Special Issue "Tobacco Control: Policy Perspectives"

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Health Economics".

Deadline for manuscript submissions: closed (30 July 2019).

Special Issue Editors

Guest Editor
Prof. Dr. Frank J. Chaloupka Website 1 Website 2 E-Mail
University of Illinois at Chicago, Health Policy Center, Institute for Health Research and Policy Chicago, United States
Interests: the impact of economic; policy and other environmental influences on health behaviors; the economics of tobacco and tobacco control; particularly in developing countries
Guest Editor
Dr. Nigar Nargis Website E-Mail
American Cancer Society, Economic and Health Policy Research, Atlanta, United States
Interests: economics; tobacco taxation; tobacco affordability; tobacco use and poverty; and regressivity in some tobacco control policies
Guest Editor
Dr. Ce Shang Website E-Mail
University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, Stephenson Cancer Center, and Department of Pediatrics, Oklahoma City, United States
Interests: health economics; experimental economics; tobacco and alcohol control policies

Special Issue Information

Dear Colleagues,

Despite considerable progress achieved in tobacco control efforts and steady reduction in smoking prevalence as well as the size of smoking population at the global level, tobacco use remains one of the major risk factors for non-communicable diseases.  It is the single most preventable cause of death globally, with over 7 million people dying each year from diseases caused by tobacco use. Meanwhile, alternative products such as electronic nicotine delivery systems and heat-not-burn cigarettes pose new challenges and opportunities for tobacco control. In order to understand how existing and potential regulation of alternative products impacts tobacco use and public health, more evidence is needed. Furthermore, the deaths and disease burden are expected to continue to shift to lower income populations and jurisdictions who are experiencing a rise in tobacco consumption. It is therefore critical to enhance the knowledge and understanding of how to accelerate the pace of reduction in tobacco use, especially among the most vulnerable populations, based on scientific evidence and the experience of tobacco control initiatives in diverse policy setting.

This Special Issue welcomes studies and reviews belonging to, each or the interface of, three broad areas of tobacco control policies:

(i)  Demand reduction (e.g., tobacco taxation, smoke-free laws, regulation of tobacco product content and disclosures, plain packaging, warning labels, knowledge and awareness about the harms of tobacco use, ban on tobacco advertising promotion and sponsorship, support for tobacco use cessation);

(ii)  Supply reduction (e.g., elimination of illicit trade in tobacco products, ban on sales to and by minors, promotion of economically viable alternatives for tobacco dependent livelihoods); and

(iii)  Harm reduction (e.g., regulation of alternative nicotine delivery products, such as, electronic cigarettes, smokeless tobacco products).

This special issue will provide readers with state-of-the-art policy perspective on tobacco control aimed at the protection of people’s health and environment. It will also pave the way forward for scientific research and action to overcome emerging challenges that are slowing down the target reduction of tobacco use.

Prof. Dr. Frank J. Chaloupka
Dr. Nigar Nargis
Dr. Ce Shang
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All papers will be peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 1800 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • Tobacco control policies
  • Impact analysis
  • Tobacco regulatory science
  • Regulation of alternative tobacco products
  • Innovation in tobacco control policies
  • Policies reducing disparities in tobacco use
  • Reduce and eliminate illicit tobacco trade
  • Policy impacts on vulnerable populations

Published Papers (13 papers)

Order results
Result details
Select all
Export citation of selected articles as:

Research

Open AccessArticle
Graphic Warning Labels Affect Hypothetical Cigarette Purchasing Behavior among Smokers Living with HIV
Int. J. Environ. Res. Public Health 2019, 16(18), 3380; https://doi.org/10.3390/ijerph16183380 - 12 Sep 2019
Abstract
Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing [...] Read more.
Cigarette pack graphic warning labels (GWLs) are associated with increased knowledge of tobacco-related harms; scant research has evaluated their effects on behavior among vulnerable populations. We used a behavioral economic approach to measure the effects of GWLs and price on hypothetical cigarette purchasing behavior among HIV-positive smokers. Participants (n = 222) completed a cigarette valuation task by making hypothetical choices between GWL cigarette packs at a fixed price ($7.00) and text-only warning label cigarette packs at increasing prices ($3.50 to $14.00; $0.25 increments). More than one-quarter (28.8%) of participants paid more to avoid GWLs. The remaining participants’ purchasing decisions appear to have been driven by price: 69.8% of participants chose the cheaper pack. Across all participants, overall monetary choice value observed for GWL cigarette packs (mean = $7.75) was greater than if choice was driven exclusively by price ($7.00). Most (87.4%) preferred the text-only warning label when GWL and text-only cigarette packs were equally priced. Correlation analysis indicated GWL pack preference was associated with agreement with statements that GWLs would stop individuals from having a cigarette or facilitate thoughts about quitting. These data suggest that GWLs may influence some HIV-positive smokers in such a way that they are willing to pay more to void seeing GWLs. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Show Figures

Figure 1

Open AccessArticle
Support for Local Tobacco Policy in a Preemptive State
Int. J. Environ. Res. Public Health 2019, 16(18), 3378; https://doi.org/10.3390/ijerph16183378 - 12 Sep 2019
Abstract
Policy at the local level is a critical component of comprehensive tobacco control programs. This study examined the relationships of individual and social factors with support for tobacco-related public policy using cross-sectional data (n = 4461) from adults participating in a statewide survey. [...] Read more.
Policy at the local level is a critical component of comprehensive tobacco control programs. This study examined the relationships of individual and social factors with support for tobacco-related public policy using cross-sectional data (n = 4461) from adults participating in a statewide survey. Weighted multivariate, multinomial logistic regression examined associations between individual and social factors and support for tobacco-free city properties and support for limiting the number of stores that sell tobacco near schools. Oklahomans were more likely to favor policies that create tobacco-free city properties than policies that limit the number of stores that sell tobacco near schools. While non-smokers were most likely to favor both policies, support for both policies was greater than 50% among current smokers. Knowledge of secondhand smoke (SHS) exposure harm and female gender were predictors of support for both policies and among current, former, and never smokers. Rural-urban status was a predictor of support among former smokers and never smokers. Tobacco use among friends and family was only a predictor among never smokers’ support for limiting the sale of tobacco near schools. This study demonstrates that level of support differs by policy type, individual smoking status, as well as among subpopulations, and identifies critical elements in the theory of change for tobacco control programs. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Open AccessArticle
Advertising Restrictions and Market Concentration in the Cigarette Industry: A Cross-Country Analysis
Int. J. Environ. Res. Public Health 2019, 16(18), 3364; https://doi.org/10.3390/ijerph16183364 - 12 Sep 2019
Abstract
There has been a large increase in the adoption of tobacco advertising restrictions worldwide over the last two decades. Much of the literature studies their direct effect on cigarette demand. This paper investigates the indirect effect of advertising restrictions by evaluating the effect [...] Read more.
There has been a large increase in the adoption of tobacco advertising restrictions worldwide over the last two decades. Much of the literature studies their direct effect on cigarette demand. This paper investigates the indirect effect of advertising restrictions by evaluating the effect of the policies on the degree of concentration in the tobacco market. By using the variation between countries in timing of adoption of advertising restrictions, I estimate difference-in-difference models to examine the effect of an advertising ban on market-concentration, as measured by HHI. I find that advertising bans lead to an increase in market-concentration: HHI increased by 0.06 points for countries that adopted a ban between 2001 and 2017 conditional on trade and socio-economic characteristics, representing a 13% increase with respect to the mean (0.44). The effect is higher in developing countries (0.08 points increase). Further, I find that ‘comprehensive’ restrictions have a stronger impact on concentration, and ‘limited’ restrictions have little or no impact. These findings point to an important trade-off for policymakers: on one hand, advertising restrictions are likely to reduce consumption of cigarettes; on the other hand, due to an increase in market-concentration, they may be giving more power to tobacco companies. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Show Figures

Figure 1

Open AccessArticle
Smoke-Free Policies and Smoking Cessation in the United States, 2003–2015
Int. J. Environ. Res. Public Health 2019, 16(17), 3200; https://doi.org/10.3390/ijerph16173200 - 02 Sep 2019
Abstract
(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic [...] Read more.
(1) Background: Smoking restrictions have been shown to be associated with reduced smoking, but there are a number of gaps in the literature surrounding the relationship between smoke-free policies and cessation, including the extent to which this association may be modified by sociodemographic characteristics. (2) Methods: We analyzed data from the Tobacco Use Supplement to the Current Population Survey, 2003–2015, to explore whether multiple measures of smoking restrictions were associated with cessation across population subgroups. We examined area-based measures of exposure to smoke-free laws, as well as self-reported exposure to workplace smoke-free policies. We used age-stratified, fixed effects logistic regression models to assess the impact of each smoke-free measure on 90-day cessation. Effect modification by gender, education, family income, and race/ethnicity was examined using interaction terms. (3) Results: Coverage by workplace smoke-free laws and self-reported workplace smoke-free policies was associated with higher odds of cessation among respondents ages 40–54. Family income modified the association between smoke-free workplace laws and cessation for women ages 25–39 (the change in the probability of cessation associated with coverage was most pronounced among lower-income women). (4) Conclusions: Heterogeneous associations between policies and cessation suggest that smoke-free policies may have important implications for health equity. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Show Figures

Figure 1

Open AccessArticle
Effects of Prices on Youth Cigarette Smoking and Tobacco Use Initiation in Ghana and Nigeria
Int. J. Environ. Res. Public Health 2019, 16(17), 3114; https://doi.org/10.3390/ijerph16173114 - 27 Aug 2019
Abstract
Background: Population growth in the African region is set to outpace the rate of decline in smoking prevalence, leading to a projected increase in the total number of smokers. As most tobacco users initiate during their adolescent years, tobacco prevention strategies targeting [...] Read more.
Background: Population growth in the African region is set to outpace the rate of decline in smoking prevalence, leading to a projected increase in the total number of smokers. As most tobacco users initiate during their adolescent years, tobacco prevention strategies targeting youth will be particularly important. Methods: This study estimated the impact of cigarette prices on youth cigarette smoking and tobacco use initiation in Ghana and Nigeria using the Global Youth Tobacco Survey data. First, we used cross-section data and logit models to estimate the effects of prices on youth cigarette smoking. Second, we created pseudo longitudinal data and used continuous-time hazard models to evaluate the impact of cigarette prices on tobacco use initiation. Results: We found that higher cigarette prices decreased both 30-day cigarette smoking and tobacco use onset significantly in both Ghana and Nigeria. Additionally, the price elasticity of cigarette smoking and tobacco use initiation ranged from −0.44 to −1.13, and −1.04 to −3.66, respectively. Conclusions: As one of the first studies on youth tobacco consumption in Sub-Saharan Africa, this study strongly suggests that policies that increase real cigarette prices can lower both cigarette smoking and tobacco use initiation among youth in Ghana and Nigeria. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Show Figures

Figure 1

Open AccessArticle
E-Cigarettes: A Disruptive Technology? An Analysis of Health Actors’ Positions on E-Cigarette Regulation in Scotland
Int. J. Environ. Res. Public Health 2019, 16(17), 3103; https://doi.org/10.3390/ijerph16173103 - 26 Aug 2019
Abstract
Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent [...] Read more.
Concerns have been raised that the divisions emerging within public health in response to electronic cigarettes are weakening tobacco control. This paper employed thematic and network analysis to assess 90 policy consultation submissions and 18 interviews with political actors to examine the extent of, and basis for, divisions between health-focused actors with regard to the harms and benefits of e-cigarettes and appropriate approaches to regulation in Scotland. The results demonstrated considerable engagement in e-cigarette policy development by health-focused actors and a widely held perception of strong disagreement. They show that actors agreed on substantive policy issues, such as age-of-sale restrictions and, in part, the regulation of advertising. Points of contestation were related to the harms and benefits of e-cigarettes and the regulation of vaping in public places. The topicality, limitations of the evidence base and underlying values may help explain the heightened sense of division. While suggesting that some opportunities for joint advocacy might have been missed, this analysis shows that debates on e-cigarette regulation cast a light upon differences in thinking about appropriate approaches to health policy development within the public health community. Constructive debates on these divisive issues among health-focused actors will be a crucial step toward advancing public health. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Show Figures

Figure 1

Open AccessArticle
Tobacco Control Policy in Scotland: A Qualitative Study of Expert Views on Successes, Challenges and Future Actions
Int. J. Environ. Res. Public Health 2019, 16(15), 2659; https://doi.org/10.3390/ijerph16152659 - 25 Jul 2019
Cited by 1
Abstract
The Scottish Government launched a tobacco control strategy in 2013 with the ambition of making Scotland tobacco smoke-free by 2034. However, 17% of the adult population in Scotland smoke cigarettes. This study aimed to provide insight into why policies are successful or not [...] Read more.
The Scottish Government launched a tobacco control strategy in 2013 with the ambition of making Scotland tobacco smoke-free by 2034. However, 17% of the adult population in Scotland smoke cigarettes. This study aimed to provide insight into why policies are successful or not and provide suggestions for future policy actions. Individual interviews with ten tobacco control experts were conducted and the results were analyzed using thematic analysis. Key successes included strong political leadership, mass media campaigns, legislation to address availability and marketing of cigarettes and tobacco products, and legislation to reduce second-hand smoke exposure. Challenges included implementing policy actions, monitoring and evaluation of tobacco control actions, addressing health inequalities in smoking prevalence, and external factors that influenced the success of policy actions. Key suggestions put forward for future policy actions included addressing the price and availability of tobacco products, maintaining strong political leadership on tobacco control, building on the success of the ‘Take it Right Outside’ mass media campaign with further mass media campaigns to tackle other aspects of tobacco control, and developing and testing methods of addressing inequalities in cigarette smoking prevalence. The findings of this study can inform future tobacco control policy in Scotland and have relevance for tobacco control policies in other countries. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Open AccessArticle
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(13), 2439; https://doi.org/10.3390/ijerph16132439 - 09 Jul 2019
Abstract
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 [...] Read more.
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. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Show Figures

Figure 1

Open AccessArticle
Why Do Farmers Grow Tobacco? A Qualitative Exploration of Farmers Perspectives in Indonesia and Philippines
Int. J. Environ. Res. Public Health 2019, 16(13), 2330; https://doi.org/10.3390/ijerph16132330 - 02 Jul 2019
Abstract
Tobacco supply remains a pressing challenge to tobacco control. Tobacco remains a dominant cash crop in many low- and middle-income countries, despite the evidence suggesting that it is not as profitable as industry claims and is harmful to health and the environment. In [...] Read more.
Tobacco supply remains a pressing challenge to tobacco control. Tobacco remains a dominant cash crop in many low- and middle-income countries, despite the evidence suggesting that it is not as profitable as industry claims and is harmful to health and the environment. In order to implement successful and sustainable alternative livelihood interventions, it is important to understand why farmers continue to grow tobacco. This study explores this question from the perspective of farmers in Indonesia and Philippines. This study was informed by interpretive description methodology. Data was collected through focus group discussions (FGDs) (n = 7) with farmers (n = ~60). The FGDs were audio recorded, transcribed verbatim, and then translated into English. An inductive thematic analysis of the data was conducted to identify and categorize the reason provided by participants. We identified two overarching themes: (1) perceived viability (profitability, ready market, and environmental factors) and (2) financial context. Financial context included lumpsum payments and access to financial loans and credit facilities in light of their lack of capital. These results highlight that, in addition to identifying viable alternatives to tobacco, institutional factors such as improved access to credit and well-developed supply chains are key to the successful uptake of alternative livelihoods. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Open AccessArticle
Integrating Smoking Cessation Care into a Medically Supervised Injecting Facility Using an Organizational Change Intervention: A Qualitative Study of Staff and Client Views
Int. J. Environ. Res. Public Health 2019, 16(11), 2050; https://doi.org/10.3390/ijerph16112050 - 10 Jun 2019
Abstract
Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components [...] Read more.
Background: Clients accessing supervised injecting facilities (SIFs) smoke at high rates. An SIF piloted an organizational change intervention to integrate smoking cessation care as routine treatment. This study aims to explore staff acceptability, perceived facilitators, and perceived barriers to implementing six core components of an organizational change intervention to integrate smoking cessation care in an SIF. Staff and client views on the acceptability, facilitators, and barriers to the provision of smoking cessation care were also examined. Methods: This paper presents findings from the qualitative component conducted post-intervention implementation. Face-to-face semi-structured staff interviews (n = 14) and two client focus groups (n = 5 and n = 4) were conducted between September and October 2016. Recruitment continued until data saturation was reached. Thematic analysis was employed to synthesise and combine respondent views and identify key themes. Results: Staff viewed the organizational change intervention as acceptable. Commitment from leadership, a designated champion, access to resources, and the congruence between the change and the facility’s ethos were important facilitators of organizational change. Less engaged staff was the sole barrier to the intervention. Smoking cessation care was deemed suitable. Key facilitators of smoking cessation care included: Written protocols, ongoing training, and visually engaging information. Key barriers of smoking cessation care included: Lack of access to nicotine replacement therapy (NRT) outside of business hours, practical limitations of the database, and concerns about sustainability of NRT. Conclusion: This study develops our understanding of factors influencing the implementation of an organisational change intervention to promote sustainable provision of smoking cessation care in the SIF setting. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Open AccessArticle
Illicit Cigarette Consumption and Government Revenue Loss in Vietnam: Evidence from a Primary Data Approach
Int. J. Environ. Res. Public Health 2019, 16(11), 1960; https://doi.org/10.3390/ijerph16111960 - 02 Jun 2019
Abstract
This article provides the first comprehensive picture and independent estimates of both illicit cigarette consumption and the resulting government tax revenue loss in Vietnam using data from a representative survey of cigarette smokers in 12 Vietnamese provinces. The survey consisted of face-to-face interviews [...] Read more.
This article provides the first comprehensive picture and independent estimates of both illicit cigarette consumption and the resulting government tax revenue loss in Vietnam using data from a representative survey of cigarette smokers in 12 Vietnamese provinces. The survey consisted of face-to-face interviews and on-site cigarette pack examinations. We find that more than 720 million illicit cigarette packs, or 20.7% of total cigarette consumption, circulated in Vietnam in 2012. Consequently, government tax revenue loss due to illicit trade ranged from US $223 to 295 million. Our estimates also indicate that (1) the most popular illicit brands were Jet and Hero, both were sold at higher prices than the average legal brand; (2) the average price of illicit cigarettes was 51% higher than the average price of legal cigarettes; and (3) majority of illicit cigarettes were sold at convenience stores, which were registered and licensed businesses. Our findings suggest that prices are not a driver of illicit cigarette consumption in Vietnam, and this illicit trade is at least partially a consequence of weak market control enforcement. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Show Figures

Figure 1

Open AccessFeature PaperArticle
Analysis of Gender Differences in the Impact of Taxation and Taxation Structure on Cigarette Consumption in 17 ITC Countries
Int. J. Environ. Res. Public Health 2019, 16(7), 1275; https://doi.org/10.3390/ijerph16071275 - 10 Apr 2019
Abstract
Although increasing taxes has been established as the most effective tobacco control policy, it is not clear whether these policies reduce cigarette consumption equally among women and men. In this study, we examine whether the association between taxation/taxation structure and cigarette consumption differs [...] Read more.
Although increasing taxes has been established as the most effective tobacco control policy, it is not clear whether these policies reduce cigarette consumption equally among women and men. In this study, we examine whether the association between taxation/taxation structure and cigarette consumption differs by gender. The data is from the International Tobacco Control Policy Evaluation (ITC) Projects in 17 countries. Cigarette consumption was measured by gender for each ITC country. Generalized estimating equations (GEE) were employed to investigate gender differences in the association between cigarette consumption and tax structures, while controlling for time-variant demographic characteristics such as unemployment rates, proportions of adults, and percent of female population. Tiered tax structures are associated with higher cigarette consumption among both males and females. Female smokers are more responsive to an average tax increase than male smokers. Among males, higher ad valorem share in excise taxes is associated with lower cigarette consumption, but it is not the case for females. Females may not be as responsive to the prices raised by ad valorem taxes, despite being responsive to average taxes, suggesting that smokers by gender may face different prices. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Open AccessArticle
Cigarette Affordability in China, 2006–2015: Findings from International Tobacco Control China Surveys
Int. J. Environ. Res. Public Health 2019, 16(7), 1205; https://doi.org/10.3390/ijerph16071205 - 03 Apr 2019
Cited by 1
Abstract
China is world’s largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers—50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to [...] Read more.
China is world’s largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers—50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to the detriment of public health. This study investigated whether the level and growth in cigarette affordability in China was equally shared by smokers from all demographic and socio-economic statuses (SES) and across all price tiers of cigarette brands. The data came from the urban smoker sample (≥18 years) of the International Tobacco Control China Surveys conducted in five waves over 2006–2015. Cigarette affordability was measured by Relative Income Price—percentage of per capita household income needed to purchase 100 cigarette packs of the last purchased brand. Overall and group-specific trends in affordability by age, gender, SES (e.g., income, education, and employment status), and price tiers were analyzed using generalized estimating equations method. Cigarette affordability was higher among older, female, and higher-SES smokers, and for cheaper brands. It increased overall and across all groups over time. The increase was significantly larger among younger and lower-SES smokers, a trend that poses an added challenge to tobacco control and health equity. To reduce cigarette affordability and consumption among these vulnerable groups, a uniform specific excise system should be introduced in place of the existing tiered ad valorem excise. The specific excise should be periodically adjusted to inflation and per capita income growth observed among younger and lower-SES people, who can potentially experience faster income growth than the national average. The excise tax policy can also be complimented with minimum price regulations and restrictions on price promotions. Full article
(This article belongs to the Special Issue Tobacco Control: Policy Perspectives)
Back to TopTop