a uniform specific excise system. In the face of growing cigarette affordability, it is crucial that the specific tax be increased routinely by an amount that induces cigarette price increases large enough to make cigarettes less affordable over time.
... This finding was in accordance with previous study which found that higher cigarette prices can increase smoking cessation as well as motivate smokers to quit despite the existence of cheaper cigarette sources. [27] An evaluation study among Korean population found that 2.3 times of current cigarette retail price is required to force people to stop smoking. [28] The simulation model predicts that an increase in tax has the potential to reduce the number of smokers, with greater effect experienced by the youth. ...
Article
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INTRODUCTION: Smoking is a significant health problem among Indonesian adolescents and adults. The Indonesian government had issued several policies to alleviate this problem, including placement of pictorial health warning (PHW) on cigarette package. There had been several evaluation studies regarding the effectivity of PHW in urban areas but none in rural areas. This study aims to evaluate the effectivity of PHW in motivating smoking cessation in a rural area in Indonesia. MATERIALS AND METHODS: This was a descriptive cross-sectional study conducted in August 2017 in Losari village, Indonesia. Respondents of this study were villagers aged 18–60 years who were active smokers and purchased cigarette with PHW on the package. The research instruments for this study were questionnaire and printout pictures of each PHW approved by the Indonesian government. RESULTS: There were 94 respondents recruited in this study. Among them, only 26 (27.7%) stated that PHW motivated them to stop smoking. From the five figures of PHW, a picture of lung cancer was the most effective PHW to motivate smoking cessation. Eighty-one of 94 respondents affirm that there are other factors besides PHW that might motivate them to stop smoking. Most of them agreed that an increase in cigarette price will force them to stop smoking. CONCLUSIONS: Current PHW used on cigarette package might be ineffective in motivating smoking cessation at Losari village. Further study with larger samples needs to be done to confirm this finding.
... Altogether, our interpretive case study investigates anti-smoking policy in Korea by using the 1 Researchers have used various names for text analytics that applies social network analysis, including "semantic network analysis" (Monge and Contractor 2003;Shim et al. 2015), "word network analysis" (Danowski 1993), "text network analysis" (Paranyushkin 2011) and "network text analysis" (Carley 1997;Popping 2003). This study uses the term "network text analysis" suggested by Carley (1997). 2 The existing public health research suggests that raising cigarette prices as a policy tool is effective among different anti-smoking policies-see Goodchild and Zheng (2019) for China; Jackson et al. (2018) for the UK; Ross et al. (2011) for the USA and Canada; Tabuchi et al. (2017) for Japan-although health concerns are the most common reason for smokers to become motivated to quit (Kasza et al. 2017). However, as Koon et al. (2016) assert, "little is known about the ways frames influence the health policy process" (p. 1). ...
Article
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Since the emergence of the argumentative turn in critical policy studies, increasing attention has been paid to the crucial role played by language, context, and communicative practices in the policy process. This study aims to investigate communicative interaction between state elites and societal stakeholders in South Korea with a focus on the anti-smoking policies of two different administrations: the Roh administration (2003–2008) and the Park administration (2013–2017). As a theoretical base, this paper proposes a stakeholder-oriented approach to legitimacy, which incorporates a policy frame analysis with the concept of a three-tier policy structure (i.e., policy goals, policy tools, and tool settings). In assessing policy legitimacy, the stakeholder-oriented approach examines whether there is congruence between the three-tier policy structure and the corresponding stakeholder framing. In the Roh administration, the policy frames among the three tiers of policy structure were centered on public health promotion, whereas in the Park administration, they expanded to the domain of tax policy. The empirical findings underscore the importance of two-way communication between the government and societal stakeholders, which can be evidenced using policy frame analysis. Ultimately, the results show that policy legitimacy is more likely to be guaranteed if there is no hidden or predetermined policy intention that can be detected by stakeholder framing analysis.
... Another important avenue for changing healthrelated behavior is through supportive legislation and policy related to the condition of interest (Rothschild 1999 ) . As noted above, smoking cessation educational activities have been augmented with legal or public policy interventions such as increased taxation on tobacco products (Ross et al. 2010 ) and bylaws against smoking in public places like restaurants, bars, or airplanes (Wake fi eld et al. 2010 ) . Restricting access to the activity combined with ongoing messaging related to adverse health effects has proven successful for reducing smoking rates at the population level. ...
Chapter
In the past decade, multi media campaigns have been held in several countries to change the general public's maladaptive beliefs and behaviors about back pain and work disability. In this chapter, we will describe: (1) Previous campaigns and their results; (2) key lessons learned from these campaigns; (3) the key questions remaining; (4) future research and strategies that should be attempted. © Springer Science+Business Media New York 2013. All rights reserved.
... It is now firmly established that increases in the cost of tobacco lead to decreases in tobacco consumption, [1][2][3] with WHO describing tobacco taxation as 'the single most effective way to encourage tobacco users to quit and prevent children from starting to smoke'. 4 In contrast to many other types of taxation, tobacco taxes tend to be widely supported by the public. ...
Article
Full-text available
In May 2016, the Australian Government announced that it would implement annual increases in tobacco excise of 12.5% up to and including 2020, raising the cost of a pack of cigarettes to $A40. This increase will lead to Australia having one of the highest prices of cigarettes in the world. Increasing the cost of tobacco is considered by public health experts to be one of the most effective strategies to reduce tobacco use, and is generally well supported by the public. However, tobacco tax increases differentially impact various subgroups of the population. Based on a review of existing literature, this paper examines some of the potential (unintended) consequences of the tax to individual and family income; illicit trade; social stigma and opportunities for lobbying by the tobacco industry. In light of these considerations, we offer strategies that might be used by policymakers to mitigate potential harms. While this paper focuses on the impacts primarily on populations in Australia, the consequences and strategies offered may be useful to other countries implementing tobacco excise increases.
... En Paraguay, los impuestos a productos de tabaco han sido motivo de discusión en los últimos años. Varios (2) autores, como por ejemplo Bardach et al , Chaloupka (32) (33) et al , y Wilson et al , sugieren que aumentar los impuestos al tabaco contribuye a disminuir la prevalencia de tabaquismo, incluso cuando exista (34) acceso a productos de menor precio . Aquí cabe mencionar que Paraguay es, en toda América, el país (35) con la oferta más barata y accesible a cigarrillos . ...
Article
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Introduction: In Paraguay, tobacco smoking negative impact demands the adoption of all available measures to reduce that impact. The presence or not of public support could potentially influence the adoption of these measures. Objective: To determine the presence of public support to tobacco control policies. Methodology: The present was a cross-sectional descriptive study that used an online survey to assess public support to 13 tobacco control policies using a Likert-type scale from 1 to 5 (strongly agree, agree, neutral, disagree, strongly disagree). Results: There were 502 participants, 67.73% of whom were women, 87.65% had completed studies at a tertiary level, and 63,75% were non-smokers. Measures that received the most support were banning smoking from public transport (98,01%) and from public buildings (93,63%), banning tobacco sales to people under the age of 18 (96,81%), and issuing a fine to those who do it (96,22%), and raising tobacco taxes either to support for the health care expenditure attributable to smoking (94,02%) or to reduce the prevalence of smoking (90,64%). Measures that received the least support were banning tobacco advertisement in points of sale (56,97%) and banning tobacco display on points of sale (51%). Conclusion: All 13 tobacco control policies assessed in the present study received the majority of support from all participants. We recommend the adoption and enforcement of these measures
... En Paraguay, los impuestos a productos de tabaco han sido motivo de discusión en los últimos años. Varios (2) autores, como por ejemplo Bardach et al , Chaloupka (32) (33) et al , y Wilson et al , sugieren que aumentar los impuestos al tabaco contribuye a disminuir la prevalencia de tabaquismo, incluso cuando exista (34) acceso a productos de menor precio . Aquí cabe mencionar que Paraguay es, en toda América, el país (35) con la oferta más barata y accesible a cigarrillos . ...
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Introducción: El impacto negativo del tabaquismo en Paraguay demanda la adopción de todas las medidas disponibles para disminuir dicho impacto. La presencia o ausencia de apoyo ciudadano podría influenciar la implementación de estas medidas. Objetivo: Determinar la presencia de apoyo ciudadano a políticas para el control del tabaco. Materiales y métodos: Estudio observacional descriptivo de corte transversal, mediante una encuesta en línea en la que se evaluó, a través de una escala tipo Likert de 1 al 5 (muy en desacuerdo, en desacuerdo, neutral, de acuerdo, muy de acuerdo), la presencia de apoyo ciudadano a 13 políticas para el control del tabaco. Resultados: Participaron del estudio 502 adultos con (5 años de residencia en el país, el 67,73% mujeres, el 87,65% universitarios, y el 63,75% no fumadores. Las medidas para el control del tabaco que recibieron mayor apoyo son prohibir fumar en el transporte público (98,01%) y en los edificios públicos (93,63%), prohibir la venta de tabaco a menores de 18 años (96,81%) y multar a aquellos que lo hagan (96,22%), y aumentar los impuestos al tabaco para pagar por los costos a la salud debidos al mismo (94,02%) o para disminuir su prevalencia (90,64%). Las medidas que recibieron menor apoyo fueron prohibir la publicidad de tabaco (56,97%) y prohibir el exhibir tabaco (51%) en los lugares de venta. Conclusiones: Las 13 políticas para el control del tabaco evaluadas en el presente trabajo recibieron el apoyo mayoritario de los participantes. Se sugiere implementar y hacer cumplir estas medidas.
... The MPOWER package of tobacco control policies is a program of six objectives promoted by the World Health Organization: Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion, and sponsorship; and Raise taxes on tobacco. Avoidance or evasion of tobacco taxation through the use of illicit tobacco undermines the effectiveness of public health policy, as cheaper prices for tobacco lead to increased tobacco use [2]. An example of tobacco tax avoidance is when an individual from a high-tax jurisdiction purchases tobacco products for their own use from duty-free shops or from lower tax jurisdictions. ...
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Background Smoking during pregnancy is associated with adverse maternal and fetal outcomes. Tobacco tax avoidance and tax evasion undermine the effectiveness of tobacco tax policies, resulting in cheaper prices for smokers and increased tobacco usage.AimsThe purpose of this study was to explore the purchasing habits of pregnant smokers with regard to tobacco expenditure and use of illicit tobacco.Methods Prospective cohort study. Face to face interviews were conducted with 90 attendees (age range 18–42 years; mean age 28 years) of a smoking cessation antenatal clinic in a large Irish tertiary level maternity hospital. Information regarding smoking habits, quantity of tobacco smoked, and location of purchase of tobacco was collected in addition to socioeconomic details. Tobacco products were examined to establish whether these were purchased from legitimate sources.Results76.6% of women smoked 10 or fewer cigarettes per day. The mean weekly spend on tobacco was €39. Seventeen women (18.8%) smoked roll-your-own tobacco. One woman (1.1%) currently possessed a pack of illicit tobacco, while another 5.5% of participants had purchased illicit tobacco in the past. Four women (4.4%) practiced tobacco tax avoidance by purchasing tobacco abroad or in Duty Free.Conclusions Use of illicit tobacco is low and only a minority of women engaged in tobacco tax avoidance. As the average price of tobacco in Ireland increases, weekly expenditure on tobacco products is a significant financial impact on low-income women. Smoking cessation would deliver significant financial gains in addition to health benefits.
... Higher prices and reduced affordability are associated with greater motivation to stop smoking and many smokers identify a price-point at which they would seriously consider quitting. [18][19][20][21] However, tobacco companies can shift tax increases across brand portfolios to preserve affordability for price-sensitive consumers; for instance, charging extra for more expensive variants (overshifting) and absorbing tax increases for the least expensive variants (undershifting). [22][23][24][25][26] Consequently, there is growing interest in non-taxation mechanisms for price control, including a minimum mark-up on wholesale price, a price cap to limit overshifting duty increases onto premium products and a minimum retail price (hereafter 'minimum pricing'). ...
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Objectives: As tobacco companies can circumvent tax increases, a minimum retail price per-cigarette/per gram of roll-your-own tobacco presents an additional mechanism for governments to reduce smoking. We examined (1) anticipated responses to a hypothetical minimum price-per-cigarette/per-gram among smokers in the UK; (2) what demographic and smoker characteristics are associated with anticipated responses; and (3) whether minimum pricing may help ex-smokers stay quit. Design: Cross-sectional survey (May–July 2019). Setting: UK. Participants Adult cigarette smokers (n=2412) and ex smokers (n=700). Main outcome measurements Anticipated responses to a hypothetical minimum price of £10.00 for 20 cigarettes (£0.50 per-cigarette) and £13.50 for 30 grams of roll-your-own tobacco (£0.45 per-gram); approximately £0.10 per-cigarette/per-gram increases on the cheapest prices in leading UK supermarkets (January 2019). Smokers were presented with ten options (eg, ‘Try to quit’) and asked which they would do (Yes/No) and then which they would most likely do. Ex-smokers were asked to what extent the minimum prices would help them stay quit (A lot vs Lesser agreement). Results: Among smokers, 55.6% said they would most likely smoke the same amount, 10.7% they would smoke less, 9.5% they would try to quit and 5.8% they would use e-cigarettes more often. Anticipated reactions were associated with demography and smoker characteristics, for example, C2DE (lower social grade) smokers were less likely than ABC1 (higher social grade) smokers to say they would smoke the same as they do now (ORAdj=0.74, 95% CI 0.62 to 0.88). Among ex-smokers, 38.5% said the minimum prices would help them stay quit ‘A lot’, more so among C2DE than ABC1 participants (ORAdj=1.80, 95% CI 1.30 to 2.49). Conclusions: In response to a hypothetical minimum price for cigarettes and roll-your-own tobacco, approximately a fifth of smokers in the UK indicated they would smoke less or quit and almost two-fifths of ex-smokers indicated the prices would help them stay quit
... [18] Such policies have the potential to impact both the proportion of smokers who make a quit attempt as well as the proportion who successful quit smoking. [8,11,[19][20][21][22] Additionally, guideline-recommended treatments for tobacco dependence (e.g. pharmacotherapy and behavioral counseling) have been shown to be effective in increasing cessation in clinical trials. ...
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Lower rates of successful quitting among low-income populations in the United States may be from slower dissemination of smoke-free homes, a predictor of cessation.To explore the role of smoke-free homes in cessation behavior across income levels.Current smokers who were ≥18 years and who participated in the longitudinal 2002-2003 (n = 2801) or 2010-2011 (n = 2723) Tobacco Use Supplements to the Current Population Survey.We categorized income as multiples of the federal poverty level (FPL) (300%FPL). Although similar in 2002, the prevalence of smoke-free homes was 33% lower among individuals living
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Importance: Raising the price of cigarettes by increasing taxation has been associated with improved perinatal and child health outcomes. Transnational tobacco companies have sought to undermine tobacco tax policy by adopting pricing strategies that maintain the availability of budget cigarettes. Objective: To assess associations between median cigarette prices, cigarette price differentials, and infant mortality across the European Union. Design, setting, and participants: A longitudinal, ecological study was conducted from January 1, 2004, to December 31, 2014, of infant populations in 23 countries (comprising 276 subnational regions) within the European Union. Interventions: Median cigarette prices and the differential between these and minimum cigarette prices were obtained from Euromonitor International. Pricing differentials were calculated as the proportions (%) obtained by dividing the difference between median and minimum cigarette price by median price. Prices were adjusted for inflation. Main outcomes and measures: Annual infant mortality rates. Associations were assessed using linear fixed-effect panel regression models adjusted for smoke-free policies, gross domestic product, unemployment rate, education, maternal age, and underlining temporal trends. Results: Among the 53 704 641 live births during the study period, an increase of €1 (US $1.18) per pack in the median cigarette price was associated with a decline of 0.23 deaths per 1000 live births in the same year (95% CI, -0.37 to -0.09) and a decline of 0.16 deaths per 1000 live births the following year (95% CI, -0.30 to -0.03). An increase of 10% in the price differential between median-priced and minimum-priced cigarettes was associated with an increase of 0.07 deaths per 1000 live births (95% CI, 0.01-0.13) the following year. Cigarette price increases across 23 European countries between 2004 and 2014 were associated with 9208 (95% CI, 8601-9814) fewer infant deaths; 3195 (95% CI, 3017-3372) infant deaths could have been avoided had there been no cost differential between the median-priced and minimum-priced cigarettes during this period. Conclusions and relevance: Higher cigarette prices were associated with reduced infant mortality, while increased cigarette price differentials were associated with higher infant mortality in the European Union. Combined with other evidence, this research suggests that legislators should implement tobacco tax and price control measures that eliminate budget cigarettes.
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Background There is evidence that the cheapest cigarettes cost even less in neighbourhoods with higher proportions of youth, racial/ethnic minorities and low-income residents. This study examined the relationship between the price of the cheapest cigarette pack and neighbourhood demographics in a representative sample of tobacco retailers in the USA. Methods Data collectors recorded the price of the cheapest cigarette pack (regardless of brand) in 2069 retailers in 2015. Multilevel linear modelling examined the relationship between price and store neighbourhood (census tract) characteristics, specifically median household income and percentage of youth, Black, Asian/Pacific Islander and Hispanic residents. Results Average price for the cheapest pack was $5.17 (SD=1.73) and it was discounted in 19.7% of stores. The price was $0.04 less for each SD increase in the percentage of youth and $0.22 less in neighbourhoods with the lowest as compared with the highest median household incomes. Excluding excise taxes, the average price was $2.48 (SD=0.85), and associations with neighbourhood demographics were similar. Conclusion The cheapest cigarettes cost significantly less in neighbourhoods with a greater percentage of youth and lower median household income. Non-tax mechanisms to increase price, such as minimum price laws and restrictions on discounts/coupons, may increase cheap cigarette prices.
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Introduction: This study examined the effects of cigarette price on intention to quit, quit attempts, and successful cessation among African American smokers in the U.S. and explored whether price effects differed by income level and menthol use status. Price effects were further compared to White counterparts. Methods: We used pooled cross-sectional data from 2006-2007 and 2010-2011 Tobacco Use Supplements to the Current Population Survey to analyze 4,213 African American recent active smokers. Three dependent variables were examined: any quit attempts in the past 12 months, successful cessation for ≥3 months, and intention to quit in the next 6 months. For each dependent variable, separate multiple logistic regression models were estimated to determine the impact of cigarette prices. Results: There was no indication that price was associated with quit attempts or successful cessation, but price was positively associated with increased odds of intending to quit among African American smokers (p<0.001). In contrast, prices were positively associated with intention to quit and quit attempts for White smokers. The association between price and intention to quit was significantly positive for African American low-income and menthol smokers but was not statistically significant for African American high-income and non-menthol smokers. There was no evidence of a price effect on quit attempts and successful cessation for each subgroup of African Americans. Conclusion: Tobacco tax policy alone may not be enough to increase quit attempts or successful cessation among African Americans. Community-based cessation programs tailored towards African American smokers, especially low-income menthol smokers, are needed.
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Basic and clinical addiction research use demand measures and analysis extensively to characterize drug use motivations. Hence, obtaining an accurate and brief measurement of demand that can be easily utilized in different settings is highly valued. In the current study, 2 versions of a breakpoint measure, designed to capture cigarette demand, were investigated in 119 smokers who were recruited from an online crowdsourcing platform. The first version determines the maximum price a smoker is willing to pay for one cigarette received right now when paid out of pocket, and the second determines the maximum price when paid using a hypothetical $100 gift card received for free. The breakpoint measures were administered along with the Cigarette Purchase Task (CPT), Fagerström Test for Cigarette Dependence (FTCD), and The Questionnaire of Smoking Urges (QSU-brief). Both single-item breakpoint versions were significantly correlated with CPT-derived demand measures loaded on the persistence factor (i.e., elasticity of demand, breakpoint, Pmax, and Omax), but not with those loaded on the amplitude factor (i.e., intensity of demand). In addition, both single-item measures were associated with metrics of tobacco dependence (e.g., FTCD, QSU) with effect sizes that are similar to the ones found between CPT-derived breakpoint and those same metrics. These findings suggest that the single-item breakpoint measure is a viable method for measuring demand that may provide a useful and efficient tool to capture crucial and distinct aspects of smoking. In addition, the breakpoint measures may help increase the utility of behavioral demand measures in novel research and clinical settings. (PsycINFO Database Record (c) 2018 APA, all rights reserved).
Article
Purpose: To understand the tobacco acquisition practices of low-income smokers in New York State in light of high cigarette prices due to high cigarette taxes. Design: Eight focus groups with low-income smokers were conducted in spring 2015 and 2016 (n = 74). Setting: New York City (NYC) and Buffalo, New York. Participants: Low-income adults aged 18 to 65 who smoke cigarettes regularly. Method: Qualitative analysis of focus group transcripts that explored differences and similarities by region. We used the interview guide-which covered the process of acquiring cigarettes and the impact of cigarette prices-as a framework for analysis to generate themes and subthemes (deductive coding). We also generated themes and subthemes that emerged during focus group discussions (inductive coding). Results: Some smokers in Western New York have switched to untaxed cigarettes from Native American reservations, whereas low-income smokers in NYC described convenient sources of bootlegged cigarettes (packs or loosies) in their local neighborhood stores, through acquaintances, or on the street. Familiarity with the retailer was key to accessing bootlegged cigarettes from retailers. Conclusions: Smokers in this study could access cheaper cigarettes, which discouraged quit attempts and allowed them to continue smoking. The availability of lower priced cigarettes may attenuate public health efforts aimed at reducing smoking prevalence through price and tax increases.
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Introduction Innovations in tobacco control interventions are required to ensure continued reductions in global tobacco use, and to minimise attributable morbidity and mortality. We therefore aimed to investigate the perceived effectiveness of current cigarette packaging warnings and the potential effectiveness of cigarettestick warnings across four countries. Methods An online survey was distributed to adult smokers in Australia, Canada, the United Kingdom, and the United States. Participants rated (using a 5-point Likert scale) and commented on the effectiveness of current cigarette packaging warnings and text warnings on eight cigarette sticks that prompted smokers to quit. Ratings were analysed using proportional odds logistic regression, and comments were analysed using content analysis. Results Participants (N=678, mean age=44.3 years) from all four countries perceived cigarette packaging warnings as being minimally effective in prompting smokers to quit, citing desensitisation and irrelevance of the warnings, with US participants particularly critical of the text-only warnings. Compared to packaging warnings, the cigarette-stick warnings describing the financial costs of smoking and the effect of smoking on others, were the highest rated in all four countries (OR=3.42, 95% CI: 2.75–4.25, p
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Introduction: Few studies have used longitudinal cohort data to examine associations of cigarette prices with smoking cessation or whether price sensitivity varies by income or education. This study examines these associations in a multicenter US cohort and explores whether associations vary by education and income. Methods: Longitudinal data from baseline daily cigarette smokers aged 18-30 years in the Coronary Artery Risk Development in Young Adults study were linked to inflation-adjusted cigarette carton prices from the Council for Community and Economic Research Cost of Living Index based on residential address at baseline and in years 7, 10, and 15 (1985-2001). Multivariable Cox models estimated hazard ratios (HRs) of first (any) smoking cessation and sustained smoking cessation (no relapse) associated with each $1 increase in time-dependent cigarette price over 15 years of follow-up. Models were adjusted for sociodemographic, health-related, and policy covariates. We assessed effect modification by education and household income. Results: Among 1489 participants, a $1.00 higher cigarette carton price was associated with a 16% higher likelihood of first smoking cessation (HR = 1.16, 95% CI = 1.11 to 1.21) and an 8% higher likelihood of sustained smoking cessation (HR = 1.08, 95% CI = 1.02 to 1.14). Associations were strongest among participants with lower income for first cessation, and among those with higher income for sustained cessation. Associations were strongest for participants with less than a high school degree for both outcomes. Conclusions: Results suggest higher cigarette prices promote smoking cessation among young to middle-aged adults, and that price sensitivity may differ by socioeconomic status. Implications: Few studies have examined longitudinal associations of cigarette prices with smoking cessation, and findings are mixed on whether price sensitivity varies by education or income. In a cohort of US adult daily smokers, cigarette prices were associated with greater likelihood of both a first cessation and sustained cessation. Price associations with first cessation were stronger among low-income smokers, but associations with sustained cessation were stronger among high-income smokers. Results suggest that although higher cigarette prices may promote short-term smoking cessation among smokers at all income levels, additional supports may be needed to facilitate sustained smoking cessation among low-income smokers.
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Cardiovascular disease (CVD) remains a leading cause of morbidity and mortality in the United States and across the world. Risk factors associated with CVD among an individual's vascular beds are often shared, as well as highly correlated. This chapter will review the current assessment of cardiovascular health, vascular disease prevention methods, strategies to maintain and optimize vascular health, and will discuss the pivotal role of population health and public policy on CVD development.
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Background : This study examined whether changes in quitting smoking differed according to smokers’ cigarettes consumed per day (CPD) and intention to quit (ITQ) after the introduction of two tobacco control measures in Korea, a tobacco tax increase in 2015 and pictorial cigarette pack warnings (PCW) in 2016. Methods : We utilized data from the Korea Welfare Panel Study from 2013 to 2017, an interval that was divided into four periods (2013–2014, 2014–2015, 2015–2016, and 2016–2017). We examined differential changes in quitting smoking by smokers’ CPD and ITQ using a generalized estimating equation model. Results : Smokers with 1–14 CPD or an ITQ were more likely to quit smoking in each period. However, when compared to the pre-policy period (2013–2014), smokers with 15 or more CPD and those with an ITQ had a higher risk ratio of quitting smoking in all study periods. In stratified analyses, when the tobacco excise tax was increased, the risk ratios of quitting smoking increased in most subgroups, especially smokers with 15 or more CPD or an ITQ. The increased risk ratio of 15 or more CPD smokers subgroup sustained afterward. However, after the introduction of PCW, there were no significant changes from the previous period in most subgroups. Conclusions : The addictive nature of tobacco and the type of tobacco control policies jointly contributed to changes in quitting smoking among Korean smokers. Tobacco control policies, particularly substantial tobacco tax increase, acted as a cue-to-action for quitting smoking among more dependent smokers.
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Introduction Increases in tobacco price are known to reduce smoking prevalence, but these correlations may be blunted by the availability of budget cigarettes, promoted by the tobacco industry to maintain profits. Objective To investigate the effect of budget cigarettes on cigarette consumption using data from Europe 2004–2014. Methods Data on the annual population-weighted cigarette consumption per adult come from the International Cigarette Consumption Database. Data on the annual tobacco price come from Euromonitor International for 23 European countries. Median prices and price differentials (operationalised as percentages obtained by dividing the difference between median and minimum prices by the median price) were examined. A linear random-effects model was used to assess associations between median prices and price differentials with cigarette consumption within 1 year and with a 1-year time lag. Results Cigarette consumption per capita declined over the study period (−29.5 cigarettes per capita per year, 95% confidence interval −46.8 to −12.1). The analysis suggests that increases in cigarette price differentials, a marker of opportunities for smokers to switch to less expensive cigarettes, may be associated with greater consumption in the same year (6.4 for a 10% increase in differential, −40.0 to 52.6) and are associated with greater consumption in the following year (67.6, 25.8 to 109.5). Conclusion These analyses suggest that even in Europe, where tobacco taxes are relatively high compared with other regions, differential cigarette pricing strategies may undermine tobacco control. Further research is needed on links between tobacco price structures and consumption, and policy design to maximise the effectiveness of tobacco taxation.
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Objectives We undertook this review to assess the impact of pricing strategies on brand choice, loyalty and quitting behaviour in Global South countries.Methods We systematically retrieved articles from Medline, CENTRAL, ScienceDirect, Google Scholar from inception up to January 2020. Studies which reported tobacco industry’s pricing strategies were eligible. We summarized the data as themes and codes using the principles of inductive qualitative thematic analysis within structured rational constructivist framework.ResultsIn total, 13 studies met inclusion criteria were included. Major strategies adopted by tobacco industries to tackle the pricing and taxation changes were increased tax absorption, differential taxation based on price, cigarette length/size which ensures modest increase in the net price of cigarettes. This in turn influences the tobacco users in terms of brand loyalty and switching as they prefer to stay with factory-made cigarettes or shift to a cheaper alternative or illegal product rather than decreasing/quitting tobacco use.Conclusions Absorption of excise tax and differential taxation are the common pricing strategies adopted by tobacco industries in Global South. These strategies together with external determinants impact the price-related tobacco control interventions.
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Background The objective of this study is to estimate the sensitivity of cigarette quantity demanded to price and income changes in Montenegro. Data and methods The sensitivity of cigarette quantity demanded to price and income changes was estimated using micro and macro analysis. Micro analysis implied the use of Deaton’s model on Household Budget Survey data (2006–2017). In macro analysis, conventional static demand model is applied using error correction and autoregressive distributed lag time series methodology on annual time series aggregated data (2001–2017). Results The same results were obtained using micro and macro analysis which contributes to the objectivity of the conducted research. Results derived from the Deaton’s model indicate a negative price elasticity of cigarettes in the range between −0.62 and −0.80 (conditional and unconditional), while in macro model estimated price elasticity is in that range and equals −0.68. Simulation results confirm the efficiency of excise tax policy changes, having an evident decrease in consumption and increase of public revenues. Conclusion Analysis of the tobacco market and regulatory environment suggests that the increase of excise and other taxes on tobacco have an important direct impact on the reduction of cigarettes and other tobacco products consumption. Our estimates of long and short-run price elasticity show that direct impact is strong and very much in accordance with the results obtained so far for other low-income and middle-income countries. This paper gives a contribution to the analysis of price elasticity of demand for cigarettes, which was for the first time conducted in Montenegro.
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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 ten waves, every November from 2005-2014. Methods: Temporary and long-term at least one year (1y+) or two 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 one-year and at least two-years, respectively. 2y+ quitters significantly increased in November 2005-November 2008 (adjusted odds ratio [AOR]=1.23, 95% confidence interval [CI]:1.06-1.43) and November 2009-November 2012 (AOR=1.85, 95% CI=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 ten 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.
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Traditionally smoking cessation studies use smoker and nonsmoker categories almost exclusively to represent individuals quitting smoking. This study tested the transtheoretical model of change that posits a series of stages through which smokers move as they successfully change the smoking habit. Ss in precontemplation ( n = 166), contemplation ( n = 794), and preparation ( n = 506) stages of change were compared on smoking history, 10 processes of change, pretest self-efficacy, and decisional balance, as well as 1-mo and 6-mo cessation activity. Results strongly support the stages of change model. All groups were similar on smoking history but differed dramatically on current cessation activity. Stage differences predicted attempts to quit smoking and cessation success at 1- and 6-mo follow-up. Implications for recruitment, intervention, and research are discussed. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
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To examine characteristics of smokers associated with the use of discount and generic cigarettes. Data for this analysis come from two population-based cross-sectional telephone surveys (1988 survey n = 32952; 1993 survey n = 11783) and a cohort tracking survey (n = 11966) of smokers aged 25-64 years conducted in 20 communities in the United States between 1988 and 1993 as part of the National Cancer Institute's Community Intervention Trial for Smoking Cessation. In each survey, current smokers were asked to report the six-digit UPC code displayed on the side of the pack of their current cigarettes. Respondents who did not have a pack available or who could not locate the UPC code number were asked to report their usual brand of cigarettes smoked. A master list of UPC code numbers was developed so that reported UPC codes could be associated with specific cigarette brand names. Brand name cigarettes were categorised as either premium or discount brands using information from the Maxwell consumer report. Respondents who reported smoking "no name" generic cigarettes were classified as smoking a discount cigarette. The reported use of discount/generic cigarettes increased from 6.2% in 1988 to 23.4% in 1993. The trend toward increased use of lower priced cigarettes was evident in all 20 communities studied. The use of low priced cigarettes was associated with lower household income, higher daily cigarette consumption, and residence in an area with higher average cigarette prices. Respondents using discount/generic cigarettes were less likely to stop smoking or to reduce cigarette consumption between 1988 and 1993 compared with those using premium brand cigarettes. The availability of discount/generic cigarettes has made smoking more affordable, which most likely has helped the cigarette industry retain customers sensitive to price, who might have otherwise reduced consumption or stop smoking altogether.
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To examine cigarette purchasing patterns of current smokers and to determine the effects of cigarette price on use of cheaper sources, discount/generic cigarettes, and coupons. Higher cigarette prices result in decreased cigarette consumption, but price sensitive smokers may seek lower priced or tax-free cigarette sources, especially if they are readily available. This price avoidance behaviour costs states excise tax money and dampens the health impact of higher cigarette prices. Telephone survey data from 3602 US smokers who were originally in the COMMIT (community intervention trial for smoking cessation) study were analysed to assess cigarette purchase patterns, use of discount/generic cigarettes, and use of coupons. 59% reported engaging in a high price avoidance strategy, including 34% who regularly purchase from a low or untaxed venue, 28% who smoke a discount/generic cigarette brand, and 18% who report using cigarette coupons more frequently that they did five years ago. The report of engaging in a price avoidance strategy was associated with living within 40 miles of a state or Indian reservation with lower cigarette excise taxes, higher average cigarette consumption, white, non-Hispanic race/ethnicity, and female sex. Data from this study indicate that most smokers are price sensitive and seek out measures to purchase less expensive cigarettes, which may decrease future cessation efforts.
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We examined whether smokers who purchased low-taxed cigarettes from American Indian reservations had lower quit attempt and cessation rates than did smokers who purchased cigarettes from full-price outlets. Smokers who bought cigarettes from American Indian reservations were half as likely to make a quit attempt and had a nonsignificant trend toward lower cessation rates (20% vs 10%) compared with those who bought full-priced cigarettes. Interventions that reduce price differentials are suggested to maximize the public health benefit of cigarette excise taxes.
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Higher cigarette prices result in decreased cigarette consumption, but some smokers may seek lower-taxed cigarette sources. This price avoidance behaviour likely dampens the health impact of higher cigarette prices although it has not been thoroughly studied. To describe the characteristics of smokers who purchase low/untaxed cigarettes and to examine how this behaviour is associated with subsequent changes in smoking behaviours. Telephone survey data from 8930 smokers from the International Tobacco Control (ITC) Four Country Survey (ITC-4) were used to assess cigarette purchase patterns and smoking behaviours in Wave 1 conducted from October to December 2002 and subsequently followed seven months later in Wave 2. Respondents' smoking status, attempts to quit, amount smoked, and cigarette purchase patterns were assessed in both waves. Rates of purchase from a low/untaxed source at the respondents' last cigarette purchase differed notably between countries at Wave 1, from less than 1% in Australia to 15% in the United Kingdom. In the UK, but not the other countries, this increased significantly to 20% at Wave 2. Smokers who were older, white/English speakers, had higher incomes, and had higher levels of education were more likely to report purchasing cigarettes from a low/untaxed source on their last purchase. Those who reported purchasing from a low/untaxed source on their last purchase at Wave 1 were less likely to have tried to quit smoking quit smoking by Wave 2 (relative risk 0.70, p < 0.01), while no overall significant association with smoking cessation was observed. Data from this study indicate that there are lower levels of making a quit attempt among purchasers of low/untaxed cigarettes compared to purchasers of full-priced cigarettes. The availability of low/untaxed cigarettes may mitigate the influence of increases in cigarette prices.
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Substantial econometric efforts have been devoted to examining the impacts prices and tobacco control policies have on smoking propensity and intensity. However, little is known about the effects prices, smoking restrictions, and other influences have on smoking cessation. This paper uses longitudinal data from the Monitoring the Future Surveys, augmented with cigarette price and policy-related measures to estimate smoking cessation equations for young adult males and females separately. The estimates clearly indicate that increases in cigarette prices would lead a significant number of young adults to quit smoking. In addition, policies restricting smoking in private worksites increase the probability of smoking cessation among employed young adult females.
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The annual 5% increase in tobacco taxes in real terms proposed in the recent White Paper on smoking has reaffirmed the commitment of successive UK Governments to above-inflation increases in tobacco taxation to encourage people to stop smoking. This paper presents evidence on the determinants of starting and quitting smoking by using data from the British Health and Lifestyle Survey and is the first to identify tax elasticities for starting and quitting smoking using British data. Self-reported individual smoking histories are coupled with a long time series for the tax rate on cigarettes to construct a longitudinal data set. Estimates are obtained for the effect of above-inflation tax rises on the age of starting smoking and the number of years of smoking. The estimates of the tax elasticity of the age of starting smoking are 0.16 for men and 0.08 for women. The estimates of the tax elasticity of quitting are −0.60 for men and −0.46 for women. These are robust to different specifications.
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Low-cost generic cigarettes grew dramatically in market share between 1990 and 1993, raising concerns that some smokers might view generics as an alternative to quitting. We report sociodemographic predictors of generic brand choice among a cross-sectional sample of California smokers and investigate changes in brand choice in a longitudinal sample of California smokers between 1990 and 1992. We also focus on brand preferences among California adolescents. One third of smokers who switched cigarette brands between 1990 and 1992 switched to generics. Non-Hispanic whites, rural residents, and lower income smokers were twice as likely to buy generics as other smokers were. Heavy cigarette consumption was strongly associated with smoking generic cigarettes. Women appeared more price-sensitive in cigarette purchasing than men did, and generic brands were the most frequently purchased cigarettes for female smokers older than age 45. Generics were less popular among adolescents than among adults. Generic cigarettes provide a low-cost alternative to price-sensitive smokers, but further studies are needed to establish the role and influence of generic cigarettes on smoking prevalence and public health. Medical Subject Headings (MeSH): smoking, smoking cessation, adolescent behavior, women, prevalence.
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Critics of public opinion polls often claim that methodological shortcuts taken to collect timely data produce biased results. This study compares two random digit dial national telephone surveys that used identical questionnaires but very different levels of effort: a "Standard" survey conducted over a 5-day period that used a sample of adults who were home when the interviewer called, and a "Rigorous" survey conducted over an 8-week period that used random selection from among all adult household members. Response rates, computed according to AAPOR guidelines, were 60.6 percent for the Rigorous and 36.0 percent for the Standard study. Nonetheless, the two surveys produced similar results. Across 91 comparisons, no difference exceeded 9 percentage points, and the average difference was about 2 percentage points. Most of the statistically significant differences were among demographic items. Very few significant differences were found on attention to media and engagement in politics, social trust and connectedness, and most social and political attitudes, including even those toward surveys.
Article
Using data from the 1979 and 1987 National Health Interview Survey (NHIS), we test whether smokers alter their smoking habits in the face of higher taxes. Smokers in high-tax states are more likely to smoke cigarettes higher in tar and nicotine. Although taxes reduce the number of cigarettes consumed per day among remaining smokers, total daily tar and nicotine intake is unaffected. Young smokers, aged 18-24, are much more responsive to changes in taxes than are older smokers, and their total daily tar and nicotine intake actually increases after a tax hike. We illustrate that tax-induced compensating behavior may eliminate some health benefits generated by reduced smoking participation. A more appropriate tax might be based on the tar and nicotine content of cigarettes.
Article
Retail stores are the primary medium for marketing cigarettes to smokers in the US. The prevalence and characteristics of cigarette retail advertising and promotions have been described by several investigators. Less is known about the proportion of cigarette sales occurring as part of a retail promotion and about the effects of tobacco control policies on cigarette promotions. To estimate the effect of the Master Settlement Agreement (MSA), state tobacco control programme funding and cigarette taxes on retail promotions for cigarettes in supermarkets in the US. Proportion of cigarette sales occurring under a retail promotion and the value of multipack promotions (eg, buy one pack, get one pack free) and cents-off promotions, measured using scanner data in supermarkets from 50 retail market areas from 1994 to 2004. Promoted cigarette sales have increased significantly since the MSA (p<0.01), and are higher in market areas with high tobacco control programme funding (p<0.01) and high cigarette tax (p<0.01). The value of a multipack promotion is higher since the MSA (p<0.01) and in market areas with high cigarette tax (p<0.01). The value of a cents-off promotion is negatively related to the MSA (p<0.01), with mixed results for tobacco control programme funding (p<0.05), and is unassociated with tax. Higher promoted cigarette sales and increased promotional values in market areas with strong tobacco control policies, compared with market areas with weaker tobacco control policies, may partially offset the decline in smoking achieved in those areas.
Article
The author investigates the determinants of the hazard rates of both starting and quitting the cigarette smoking habit. The model is an ordered probit split-sample duration model with lagged duration dependence and time-varying covariates (cigarette price and regulation). Duration of the smoking habit is approximately unitary elastic with respect to cigarette price. The hazard rate of starting smoking peaks sharply and quickly declines before age twenty. Both nonparametric and parametric results indicate that the quitting hazard rate rises with the habit's duration, a result at odds with survey data but consistent with the economic model of rational addiction. Copyright 1998 by Oxford University Press.
for the ITCPES Research Team. International Tobacco Control Policy Evaluation Survey (ITC 4-Country Survey) Wave 1 Tech-nical Report. Waterloo; 2004. Available online at
  • D Hammond
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Hammond D., Fong G. T., Thompson M. E., Driezen, P. for the ITCPES Research Team. International Tobacco Control Policy Evaluation Survey (ITC 4-Country Survey) Wave 1 Tech-nical Report. Waterloo; 2004. Available online at: http:// www.itcproject.org/Library/countries/4country/reports/ itcwltechr
Trends in Average State Cigarette Tax Rates DC: Campaign for Tobacco-Free Kids; 2009. 21. Physicians for a Smoke-Free Canada. Per Capita Consumption
  • Campaign
  • Tobacco-Free
Campaign for Tobacco-Free Kids. Trends in Average State Cigarette Tax Rates. Washington, DC: Campaign for Tobacco-Free Kids; 2009. 21. Physicians for a Smoke-Free Canada. Per Capita Consumption 1990–2007.
The Tax Burden on Tobacco: Histori-cal Compilation Virginia: Orzechowski and Walker; 2008. Do cigarette prices motivate smokers to quit?
  • Orzechowski
  • Walker
Orzechowski and Walker. The Tax Burden on Tobacco: Histori-cal Compilation 2008, Vol 43. Virginia: Orzechowski and Walker; 2008. Do cigarette prices motivate smokers to quit?
Cigarette Purchase Patterns and Cigarette Prices in Four Countries: Findings from the International Tobacco Control Policy Evaluation Survey. Paper presented at the
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Cummings K., Hyland A., Travers M., Fong G. T., Chaloupka F. J., Ross H. et al. Cigarette Purchase Patterns and Cigarette Prices in Four Countries: Findings from the International Tobacco Control Policy Evaluation Survey. Paper presented at the 2004 Society for Research on Nicotine and Tobacco Annual Meeting, Scottsdale, AZ, 21 February 2004.
Physicians for a Smoke-Free Canada
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Ottawa, Canada: Physicians for a Smoke-Free Canada; 2008.
Tax Revenue from Tobacco Sales. Ottawa, Canada: Physicians for a Smoke-Free Canada
  • Physicians
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Physicians for a Smoke-Free Canada. Tax Revenue from Tobacco Sales. Ottawa, Canada: Physicians for a Smoke-Free Canada; 2008.
Impact of response rates on estimates of smoking prevalence: comparison of state-specific estimates from the BRFSS and the CPS Tobacco Use Supplement
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Wortley, P.; Mariolis, P. Impact of response rates on estimates of smoking prevalence: comparison of state-specific estimates from the BRFSS and the CPS Tobacco Use Supplement. Paper presented at the American Association for Public Opinion Research (AAPOR) Conference; March 2002;
Tobacco Control Policies and Youth Smoking. Cambridge, MA: National Bureau of Eco-nomic Research
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Chaloupka F., Grossman M. Price, Tobacco Control Policies and Youth Smoking. Cambridge, MA: National Bureau of Eco-nomic Research; 1996.
The Erosion of Federal Cigarette Taxes over Time. Washington, DC: Campaign for Tobacco-Free Kids
  • Campaign
  • Tobacco-Free
Campaign for Tobacco-Free Kids. The Erosion of Federal Cigarette Taxes over Time. Washington, DC: Campaign for Tobacco-Free Kids; 2009.
The Tax Burden on Tobacco: Historical Compilation Orzechowski and Walker
  • Walker Orzechowski
Orzechowski and Walker. The Tax Burden on Tobacco: Historical Compilation 2008, Vol 43. Virginia: Orzechowski and Walker; 2008.
Trends in Average State Cigarette Tax Rates: Campaign for Tobacco- Free Kids
  • Tobacco-Free Campaign
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Campaign for Tobacco-Free Kids. Trends in Average State Cigarette Tax Rates. Washington, DC: Campaign for Tobacco- Free Kids; 2009.
Reducing Tobacco Use: A Report of the Surgeon General
US Department of Health and Human Services. Reducing Tobacco Use: A Report of the Surgeon General. Atlanta, GA: US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office of Smoking and Health; 2000.
Per Capita Consumption: Physicians for a Smoke-Free Canada
  • Physicians
  • Free Smoke
  • Canada
Physicians for a Smoke-Free Canada. Per Capita Consumption 1990–2007. Ottawa, Canada: Physicians for a Smoke-Free Canada; 2008.
Cigarette Purchase Patterns and Cigarette Prices in Four Countries: Findings from the International Tobacco Control Policy Evaluation Survey
  • K Cummings
  • A Hyland
  • M Travers
  • G T Fong
  • F J Chaloupka
  • H Ross
Cummings, K.; Hyland, A.; Travers, M.; Fong, GT.; Chaloupka, FJ.; Ross, H., et al. Cigarette Purchase Patterns and Cigarette Prices in Four Countries: Findings from the International Tobacco Control Policy Evaluation Survey. Paper presented at the 2004 Society for Research on Nicotine and Tobacco Annual Meeting;
  • F Chaloupka
  • M Grossman
  • Price
Chaloupka, F.; Grossman, M. Price, Tobacco Control Policies and Youth Smoking. Cambridge, MA: National Bureau of Economic Research; 1996.
for the ITCPES Research Team. International Tobacco Control Policy Evaluation Survey (ITC 4-Country Survey) Wave 1 Technical Report. Waterloo
  • D Hammond
  • G T Fong
  • M E Thompson
  • P Driezen
Hammond D., Fong G. T., Thompson M. E., Driezen, P. for the ITCPES Research Team. International Tobacco Control Policy Evaluation Survey (ITC 4-Country Survey) Wave 1 Technical Report. Waterloo; 2004. Available online at: http:// www.itcproject.org/Library/countries/4country/reports/ itcwltechr
The Erosion of Federal Cigarette Taxes over Time
  • Tobacco-Free Campaign For
  • Kids
Campaign for Tobacco-Free Kids. The Erosion of Federal Cigarette Taxes over Time. Washington, DC: Campaign for Tobacco-Free Kids; 2009.
Virginia: Orzechowski and Walker
  • Walker Orzechowski
Orzechowski and Walker. The Tax Burden on Tobacco: Historical Compilation 2008, Vol 43. Virginia: Orzechowski and Walker; 2008.
P. for the ITCPES Research Team International Tobacco Control Policy Evaluation Survey (ITC 4-Country Survey) Wave 1
  • D Hammond
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  • Driezen
  • Chaloupka