Tobacco Tax Increase Research Articles

Increased tobacco taxation associated with decreased consumption and bladder cancer incidence.

The temporal relationship between smoking exposure and bladder cancer (BC) diagnosis remains ill-defined. This study aims to cross-correlate and temporally associate changes in United States (US) tobacco tax and consumption with BC incidence. US tobacco consumption, tobacco tax data, and BC incidence rates from 1975-2019 were retrieved. A cross-correlation lag time for tobacco tax and consumption on BC incidence was calculated while controlling for national health expenditure. Proxied lag weighted semi-log linear models to determine the rate of change in BC incidence rates associated with a 1% change in tobacco tax percentages on a national and state level. A 1% increase in tobacco tax was associated with a 1.77% decrease in BC incidence over a 6-year period (R2=0.9687, p=0.00044). 22 states had a statistically significant decline in BC incidences correlated with increasing tobacco taxation. Reduction in BC incidence >0.5% were observed in states along the Western and Eastern US borders. Montana, Utah, Nebraska, Arkansas, and Tennessee did not have decreasing BC incidences from tobacco tax increases. California had the most drastic decline in BC incidence (1.98%). Nationally, tobacco consumption decrease in 1 pack per capita was associated with a 0.47% decrease in BC incidence over a 28-year period (R2=0.984, p=0.00011). Declining US tobacco consumption may indicate significant reduction in BC incidence through 2047. Primary prevention through adaptation of state-legislated tax changes may contribute to a reduction in BC incidence in states lying within the Central US. A national tobacco tax initative can be considered given the improvement in population health.

Mental health and support for rigorous tobacco control strategies in South Australia

IntroductionTobacco endgame strategy includes policies to end the tobacco epidemic. As tobacco smoking prevalence is higher among people with mental health conditions (MHC), understanding the impact of rigorous tobacco control...

Widening the price gap: the effect of the Netherlands' 2020 tax increase on tobacco prices.

The public health impact of a tobacco tax increase depends on the extent to which the industry passes the increase onto consumers, also known as tax-pass through. In 2020, the Netherlands announced tax increases aimed to increase the retail price by €1 per 20 factory-made cigarettes and €2.50 per 50 grams of roll-your-own tobacco. This study examines the pass-through rate after the tax increase, and whether this differed by type of tobacco and brand segment. Self-reported prices of 117 tobacco brand varieties (cigarettes=72, roll-your-own=45) pre- and post-tax increase were extracted from the 2020 International Tobacco Control (ITC) Netherlands Surveys (n=2959 respondents). We calculated the tax pass-through rate per variant, examining differences between type of tobacco and brand segments. On average, cigarette prices increased by €1.12 (SD=0.49) (112% of €1) and roll-your-own prices by €2.53 (SD=0.60) (101% of €2.50). Evidence of differential shifting across segments was found, with evidence of overshifting in non-discount varieties. The average price of discount varieties increased with €0.20 less than non-discount varieties. Similarly, the net-of-tax price decreased in discount varieties (cigarettes=-€0.02; roll-your-own=-€0.05), but increased in non-discount varieties (cigarettes= +€0.14; roll-your-own= +€0.20). Despite the large tax increase, the industry increased prices in line or above the required level. Through differential shifting, the price gap between discount and non-discount varieties has widened, which may reduce the public health impact of the tax increase. Measures aimed at reducing price variability should be strengthened in taxation policy, such as the European Tobacco Tax Directive. We found that the industry used differential shifting after a significant tobacco tax increase in the Netherlands. Prices increased more than required in higher-priced products, but not in lower-priced products. This pattern was found both for factory-made cigarettes and roll-your-own tobacco. Through differential shifting, the industry undermines the potential public health impact of tobacco tax increases, by offering a relatively cheaper alternative, which discourages people to quit or reduce consumption. The revision of the European Tobacco Tax Directive (TTD) provides an opportunity to address the widening price gap - both between and within product segments - across the European Union.

Tax increases as an incentive to quit smoking: is thinking about quitting due to a tobacco tax increase associated with post-tax increase smoking cessation?

BackgroundThe cost of tobacco is one of the most reported reasons to quit smoking. The Netherlands increased tobacco taxes twice in the span of nine months: a €1 increase per pack in April 2020, and a €0.12 increase per pack in January 2021. This study examines to what extent people report to think about quitting due to the upcoming tax increase(s), as well as how it relates to their age, income or educational level. Additionally, we examined whether thinking about quitting was associated with quit intention and quit behaviour, and whether these associations were different for the two tax increases.MethodsLongitudinal data from the International Tobacco Control (ITC) Netherlands Surveys, Cohort 2 were used (N = 5919 observations; wave 1 (February – March 2020): n = 2051; wave 2 (September – November 2020): n = 1919; wave 3 (June – July 2021): n = 1949). Generalised Estimating Equation (GEE) regressions were fit to test the associations between thinking about quitting due to the tax increase and post-tax increases in quit intention, serious quit attempts, and quitting smoking (≤ 1 cigarette a month), as well as sociodemographic variables.ResultsCirca half of the people who smoke reported thinking about quitting smoking due to the upcoming tax increase (Wave 1 = 51.3% (n = 1052); Wave 2 = 47.3% (n = 849)). Individuals who reported thinking about quitting smoking due to upcoming tax increase(s) were more likely to have increased their quit intention (aOR: 2.00, p ≤ .001) or have carried out a serious quit attempt (aOR:1.48, p ≤ .001) post-tax increase. More people attempted to quit smoking between wave 2 and 3 (post 2021 increase) than between wave 1 and 2 (post 2020 increase). We did not find an interaction effect between wave and thinking about quitting for quit intention, quit attempts, and quitting smoking.ConclusionsTax increases stimulate people to think about quitting. Thinking about quitting due to an upcoming tax increase was associated with more positive quit intention and serious quit attempts.

Distributional Impacts of Tobacco Excise Taxes in Serbia.

Numerous studies worldwide have investigated the impact of tobacco tax increase on household welfare, focusing on concerns regarding potential tobacco taxation regressivity and its effects on the poorest, whereas their scope was limited to the working population. To explore the effects of tax changes on household budgets, accounting for the retired population as well, we employed the modified Extended Cost-Benefit Analysis (ECBA) framework, assuming a 43.6% specific tax increase that fits the EU Tobacco Tax Directive recommendation of minimum EUR 90 excise taxes per 1,000 cigarettes. Our analysis encompassed changes in: 1) tobacco expenditure (accounting for price elasticities by income groups: low-, middle-, and high-income), 2) medical costs linked to smoking-related diseases (utilizing relative risk of morbidity/mortality and smoking-attributable fractions), 3) years of working life (considering the years of working life lost among the working population), and 4) years of pension receipt (accounting for the years of retirement life lost due the premature death). Under an assumed specific excise increase leading to a 22.4% retail tobacco price rise, the net gains in disposable household budgets would be 0.01% for high-income, 1.3% for middle-income, and 2.9% for low-income households. A tax increase would yield a progressive effect on income distribution, benefiting the most economically disadvantaged population thereby contributing to a more equitable income distribution. To effectively reduce tobacco consumption, subsequent smoking-related medical costs, and associated productivity and pension losses, it is recommended that Serbia implement a minimum 43.6% increase in the specific tobacco excise tax.

Macroeconomic impact of tobacco taxation in Indonesia

BackgroundA significant tobacco tax increase has long been advocated to reduce Indonesia’s high smoking prevalence. However, implementing such a policy remains challenging due to the tobacco industry’s argument that it...

Crowding out and impoverishing effect of tobacco in Mexico

IntroductionTobacco is one of the world’s largest preventable causes of premature death, accounting for more than 8 million deaths and costing the global economy US$1.4 trillion each year. Smoking is...

On the impacts of higher tobacco taxes in Argentina: a computable general equilibrium approach

ObjectivesWe analyse the employment effects of increasing tobacco taxation in Argentina by building a computable general equilibrium (CGE) model.MethodsIn line with recent changes in tobacco taxation in the country, the...

Tobacco control policies and respiratory conditions among children presenting in primary care

Tobacco control policies can protect child health. We hypothesised that the parallel introduction in 2008 of smoke-free restaurants and bars in the Netherlands, a tobacco tax increase and mass media campaign, would be associated with decreases in childhood wheezing/asthma, respiratory tract infections (RTIs), and otitis media with effusion (OME) presenting in primary care. We conducted an interrupted time series study using electronic medical records from the Dutch Integrated Primary Care Information database (2000–2016). We estimated step and slope changes in the incidence of each outcome with negative binomial regression analyses, adjusting for underlying time-trends, seasonality, age, sex, electronic medical record system, urbanisation, and social deprivation. Analysing 1,295,124 person-years among children aged 0–12 years, we found positive step changes immediately after the policies (incidence rate ratio (IRR): 1.07, 95% CI: 1.01–1.14 for wheezing/asthma; IRR: 1.16, 95% CI: 1.13–1.19 for RTIs; and IRR: 1.24, 95% CI: 1.14–1.36 for OME). These were followed by slope decreases for wheezing/asthma (IRR: 0.95/year, 95% CI: 0.93–0.97) and RTIs (IRR: 0.97/year, 95% CI: 0.96–0.98), but a slope increase in OME (IRR: 1.05/year, 95% CI: 1.01–1.09). We found no clear evidence of benefit of changes in tobacco control policies in the Netherlands for the outcomes of interest. Our findings need to be interpreted with caution due to substantial uncertainty in the pre-legislation outcome trends.

Tobacco Control in Denmark: How the Ugly Duckling Turned into a Swan.

The implementation of tobacco control policies has been a neglected topic in tobacco research. A comprehensive Tobacco Action Plan including plain packaging, a point-of-sale display ban, a ban on characterizing flavors (in products other than cigarettes), a strengthening of the promotion and marketing ban, a ban on the sale of novel nicotine products to minors, smoke-and nicotine-free-school hours in all-schools with minors, and a significant increase in tobacco tax, was adopted in Denmark in 2019. Eleven people involved or very close to the advocacy process were invited, two did not respond and nine attended our research center. We used the nominal group technique, a consensus method, to identify the most important driving factors for passing the Tobacco Action Plan. The round-robin identified 39 driving factors merged into 13 in the clarification phase. In the ranking phase, participants agreed on seven factors that they perceived have strongly influenced the political will to strengthen national tobacco control comprehensively. The most important factors were national data and evidence, a nationwide alliance with broad partnerships, a strict focus on young people, continuous media coverage, intensive lobbying by many different advocates, making it a community agenda-not a political one, and effective professional campaigns. Our findings agree with experiences from other countries that significantly improved tobacco control. The Danish strategy, including a nationwide alliance with broad partnerships, had a high influence on the political agenda. In this study, there was a consensus that seven factors strongly influenced the political will to comprehensively strengthen the national tobacco control in Denmark in a short time: national data and evidence; a nationwide alliance with broad partnerships; a strict focus on children and young people; continuous media coverage; intensive lobbying by many different advocates; making it a community agenda-not a political one, and effective professional campaigns. This is consistent with findings from other countries.

Analyzing arguments on tobacco tax increases. Focus on French parliamentary questions and responses, 2000-2020.

Tax increases are the most effective but still the least-used tobacco control measure. The tobacco industry (TI) employs lobbying strategies to oppose the implementation of tax policies on its products. Over the past two decades, French tobacco tax policies have been characterized by a relative inconsistency. This research aims to understand why, by analyzing the arguments of French policymakers (MPs and government) between 2000 and 2020 in favor or against tax increases. To capture parliamentary debates, we performed an advanced term search on the French National Assembly website, using the keyword 'tobacco'. The search returned 5126 available documents out of which 1106 (12.6%, 645 questions, 461 responses) covered price and taxation and were included. They were analyzed using descriptive statistics and thematic content analysis (NVivo) and were compared, when relevant, to arguments raised in the international literature on TI lobbying against taxation increases. We found 3176 arguments on tobacco taxation: 77.2% were against tobacco tax increases and 22.7% were in favor of tax policies. Arguments varied depending on the source: 92.4% of MPs' arguments were against tax increases, while 52.1% of arguments from government responses were in favor. The anti-tax arguments were similar to those identified in the international literature that singled out negative economic and social consequences (illicit trade, penalizing tobacconists). Other arguments that were more specific to the French context, highlighted the key economic and social role played by tobacconists in France. Pro-tax arguments highlighted the health, economic and social benefits of tax policies. This is the first French tobacco research on parliamentary documents, although Parliament is a place of direct TI lobbying. It will enable public health actors to better understand the arguments used by the TI in order to counter them in front of MPs, and to better monitor debates in Parliament.

Exploring the value in variations of the Relative Income Price (RIP) for calculating cigarette affordability: An illustration using Malaysia.

The relationships between cigarette affordability, consumer income levels and distribution, and tax increases are complex and underexplored. This study investigates different ways of calculating the Relative Income Price (RIP) measure of affordability using Malaysia as a case study. We calculate cigarette affordability in Malaysia between 2009-2019 using government data, and multiple RIP variants. The conventional RIP calculation relies on 2,000 sticks and GDP (henceforth standard RIP). We explore that and other variants that use annual cigarette consumption estimates and/or proportions of various financial measures of wealth in both rural and urban areas. Our findings indicate broadly consistent trends in cigarette affordability across all methods. From 2009 to 2012, there was a slight decrease in the percentage of wealth required to purchase cigarettes, followed by an increase in 2015 and 2016, and then another decline, suggesting a recent trend toward increased affordability. Using the standard RIP method, 0.9 percentage points(pp) more of per capita GDP was required between 2009 and 2016, but, by 2019 it was 0.1pp less than in 2016. However, Household Income Per Capita (HIPC) and Household Expenditure Per Capita (HEPC) provide a more nuanced perspective on cigarette affordability compared to GDP per capita, as they reveal larger shifts in affordability. The conventional 2,000 sticks method using HIPC from 2009 to 2016 indicated 0.3pp more of income was required to purchase cigarettes, but by 2019, it was 1.0pp less than in 2016. Using HIPC with actual consumption estimates, smokers required approximately 0.9pp more of average income to purchase cigarettes between 2014 and 2016, but 2.5pp less from 2016 to 2019. Actual consumption estimates offer insight into smokers' ability to offset higher purchase costs by adjusting consumption patterns without quitting. We conclude that to address issues related to cigarette affordability, the Malaysian government should consider increasing tobacco tax vis-à-vis income growth.

Popular Votes on Tobacco Tax Increases, 2012–2022

Context: Researchers have examined the campaign strategies, messaging, and outcomes of popular votes on tobacco tax increases from 1998 to 2008, but no study has investigated measures that have appeared since 2008. Methods: The author uses state newspaper archives, voter pamphlets, academic reports, advocacy websites, and personal interviews to obtain information about the 11 tobacco tax increase ballot measures that appeared from 2012 to 2022. Findings: The three measures that succeeded during 2012–2022 featured sufficient financial resources, collaboration with influential stakeholders, and early public support. Two of the three successful measures offered significant concessions to the tobacco industry, and both were designed as legislatively referred statutes. Elsewhere, proponents sought unsuccessfully to enact citizen-led initiatives that would allocate revenue to progressive policy priorities. In contrast to previous eras, tobacco industry arguments often centered around antitax and antigovernment rhetoric, which was viewed as especially compelling in conservative states. The industry's success rate was higher than in the past, and it continued to outspend its opponents, sometimes by staggering margins. Conclusions: Campaign spending and early support remain critical to the success of tobacco tax ballot measures. Big Tobacco can extract significant concessions even in defeat, and direct democracy is an effective but imperfect ally to tobacco control advocates.

The Challenges of Tobacco Fiscal Policy Implementation in Mexico From the Perspective of Key Actors.

Raising tobacco taxes is considered the most effective strategy to avoid smoking initiation and discourage its use, especially among vulnerable groups. However, few low- and middle-income countries have adopted high tobacco taxes. Raising taxes is, therefore, an opportunity to strengthen and accelerate tobacco control. The objective of this study is to analyze the barriers and facilitators to the tobacco tax increase in Mexico. Based on the Governance Analytical Framework, data were generated through 17 in-depth interviews with key intersectoral actors for fiscal policy. The interviews were transcribed and coded according to Hufty's theory of governance. Robust scientific evidence, intersectoral coordination, and the presence of "champions" boosted progress in tobacco control (facilitators). The main barriers were the incomplete implementation of the World Health Organization-Framework Convention on Tobacco Control (WHO-FCTC) and MPOWER package and lack of commitment ("political will") by government decision makers and legislators, misinformation about the effects of tobacco taxes, and strong tobacco industry interference. Robust evidence is necessary but not sufficient to advance the implementation of the MPOWER (WHO-FCTC) actions. To achieve tobacco tax increases and public policies that protect people from unhealthy products in general, the implementation of policies or legal frameworks against industry interference in the development of public policies is imperative. By analyzing the barriers and facilitators to increasing the tobacco tax in Mexico, this study identifies two key messages: (1) The need to sensitize legislators and the general population to the problem of smoking not only through epidemiological data but also through testimonies that highlight the life experiences and adversities faced by people who smoke. (2) The need for a regulatory framework to prevent industry interference in public affairs and conflicts of interest. The same framework could be very useful for public health policies to control the consumption of ultra-processed food products or alcohol.

Taxation of tobacco, alcohol, and sugar-sweetened beverages: reviewing the evidence and dispelling the myths

The article reviews the large body of evidence on how taxation affects the consumption of tobacco, alcohol, and sugar-sweetened beverages (SSB). There is abundant evidence that demand for tobacco, alcohol,...

Managing Public Health Spending Growth: Public’s Views

The need to guarantee public health spending sustainability remains on the governments’ agenda, despite constant efforts to improve health sector efficiency and to contain health spending growth. In this paper, we analyse citizens’, managers’ and health professionals’ views concerning the choice of alternative National Health Service (NHS)’ financing sources and the selection of priority areas to be financed from public funds. The main novelty of this study is the auscultation and the evaluation of different stakeholders’ perspectives concerning health spending decisions, namely, health professionals, managers and the general public. An online questionnaire was used to collect data. Methods include descriptive and inferential statistics, a Pareto graph and a factorial analysis. Our results reveal the preferable additional NHS funding sources are lottery and games of chance and the increase in alcohol and tobacco taxes. The respondents defend that priorities should consider the improvement of the population’s health status, namely, considering the universality of access, equity, effectiveness and efficiency, in line with the NHS’ mission. Health professionals are also concerned about disease prevention and health promotion. This paper contributes empirical evidence to support health manager decisions, focusing on rationing decisions and alternative financing sources.

The health, economic and social burden of smoking in Argentina, and the impact of increasing tobacco taxes in a context of illicit trade.

Tobacco tax increases, the most cost-effective measure in reducing consumption, remain underutilized in low and middle-income countries. This study estimates the health and economic burden of smoking in Argentina and forecasts the benefits of tobacco tax hikes, accounting for the potential effects of illicit trade. Using a probabilistic Markov microsimulation model, this study quantifies smoking-related deaths, health events, and societal costs. The model also estimates the health and economic benefits of different increases in the price of cigarettes through taxes. Annually, smoking causes 45,000 deaths and 221,000 health events in Argentina, costing USD 2782 million in direct medical expenses, USD 1470 million in labor productivity loss costs, and USD 1069 million in informal care costs-totaling 1.2% of the national gross domestic product. Even in a scenario that considers illicit trade of tobacco products, a 50% cigarette price increase through taxes could yield USD 8292 million in total economic benefits accumulated over a decade. Consequently, raising tobacco taxes could significantly reduce the health and economic burdens of smoking in Argentina while increasing fiscal revenue.

Cost-Effectiveness of Four Tobacco Control Interventions in Mongolia.

The aim of this study is to quantify the cost-effectiveness of four tobacco control interventions: Tobacco taxation, mass media campaigns, school programs, and cessation support, and to illustrate how available evaluation tools can be adapted to the local setting. We used the dynamic population health modeling-health impact assessment tool to project the future smoking prevalence associated with the interventions and to simulate the resulting smoking-related disease burden over time. Applying the most recent available national Mongolian data as input, the costs and effects of four interventions were compared to a business-as-usual scenario, resulting in costs per life year gained and per disability-adjusted life years (DALYs) averted. Three years after implementation, all interventions reduce the prevalence of current smoking, with the strongest reduction observed with the increase in tobacco tax (5.1% points), followed by mass media campaigns (1.6% points), school programs (1.3% points), and cessation support interventions (0.6% points). School programs were a cost-saving tobacco control intervention compared to current practice in Mongolia, while the other programs resulted in additional costs compared to business as usual. Compared to the World Health Organization (WHO) thresholds, all interventions would be considered "very cost-effective" in terms of cost per DALY averted (below US$ 4295 per DALY averted) in Mongolia. Large-scale interventions such as taxation and mass media campaigns result in both cost-effectiveness and important health benefits in relation to intervention costs. Reducing the prevalence of smoking among the male population would be particularly worthwhile in Mongolia. This study shows that in Mongolia school programs were a cost-saving intervention, while the cost-effectiveness ratios were US$ 25 per disability-adjusted life year (DALY) averted for mass media campaigns, US$ 74 for taxation, and US$ 1961 for cessation support interventions. Compared to the WHO thresholds, all interventions would be considered "very cost-effective" in terms of expenses per DALY averted (<US$ 4295 per DALY averted), making it beneficial to scale up the WHO-Monitor tobacco use and prevention, Protect people from smoke, Offer help to quit smoking, Warn about the danger, Enforce bans, and Raise taxes (MPOWER) interventions to reduce the burden from smoking in Mongolia.

Smoking prevention that increases tax revenue: tobacco taxes in the Czech Republic 2004-2020.

Increasing tobacco excise tax is one of the most effective smoking-prevention tools. The aim of the study is to assess the use of this tool in the Czech Republic (CR) by studying trends in cigarette taxes, prices, tax revenue, and the affordability of cigarettes in the CR. Data on cigarette consumption, their tax rates, price, and tax revenue in the CR for 2004-2020 come from multiple sources. We used the consumer price index to convert nominal values to real values. Given an average daily consumption of 12.7 cigarettes per smoker, the affordability of cigarettes was measured as a percentage of the average monthly wage needed to buy 19 cigarette packs. Despite recent increases in excise taxes, cigarettes in the CR are becoming more affordable. We found that the affordability of cigarettes was greater in 2020 than in 2008. The values of both the specific and the minimum excise taxes are currently being eroded by inflation. Cigarette consumption has declined from 2015 to 2020, and the government still received a bit more excise tax revenue due to its earlier tax policy. However, if taxes are not increased further, the revenue will start to decline. Despite the trend of increasing tobacco taxes in the CR, both the affordability of cigarettes and their use are still high in the country. This means that the CR is not using tax policy effectively enough to reduce smoking prevalence. It needs a substantial and sudden tax increase, in addition to the currently planned tax increases, to reduce smoking prevalence and lower the burden of tobacco use in the economy. Such a move would not only improve public health in the CR, but also increase government revenue.

Smokers’ strategies to reduce tobacco spending after a major tobacco tax increase: Findings from the 2020 International Tobacco Control (ITC) Netherlands Survey

Smokers’ strategies to reduce tobacco spending after a major tobacco tax increase: Findings from the 2020 International Tobacco Control (ITC) Netherlands Survey