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Open AccessArticle

State-Level Affordability of Factory-Made Cigarettes among Current US Smokers: Findings from the ITC US Survey, 2003–2015

1
Department of Psychology, University of Waterloo, Waterloo, ON N2L 3G1, Canada
2
School of Public Health and Health Systems, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Economic and Health Policy Research, American Cancer Society, Washington, DC 20004, USA
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Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON N2L 3G1, Canada
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Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston, SC 29425, USA
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Ontario Institute for Cancer Research, Toronto, ON M5G 0A3, Canada
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Division of Health Policy and Administration, School of Public Health, University of Illinois at Chicago, Chicago, IL 60612-4394, USA
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National Bureau of Economic Research, Cambridge, MA 02138, USA
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Oklahoma Tobacco Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma, OK 73104, USA
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Department of Health Administration, Governors State University, University Park, IL 60484-0975, USA
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Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL 60612-4394, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2019, 16(13), 2439; https://doi.org/10.3390/ijerph16132439
Received: 14 April 2019 / Revised: 24 June 2019 / Accepted: 29 June 2019 / Published: 9 July 2019
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Cigarette affordability measures the price smokers pay for cigarettes in relation to their incomes. Affordability can be measured using the relative income price of cigarettes (RIP), or the price smokers pay to purchase 100 packs of 20 cigarettes divided by their per capita household income. Using longitudinal data from 7046 smokers participating in the International Tobacco Control (ITC) US Survey, the purpose of this study was to test whether affordability significantly changed following the US federal tax increase implemented on 1 April 2009. This study also estimated temporal trends in affordability from 2003–2015 at state and national levels using small area estimation methods and segmented linear mixed effects regression models. RIP increased slightly during 2003–2008. This was followed by a 30% increase during 2008–2010, indicating cigarettes were less affordable after the federal tax increase. RIP continued to increase during 2010–2013 but decreased during 2013–2015, suggesting cigarettes have recently become more affordable for US smokers. State-level trends in RIP were consistent with overall national trends. Controlling for other factors, a $1 increase in the state excise tax was significantly associated with a 9% increase in RIP, indicating state taxes reduced affordability. Tax-induced price increases must keep pace with underlying economic conditions to ensure cigarettes do not become more affordable over time. View Full-Text
Keywords: United States; tobacco; economics; price; taxation; affordability; small area estimation United States; tobacco; economics; price; taxation; affordability; small area estimation
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Driezen, P.; Nargis, N.; Thompson, M.E.; Cummings, K.M.; Fong, G.T.; Chaloupka, F.J.; Shang, C.; Cheng, K.-W. State-Level Affordability of Factory-Made Cigarettes among Current US Smokers: Findings from the ITC US Survey, 2003–2015. Int. J. Environ. Res. Public Health 2019, 16, 2439.

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