Tobacco Tax Increase Research Articles

Ten-year experience of smoking cessation in a single center in Japan

Long-term, real-world data, as opposed to academic or research data, on outcomes of smoking cessation clinics are scarce. We assessed patient outcomes over a 10-year period at a smoking cessation clinic in a community teaching hospital in Japan and explored predictors of successful smoking cessation. We used data from a prospective registry of cigarette smokers who participated in a 3-month smoking cessation program comprising combined pharmacological treatment and cognitive behavioral therapy and explored factors associated with program execution and successful smoking cessation. The primary outcome was smoking cessation, defined by quitting completely between the 8-week and 12-week sessions, with verification according to exhaled carbon monoxide (CO) level of ≤10 ppm. Between August 2007 and December 2017, 813 patients with nicotine dependence participated in the program. The number of participants decreased after Japan׳s 2010 tobacco tax increase. Among participants, 433 (53.3%) completed the program. In multivariate analysis, the number of cigarettes smoked daily (odds ratio [OR] 0.98, 95% confidence interval [CI] 0.96, 0.99), cardiovascular disease (OR 1.75, 95% CI 1.16, 2.68), chronic obstructive pulmonary disease (OR 1.74, 95% CI 1.10, 2.78), and gastric/duodenal ulcer (OR 1.77, 95% CI 1.04, 3.08) were significantly associated with program completion. Among program completers, 288 (66.5%) achieved smoking cessation. Exhaled CO level (OR 0.94, 95% CI 0.93, 0.97) and mental disorders (OR 0.53, 95% CI 0.33, 0.85) were negatively associated with successful smoking cessation. Baseline exhaled CO level and mental disorders were significantly associated with either success or failure of smoking cessation.

Public finances and tobacco taxation with product variety: Theory and application to Senegal and Nigeria.

This study endeavors to answer two questions: which category of excise taxes is more appropriate for Senegal and Nigeria and which consequences an increase of the tobacco taxes would have on the price, the demand and the tax revenues in each one of the two countries? To answer these questions, we adopt a double approach: first, a theoretical model of taxation with variety; and second, a simulation model to answer the second question. The results of the theoretical model indicate that, in the context of excise taxation, the number of products variety—or that of cigarette brands—directly affects both the degree of market concentration and the marginal effects of specific and ad valorem excise taxes on the price of tobacco. In addition, the comparison of the marginal effects of ad valorem and specific excise taxes depends on the marginal costs of production of different varieties weighted by the tax rates and the number of varieties. Our empirical results first show that the specific excise taxes are more adapted to Senegal while ad valorem excise taxes fit best Nigeria. This result crucially matters for the excise taxes are exclusively of an ad valorem nature in both Senegal and Nigeria. It is perfectly possible to envisage a situation where the two main forms of excise taxes could co-exist. It also appears from our results that tax development does not have the same implications for the two countries. Increasing tobacco taxes in Senegal strongly reduces the demand, but also induces a decrease in the tax revenues, while this will imply a lesser decline in demand in Nigeria accompanied however by a sharp increase of the country’s tax revenues. This difference stems from the fact that the price-elasticity of tobacco demand is very high in Senegal, contrary to Nigeria. Finally, it is important to mention that there is a specific threshold beyond which the tax increases cease to have a positive effect on tax revenues in Nigeria.

Smoking related outcomes before and after implementation of tobacco-free grounds in residential substance use disorder treatment programs

BackgroundThis study examined the impact of a tobacco-free grounds (TFG) policy and the California $2.00/pack tobacco tax increase on tobacco use among individuals in residential substance use disorder (SUD) treatment. MethodsWe conducted three cross-sectional surveys of clients enrolled in three residential SUD treatment programs. Wave 1 (Pre-TFG) included 190 clients, wave 2 (post-TFG and pre-tax increase) included 200 clients, and wave 3 (post-tax increase) included 201 clients. Demographic and tobacco-use characteristics were first compared between waves using bivariate comparisons. Regression models were used to compare each outcome with survey wave as the predictor, while adjusting for demographic characteristics and nesting of participants within programs. ResultsOdds of clients being current smokers was lower (AOR = 0.43, 95%CI = 0.30,0.60) after implementation of TFG compared to baseline. Adjusted mean ratio (AMR) for cigarettes per day was lower post-TFG compared to baseline (AMR = 0.70, CI = 0.59, 0.83). There were no differences, across waves, in tobacco-related knowledge, attitudes, or services received by program clients, or use of nicotine replacement therapy. Increased cigarette taxation was not associated with reductions in client smoking. ConclusionImplementation of a TFG policy was associated with a lower prevalence of client smoking among individuals in residential SUD treatment. Increased state cigarette excise taxes were not associated with a further reduction in client smoking in the presence of TFG policies, though this may have been confounded by relaxing of the TFG policy. SUD treatment programs should promote TFG policies and increase tobacco cessation services for clients.

The potential impact and cost-effectiveness of tobacco reduction strategies for tuberculosis prevention in Canadian Inuit communities

BackgroundTuberculosis (TB) remains a significant public health problem in Canadian Inuit communities. In 2016, Canadian Inuit had an incidence rate 35 times the Canadian average. Tobacco use is an important risk factor for TB, and over 60% of Inuit adults smoke. We aimed to estimate changes in TB-related outcomes and costs from reducing tobacco use in Inuit communities.MethodsUsing a transmission model to estimate the initial prevalence of latent TB infection (LTBI), followed by decision analysis modelling, we conducted a cost-effectiveness analysis that compared the current standard of care for management of TB and LTBI without additional tobacco reduction intervention (Status Quo) with (1) increased tobacco taxation, (2) pharmacotherapy and counselling for smoking cessation, (3) pharmacotherapy, counselling plus mass media campaign, and (4) the combination of all these. Projected outcomes included the following: TB cases, TB-related deaths, quality-adjusted life years (QALYs), and health system costs, all over 20 years.ResultsThe combined strategy was projected to reduce active TB cases by 6.1% (95% uncertainty range 4.9–7.0%) and TB deaths by 10.4% (9.5–11.4%) over 20 years, relative to the status quo. Increased taxation was the only cost-saving strategy.ConclusionsCurrently available strategies to reduce commercial tobacco use will likely have a modest impact on TB-related outcomes in the medium term, but some may be cost saving.

The Impact of Tobacco Taxation Policy on Slim Cigarette Use and the Growing Popularity of Slim Cigarettes in China Since 2014

Introduction: In 2016, China became the largest market for slim cigarettes in the world, selling 68.945 billion sticks. The purpose of this study is to examine the impact of China’s 2015 tobacco taxation policy on slim cigarette consumption and the product’s market trends. Methods: Monthly data on the market share of slim cigarettes and their average price between January 2014 and June 2017 were used to show tobacco market trends and to estimate the impact of the 2015 tobacco tax increase on tobacco consumption. Segmented regression analysis was used to estimate the immediate effect of the 2015 tax policy and the time trends in consumption due to the policy change. Findings: After the tobacco tax increase was announced in May 2015, the market share of slim cigarettes initially decreased by 0.2117 (p = 0.067). However, by the third month after the policy change, consumption began to increase, and the market share of slim cigarettes was 1.6 times the normal increase over time. Slim cigarettes gained a 2.02% additional share by the second quarter of 2017 (from 2.58% to 4.60%), controlling for the price difference between slim cigarettes and regular cigarettes. The coefficient of the share and the price ratio (slim cigarettes/regular cigarettes) was ?0.7536 (p = 0.0044), suggesting that slim cigarettes are a substitute for regular cigarettes. Estimates also show that after the tax increase was implemented, consumption of slim cigarettes increased almost three times the normal consumption rate (0.0069 versus 0.0024). Conclusion: The slim cigarette industry in China has grown rapidly in recent years. The 2015 tax increase has had only minimal or short-term impact on reducing the growing popularity of slim cigarettes. Since slim cigarettes are a substitute for regular cigarettes, more empirical research is urgently needed to study the health impacts of slim cigarette use and the impact of tobacco control policies on slim cigarette consumption.

The Road to Universal Health Coverage in Myanmar Runs through Non-Communicable Disease Risk Factors: Supporting Evidence from WHO in 2009 and 2014 and the Global Burden of Disease Study 2016

Background: The recent surge in economic development in Myanmar will also contribute to accelerating the health burden shift from acute infectious to chronic non-communicable diseases (NCDs) across the country. With just 11 years to achieve its goal of universal health coverage by the year 2030, significant efforts will be needed to quantify the scale of the burden facing decision-makers about health system strengthening and redevelopment. Convergence of the health systems will be an additional challenge in Myanmar. Methods: Results from a WHO study in 2009 and 2014, combined with data from the 2016 Global Burden of Disease Study, were compiled and analysed for Myanmar to assess the levels and trends of selected NCDs and NCD risk factors. Results: The prevalence of major NCDs in Myanmar are in general higher than global and regional averages, with a significant increase in diabetes mellitus and chronic obstructive pulmonary diseases in the last 25 years. Major NCD risk factors in Myanmar include smoking, use of smokeless tobacco, alcohol consumption among men, low level of fruit and vegetable consumption, hypertension, and emerging of overweight and obesity, especially among women. Tobacco use increased in both sexes between 2009 and 2014, but only significantly in men. Rates of hypertension increased for both men and women, including those currently on medications—suggesting a need for better treatment regimens. Overweight and obesity rates increased in both men and women, although the increase in obesity for men was not significant. Alcohol consumption results were mixed—with lower levels of high level drinking in men, but generally increased consumption by women. Intake of fruit and vegetables increased slightly between 2009 and 2014 and rates of high levels of physical activity also increased. Diabetes prevalence rates increased significantly in women (X2 = 11.3; p = 0.01) and men (X2 = 9.6; p = 0.02) between 2009 and 2014. Conclusions: Improved awareness of risk factors, coupled with early diagnosis and effective treatment of conditions and risks, is paramount to keeping the population healthy and economically active, and maintaining health care costs. Proven cost-effective interventions to prevent and control NCD-related risk factors, notably increasing tobacco taxes, should be endorsed and implemented in the population. Inaction could hamper the country’s effort to achieve universal health coverage by the year 2030.

Examining quit attempts and successful quitting after recent cigarette tax increases

As cigarette smoking rates decline, an important policy question is whether increasing cigarette taxes will continue to encourage smoking cessation. We tested this question following recent tobacco tax increases. Data were from the Minnesota Adult Tobacco Survey, a serial cross-sectional telephone survey conducted statewide, and was limited to past-year cigarette smokers in 2010 (n = 1029) and 2014 (n = 1382). Weighted estimates were calculated of the prevalence of past year smokers, smokers who attempted to quit smoking, and those who successfully quit by demographics, tobacco use, use of evidence-based cessation assistance to quit, and smoker perceptions of the tax increases. Among past year smokers, almost 60% reported a quit attempt in both years, 12.8% successfully quit in 2010 and 15.6% in 2014. Although older age, daily smoking, mean cigarettes per day, and more days of e-cigarette use, were associated with quit attempts in unadjusted models, only the perceived tax increase effect (AOR = 8.9; 95% CI 6.3–12.5) and low nicotine dependence (AOR = 1.9, 95% CI 1.3–2.7) were associated with making a quit attempt in adjusted models. Successful 12-month quits were predicted by college education (AOR = 3.2, 95% CI 1.3–7.8), the use of cessation support (AOR = 2.1, 95% CI 1.3–3.6), and reporting the tax increase helped maintain a quit (AOR = 12.3, 95% CI 7.5–20.1). These findings suggest that a large tax increase is effective in promoting quitting even in the presence of strong tobacco control measures such as indoor smoking bans and other smoking restrictions, mass media campaigns, and universal access to cessation support.

Tobacco control in Germany and worldwide

In Germany, several tobacco control policies have been implemented since 2002. These include tobacco tax increases, restrictions on sale and advertising, smoke-free legislation, and health warnings on tobacco products. All of those contributed to the emerging trend towards nonsmoking - especially among youth and young adults - as well as to the impressive decline of cigarette sales from 145.1billion cigarettes in 2002 to 75.8billion in 2017. Despite this, still 13% of all deaths are attributable to smoking in Germany.Other countries are acting in amore committed manner and are implementing much stronger tobacco control policies than Germany. Germany is the only EU country that doesn't yet have abillboard ban on tobacco advertising, the smoke-free legislation is weak due to exceptions, and for more than ten years the tobacco tax has not been markedly increased. Globally, more than 30countries have implemented at the highest possible level four of the six most important tobacco control policies as defined by the World Health Organization - Germany has implemented only two policies. Therefore, on an international scale, Germany is clearly lagging behind in tobacco control and on the European Tobacco Control Scale it is ranked second last. Amore committed and compelling approach towards tobacco control is required in Germany to reach aposition in terms of protecting the population from the devastating health hazards of smoking, which would be appropriate for aleading industrial nation.

Abstract A44: University of Guam/University of Hawaii Cancer Center Partnership: Fourteen years of progress in addressing cancer health disparities in Pacific Islanders

Abstract The University of Guam (UOG)/University of Hawaii Cancer Center (UHCC) Partnership aims to grow cancer research capacity at UOG; develop cancer health disparities research at UHCC focusing on Pacific Islanders (PI); raise awareness of cancer and cancer prevention in Guam (GU), Hawaii (HI), and the U.S. Associated Pacific Islands (USAPI); and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprising 6 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 14 years of research, training, and outreach designed to reduce cancer health disparities and advance health equity among PI in GU, HI, and the USAPI. Since 2009, the Partnership has funded 17 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and betel nut chewing--a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Approximately 75 manuscripts have been published, approximately 100 abstracts presented, and 13 grants secured. To address the under-representation of PI in biomedical sciences, the Partnership has supported 30 graduate fellows, including 76 doctoral students at UH. Two PhD graduates are now faculty members at UOG and engaged in cancer health disparities research. UOG's Micronesian Studies Program now offers a cancer health disparities track, developed by the Partnership and tailored for the Pacific region. In addition, UOG/UHCC faculty, junior investigators, and pre/postdocs receive mentorship, career development, and summer research fellowships; to date, six UOG faculty have participated in the summer fellowship program at UHCC and two have subsequently secured pilot funding. Outreach projects have explored community-based participatory approaches to youth tobacco-use prevention and cessation in Guam, and the use of social networking to reduce tobacco-related cancer risk. Community-based participatory research has also led to landmark tobacco-control legislation in Guam, resulting in decreased tobacco use and increased tobacco taxes, a percentage of which supports cancer programs and patient services in Guam including the Guam Cancer Registry. Current outreach efforts aim to increase cervical cancer screening among Micronesian migrants and build cancer prevention knowledge and awareness among physicians who serve them in Guam and Hawaii. In conclusion, the Partnership has significantly increased research capacity at UOG and cultivated interest in cancer research among under-represented minority students at the partnering institutions. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Carl-Wilhelm Vogel, David C. Ward, Neal A. Palafox, Hali R. Robinett, Rachael T. Leon Guerrero, Robert A. Underwood, John A. Peterson. University of Guam/University of Hawaii Cancer Center Partnership: Fourteen years of progress in addressing cancer health disparities in Pacific Islanders [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr A44.

Social phenomena following the tobacco tax increase in South Korea: Lessons and policy implications.

INTRODUCTIONThis paper reviews the trial and error occurring before an increase in cigarette prices and the subsequent effects of this in South Korea. In addition, we introduce the social phenomena that occur as a result of an increase in tobacco tax, and propose effective strategies and principles that need to be taken into account before increasing cigarette prices.METHODSWe compared changes to smoking rates before and after the increase in cigarette prices. To investigate the changes that occurred before South Korea’s increase in tobacco tax, we first analysed the state of cigarette consumption and then the change in smoking rates.RESULTSThe increase in cigarette prices caused an immediate backlash from smokers, particularly low-income groups and those claiming tax inequality. In particular, the sales of electronic nicotine delivery systems (ENDS) increased dramatically and the lower price marketing of tobacco companies led to short-term market share increases. As expected, smoking rates in South Korea decreased. However, because the price increase was not sufficient to encourage widespread smoking cessation, the decrease in smoking rates was not significant.CONCLUSIONSBecause the primary objective of the cigarette pricing policy was not designed to promote public health, by reducing smoking rates, it received public criticism. To avoid public criticism, the government must emphasize and convince the public that the primary objective of increasing cigarette prices is to protect public health through a decline in smoking rates. Ideally, health authorities should play a leading role in formulating tobacco tax policy.

Early assessment of China's 2015 tobacco tax increase.

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.

Increase in tobacco tax does not lead to increase in illicit cigarette consumption in Hong Kong: findings from a top-down approach against tobacco industry-funded results

3.2. Advances in protection from tobacco pollution, second- and third-hand smoke (EP-138-3)

Lived experience of tobacco tax increase among socioeconomically disadvantaged smokers

Lived experience of tobacco tax increase among socioeconomically disadvantaged smokers

Impact of increased tobacco tax on revenue and prices in Panama 2009 - 2016

Impact of increased tobacco tax on revenue and prices in Panama 2009 - 2016

Political battle in increasing tobacco tax to support Universal Health Coverage in Indonesia

Political battle in increasing tobacco tax to support Universal Health Coverage in Indonesia

The Health Gains, Financial Risk Protection Benefits, and Distributional Impact of Increased Tobacco Taxes in Armenia

—The majority of Armenian adult males smoke, yet tobacco taxes in Armenia are among the lowest in Europe and Central Asia. Increasing taxes on tobacco is one of the most cost-effective public health interventions, but many opponents often cite regressivity as an argument against tobacco taxation. We use a mixed-methods approach to study the potential regressivity of tobacco taxation and the extent to which the regressivity argument hindered increases in tobacco taxation in Armenia. First, we pursued an extended cost-effectiveness analysis (ECEA) to assess the health, financial, and distributional consequences (by consumption quintile) of increases in the excise tax on cigarettes in Armenia. We simulated a hypothetical price hike leading to a tax rate of about 75% of the retail price of cigarettes, which would be fully passed on to consumers. Second, we conducted a series of stakeholder interviews to examine the importance of the regressivity argument and identify the factors that allowed tobacco tax increases to be adopted as public policy in Armenia. We show that increased excise taxes would bring large health and financial benefits to Armenian households. Half of tobacco-related premature deaths and 27% of associated poverty cases averted would be concentrated among the bottom 40% of the population. Though regressivity was raised as a concern at the initial stages of the policy adoption process, our qualitative stakeholder analysis indicates that the recent accession to the Eurasian Economic Union and the fiscal constraints faced by the government created a window of opportunity for tobacco taxation to be placed on the policy agenda and adopted as government policy, and the ECEA findings were an important input into the process.

Quasi-experimental evidence on tobacco tax regressivity

Tobacco taxes are known to reduce tobacco consumption and to be regressive, such that tobacco control policy may have the perverse effect of further harming the poor. However, if tobacco consumption falls faster amongst the poor than the rich, tobacco control policy can actually be progressive. We take advantage of persistent and committed tobacco control activities in South Africa to examine the household tobacco expenditure burden. For the analysis, we make use of two South African Income and Expenditure Surveys (2005/06 and 2010/11) that span a series of such tax increases and have been matched across the years, yielding 7806 matched pairs of tobacco consuming households and 4909 matched pairs of cigarette consuming households. By matching households across the surveys, we are able to examine both the regressivity of the household tobacco burden, and any change in that regressivity, and since tobacco taxes have been a consistent component of tobacco prices, our results also relate to the regressivity of tobacco taxes. Like previous research into cigarette and tobacco expenditures, we find that the tobacco burden is regressive; thus, so are tobacco taxes. However, we find that over the five-year period considered, the tobacco burden has decreased, and, most importantly, falls less heavily on the poor. Thus, the tobacco burden and the tobacco tax is less regressive in 2010/11 than in 2005/06. Thus, increased tobacco taxes can, in at least some circumstances, reduce the financial burden that tobacco places on households.

Tabaquismo en el adolescente

Smoking in adolescents produces addiction to nicotine, damage to the cardiorespiratory apparatus, and it is also a gateway to the use of illicit drugs. In the United States, electronic cigarettes are more frequently used by young people than conventional cigarettes, believing that they are less harmful to health, however, it is known that these devices produce combustion and deliver nicotine inhaled so their use leads traditional cigarette consumption and exposure to carcinogenic substances. For all of the above, tobacco control efforts must be: public policies (tobacco tax increases, mass advertising campaigns, smoke-free environments, restriction of advertising), early register and timely treatment of adolescents who have initiated tobacco consumption through the ABC-D as it appears in the First Guidelines of Clinical Practice of Smoking Treatment, Chile 2017, for this it is necessary that the health professionals receive training. Regarding second-hand smoke, pediatricians must refer parents to smoking cessation that can be telephone (6003607777, Salud Responde MINSAL, this number appears on cigarette packets).

Cost-effectiveness analysis of population-based tobacco control strategies in the prevention of cardiovascular diseases in Tanzania.

BackgroundTobacco consumption contributes significantly to the global burden of disease. The prevalence of smoking is estimated to be increasing in many low-income countries, including Tanzania, especially among women and youth. Even so, the implementation of tobacco control measures has been discouraging in the country. Efforts to foster investment in tobacco control are hindered by lack of evidence on what works and at what cost.AimsWe aim to estimate the cost and cost-effectiveness of population-based tobacco control strategies in the prevention of cardiovascular diseases (CVD) in Tanzania.Materials and methodsA cost-effectiveness analysis was performed using an Excel-based Markov model, from a governmental perspective. We employed an ingredient approach and step-down methodologies in the costing exercise following a government perspective. Epidemiological data and efficacy inputs were derived from the literature. We used disability-adjusted life years (DALYs) averted as the outcome measure. A probabilistic sensitivity analysis was carried out with Ersatz to incorporate uncertainties in the model parameters.ResultsOur model results showed that all five tobacco control strategies were very cost-effective since they fell below the ceiling ratio of one GDP per capita suggested by the WHO. Increase in tobacco taxes was the most cost-effective strategy, while a workplace smoking ban was the least cost-effective option, with a cost-effectiveness ratio of US$5 and US$267, respectively.ConclusionsEven though all five interventions are deemed very cost-effective in the prevention of CVD in Tanzania, more research on budget impact analysis is required to further assess the government’s ability to implement these interventions.

Undermining government tax policies: Common legal strategies employed by the tobacco industry in response to tobacco tax increases

Effective tobacco tax increases reduce tobacco consumption, threatening the profitability of the tobacco industry. In response, the tobacco industry employs strategies to negate or minimize the full effects of tobacco tax increases. By interacting with various government agencies and non-governmental organizations we identified seven such strategies: stockpiling, changing product attributes or production processes, lowering prices, over-shifting prices, under-shifting prices, timing of price increases, and engaging in price discrimination and/or offering promotions. Each strategy is described in terms of the motivation for their employment, the consequences for tobacco use and tax revenue, and measures to counter them. Country case studies illustrate the successful execution of the strategies and possible government responses.Many of the tobacco industry's responses to tobacco tax increases are predictable, since they are being employed systematically across countries. Governments can and should adopt appropriate measures to eliminate or reduce tobacco industry manipulation. This requires systematic data collection in order to monitor tobacco industry behavior.