Research article
Taxation Reduces Social Disparities in Adult Smoking Prevalence

https://doi.org/10.1016/j.amepre.2008.11.013Get rights and content

Background

The CDC, the WHO, and the World Bank promote increases in the price of cigarettes as an effective and important tobacco-control strategy. This study was designed to assess the extent to which the association between the price of cigarettes and smoking prevalence, as measured monthly, varies by income group.

Methods

Australian population survey data collected monthly from January 1991 to December 2006 were used to estimate Poisson regression models to assess the impact of the price of cigarettes on smoking prevalence across three income groups. Analyses were conducted in 2008.

Results

There was strong evidence that real price and prevalence were negatively associated (p<0.001) and that the association was stronger in lower-income groups (p<0.001). One Australian dollar increase in price was associated with a decline of 2.6%, 0.3%, and 0.2% in the prevalence of smoking among low-, medium-, and high-income groups, respectively.

Conclusions

Increasing the price of cigarettes not only is an effective tobacco-control strategy to lower smoking prevalence in the general population, but also may provide a means of reducing social disparities in smoking.

Introduction

International research has estimated that at least one third of socioeconomic disparities in mortality are due to socioeconomic differences in smoking prevalence. In the U.S., Canada, and Poland, eliminating differences that relate to smoking would reduce the social gradient in mortality among men by half.1 In the United Kingdom (UK), tobacco causes approximately two thirds of the differences in risk of death across social class in men.2 In Australia, smoking accounts for over one third of excess deaths that are attributed to low education in men.3 Reducing socioeconomic disparities in smoking behavior will lead to the amelioration of health disparities. Although tobacco-control policies and interventions have been successful in reducing the prevalence of smoking in the general population, disparities in prevalence persist.4 This study examines the role of taxation in reducing these disparities.

Many studies have shown that higher cigarette prices decrease the prevalence of smoking as well as the number of cigarettes consumed by smokers.5, 6 Accordingly, major public health organizations such as the WHO, the World Bank, and the CDC promote increases in the price of cigarettes as an effective and important tobacco-control strategy.7, 8, 9 Further, several studies10, 11, 12, 13, 14, 15, 16, 17, 18 from the U.S., UK, and Canada provide evidence that lower socioeconomic groups, women, older adults, minorities, and youth are more responsive to price. However, there are also reports19, 20, 21 that do not show an effect of price on smoking or a difference in price responsiveness across socioeconomic groups.

A shortcoming of all previously published studies in this field pertains to the use of smoking-prevalence data that are collected annually. Although price data are normally available on a monthly basis or as often as price changes in a given year, population surveys seldom provide smoking data more frequently than annually. Thus, previous analyses have used years as the unit of analysis and correlated average annual price with smoking prevalence. The use of annual data may provide inaccurate estimates of the effect of price on smoking behavior, because each instance of a price increase or stabilization within a given year may have a fast-acting impact on smoking.17

In the present research, a unique data set is used that provides monthly national smoking-prevalence data for sociodemographic groups in the period from February 1991 to December 2006 in Australia. This period saw marked variability in the frequency and extent of increases in the price of cigarettes, with very large increases in state government fees applied to wholesale costs in different states at various times between 1993 and 1995; moderate increases in federal excise and customs duties in 1992 and 1995; and reforms of all the taxes applicable to tobacco products implemented between November 1999 and February 2001, resulting in large increases in budget cigarette brands. Federal excise and customs duties are automatically increased in line with inflation in Australia, but apart from price increases resulting from indexation every 6 months, there was little real change in cigarette prices in 1991, between 1997 and 1999, or in the 70 months from 2001 to the end of 2006.22 The aim of this research was to employ monthly smoking prevalence and price data to examine how the effect of price on prevalence differed across income groups.

Section snippets

Data and Measurement

Data on smoking prevalence, income, and other sociodemographic variables came from face-to-face interviews of 515,866 individuals aged ≥18 years from January 1991 to December 2006. The data were collected by Roy Morgan Research, an Australian market research company, and extracted from their archived data originally collected for its syndicated data collection. This collection is currently known as Roy Morgan Single Source.23 Respondents were from the five largest Australian capital

Results

Of the 515,866 respondents in the analysis, 48% were men, 21% were aged 18–29 years, and 41% were aged 30–49 years. The 2001 Census of the Population in Australia reported that 51% were men, with 19.5% aged 18–29 years, and 34.1% aged 30–49 years. Approximately 18% and 58% of the sample had low and medium levels of education, respectively. Approximately 23% and 45% had low and medium incomes, respectively. Figure 1 shows the trends in the overall smoking prevalence in the study period, between

Discussion

This study examined the differential impact of cigarette prices on smoking prevalence across income groups, using monthly data from the period 1991 to 2006 in Australia. The findings revealed that real price is negatively associated with smoking prevalence and that lower-income groups are more responsive to price.

The study was unique in that it used monthly smoking-prevalence and cigarette-price data up to December 2006 and was therefore able to provide a more accurate and updated estimate of

References (51)

  • Reducing tobacco use: a Report of the Surgeon General

    (2000)
  • WHO framework convention on tobacco control

    (2005)
  • P. Jha et al.

    Curbing the epidemic: governments and the economics of tobacco control

    (1999)
  • Best practices for comprehensive tobacco control programs—2007

    (2007)
  • M.C. Farrelly et al.

    Response by adults to increases in cigarette prices by socioeconomic characteristics

    South Econ J

    (2001)
  • D. Levy

    Employer-sponsored insurance coverage of smoking cessation treatments

    Am J Manag Care

    (2006)
  • J. Townsend

    Price and consumption of tobacco

    Br Med Bull

    (1996)
  • K. Meier et al.

    The effect of cigarette taxes on cigarette consumption, 1955 through 1994

    Am J Public Health

    (1997)
  • D.E. Peterson et al.

    The effect of state cigarette tax increases on cigarette sales, 1955 to 1988

    Am J Public Health

    (1992)
  • J. Townsend et al.

    Cigarette smoking by socioeconomic group, sex, and age: effects of price, income, and health publicity

    BMJ (Clinical Research Ed)

    (1994)
  • H. Sung et al.

    A major state tobacco tax increase, the master settlement agreement, and cigarette consumption: the California experience

    Am J Public Health

    (2005)
  • P. Borren et al.

    Are increases in cigarette taxation regressive?

    Health Econ

    (1992)
  • P. Franks et al.

    Cigarette prices, smoking, and the poor: implications of recent trends

    Am J Public Health

    (2007)
  • M. Scollo

    The pricing and taxation of tobacco products in AustraliaTobacco in Australia, Facts and Issues

    (2008)
  • Roy Morgan Research. Roy Morgan Single Source. Melbourne Australia: Roy Morgan...
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