Effects of Tobacco Taxation and Pricing on Smoking Behavior in High Risk Populations: A Knowledge Synthesis
Abstract
:1. Introduction
If it were totally up to me, I would raise the cigarette tax so high the revenues from it would go to zero.– Michael Bloomberg (New York mayor)
1.1. Youth (<19 years)
1.2. Young Adults (18–24 years)
1.3. Low Socio-Economic Status (SES)
1.4. Dual Diagnosis
1.5. Heavy and/or Long-Term Smokers
1.6. Aboriginal People
- Main Effects: Do subpopulations respond differently than the general population to changes in tobacco taxation and pricing?
- Synergistic Effects: What are the interactive effects between taxation and other tobacco control policies among the subpopulations under review?
- Inadvertent Effects: Do subpopulations adopt price minimization strategies (e.g., switching to discount brands, smoking more of a cigarette, contraband) in response to increased cigarette prices?
2. Methods
2.1. Systematic Review
Search Strategy
Study Selection and Inclusion Criteria
Data Extraction and Quality Assessment
Quality Assessment
Data Analysis and Synthesis
2.2. Expert Panel
- Initial Phase: to obtain feedback on the study plan;
- Analysis Phase: to discuss findings, develop policy recommendations, and identify priorities for future research based on gaps in literature.
3. Results
3.1. Main Effects
Youth
Young Adults
Low SES
Dual Diagnosis
Heavy and/or Long-Term Smokers
Aboriginal Persons
3.2. Synergistic Effects
3.3. Inadvertent Effects
4. Discussion
4.1. Limitations of Study
4.2. Recommendations
- Policy
- Increase price of cigarettes through higher cigarette taxes, or by using other similar or complementary means, such as minimum prices.
- Implement “smart tax” policies: Maximize the benefits of tobacco taxation by:
- ♦ restricting price-based promotions, and
- ♦ aggressively curbing sale of contraband cigarettes.
- Research
- Conduct a meta-analysis of studies reviewed in this report:
- ♦ to provide a robust estimate of the magnitude of price-responsiveness, particularly for youth and young adults.
- Study the effects of large tax increases:
- ♦ to determine whether large tax increases have greater or lesser effects than smaller tax increases. Generally smaller changes in cigarette tax increases have been studied to date.
- Establish a centralized repository of data:
- ♦ to ensure that datasets can be readily accessed to facilitate research on tobacco control policies, including taxation. This would encourage consistent measures of smoking behavior and price measures.
- Examine synergies between taxation and other tobacco control policies:
- ♦ to determine whether there are important synergies between tobacco taxation and other tobacco control policies that may either enhance or moderate effects. Multivariate analyses (e.g., hierarchical linear modeling; path analyses; structural equation modeling) can help elucidate the differential and combined effects of various policies.
- Study the unintended consequences of increased taxation on cigarettes:
- ♦ to determine whether inadvertent effects such as price minimization strategies diminish the public health value of tax increases.
- Incorporate gender stratification routinely in study designs and analyses:
- ♦ to determine whether there are gender differences in the effects of increased cigarette prices on smoking behavior. While some studies in this review analyzed results by gender, the majority did not.
- Expedite research on dual diagnosis, heavy/long-term smokers and Aboriginals:
- ♦ more and better data are needed on these subpopulations because of higher smoking rates and limited research.
5. Conclusions
Benjamin Franklin once said, “In this world, nothing can be said to be certain, except death and taxes.” Yet we have a tax that could prevent hundreds of millions of premature deaths. It is time to use it more effectively [123].
Acknowledgments
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Subpopulation | % of Total population | Smoking prevalence (%) | ||
---|---|---|---|---|
Canada | US | Canada | US | |
General Population | 33,212,696 (total population) | 303,824,640 (total population) | 19 | 20.8 |
Youth | 6.8 | 7.2 | 15 | 22 |
Young Adults | 9.2 | 9.9 | 25 | 26 |
Low SES | 11.4 | 17 | ** | ** |
Income * | ||||
Education | ||||
Dual Diagnosis | 5–10 | 5–10 | 38–57 | 41–62 |
Heavy and/or Long-term Smokers | ** | ** | ** | ** |
Aboriginals | 3.8 | 1.5 | 60 | 32 |
Results | Initiation | Cessation | Stages of smoking uptake | Participation (prevalence) | Consumption (quantity smoked by smokers) |
---|---|---|---|---|---|
Yes, reduces youth smoking | 7 | 5 | 3 | 23 | 17 |
No, does not reduce youth smoking | 9 | 3 | 0 | 4 | 2 |
It depends—reduces smoking in some cases | 6 | 2 | 2 | 4 | 1 |
Totals | 22 | 10 | 5 | 31 | 20 |
Results | Initiation | Cessation | Stages of smoking uptake | Participation (prevalence) | Consumption (quantity smoked by smokers) |
---|---|---|---|---|---|
Yes, reduces young adult smoking | 1 | 4 | 1 | 9 | 10 |
No, does not reduce young adult smoking | 3 | 1 | 0 | 1 | 0 |
Total # Studies | 4 | 5 | 1 | 10 | 10 |
Subpopulation | Recommendations |
---|---|
Youth Young Adults |
|
Low SES |
|
Dual Diagnosis Heavy and/or Long-Term Smokers |
|
Aboriginal People |
|
© 2011 by the authors; licensee MDPI, Basel, Switzerland This article is an open-access article distributed under the terms and conditions of the Creative Commons Attribution license (http://creativecommons.org/licenses/by/3.0/).
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Bader, P.; Boisclair, D.; Ferrence, R. Effects of Tobacco Taxation and Pricing on Smoking Behavior in High Risk Populations: A Knowledge Synthesis. Int. J. Environ. Res. Public Health 2011, 8, 4118-4139. https://doi.org/10.3390/ijerph8114118
Bader P, Boisclair D, Ferrence R. Effects of Tobacco Taxation and Pricing on Smoking Behavior in High Risk Populations: A Knowledge Synthesis. International Journal of Environmental Research and Public Health. 2011; 8(11):4118-4139. https://doi.org/10.3390/ijerph8114118
Chicago/Turabian StyleBader, Pearl, David Boisclair, and Roberta Ferrence. 2011. "Effects of Tobacco Taxation and Pricing on Smoking Behavior in High Risk Populations: A Knowledge Synthesis" International Journal of Environmental Research and Public Health 8, no. 11: 4118-4139. https://doi.org/10.3390/ijerph8114118