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Abstract
Objective Increasing the price of cigarettes reduces consumption, with a global price elasticity of approximately −0.4. In the UK where the cost of cigarettes is already relatively high, there is an issue surrounding public acceptance of further price rises ahead of the inflation rate. Previous research suggests that price increases may be supported where funds are dedicated to tobacco control. This study assessed public support in England for such a policy.
Methods A cross-sectional household survey was conducted in England between August 2008 and January 2009. A representative sample of 8736 respondents aged 16+, of whom 1900 (22%) were cigarette smokers at the time of the survey, was recruited. The primary outcome measure was support for a 20p (4%) price increase on a pack of cigarettes with proceeds going to fund tobacco control activities.
Results 6216 participants (71%), including half (47%) of current cigarette smokers, indicated that they would support a 20p price increase if funds were dedicated to tobacco control activities. Levels of support among smokers were similar across the social gradient and gender. Younger smokers were more likely to support the increase. Smokers who smoked 0–10 cigarettes per day were more supportive of the increase than heavier smokers.
Conclusions There is broad public support for raising the cost of cigarettes with funds being used for tobacco control activities. The absence of a social gradient among smokers concurs with other research showing that more disadvantaged smokers are as engaged with tobacco control objectives as more affluent smokers.
- Public policy
- taxation and price
- public opinion polls
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Introduction
Tobacco price increases are effective in reducing cigarette consumption and smoking prevalence.1 2 Making tobacco more expensive can encourage smokers to quit, prevent potential new smokers from starting to smoke and reduce relapse among ex-smokers.1 Globally it has been estimated that a 10% price increment could prompt a 4% decrease in consumption.3 In countries such as the UK where smoking prevalence is 20–25%, a 10% price increase would likely cause a 1% decrease in prevalence. This could prevent up to 5000 premature deaths per year.4
There are, however, concerns that in many countries current tobacco prices are relatively high already and that there would be widespread opposition to further price rises. Relative to income, cigarette prices in the UK are among the highest observed in affluent countries.5 6 Additionally, price levies may have a disproportionate financial impact on low-income smokers and heavy smokers.7 Both smokers and non-smokers may also have ideological reservations around limiting smokers' freedom of choice and espousing higher taxation.8 However, where tobacco levies are at least partially dedicated to tobacco control activities, rather than general government expenditure, there is often greater support.9 10 This may be attributed to widespread recognition among both smokers and non-smokers of the harms of smoking and the expected utility of such a policy for discouraging tobacco consumption.11
There is general agreement among tobacco control experts that imposing price levies to fund tobacco control is a worthwhile policy,12 and at least 10 countries direct tobacco tax revenue to tobacco control.11 The effectiveness of a dedicated tobacco tax may hinge on public support: price rises are unlikely to be feasible if there is strong public opposition. This paper reports survey data on support for an above inflation increase in UK cigarette prices (20p or 4%) with proceeds dedicated to tobacco control activities.
Methods
Data and participants
Data were collected as part of the Smoking Toolkit Study,13 a series of monthly surveys designed to provide information on smoking and smoking cessation patterns and behaviour among smokers, ex-smokers and never-smokers in England. The surveys, run by the British Market Research Bureau, were carried out using a random location sampling design, with initial random selection of grouped output areas (containing 300 households), stratified by ACORN characteristic and region.14 Data are collected using face-to-face computer-assisted interviews by trained interviewers with one member per household, based on quotas which account for the probability of being at home (eg, gender, part-time working and age).
This study uses data from five waves of data collection, when questions on support for price increases to fund tobacco control were included. A total of 8735 participants were interviewed in these waves, which took place between August 2008 and January 2009. Data were weighted to match demographic characteristics to the 2001 census.
Measures
Support for a 20p price increase was assessed via the following question: ‘Would you support an increases of 20p on the price of a packet of cigarettes, with all the money being used for tobacco control activities to try to prevent young people taking up smoking, and to encourage and support smokers in quitting? (Yes, No, Don't know)’.
Participants were classified as current cigarette smokers if they indicated that they smoke cigarettes (including hand-rolled) every day or not every day. Participants who had previously smoked for a period of over 1 year, but had stopped completely in the last year or more than a year ago, were classified as ex-smokers. ‘Never smokers’ were those who had not previously smoked for a period of 1 year or more. Owing to low sample size, non-cigarette smokers, who reported smoking tobacco of some kind but not cigarettes (eg, pipe, cigar) (49 participants; 0.6%), were excluded from analysis, as were four participants (0.1%) who did not know whether they were a smoker.
Current cigarette smokers reported how many cigarettes they typically smoked per day (Don't know, <1, 1–10, 11–20, 21–30, 31–40, 41–50, 51+). Few smokers reported smoking less than one cigarette (0.3% of all current cigarette smokers) or more than 20 per day (21–30: 6.6%; 31–40: 1.6%; 41–50: 0.4%; 51+: 0.1%). Hence, cigarette smokers were grouped into three clusters according to consumption: <1–10, 11–20, or 21+ cigarettes per day.
Participants also provided categorical data on age (16–24, 25–34, 35–44, 45–54, 55–64, 65+ years), gender, and social grade (AB=higher and intermediate professional/managerial, C1=supervisory, clerical, junior managerial/administrative/professional, C2=skilled manual workers, D=semi-skilled and unskilled manual workers, E=on state benefit, unemployed, lowest grade workers).
Analysis
χ2 Tests were used to assess variation in support by data collection wave, smoking status, gender and social grade classifications. The final sample entered for analysis was 8682.
Results
There were no differences in support for the price increase between data collection waves (χ2 [8]=11.29, p=0.19), and so data were collapsed across waves.
Sample characteristics
In all, 1900 participants (22%) were current cigarette smokers, the majority of whom smoked <1–10 cigarettes (49%) or 11–20 cigarettes (42%) per day; 1059 participants (12%) were ex-smokers and 5723 (66%) were never-smokers.
Support for dedicated 20p increase
A total of 6187 participants (71%) supported a 20p increase on cigarette prices to fund tobacco control activities. As figure 1 shows, 888 (47%) current cigarette smokers supported the price increase. Support among cigarette smokers was similar across social grades (χ2 [8]=11.34, p=0.18) and gender (χ2 [2]=3.78, p=0.15), though there were differences according to age (χ2 [10]=26.29, p=0.003), with 45–50% support among smokers in age groups under 55 reducing to 36–38% support among smokers aged 55+. Among smokers, support differed according to consumption (χ2 [4]=22.56, p<0.001), with highest support among those who smoked <1–10 cigarettes per day (52%), with 42% of smokers of 11–20 cigarettes per day supporting the increase, and 39% of those smoking 21 or more cigarettes per day.
Support for a 20p (4%) increase on a packet of cigarettes to fund tobacco control activities as a function of smoking status and social grade. NB: Social grade AB=higher and intermediate professional/managerial, C1=supervisory, clerical, junior managerial/administrative/professional, C2=skilled manual workers, D=semi-skilled and unskilled manual workers, E=on state benefit, unemployed, lowest grade workers. Error bars represent 95% CIs.
A total of 778 (73%) of ex-smokers were in favour of the policy, with no differences according to age, gender, or social grade (minimum p=0.45).
Of never-smokers, 4521 (79%) supported the policy, with significantly greater support at higher social grades (χ2 [8]=90.83, p<0.001).
Discussion
The broad support for an above inflation (4%) price increase on cigarettes to fund tobacco control echoes previous research showing support for dedicated cigarette price increases among smokers and non-smokers alike9 10 and suggests that such a strategy is viable in the UK. That almost 50% of smokers supported the measure reinforces this view. Smokers opposed to price increases are likely to be motivated by self-interest,15 and so support may be increased by enhancing smokers' motivation to quit.10 A public awareness campaign of the benefits in terms of human lives saved may strengthen support among non-smokers.
Notably, support was similar in smokers across the social gradient. This suggests that more disadvantaged and more affluent smokers are equally engaged with tobacco control objectives, which is also evidenced by the absence in England of a social gradient in rates of stop-smoking attempts.16
Support for price increments may be contingent on directing revenue to tobacco control activities.9 If such a policy were to be implemented, sustaining this support may require that funds are seen to be used efficiently in meeting this purpose.11 Implementation might be usefully accompanied by regular attitudinal surveys to monitor levels of public support. Additionally, further survey work might further explore qualifiers of support for alternative price increase policies.
Increasing cigarette prices through taxation may increase use of smuggled tobacco. Approximately 21% of tobacco smoked in the UK is currently from smuggled sources.17 However, the rapid increase in smuggling in the UK seen in the 1990s predated the above-inflation price rise and was likely caused by the export practices of the tobacco industry.18
We recognise that increasing tobacco taxes above the rate of inflation involves more than a consideration of price acceptance. The government may require reassurance that any combined effect on reduction in consumption and a possible trading down to hand-rolled or smuggled tobacco would not reduce revenue. Advancing this policy will require discussion between relevant government departments and its advisors and lobby groups. Further research into the nature of the barriers to adopting policies of this kind would be worthwhile.
There are two notable limitations to our study. First, our classification of individuals who have never smoked for a year or more as ‘never smokers’ potentially includes individuals who have previously smoked heavily for less than 1 year. There is however no consensual definition of a ‘never smoker’. Our classifications are based on the distinction between people who have likely smoked for long enough to establish a regular pattern (‘ex-smokers’) and those that have not (‘never smokers’). Our findings must be interpreted in light of these classifications. Additionally, we did not record support for price increases per se, and so cannot assess whether support was contingent on allocating funds to tobacco control. Previous research however suggests that support is increased where funds are dedicated to tobacco control.9 11
What is already known
Price increases are an effective means of reducing tobacco consumption. Taxes on tobacco, with revenue dedicated at least partly to tobacco control activities, are used in various countries around the world. Support for such dedicated tax increases is greater than where revenue is used for other government purposes.
What this paper adds
Around half of smokers in England would support a 20p (4%) price increase on cigarettes where revenue is directed towards tobacco control. Such a policy is likely to be a feasible tobacco control strategy in the UK.
Acknowledgments
We thank Luk Joossens for his helpful comments on an earlier draft of our manuscript.
Footnotes
Funding Cancer Research UK, PO Box 123, London WC2A 3PX. The study team is part of the UK Centre for Tobacco Control Studies.
Competing interests BG has no competing interests. RW undertakes research and consultancy for, and has received travel expenses and hospitality from, companies that develop and market smoking cessation medications. RW has a share in a patent for a novel nicotine delivery device.
Provenance and peer review Not commissioned; externally peer reviewed.