How Do Price Minimizing Behaviors Impact Smoking Cessation? Findings from the International Tobacco Control (ITC) Four Country Survey

Andrea S Licht,Frank J Chaloupka,Andrew J Hyland,K Michael Cummings,Geoffrey T Fong,Ron Borland,Richard J O’Connor,Nigar Nargis

doi:10.3390/ijerph8051671

Abstract

This paper examines how price minimizing behaviors impact efforts to stop smoking. Data on 4,988 participants from the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey who were smokers at baseline (wave 5) and interviewed at a 1 year follow-up were used. We examined whether price minimizing behaviors at baseline predicted: (1) cessation, (2) quit attempts, and (3) successful quit attempts at one year follow up using multivariate logistic regression modeling. A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation. Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes. Smokers who engaged in any price/tax avoidance behaviors were 28% less likely to report cessation. Persons using low/untaxed sources were less likely to quit at follow up, those purchasing cartons were less likely to make quit attempts and quit, and those using discount cigarettes were less likely to succeed, conditional on making attempts. Respondents who utilized multiple behaviors simultaneously were less likely to make quit attempts and to succeed. SES did not modify the effects of price minimizing behaviors on cessation outcomes. The data from this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at to reduce reducing smoking prevalence through price and tax increases among all SES groups.

Highlights

Raising cigarette prices has been shown to be an effective way to control smoking [1,2,3,4,5], as past literature has demonstrated that higher cigarette prices result in decreased cigarette consumption, increased quit attempts, and higher rates of smoking cessation [4,5,6,7,8]
These price minimizing behaviors may decrease the public health benefits that are had from increasing cigarette prices through taxation, as engaging in price minimizing behaviors were associated with decreased likelihood of both making quit attempts and reporting cessation at follow-up
The estimates presented in this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at reducing smoking prevalence through price and tax increases

Summary

Introduction

Raising cigarette prices has been shown to be an effective way to control smoking [1,2,3,4,5], as past literature has demonstrated that higher cigarette prices result in decreased cigarette consumption, increased quit attempts, and higher rates of smoking cessation [4,5,6,7,8]. Among US adults, a 10% increase in price is estimated to result in a 3–5% decrease in cigarette demand, while most estimates center around a 4% reduction [3,9,10,11,12]. Tax-induced cigarette price increases may represent a key policy option to drive cessation as evidence suggest they are effective in reducing smoking prevalence and result in large gains in both total and quality adjusted life years [15]. According to the Centers for Disease Control and Prevention, smokers with lower incomes, those from minority populations, and those who are younger are more likely to reduce the number of cigarettes smoked per day or quit in response to a price increase [16]. Following a tax increase in California [18], a significantly greater proportion of smokers reported making quit attempts

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