The impact of tobacco tax cuts on smoking initiation among Canadian young adults

BACKGROUND: Although the majority of smokers initiate smoking during their teenage years, significant rates of initiation occur among young adults. Adolescents are more price sensitive than adults, but little is known about the impact of tobacco taxation on smoking initiation among young adults. Using a longitudinal design, this study examined the impact of decreased cigarette price, resulting from tobacco tax cuts, on smoking initiation among Canadian young adults aged 20 to 24 years. METHODS: Using Statistics Canada's National Population Health Survey longitudinal file, this study examined young adults who did not smoke at baseline in 1994-1995 (n=636, representing over 1 million young adults) and who were reassessed at follow-up (1996-1997). Multivariable logistic regression analysis using bootstrap weights was conducted to estimate the impact of decreased cigarette price on smoking initiation. The analysis controlled for the potential confounding effect of sociodemographic and tobacco control variables. Sensitivity analyses were conducted. Price elasticity was estimated. Analyses were conducted in 2003 and 2004. RESULTS: Approximately 10% of young adults had initiated smoking at follow-up. Decreased cigarette price was significantly associated with higher smoking initiation (adjusted odds ratio per $1 decrease for a carton of cigarettes=1.15, 95% confidence interval [CI]=1.01-1.32, p=0.042). Sensitivity analyses showed similar results. Price elasticity was 3.36 (95% CI=0.07-6.75). CONCLUSIONS: Young adults are sensitive to cigarette prices. Reductions in cigarette prices will lead to increased smoking initiation among this group. Tobacco taxation should be an effective strategy to reduce smoking initiation among young adults.     

Tobacco taxation and public health: ethical problems, policy responses

This article aims to describe the major ethical issues surrounding tobacco taxation, and to identify policy responses to minimise any ethical dilemmas. It uses the standard ethical framework for biomedicine (covering beneficence, non-maleficence, respect for autonomy and justice), in conjunction with relevant data on tobacco taxation from various developed countries. Tobacco taxation contributes substantial benefits at the population level by protecting health (i.e., by deterring the uptake of smoking by youth, by promoting quitting, and by reducing harm from exposure to second-hand smoke (SHS)). However, tobacco taxes can contribute to financial hardship among low-socioeconomic status populations where smoking persists. Such taxes can contribute to autonomy, by reducing SHS exposure to non-smokers, and by allowing freedom from nicotine-dependency for those who quit smoking or do not start regular smoking as a result of high tobacco prices. Furthermore, increases in tobacco taxation may reduce health inequalities and so contribute to justice. Nevertheless, the additional tax burden imposed on smokers who wish to continue to smoke, or are unable to quit, can be considered unjust. The autonomy of such smokers may be partly impaired. Although tobacco tax can be regarded as ethically justifiable because of its substantial overall benefit to society, there is substantial scope for policy changes to further reduce any harms and injustices for those populations who continue to smoke.     

Adult tobacco use levels after intensive tobacco control measures: New York City, 2002-2003

OBJECTIVES: We sought to determine the impact of comprehensive tobacco control measures in New York City. METHODS: In 2002, New York City implemented a tobacco control strategy of (1) increased cigarette excise taxes; (2) legal action that made virtually all work-places, including bars and restaurants, smoke free; (3) increased cessation services, including a large-scale free nicotine-patch program; (4) education; and (5) evaluation. The health department also began annual surveys on a broad array of health measures, including smoking. RESULTS: From 2002 to 2003, smoking prevalence among New York City adults decreased by 11% (from 21.6% to 19.2%, approximately 140000 fewer smokers). Smoking declined among all age groups, race/ethnicities, and education levels; in both genders; among both US-born and foreign-born persons; and in all 5 boroughs. Increased taxation appeared to account for the largest proportion of the decrease; however, between 2002 and 2003 the proportion of cigarettes purchased outside New York City doubled, reducing the effective price increase by a third. CONCLUSIONS: Concerted local action can sharply reduce smoking prevalence. However, further progress will require national action, particularly to increase cigarette taxes, reduce cigarette tax evasion, expand education and cessation services, and limit tobacco marketing.     

Tobacco Taxation and Its Prospective Impact on Disparities in Smoking Initiation and Progression Among Young Adults

PurposeLimited research exists on tobacco taxes and cigarette smoking initiation and progression, particularly across different sociodemographic groups in young adulthood. This project examines how cigarette pack price in late adolescence prospectively relates to smoking initiation and progression by 21 years of age, focusing on differences across demographics.MethodsData are from the longitudinal Monitoring the Future project (2001–2017). Monitoring the Future examines drug use behaviors with nationally representative samples of 12th graders annually. Subsamples of 12th graders are followed up longitudinally. We examined past 30-day cigarette smoking among baseline never smokers (N = 9,232) and daily smoking among youths who were not daily cigarette smokers at baseline (N = 15,141). Using logistic regression, we examined state-level cigarette pack price at a modal age of 18 years and smoking at follow-up ages 19–20 years; we used interaction terms to assess differences across sociodemographic groups (by gender, race/ethnicity, and parental education).ResultsFor each dollar increase in price at baseline, the odds of initiation by age 19–20 years were reduced by 12% (adjusted odds ratio = .88; 95% confidence interval = .78, .99) and the odds of progression to daily smoking were reduced by 16% (adjusted odds ratio = .84; 95% confidence interval = .76, .92). After adjusting for multiple testing, for both outcomes there were no statistically significant interactions between price and demographics.ConclusionsCigarette prices in late adolescence were associated with a prospective reduction in cigarette smoking initiation and progression among young adults, with limited differences across sociodemographic characteristics. Higher cigarette prices can prevent smoking initiation and progression; however, complementary interventions are needed to reduce initiation and progression among subgroups disproportionately affected by tobacco.     

Do cigarette taxes affect children's body mass index? The effect of household environment on health

Several recent studies demonstrate a positive effect of cigarette prices and taxes on obesity among adults, especially those who smoke. If higher cigarette costs affect smokers' weights by increasing calories consumed or increasing food expenditures, then cigarette taxes and prices may also affect obesity in children of smokers. This study examines the link between child body mass index (BMI) and obesity status and cigarette costs using data from the National Longitudinal Survey of Youth-79 (NLSY79). Controlling for various child, mother, and household characteristics as well as child-fixed effects, I find that cigarette taxes and prices increase BMI in the children of smoking mothers. Interestingly, and unlike previous research findings for adults, higher cigarette taxes do not increase the likelihood of obesity in children. These findings are consistent with a causal mechanism in which higher cigarette costs reduce smoking and increase food expenditures and consumption in the household.     

A balanced tobacco control policy

By raising the price of cigarettes through tobacco taxes, policymakers might only be delaying some smokers' initiation of smoking rather than permanently preventing them from smoking. This is one of several reasons for adopting a balanced tobacco control policy that relies only in part on cigarette taxation.     

Smoking initiation among youth: the role of cigarette excise taxes and prices by race/ethnicity and gender

Existing evidence for the role of cigarette excise taxes and prices as significant determinants of youth smoking initiation is mixed. A few studies have considered the possibility that the impact of cigarette taxes and prices might differ by gender or race/ethnicity. In this paper, we address the role of cigarette taxes and prices on youth smoking initiation using the National Longitudinal Survey of Youth 1997 cohort and discrete-time survival methods. We present results overall and by gender, race/ethnicity, and gender by race/ethnicity. We examine initiation over the age range during which youth are most at risk of initiation and over a period in which substantial changes have occurred in tax and price. The result for cigarette excise taxes is small and mixed across alternative specifications, with the effect strongest for black youth. Cigarette prices are more consistently a significant determinant of youth smoking initiation, especially for black youth.     

Tobacco taxes,prices and demand for tobacco products: a comparative analysis

This paper analyzes the extent to which an increase in tobacco taxes affects the demand for tobacco products, especially for cigarettes. Comparison of the studies reviewed revealed that higher tobacco taxes result in higher tobacco prices. The price-elasticity of cigarette demand in low- and middle-income countries is about double that in high-income countries, about 0.4. Furthermore, because of the addictive nature of tobacco use, demand for tobacco products is more elastic in the long run than in the short run. The effect of higher tobacco taxes is greater on the young, among whom demand is more sensitive to price than among adults. The empirical evidence for Spain estimates the price elasticity of cigarette demand in the short run to be in the range of 0.5 to 0.3, a result which is similar to other studies. These results do not suggest that tax policy is an effective tool for tobacco control, although taxes are useful for their revenue generating potential and for compensating the external costs generated by tobacco consumption. Furthermore, when the possibilities of substitutions among brands and the strategies of the tobacco industry to compensate for the effects of taxes (lowering prices and encouraging cigarette smuggling) are considered, the panorama is even more pessimistic     

The importance of peer effects, cigarette prices and tobacco control policies for youth smoking behavior

This paper expands the youth cigarette demand literature by undertaking an examination of the determinants of smoking among high school students incorporating the importance of peer effects and allowing cigarette prices (taxes) and tobacco control policies to have a direct effect and an indirect effect (via the peer effect) on smoking behavior. To control for the potential endogeneity of our school-based peer measure we implement a two-stage generalized least squares estimator for a dichotomous dependent variable and implement a series of diagnostic tests. The key finding is that peer effects play a significant role in youth smoking decisions: moving a high-school student from a school where no children smoke to a school where one quarter of the youths smoke is found to increase the probability that the youth smokes by about 14.5 percentage points. The results suggest that there is a potential for social multiplier effects with respect to any exogenous change in cigarette taxes or tobacco control policies.     

Intended and unintended effects of e-cigarette taxes on youth tobacco use

Over the past decade, rising youth use of e-cigarettes and other electronic nicotine delivery systems (ENDS) has contributed to aggressive regulation by state and local governments. Between 2010 and mid-2019, ten states and two large counties adopted ENDS taxes. We use two large national surveys (Monitoring the Future and the Youth Risk Behavior Surveillance System) to estimate the impact of ENDS taxes on youth tobacco use. We find that ENDS taxes reduce youth ENDS consumption, with estimated ENDS tax elasticities of -0.06 to -0.21. However, we estimate sizable positive cigarette cross-tax effects, suggesting economic substitution between cigarettes and ENDS for youth. These substitution effects are particularly large for frequent cigarette smoking. We conclude that the unintended effects of ENDS taxation may considerably undercut or even outweigh any public health gains.     

Channels of cigarette distribution, price and tobacco consumption in Italy

BACKGROUND: Limited information is available on the role of smuggling and of perceived influence of cigarette price on tobacco consumption in Italy. To elucidate the issues, we included specific questions in a survey on smoking in Italy. METHODS: Between March and April 2004, we conducted a survey on 3050 individuals aged 15 or over, representative of the general adult Italian population. The questionnaire included the estimate of the role of various channels of cigarette distribution and information on the self-reported perception of influence of prices on cigarette consumption in the young. RESULTS: Among current smokers, 85.6% bought cigarettes from tobacco shops, 7.5% from vending machines, and 6.9% from other channels of distribution, including smuggling, and internet (plus offered cigarettes). Overall, 35.9% of ever smokers (37.9% of males and 32.8% of females) reported that the prices had an intermediate to high influence on cigarette consumption in the young. Younger and less educated smokers were not more prone to report an influence of prices. CONCLUSIONS: These data indicate that in Italy smuggling now covers a limited proportion of cigarette sales, while cigarette prices have a substantial influence on tobacco consumption in the young.     

Purchasing patterns and smoking behaviors after a large tobacco tax increase: a study of Chinese Americans living in New York City

OBJECTIVES: Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens the public health benefits of higher-priced cigarettes. Few studies examine responses to cigarette tax policies, particularly among high-risk minority populations. This study examined the prevalence and correlates of tax avoidance and changes in smoking behaviors among Chinese American smokers in New York City after a large tax increase. METHODS: We conducted a cross-sectional study with data for 614 male smokers from in-person and telephone interviews using a comprehensive household-based survey of 2,537 adults aged 18-74 years. Interviews were conducted in multiple Chinese dialects. RESULTS: A total of 54.7% of respondents reported engaging in at least one low- or no-tax strategy after the New York City and New York State tax increases. The more common strategies for tax avoidance were purchasing cigarettes from a private supplier/importer and purchasing duty free/overseas. Higher consumption, younger age, and number of years in the U.S. were consistently associated with engaging in tax avoidance. Younger and heavier continuing smokers were less likely to make a change in smoking behavior in response to the tax increase. Despite high levels of tax avoidance and varying prices, nearly half of continuing smokers made a positive change in smoking behavior after the tax increase. CONCLUSIONS: Expanded legislation and enforcement must be directed toward minimizing the availability of legal and illegal low- or no-tax cigarette outlets. Public education and cessation assistance customized for the Chinese American community is key to maximizing the effectiveness of tobacco tax policies in this population.     

Comparison of cigarette and water-pipe smoking by Arab and non-Arab-American youth

BACKGROUND: Water-pipe smoking is a rapidly growing form of tobacco use worldwide. Building on an earlier report of experimentation with cigarette and water-pipe smoking in a U.S. community sample of Arab-American youth aged 14-18 years, this article examines water-pipe smoking in more detail (e.g., smoking history, belief in harmfulness compared to cigarettes, family members in home who smoke water pipes) and compares the water-pipe-smoking behaviors of Arab-American youth with non-Arab-American youth in the same community. METHODS: A convenience sample of 1872 Arab-American and non-Arab-American high school students from the Midwest completed a 24-item tobacco survey. Data were collected in 2004-2005 and analyzed in 2007-2008. RESULTS: Arab-American youth reported lower percentages of ever cigarette smoking (20% vs 39%); current cigarette smoking (7% vs 22%); and regular cigarette smoking (3% vs 15%) than non-Arab-American youth. In contrast, Arab-American youth reported significantly higher percentages of ever water-pipe smoking (38% vs 21%) and current water-pipe smoking (17% vs 11%) than non-Arab-American youth. Seventy-seven percent perceived water-pipe smoking to be as harmful as or more harmful than cigarette smoking. Logistic regression showed that youth were 11.0 times more likely to be currently smoking cigarettes if they currently smoked water pipes. Youth were also 11.0 times more likely to be current water-pipe smokers if they currently smoked cigarettes. If one or more family members smoked water pipes in the home, youth were 6.3 times more likely to be current water-pipe smokers. The effects of ethnicity were reduced as a result of the explanatory value of family smoking. CONCLUSIONS: Further research is needed to determine the percentages, patterns, and health risks of water-pipe smoking and its relationship to cigarette smoking among all youth. Additionally, youth tobacco prevention/cessation programs need to focus attention on water-pipe smoking in order to further dispel the myth that water-pipe smoking is a safe alternative to cigarette smoking.     

Does cigarette price influence adolescent experimentation?

The economics literature generally agrees that state and federal excise taxes can play an important role in deterring adolescent smoking. Teens' apparent responsiveness to cigarette prices is puzzling, since the majority of adolescent smokers do not buy their cigarettes. Teens typically do not begin to purchase cigarettes until they have developed an established pattern of smoking. Previous studies have not had adequate measures of smoking experience to explore whether adolescents' price responsiveness may vary by smoking experience. This paper uses data from a 1993 national survey of youth smoking to explore this hypothesis.     

Tobacco industry price-subsidizing promotions may overcome the downward pressure of higher prices on initiation of regular smoking

Real cigarette prices in the US increased from the early 1980s to early 1990s. Holding all else equal, adolescent initiation of regular smoking should have declined during this period. Using national population-based surveys (n = 336 343) conducted in the 1990s, we present trends (early 1960s to mid-1990s) in the initiation of regular smoking among 14-17-year-old adolescents and 18-21-year-old young adults. We also present trends in consumer-price-index-adjusted cigarette price and tobacco-industry expenditures for price-subsidizing promotions. We relate price and price-subsidizing tobacco industry expenditures to trends in initiation in the two age groups, using autoregressive integrated moving average models (ARIMA). From the model results, we conclude that price-subsidizing promotions may provide the tobacco industry with an effective way to segment the market. That is, they effectively offer lower prices to population subgroups that are more price-sensitive (e.g. young smokers not yet addicted), countering the depressing effect of general price increases on smoking. Thus, we find that the relationship of cigarette price to smoking behavior is more complex than previously described.     

Is smoking delayed smoking averted?

Antismoking efforts often target teenagers in the hope of producing a new generation of never smokers. Teenagers are more responsive to tobacco taxes than are adults. The author summarizes recent evidence suggesting that delaying smoking initiation among teenagers through higher taxes does not generate proportionate reductions in prevalence rates through adulthood. In consequence, the impact of taxes on smoking among youths overstates the potential long-term public health effects of this tobacco control strategy.     

Public policy and smoking cessation among young adults in the United States

In the wake of significant budget shortfalls, numerous states have increased cigarette excise taxes to boost revenues. This study examines whether or not increasing the price of cigarettes, which will occur as a consequence of cigarette excise tax increases, and implementing stronger restrictions on smoking in private worksites and other public places have an impact on smoking cessation decisions of young adults, thereby influencing public health in the United States (US). This paper employs longitudinal data on young adults from the Monitoring the Future Surveys matched with information on site-specific prices and measures of clean indoor air restrictions. A Cox regression is employed to estimate the smoking cessation equations. The estimates clearly indicate that increasing the price of cigarettes increases the number of young adults who quit smoking. The average price elasticity of cessation is 0.35. In addition, stronger restrictions on smoking in private worksites and public places other than restaurants increase the probability of young adult smoking cessation. Given the well-documented benefits of smoking cessation, a significant increase in cigarette excises taxes may be one of the most effective means to reduce premature death and disease in the United States.     

Registered indians and tobacco taxation: a culturally-appropriate strategy?

Taxation of tobacco is a widely-used strategy that prompts smoking cessation among adults and reduces cigarette consumption among continuing smokers. Registered Indian tobacco use prevalence is at least double that of the rest of Canadians and is in part due to the lower cost of tobacco products purchased on reserve by Registered Indians (RIs) as they are tax exempt. Although registered Indian communities have the ability to collect tax on tobacco products and direct the use of these revenues, this strategy is rarely utilized. Tobacco taxation could have substantial health and economic benefits to RI communities, but perhaps is not culturally-appropriate. In order to better support RI communities, governments and other organizations need to examine this policy instrument in the context of RI populations.     

State cigarette excise taxes - United States, 2010-2011

Increasing the price of cigarettes reduces the demand for cigarettes, thereby reducing youth smoking initiation and cigarette consumption and decreasing the prevalence of cigarette use in the United States overall, particularly among youths and young adults. The most common way governments have increased the price of cigarettes is by increasing cigarette excise taxes, which currently are imposed by all states and the District of Columbia. To update data on state cigarette excise taxes in 2009, CDC conducted a survey of changes in state cigarette excise taxes during 2010-2011. During that period, eight states increased their cigarette excise taxes, and one state decreased its tax; as a result, the mean state tax increased from $1.34 in 2009 to $1.46 in 2011. Previous evidence indicates that further increases in cigarette excise taxes would be expected to result in further reductions in demand for cigarettes, decreasing smoking and associated morbidity and mortality.     

Smokers' Strategic Responses to Sin Taxes: Evidence from Panel Data in Thailand

In addition to quitting and cutting consumption, smokers faced with higher cigarette prices may compensate in several ways that mute the health impact of cigarette taxes. This study examines three price avoidance strategies among adult male smokers in Thailand: trading down to a lower‐priced brand, buying individual sticks of cigarettes instead of packs, and substituting roll‐your‐own tobacco for factory‐manufactured cigarettes. Using two panels of microlevel data from the International Tobacco Control Southeast Asia Study, collected in 2005 and 2006, we estimate the effects of a substantial excise tax increase implemented throughout Thailand in December 2005. We present estimates of the marginal effects and price elasticities for each of five consumer behaviors. We find that, controlling for baseline smoking characteristics, sociodemographics, and policy variables, quitting is highly sensitive to changes in cigarette prices, but so are brand choice, stick‐buying, and use of roll‐your‐own tobacco. Neglecting such strategic responses leads to overestimates of a sin tax's health impact, and neglecting product substitution distorts estimates of the price elasticity of cigarette demand. We discuss the implications for consumer welfare and several policies that mitigate the adverse impact of consumer responses. Copyright © 2013 John Wiley & Sons, Ltd.