While prevalence rates in this group are often difficult to ascertain, they are thought to be substantially higher than those of the general youth population. Most studies reviewed are cross-sectional and do not have the methodological rigor of longitudinal research. Also, studies generally have used large datasets that are not built to address specific questions regarding taxation.
Since smoking behavior is determined by a number of factors and their interactions, it is a challenge to elucidate the specific impact of price. The following recommendations address policy and research needs for reducing the disproportionate burden of tobacco use among the six subpopulations Table 4 gives further details :. Evaluate the distinctions and differential impacts of higher cigarette prices on subsets of youth—e. Conduct research on the importance of other determinants of youth and young adult smoking behavior in addition to cigarette price e.
Combine price increases with a comprehensive tobacco prevention and control program for maximum effectiveness. Accompany increased prices with other tobacco control measures, specific to low SES populations, e. Determine the effectiveness of increasing the price of cigarettes as a policy tool for reducing smoking among these subpopulations.
Examine the effectiveness of increasing the price of cigarettes as a policy tool for reducing smoking among Aboriginal people. Conduct research on the following topics: impediments to using taxation as a tobacco control policy; effective processes for implementing taxes on tobacco products; impact of taxation and price of cigarettes on smoking behavior of those living on-reserve and off-reserve, and in reducing contraband sales.
Increase price of cigarettes through higher cigarette taxes, or by using other similar or complementary means, such as minimum prices. Generally smaller changes in cigarette tax increases have been studied to date. This would encourage consistent measures of smoking behavior and price measures. Multivariate analyses e. While some studies in this review analyzed results by gender, the majority did not. Significant strides have been made in reducing smoking over the past three decades, particularly in high-income countries.
Nevertheless, the health toll of smoking remains a compelling global health challenge. Concerted efforts are needed to reach a higher summit in tobacco control, especially with subpopulations at most risk. The economic literature has made unique and important contributions to our understanding of the effectiveness of tobacco taxation on ameliorating the health consequences of smoking. Indeed, the evidence from this knowledge synthesis strongly supports increasing cigarette prices through tobacco taxation as a powerful strategy for achieving major reductions in smoking behavior among some, but not all, high-risk populations.
For instance, increasing the price of cigarettes is a very effective policy tool for reducing smoking participation and consumption among youth, young adults and persons of low socioeconomic status. In contrast, major gaps exist in our knowledge about the impact of price on persons diagnosed with mental health or non-nicotine substance abuse disorders, heavy and long-term smokers, and Aboriginal people. Given their high prevalence of smoking, urgent attention is needed to develop effective tobacco control policies for these subpopulations.
A related issue is whether or not increased prices have an effect on reducing smoking initiation among youth and young adults. The findings from this study should be of particular value to policy-makers and researchers in their efforts to design and improve the effectiveness of tobacco control measures. Although further work is needed, tobacco taxation is a key policy measure for driving success. It is time to use it more effectively [ ]. We are grateful to the following 12 Expert Panel members, whose expertise contributed greatly to the quality and findings of this study: Chaloupka, F.
The funding source had no role in the writing of the paper.
Pearl Bader Principal Author took the lead in the study design, implementation, and analysis, and was responsible for writing the manuscript. David Boisclair Co-Author helped with the study design, implementation, analysis and edit of the manuscript. Roberta Ferrence Senior Responsible Author was responsible for the conception, funding and oversight of the study and contributed to the study design and edit of the manuscript. All authors declare that they have no conflicting interests.
National Center for Biotechnology Information , U. Published online Oct Author information Article notes Copyright and License information Disclaimer. This article has been cited by other articles in PMC. Abstract Tobacco taxation is an essential component of a comprehensive tobacco control strategy.
Keywords: tobacco taxation and pricing, high-risk subpopulations, public health policy, smoking cessation. Introduction If it were totally up to me, I would raise the cigarette tax so high the revenues from it would go to zero. Table 1 Subpopulation size and smoking prevalence — [ 28 — 32 ]. Open in a separate window. Young Adults 18—24 years Young Adults 18—24 years continue to smoke at high rates, despite strong public awareness of the health hazards [ 11 ]. Low Socio-Economic Status SES Smoking is strongly linked to social and economic status and is a significant contributor to inequalities in health.
Aboriginal People Aboriginal people in North America have substantially higher rates of smoking than the general population Table 1. Methods 2. Systematic Review Search Strategy An extensive search was conducted to identify relevant studies, both published and unpublished, on the impact of price on smoking behavior of the six subpopulations. Study Selection and Inclusion Criteria Two independent reviewers assessed titles and abstracts for relevance and inclusion.
Data Extraction and Quality Assessment Citations were screened using the above criteria and full texts of all citations considered relevant to the study were obtained. Quality Assessment Each study was rated by one reviewer, and checked by the other, to assess the strength of evidence. Expert Panel An integral component of this Knowledge Synthesis was a comprehensive evaluation of evidence that included expert knowledge and advice.
The Expert Panel met twice: 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. Results 3. Main Effects The majority of studies 67 focused on the impact of increased price on youth. Youth Sixty-seven studies 57 published; 10 unpublished met our selection criteria. Table 2 Impact of increased taxation and price on youth smoking behavior. 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 Young Adults Nineteen studies 16 published; three unpublished focused on the impact of price on young adults.
Table 3 Impact of increased taxation and price on young adult smoking behavior. 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 Low SES The majority of studies rated strong or moderate reported significant smoking participation and consumption effects for low income, low education populations.
Dual Diagnosis Three studies examined the impact of price on populations with a dual diagnosis. Aboriginal Persons Only two studies examined the impact of price on smoking behavior. Synergistic Effects Although some studies examined the independent effects of tobacco control policies in addition to price, few looked at the synergistic effects or interactions between these policies.
Health - Tobacco excise increase
Inadvertent Effects Few studies in this review evaluated the potential unintended consequences of increased cigarette taxation, such as compensatory smoking behavior or greater use of contraband cigarettes. Discussion Assessing the Main Effects of population strategies, such as tobacco taxation and pricing, on high-risk subpopulations is important for understanding the reach and effectiveness of such strategies. Limitations of Study There are limitations in the evidence base of some of the subpopulations. Recommendations The following recommendations address policy and research needs for reducing the disproportionate burden of tobacco use among the six subpopulations Table 4 gives further details : Table 4 Subpopulation recommendations.
Subpopulation Recommendations Youth Young Adults Conduct further studies on the impact of cigarette price on smoking initiation Evaluate the distinctions and differential impacts of higher cigarette prices on subsets of youth—e. Aboriginal People Examine the effectiveness of increasing the price of cigarettes as a policy tool for reducing smoking among Aboriginal people. Conclusions Significant strides have been made in reducing smoking over the past three decades, particularly in high-income countries.
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Acknowledgments We are grateful to the following 12 Expert Panel members, whose expertise contributed greatly to the quality and findings of this study: Chaloupka, F. References 1.
8 REVIEW OF LITERATURE
World Health Organization. World Health Organization: Geneva, Switzerland; Jha P. Tobacco Control in Developing Countries. Moyer C. Chaloupka F. Price, tobacco control policies and smoking among young adults. Health Econ. Breslau N. Smoking cessation in young adults: Age at initiation of cigarette smoking and other suspected influences. Public Health.
Milestones in the process of cessation among novice adolescent smokers. Cunningham R. Convincing teens to quit smoking, not prevention, is top priority. The Globe and Mail. Bader P. Knowledge synthesis of smoking cessation among employed and unemployed young adults. Tercyak K. Dinno A.
Tobacco control policies are egalitarian: A vulnerabilities perspective on clean indoor air laws, cigarette prices, and tobacco use disparities. Chapman S. Falling prevalence of smoking: How low can we go? Picard A. Ong M.
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Sensitivity to cigarette prices among individuals with alcohol, drug or mental disorders. Saffer H. Lasser K. Smoking and mental illness: A population-based prevalence study.
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