Tobacco Tax Increase Research Articles

Trends in Disease Burden Attributable to Tobacco in China, 1990-2017: Findings From the Global Burden of Disease Study 2017.

In 2018, there were more than 371 million cigarette smokers and 12. 6 million electronic cigarette users, with 340.2 million non-smokers exposed to secondhand smoke (SHS) in China, which resulted in heavy tobacco-attributable disease burden. According to the definition by the Global Burden of Disease Study 2017 (GBD 2017), tobacco is a level 2 risk factor that consists of three sublevel risk factors, namely, smoking, SHS, and chewing tobacco. In this study, we aimed to evaluate the trends in deaths and disability-adjusted life years (DALYs) attributable to tobacco, smoking, SHS, and chewing tobacco by sex in China from 1990 to 2017 and to explore the leading causes of tobacco-attributable deaths and DALYs using data from the GBD 2017. From 1990 to 2017, the tobacco-attributable death rates per 100,000 people decreased from 75.65 [95% uncertainty interval (95% UI) = 56.23–97.74] to 70.90 (95% UI = 59.67–83.72) in females and increased from 198.83 (95% UI = 181.39–217.47) to 292.39 (95% UI = 271.28–313.76) in males. From 1990 to 2017, the tobacco-attributable DALY rates decreased from 2209.11 (95% UI = 1678.63–2791.91) to 1489.05 (95% UI = 1237.65–1752.57) in females and increased from 5650.42 (95% UI = 5070.06–6264.39) to 6994.02 (95% UI = 6489.84–7558.41) in males. In 2017, the tobacco-attributable deaths in China were concentrated on chronic obstructive pulmonary disease, ischemic heart disease, lung cancer, and stroke. The focus of tobacco control for females was SHS in 1990, whereas smoking and SHS were equally important for tobacco control in females in 2017. Increasing tobacco taxes and prices may be the most effective and feasible measure to reduce tobacco-attributable disease burdens.

Questioning the regressivity of tobacco taxes: a distributional accounting impact model of increased tobacco taxation

BackgroundTobacco taxes, as with other ‘sin taxes’, are generally regarded as a highly cost-effective mechanism to reduce consumption but are often considered by policymakers to be regressive, undermining efforts to...

Abstract C125: University of Guam/University of Hawaii Cancer Center partnership: Fifteen 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 US Associated Pacific Islands (USAPI); and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprising 5 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 15 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 18 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 16 grants secured. To address the under-representation of PI in biomedical sciences, the Partnership has supported 30 graduate fellows, including 8 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, 8 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, John A. Peterson. University of Guam/University of Hawaii Cancer Center partnership: Fifteen years of progress in addressing cancer health disparities in Pacific Islanders [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr C125.

Abstract D040: University of Guam/University of Hawaii Cancer Center Partnership: Sixteen 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 US Associated Pacific Islands (USAPI), and increase the number of cancer and biomedical science researchers of PI ancestry in the United States. An infrastructure comprised of 4 principal investigators, over 30 participating faculty, administrative staff, and external and internal reviewers, backed by institutional support and NCI sponsorship, has supported 16 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 19 cancer research projects addressing cancer research priorities of global and regional relevance, including cervical cancer and Areca (betel) nut chewing - a traditional practice associated with oral pre/carcinoma, affecting 600 million users worldwide. Ninety peer-reviewed manuscripts have been published, over 100 abstracts presented, and 19 grants secured. To address the underrepresentation of PI in biomedical sciences, the Partnership has supported 33 graduate students including 7 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, eight UOG faculty have participated in the summer fellowship program at UHCC and most had received U54pilot 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 colorectal cancer screening and HPV vaccination while building knowledge and awareness among physicians who serve Pacific Islanders in Guam and Hawaii. In conclusion, research capacity at UOG has significantly increased, disparities research at UHCC has expanded, and underrepresented minority students are pursuing careers in cancer research. Supported by NCI grants U54CA143727 and U54CA143728. Citation Format: Rachael T Leon Guerrero, Margaret Hattori-Uchima, Hali R Robinett, Carl-Wilhelm Vogel, Neal A Palafox. University of Guam/University of Hawaii Cancer Center Partnership: Sixteen years of progress in addressing cancer health disparities in Pacific Islanders [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr D040.

Differential changes in quitting smoking by daily cigarette consumption and intention to quit after the introduction of a tobacco tax increase and pictorial cigarette pack warnings in Korea, 2013–2017

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.

Empirical analysis on the illicit trade of cigarettes in Vietnam

This paper examined how a higher tax on tobacco would affect illicit trade in Vietnam. This paper used the gap method to estimate the gap between cigarette domestically tax-paid sales and domestic consumption. Data were from the tax-paid sales by the Vietnam Steering Committee on Smoking and Health (VINACOSH), the Vietnam Tobacco Association, the General Tax Department, as well as two rounds of the Global Adult Tobacco Survey in 2010 and 2015. The results indicated that Vietnam had a negative volume of illicit trade, either a result of under-reporting of tobacco use or due to net smuggling of tax-paid cigarettes out of the country. Furthermore, the trend showed an increased negative volume over time, which indicated that increases in tobacco taxes in the interleading years did not result in an increase in illicit trade in tobaccos in Vietnam. Vietnam's low prices on domestic cigarettes created favourable conditions for cigarette smugglers and provided easy access to illicit cigarettes for the Vietnamese people, but the absence of a relationship between tax changes and smuggling suggested that potential increases in the excise tax should not be discouraged by the threat of an increase in illicit trade. The government should increase taxes on cigarettes to raise domestic cigarette prices and take strong policy measures to create a more transparent social environment, therefore effectively reducing the prevalence of illicit cigarettes in Vietnam.

Smoking Behavior in Low- and High-Income Adults Immediately Following California Proposition 56 Tobacco Tax Increase.

Objectives. To compare the association of California Proposition 56 (Prop 56), which increased the cigarette tax by $2 per pack beginning on April 1, 2017, with smoking behavior among low- and high-income adults.Methods. Drawing on a sample of 17 206 low-income and 21 324 high-income adults aged 21 years or older from the 2012 to 2018 California Behavioral Risk Factor Surveillance System data, we explored 2 outcomes: current smoking prevalence and smoking intensity (average number of cigarettes per day among current smokers). For each income group, we estimated a multivariable logistic regression to analyze the association of Prop 56 with smoking prevalence and a multivariable linear regression to analyze the association of Prop 56 with smoking intensity.Results. Although we observed no association between smoking intensity and Prop 56, we found a statistically significant decline in smoking prevalence among low-income adults following Prop 56. No such association was found among the high-income group.Conclusions. Given that low-income Californians smoke cigarettes at greater rates than those with higher incomes, our results provide evidence that Prop 56 is likely to reduce income disparities in cigarette smoking in California.

Are anti-smoking social norms associated with tobacco control mass media campaigns, tax and policy changes? Findings from an Australian serial cross-sectional population study of smokers

BackgroundAnti-smoking social norms are associated with subsequent quitting behaviours. We examined if exposure to tobacco control advertisements and policy changes predict subjective (perceived disapproval of smoking among close family and...

Effect of tobacco control policies on the Swedish smoking quitline using intervention time-series analysis

ObjectivesTo coherently examine the responsiveness of the Swedish National Tobacco Quitline (SNTQ) to different types of anti-smoking policies over an extended period of calendar time.DesignQuasi-experimental design with an intervention time-series...

Analysis of tobacco industry pricing strategies in 23 European Union countries using commercial pricing data

BackgroundThe 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),...

Smoking prevalence following tobacco tax increases in Australia between 2001 and 2017: an interrupted time-series analysis

Building on substantial tobacco control action over the previous decade, Australia increased the taxes on tobacco by 25% without forewarning on April 30, 2010. Australia then became one of a few countries to pre-announce a series of increases in tobacco taxes, with annual 12·5% increases starting from December, 2013. We aimed to examine the effects of both tax increases on smoking prevalence. By use of survey data from Australians aged 14 years and older in five capital cities, we did an interrupted time-series analysis to model the monthly prevalence of smoking (overall, of factory-made cigarettes [FMC], and of roll-your-own tobacco [RYO]), in the total sample and stratified by socioeconomic status subgroups. We measured outcomes in May, 2001-April, 2010; May, 2010-November, 2013; and December, 2013-April, 2017. The 25% tax increase was associated with immediate (-0·745 percentage points; 95% CI -1·378 to -0·112) and sustained reductions in prevalence (monthly trend -0·023 percentage points; -0·044 to -0·003), which were driven by reductions in the prevalence of smoking of FMC. The prevalence of smoking of RYO increased between May, 2010, and November, 2013, after the 25% tax increase. At the start of the pre-announced annual 12·5% increases, we observed an immediate reduction in smoking (-0·997 percentage points; -1·632 to -0·362), followed by decreasing overall prevalence (monthly trend -0·044 percentage points; -0·063 to -0·026) due to ongoing decreases in the prevalence of FMC smoking and a cessation of increases in the prevalence of smoking of RYO. Immediate decreases in smoking and changing trends in the prevalence of smoking of RYO were most evident among groups with a lower socioeconomic status. Large tax increases are effective in reducing smoking prevalence, both as a single increase without forewarning and as a pre-announced series of increases. However, taxes on tobacco are best structured to apply equally to FMC and RYO products. Tobacco control policies should prohibit price marketing that otherwise erodes the full impact of such tax increases. Cancer Council Victoria.

Evaluation of the tobacco control policies of the Moon Jae-in government

Tobacco use is the most important preventable cause of mortality in South Korea and worldwide. This study aimed to evaluate the tobacco control policies of the Moon Jae-in government, which was established in May 10, 2017. Before the Moon Jae-in government, the tobacco tax was raised by the Park Geun-hye government from 2,500 won to 4,500 won (80% increase), but the price of cigarettes was still much lower in Korea than in other high-income countries. Cigarette smoking has been prohibited in all restaurants and bars since 2015; however, smoking rooms are allowed. Only large buildings are smoke-free. Pictorial warnings on cigarette packages were introduced in December 2016; however, they cover only 30% of the main packaging. Smoking cessation services provided by health care facilities have been subsidized by public health insurance since 2015. However, the advertisement, promotion, and sponsorship of tobacco are not further regulated. Since the beginning of the Moon Jae-in government, there has been no further strengthening of major tobacco control policies except for limited expansion of smoke-free public places and introduction of a lung cancer screening program. The first government-level tobacco control policies by the Moon Jae-in government, announced in May 2019, included increasing the size of the pictorial warnings and introducing standardized packaging by 2025, along with incremental expansion of smoke-free public places with prohibition of smoking rooms. These moves are positive; however, they do not include increasing tobacco taxes and regulating advertisement, promotion, and sponsorship of tobacco, which together are the backbone of tobacco control policies. The Moon Jae-in government should strengthen comprehensive tobacco control policies, ncluding tobacco taxes and banning tobacco advertisement, promotion, and sponsorship, to protect public health.

Example 1: Danish regulations to phase out smoking

Abstract In recent years, progress in Danish tobacco control has come to a halt and there has been an increase in smoking prevalence. A capacity assessment report on the implementation of effective tobacco control measures concluded that there is no overall strategy or plan to protect children, adolescents and adults from the harms of tobacco, despite the national vision of no children and adolescents smoking by 2030. Another finding was that the tobacco industry is influential in Danish policy-making and not properly regulated. Key recommendations were: 1) Develop an overall, comprehensive strategy and implement a well-designed plan. 2) Increase tobacco taxes. 3) Adopt plain packaging and a point-of-sale display ban. 4) Ensure protection from exposure to second-hand smoke and 5) Protect public health policy from the influence of the tobacco industry. The Danish Government, however, is very reluctant and there is no sign of implementation of the recommendations, despite strong public support. On the other hand, there is progress at local level as many municipalities and private workplaces have implemented smokefree working hours (no smoking at all during working hours, even if you work at home), schools have implemented smokefree school hours (no smoking from 8 to 16, even if pupils go home for lunch or break) and large supermarket chains have implemented point-of-sale display bans.

Retailers’ perspectives on selling tobacco in a low-income San Francisco neighbourhood after California’s $2 tobacco tax increase

BackgroundCalifornia’s tobacco tax increased by $2.00 per pack in 2017. Although such increases are among the most effective tobacco control strategies, little is known about their impact from the perspective...

Smoking prevalence and attributable deaths in Thailand: predicting outcomes of different tobacco control interventions

BackgroundDespite substantial positive impacts of Thailand’s tobacco control policies on reducing the prevalence of smoking, current trends suggest that further reductions are needed to ensure that WHO’s 2025 voluntary global target of a 30% relative reduction in tobacco use is met. In order to confirm this hypothesis, we aim to estimate the effect of tobacco control policies in Thailand on the prevalence of smoking and attributed deaths and assess the possibilities of achieving WHO’s 2025 global target. This paper addresses this knowledge gap which will contribute to policy control measures on tobacco control. Results of this study can help guide policy makers in implementing further interventions to reduce the prevalence of smoking in Thailand.MethodA Markov chain model was developed to examine the effect of tobacco control policies, such as accessibility restrictions for youths, increased tobacco taxes and promotion of smoking cessation programs, from 2015 to 2025. Outcomes included smoking prevalence and the number of smoking-attributable deaths. Due to the very low prevalence of female smokers in 2014, this study applied the model to estimate the smoking prevalence and attributable mortality among males only.ResultsGiven that the baseline prevalence of smoking in 2010 was 41.7% in males, the target of a 30% relative reduction requires that the prevalence be reduced to 29.2% by 2025. Under a baseline scenario where smoking initiation and cessation rates among males are attained by 2015, smoking prevalence rates will reduce to 37.8% in 2025. The combined tobacco control policies would further reduce the prevalence to 33.7% in 2025 and 89,600 deaths would be averted.ConclusionCurrent tobacco control policies will substantially reduce the smoking prevalence and smoking-attributable deaths. The combined interventions can reduce the smoking prevalence by 19% relative to the 2010 level. These projected reductions are insufficient to achieve the committed target of a 30% relative reduction in smoking by 2025. Increased efforts to control tobacco use will be essential for reducing the burden of non-communicable diseases in Thailand.

The demand for cigarettes: New evidence from South Africa

ABSTRACT This paper estimates the price elasticity of demand for cigarettes in South Africa. Based on longitudinal data drawn from the South Africa National Income and Dynamic Study, we compare the results from the random and fixed effect panel estimation to estimates from the two-part model. We obtain negative price elasticity of demand for cigarettes, with significantly larger price elasticity estimates from the two-part model. The results suggest that a 10% increase in price reduces cigarette consumption by 4.3% for the economy brands and 6.9% for the mid-price brands. However, we find that over the same period, estimates from the fixed effect model are statistically insignificant. This is probably due to the limited within variation in both cigarette consumption and cigarette prices. Thus, with between variation models, increased tobacco taxes can, in the presence of the changing market structure, remain a desirable policy tool for reducing cigarette consumption.

Consumption of legal and illegal cigarettes in the Gambia

BackgroundThe prevalence of cigarette smoking in the Gambia is relatively high, compared with most African countries. Little is known about the characteristics of the smokers and their habits, particularly with...

Tobacco Industry Promotions and Pricing After Tax Increases: An Analysis of Internal Industry Documents.

Increasing tobacco taxes, and through them, prices, is an effective public health strategy to decrease tobacco use. The tobacco industry has developed multiple promotional strategies to undercut these effects; this study assessed promotions directed to wholesalers and retailers and manufacturer price changes that blunt the effects of tax and price increases. We reviewed tobacco industry documents and contemporaneous research literature dated 1987 to 2016 to identify the nature, extent, and effectiveness of tobacco industry promotions and price changes used after state-level tobacco tax increases. Tobacco companies have created promotions to reduce the effectiveness of tobacco tax increases by encouraging established users to purchase tobacco in lower-tax jurisdictions and sometimes lowering manufacturer pricing to "undershift" smaller tax increases, so that tobacco prices increased by less than the amount of the tax. Policymakers should address industry efforts to undercut an effective public health intervention through regulating minimum prices, limiting tobacco industry promotions, and by enacting tax increases that are large, immediate, and result in price increases. Tobacco companies view excise tax increases on tobacco products as a critical business threat. To keep users from quitting or reducing tobacco use in response to tax increases, they have shifted manufacturer pricing and developed specific promotions that encourage customers to shop for lower-taxed products. Health authorities should address tobacco industry efforts to undercut the effects of taxes by regulating prices and promotions and passing large and immediate tax increases.

Call to Action to Reduce Tobacco Use During Pregnancy

Tobacco use is a leading preventable cause of adverse maternal and child health outcomes. However, many women in the United States still report smoking during the third trimester of pregnancy. Smoking rates during pregnancy are particularly high among vulnerable women, such as those who experience mental illness, substance use disorder, homelessness, or interpersonal violence. The Tobacco Control Vaccine is a model based on population-level, evidence-based practices to reduce tobacco use. The four elements of the Tobacco Control Vaccine are access to treatment for tobacco dependence, smoke-free policies, increased tobacco taxes, and media campaigns. The purpose of this commentary is a call to action for health care providers to advocate for increased access to treatment for tobacco dependence; stay up-to-date on innovative, tailored treatment practices; and advocate for comprehensive, smoke-free policies, higher tobacco taxes, and media campaigns to help pregnant women quit smoking and avoid relapse in the postpartum period.

Estimation of tobacco price elasticity in Serbia: evidence from macro and micro approach

Previous research has indicated that tobacco price elasticity is negative and relatively inelastic. However, no such estimates are available for Serbia and Western Balkan region in general. Serbia is a middle income country with high tobacco consumption, low prices of cigarettes, and large perceived impact of multinational tobacco producing companies on public revenues, export, and employment. The aim of this research is to provide the first estimates of the tobacco price elasticity for Serbia based on two estimation approaches. The first approach includes macro-level time series and regression (cointegration) analysis. The second approach is based on the microdata from the Household Budget Survey and a theoretical model proposed by Deaton (1988). According to our macro-level approach estimated cigarettes price elasticity in Serbia ranges between -0.76 and -0.62, while micro-level approach suggests elasticity at intensive margin of -0.45. Bootstrapping procedures confirm that reported elasticities are statistically significant. Our research suggests that by increasing tobacco taxes, and consequently tobacco prices, the government can produce two positive effects: lower cigarettes consumption and higher government revenue. Given that the estimated elasticity is negative, the increase in tobacco prices would result in lower cigarettes demand, which could lower the negative consequences of smoking on health. On the other hand, the relatively inelastic elasticity suggests that demand reduction would not be proportional to the increase of the price, which would, in turn, result in the increase of the government revenue from the tobacco tax collection.