1
|
Levy DT, Cadham CJ, Sanchez-Romero LM, Knoll M, Travis N, Yuan Z, Li Y, Mistry R, Douglas CE, Tam J, Sertkaya A, Warner KE, Meza R. An Expert Elicitation on the Effects of a Ban on Menthol Cigarettes and Cigars in the United States. Nicotine Tob Res 2021; 23:1911-1920. [PMID: 34097061 DOI: 10.1093/ntr/ntab121] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/04/2021] [Indexed: 11/13/2022]
Abstract
INTRODUCTION The US FDA announced its intention to ban menthol in cigarettes. However, information is needed on how a federal ban would affect population health. We conducted an expert elicitation to gauge the impact of a menthol cigarette and cigar ban in the US. METHODS We developed and pilot tested a questionnaire that focused on tobacco use transitions of current smokers (age 18-24 menthol, age 35-54 menthol, and age 35-54 non-menthol) and potential menthol smokers (age 12-24). Using a structured expert elicitation, we estimated mean net transitions under a ban from cigarette use to combustible tobacco product, smokeless tobacco, novel nicotine delivery product (NNDPs, such as e-cigarettes) use, or no tobacco use. RESULTS Eleven experts provided responses. Of those ages 12-24 who would have initiated menthol cigarette use in the absence of a ban, the experts estimated that 41% would still initiate combustible products under a ban, while 18% would initiate with NNDPs and 39% would not initiate regular tobacco use. Combustible use by menthol smokers ages 35-54 was expected to decline by 20% post-ban relative to pre-ban rates, half switching to NNDPs and half quitting all tobacco use. Menthol smokers ages 18-24 were expected to reduce combustible use by 30%, with 16% switching to NNDPs. Greater reductions in combustible use were estimated for African-Americans across the three age groups. Negligible impacts were expected for current adult non-menthol smokers. CONCLUSIONS According to expert opinion, a menthol ban is expected to substantially reduce smoking initiation and combustible tobacco product use among current menthol smokers.
Collapse
Affiliation(s)
- David T Levy
- Georgetown University-Lombardi Comprehensive Cancer Center, DC, USA
| | | | | | - Marie Knoll
- Georgetown University-Lombardi Comprehensive Cancer Center, DC, USA
| | - Nargiz Travis
- Georgetown University-Lombardi Comprehensive Cancer Center, DC, USA
| | - Zhe Yuan
- Georgetown University-Lombardi Comprehensive Cancer Center, DC, USA
| | - Yameng Li
- Georgetown University-Lombardi Comprehensive Cancer Center, DC, USA
| | - Ritesh Mistry
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Clifford E Douglas
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jamie Tam
- School of Public Health, Yale University, Hartford, Conn, USA
| | | | - Kenneth E Warner
- Department of Health Management and Policy, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rafael Meza
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
2
|
Apollonio DE, Glantz SA. Tobacco Industry Promotions and Pricing After Tax Increases: An Analysis of Internal Industry Documents. Nicotine Tob Res 2020; 22:967-974. [PMID: 31058282 PMCID: PMC7249914 DOI: 10.1093/ntr/ntz068] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 04/25/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Increasing tobacco taxes, and through them, prices, is an effective public health strategy to decrease tobacco use. The tobacco industry has developed multiple promotional strategies to undercut these effects; this study assessed promotions directed to wholesalers and retailers and manufacturer price changes that blunt the effects of tax and price increases. METHODS We reviewed tobacco industry documents and contemporaneous research literature dated 1987 to 2016 to identify the nature, extent, and effectiveness of tobacco industry promotions and price changes used after state-level tobacco tax increases. RESULTS Tobacco companies have created promotions to reduce the effectiveness of tobacco tax increases by encouraging established users to purchase tobacco in lower-tax jurisdictions and sometimes lowering manufacturer pricing to "undershift" smaller tax increases, so that tobacco prices increased by less than the amount of the tax. CONCLUSIONS Policymakers should address industry efforts to undercut an effective public health intervention through regulating minimum prices, limiting tobacco industry promotions, and by enacting tax increases that are large, immediate, and result in price increases. IMPLICATIONS Tobacco companies view excise tax increases on tobacco products as a critical business threat. To keep users from quitting or reducing tobacco use in response to tax increases, they have shifted manufacturer pricing and developed specific promotions that encourage customers to shop for lower-taxed products. Health authorities should address tobacco industry efforts to undercut the effects of taxes by regulating prices and promotions and passing large and immediate tax increases.
Collapse
Affiliation(s)
- Dorie E Apollonio
- Department of Clinical Pharmacy, University of California, San Francisco, CA
| | - Stanton A Glantz
- Department of Medicine, University of California, San Francisco, CA
| |
Collapse
|
3
|
Kurti M, He Y, Silver D, Giorgio M, von Lampe K, Macinko J, Ye H, Tan F, Mei V. Presence of Counterfeit Marlboro Gold Packs in Licensed Retail Stores in New York City: Evidence From Test Purchases. Nicotine Tob Res 2020; 21:1131-1134. [PMID: 29846723 DOI: 10.1093/ntr/nty096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 05/21/2018] [Indexed: 11/13/2022]
Abstract
BACKGROUND There are no independent studies measuring the availability of premium brand counterfeit cigarettes in New York City from licensed retailers. METHODS We forensically analyzed the cigarette packaging of Marlboro Gold (n = 1021) purchased from licensed tobacco retailers in New York City, using ultraviolet irradiation and light microscopy to determine whether they were counterfeit. RESULTS We find that while only 0.5% (n = 5) of our sample exhibits at least one characteristic synonymous with counterfeit packaging, none of our packs can be conclusively classified as counterfeit. CONCLUSIONS We do not find any counterfeit Marlboro Gold packs purchased at full price from licensed cigarette retailers throughout New York City. Future research using test purchases should include other venues (eg, street and online) and specifically ask for discounts to ascertain the overall presence of counterfeit cigarettes. IMPLICATIONS This is the first study to independently measure the availability of counterfeit cigarette packs purchased at full price from licensed retailers in New York City. We find that none of the Marlboro Gold packs purchased from licensed cigarette retailers are counterfeit.
Collapse
Affiliation(s)
- Marin Kurti
- Center for Tobacco Studies, Rutgers School of Public Health, Piscataway, NJ.,Department of Social and Behavioral Health Sciences, Rutgers School of Public Health, Piscataway, NJ
| | - Yi He
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| | - Diana Silver
- Department of Public Health Policy, College of Global Public Health, New York University, New York, NY
| | - Margaret Giorgio
- Department of Public Health Policy, College of Global Public Health, New York University, New York, NY
| | - Klaus von Lampe
- Department of Law, Police Science and Criminal Justice Administration, John Jay College of Criminal Justice, New York, NY
| | - James Macinko
- Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, CA.,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA
| | - Hua Ye
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| | - Fidelis Tan
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| | - Victoria Mei
- Department of Sciences, John Jay College of Criminal Justice, New York, NY
| |
Collapse
|
4
|
Schroth KRJ, Villanti AC, Kurti M, Delnevo CD. Why an FDA Ban on Menthol Is Likely to Survive a Tobacco Industry Lawsuit. Public Health Rep 2019; 134:300-306. [PMID: 30970219 DOI: 10.1177/0033354919841011] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Kevin R J Schroth
- 1 Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Andrea C Villanti
- 2 Vermont Center on Behavior and Health, University of Vermont, Burlington, VT, USA
| | - Marin Kurti
- 1 Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| | - Cristine D Delnevo
- 1 Center for Tobacco Studies, Rutgers School of Public Health, New Brunswick, NJ, USA
| |
Collapse
|
5
|
Wang-Schweig M, Lipperman-Kreda S, Lee JP. Rapid Assessment for Establishing Evidence of an Underground Cigarette Market in Oakland Chinatown: A Dual Approach. J Health Care Poor Underserved 2018; 29:615-622. [PMID: 29805127 DOI: 10.1353/hpu.2018.0045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
We conducted a preliminary study to rapidly assess (1) whether an underground cigarette market exists in the area known as Oakland Chinatown in Oakland, California; and if so, (2) who consumes untaxed cigarettes in this ethnic enclave to provide a basis for further investigation.
Collapse
|
6
|
Macinko J, Silver D. Impact of New York City's 2014 Increased Minimum Legal Purchase Age on Youth Tobacco Use. Am J Public Health 2018; 108:669-675. [PMID: 29565664 DOI: 10.2105/ajph.2018.304340] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the impact of New York City's (NYC's) 2014 increase of the minimum legal purchase age (MLPA) for tobacco and e-cigarettes from 18 to 21 years. METHODS We performed a difference-in-differences analysis comparing NYC to the rest of New York State by using repeated cross-sections of the New York Youth Tobacco Survey (2008-2016) and to 4 Florida cities by using the Youth Risk Behavior Surveys (2007-2015). RESULTS Adolescent tobacco use declined slightly in NYC after the policy change. However, this rate of change was even larger in control locations. In NYC, e-cigarette use increased and reported purchases of loose cigarettes remained unchanged, suggesting uneven policy implementation, enforcement, or compliance. CONCLUSIONS Increasing the MLPA to 21 years in NYC did not accelerate reductions in youth tobacco use any more rapidly than declines observed in comparison sites. Public Health Implications. Other cities and states currently raising their MLPA for tobacco may need to pay close attention to policy enforcement and conduct enhanced monitoring of retailer compliance to achieve the full benefits of the policy.
Collapse
Affiliation(s)
- James Macinko
- James Macinko is with the Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles. Diana Silver is with The College of Global Public Health, New York University, New York, NY
| | - Diana Silver
- James Macinko is with the Departments of Health Policy and Management and Community Health Sciences, Fielding School of Public Health, University of California, Los Angeles. Diana Silver is with The College of Global Public Health, New York University, New York, NY
| |
Collapse
|
7
|
Barker DC, Wang S, Merriman D, Crosby A, Resnick EA, Chaloupka FJ. Estimating cigarette tax avoidance and evasion: evidence from a national sample of littered packs. Tob Control 2018; 25:i38-i43. [PMID: 27697946 PMCID: PMC5099225 DOI: 10.1136/tobaccocontrol-2016-053012] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Accepted: 06/02/2016] [Indexed: 11/03/2022]
Abstract
INTRODUCTION A number of recent studies document the proportion of all cigarette packs that are 'contraband' using discarded packs to measure tax avoidance and evasion, which we call tax non-compliance. To date, academic studies using discarded packs focused on relatively small geographical areas such as a city or a neighbourhood. METHODS We visited 160 communities across 38 US states in 2012 and collected data from littered cigarette packs as part of the State and Community Tobacco Control (SCTC) Research Initiative and the Bridging the Gap Community Obesity Measures Project (BTG-COMP). Data collectors were trained in a previously tested littered pack data collection protocol. RESULTS Field teams collected 2116 packs with cellophane across 132 communities. We estimate a national tax non-compliance rate of 18.5% with considerable variation across regions. Suburban areas had lower non-compliance than urban areas as well as areas with high and low median household income areas compared with middle income areas. DISCUSSION We present the first academic national study of tax non-compliance using littered cigarette packs. We demonstrate the feasibility of meaningful large-scale data collection using this methodology and document considerable variation in tax non-compliance across areas, suggesting that both policy differences and geography may be important in control of illicit tobacco use. Given the geography of open borders among countries with varying tax rates, this simple methodology may be appropriate to estimate tax non-compliance in countries that use tax stamps or other pack markings, such as health warnings.
Collapse
Affiliation(s)
- Dianne C Barker
- Barker Bi-Coastal Health Consultants, Inc, Calabasas, California, USA
| | - Shu Wang
- Department of Political Science, Michigan State University, East Lansing, Michigan, USA
| | - David Merriman
- University of Illinois, Institute of Government and Public Affairs, Chicago, Illinois, USA Department of Public Administration, University of Illinois at Chicago, Chicago, Illinois, USA
| | - Andrew Crosby
- Department of Public Administration, Pace University, New York, New York, USA
| | - Elissa A Resnick
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, Illinois, USA
| | - Frank J Chaloupka
- University of Illinois at Chicago, Institute for Health Research and Policy, Chicago, Illinois, USA
| |
Collapse
|
8
|
Lee JG, Golden SD, Ribisl KM. Limited indications of tax stamp discordance and counterfeiting on cigarette packs purchased in tobacco retailers, 97 counties, USA, 2012. Prev Med Rep 2017; 8:148-152. [PMID: 29034149 PMCID: PMC5635242 DOI: 10.1016/j.pmedr.2017.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2017] [Revised: 09/19/2017] [Accepted: 09/23/2017] [Indexed: 11/18/2022] Open
Abstract
Increasing the per-unit cost of tobacco products is one of the strongest interventions for tobacco control. In jurisdictions with higher taxes in the U.S., however, cigarette pack litter studies show a substantial proportion of littered packs lack the appropriate tax stamp. More limited but still present counterfeiting also exists. We sought to examine the role of tobacco retailers as a source for untaxed and counterfeit products. Data collectors purchased Newport Green (menthol) or Marlboro Red cigarette packs in a national probability-based sample of tobacco retailers (in 97 counties) from June–October 2012. They made no effort to buy counterfeit or untaxed cigarettes. In this cross-sectional study, we assessed the presence, tax authority, and type (low-tech thermal vs. encrypted) of cigarette pack tax stamps; concordance of tax stamps with where the pack was purchased; and, for Marlboro cigarettes, publicly available visible indicators of counterfeiting. We purchased 2147 packs of which 2033 had tax stamps. Packs missing stamps were in states that do not require them. We found very limited discordance between store location and tax stamp(s) (< 1%). However, a substantial minority of cigarette packs had damaged tax stamps (13%). This occurred entirely with low-tech tax stamps and was not identified with encrypted tax stamps. We found no clear evidence of counterfeit products. Almost all tax stamps matched the location of purchase. Litter studies may be picking up legal tax avoidance instead of illegal tax evasion or, alternatively, purchase of illicit products requires special request by the purchaser. This study purchased 2147 cigarette packs in 97 U.S. counties. No clear indicators of cigarette counterfeiting were found. Virtually all packs had the correct tax stamp affixed. Inspection protocols for illicit cigarettes should consider real-world behaviors.
Collapse
Affiliation(s)
- Joseph G.L. Lee
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 1000 East 5 Street, Greenville, NC 27858, USA
- Corresponding author at: Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 1000 E. 5 St., Mail Stop 529, Greenville, NC 27858, USA.Department of Health Education and PromotionCollege of Health and Human PerformanceEast Carolina University1000 E. 5 St., Mail Stop 529GreenvilleNC27858USA
| | - Shelley D. Golden
- Department of Health Behavior, UNC Gillings School of Global Public Health, 145 Dauer Drive, Chapel Hill, NC 27599, USA
| | - Kurt M. Ribisl
- Department of Health Behavior, UNC Gillings School of Global Public Health, 145 Dauer Drive, Chapel Hill, NC 27599, USA
- Lineberger Comprehensive Cancer Center, UNC School of Medicine, Chapel Hill, NC, USA
| |
Collapse
|
9
|
Brown J, Welding K, Cohen JE, Cherukupalli R, Washington C, Ferguson J, Clegg Smith K. An analysis of purchase price of legal and illicit cigarettes in urban retail environments in 14 low- and middle-income countries. Addiction 2017; 112:1854-1860. [PMID: 28556313 PMCID: PMC5600117 DOI: 10.1111/add.13881] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2016] [Revised: 10/05/2016] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Abstract
BACKGROUND/AIMS To estimate and compare price differences between legal and illicit cigarettes in 14 low- and middle-income countries (LMIC). DESIGN A cross-sectional census of all packs available on the market was purchased. SETTING Cigarette packs were purchased in formal retail settings in three major cities in each of 14 LMIC: Bangladesh, Brazil, China, Egypt, India, Indonesia, Mexico, Pakistan, the Philippines, Russia, Thailand, Turkey, Ukraine and Vietnam. PARTICIPANTS A total of 3240 packs were purchased (range = 58 packs in Egypt to 505 in Russia). Packs were categorized as 'legal' or 'illicit' based on the presence of a health warning label from the country of purchase and existence of a tax stamp; 2468 legal and 772 illicit packs were in the analysis. MEASUREMENTS Descriptive statistics stratified by country, city and neighborhood socio-economic status were used to explore the association between price and legal status of cigarettes. FINDINGS The number of illicit cigarettes in the sample setting was small (n < 5) in five countries (Brazil, Egypt, Indonesia, Mexico, Russia) and excluded from analysis. In the remaining nine countries, the median purchase price of legal cigarettes ranged from US$0.32 in Pakistan (n = 72) to US$3.24 in Turkey (n = 242); median purchase price of illicit cigarettes ranged from US$0.80 in Ukraine (n = 14) to US$3.08 in India (n = 41). The difference in median price between legal and illicit packs as a percentage of the price of legal packs ranged from 32% in Philippines to 455% in Bangladesh. Median purchase price of illicit cigarette packs was higher than that of legal cigarette packs in six countries (Bangladesh, India, Pakistan, Philippines, Thailand, Vietnam). Median purchase price of illicit packs was lower than that of legal packs in Turkey, Ukraine and China. CONCLUSIONS The median purchase price of illicit cigarettes is higher than that of legal cigarette packs in Bangladesh, India, Pakistan, Philippines, Thailand, and Vietnam, Brazil, Egypt, Indonesia, Mexico, Russia appear to have few or no illicit cigarettes for purchase from formal, urban retailers.
Collapse
Affiliation(s)
- Jennifer Brown
- Institute for Global Tobacco ControlDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Kevin Welding
- Institute for Global Tobacco ControlDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Joanna E. Cohen
- Institute for Global Tobacco ControlDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Rajeev Cherukupalli
- Institute for Global Tobacco ControlDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Carmen Washington
- Institute for Global Tobacco ControlDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Jacqueline Ferguson
- Institute for Global Tobacco ControlDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| | - Katherine Clegg Smith
- Institute for Global Tobacco ControlDepartment of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public HealthBaltimoreMDUSA
| |
Collapse
|
10
|
Is Every Smoker Interested in Price Promotions? An Evaluation of Price-Related Discounts by Cigarette Brands. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2017; 22:20-8. [PMID: 26598952 DOI: 10.1097/phh.0000000000000223] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT Raising unit price is one of the most effective ways of reducing cigarette consumption. A large proportion of US adult smokers use generic brands or price discounts in response to higher prices, which may mitigate the public health impacts of raising unit price. OBJECTIVE The main purpose of this study was to evaluate the retail price impact and the determinants of price-related discount use among US adult smokers by their most commonly used cigarette brand types. METHODS Data from the 2009-2010 National Adult Tobacco Survey, a telephone survey of US adults 18 years or older, was used to assess price-related discount use by cigarette brands. Price-related discounts included coupons, rebates, buy 1 get 1 free, 2 for 1, or any other special promotions. Multivariate logistic regression was used to assess sociodemographic and tobacco use determinants of discount use by cigarette brands. RESULTS Discount use was most common among premium brand users (22.1%), followed by generic (13.3%) and other brand (10.8%) users. Among premium brand users, those who smoked 10 to 20 cigarettes per day were more likely to use discounts, whereas elderly smokers, non-Hispanic blacks, those with greater annual household income, dual users of cigarettes and other combustible tobacco products, and those who had no quit intentions were less likely to do so. Among generic brand users, those who had no quit intentions and those who smoked first cigarette within 60 minutes after waking were more likely to use discounts. CONCLUSIONS Frequent use of discounts varies between smokers of premium and generic cigarette brands. Setting a high minimum price, together with limiting the use of coupons and promotions, may uphold the effect of cigarette excise taxes to reduce smoking prevalence.
Collapse
|
11
|
Lightwood J, Glantz SA. Smoking Behavior and Healthcare Expenditure in the United States, 1992-2009: Panel Data Estimates. PLoS Med 2016; 13:e1002020. [PMID: 27163933 PMCID: PMC4862673 DOI: 10.1371/journal.pmed.1002020] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Accepted: 03/31/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Reductions in smoking in Arizona and California have been shown to be associated with reduced per capita healthcare expenditures in these states compared to control populations in the rest of the US. This paper extends that analysis to all states and estimates changes in healthcare expenditure attributable to changes in aggregate measures of smoking behavior in all states. METHODS AND FINDINGS State per capita healthcare expenditure is modeled as a function of current smoking prevalence, mean cigarette consumption per smoker, other demographic and economic factors, and cross-sectional time trends using a fixed effects panel data regression on annual time series data for each the 50 states and the District of Columbia for the years 1992 through 2009. We found that 1% relative reductions in current smoking prevalence and mean packs smoked per current smoker are associated with 0.118% (standard error [SE] 0.0259%, p < 0.001) and 0.108% (SE 0.0253%, p < 0.001) reductions in per capita healthcare expenditure (elasticities). The results of this study are subject to the limitations of analysis of aggregate observational data, particularly that a study of this nature that uses aggregate data and a relatively small sample size cannot, by itself, establish a causal connection between smoking behavior and healthcare costs. Historical regional variations in smoking behavior (including those due to the effects of state tobacco control programs, smoking restrictions, and differences in taxation) are associated with substantial differences in per capita healthcare expenditures across the United States. Those regions (and the states in them) that have lower smoking have substantially lower medical costs. Likewise, those that have higher smoking have higher medical costs. Sensitivity analysis confirmed that these results are robust. CONCLUSIONS Changes in healthcare expenditure appear quickly after changes in smoking behavior. A 10% relative drop in smoking in every state is predicted to be followed by an expected $63 billion reduction (in 2012 US dollars) in healthcare expenditure the next year. State and national policies that reduce smoking should be part of short term healthcare cost containment.
Collapse
Affiliation(s)
- James Lightwood
- School of Pharmacy, University of California, San Francisco, San Francisco, California, United States of America
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, United States of America
| | - Stanton A. Glantz
- Center for Tobacco Control Research and Education, University of California, San Francisco, San Francisco, California, United States of America
- Division of Cardiology, Department of Medicine, University of California, San Francisco, San Francisco, California, United States of America
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, San Francisco, California, United States of America
| |
Collapse
|
12
|
Consroe K, Kurti M, Merriman D, von Lampe K. Spring Breaks and Cigarette Tax Noncompliance: Evidence From a New York City College Sample. Nicotine Tob Res 2016; 18:1773-9. [DOI: 10.1093/ntr/ntw087] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Accepted: 03/11/2016] [Indexed: 11/13/2022]
|
13
|
Kurti M, He Y, von Lampe K, Li Y. Identifying counterfeit cigarette packs using ultraviolet irradiation and light microscopy. Tob Control 2015; 26:29-33. [DOI: 10.1136/tobaccocontrol-2015-052555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 11/25/2015] [Indexed: 11/03/2022]
|
14
|
Silver D, Giorgio MM, Bae JY, Jimenez G, Macinko J. Over-the-counter sales of out-of-state and counterfeit tax stamp cigarettes in New York City: Table 1. Tob Control 2015; 25:584-6. [DOI: 10.1136/tobaccocontrol-2015-052355] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2015] [Accepted: 08/05/2015] [Indexed: 11/04/2022]
|
15
|
Abstract
In a variety of urban health frameworks, cities are conceptualized as complex and dynamic yet commonly used epidemiological methods have failed to address this complexity and dynamism head on due to their narrow problem definitions and linear analytical representations. Scholars from a variety of disciplines have also long conceptualized cities as systems, but few have modeled urban health issues as problems within a system. Systems thinking in general and system dynamics in particular are relatively new approaches in public health, but ones that hold immense promise as methodologies to model and analyze the complexity underlying urban processes to effectively inform policy actions in dynamic environments. This conceptual essay reviews the utility of applying the concepts, principles, and methods of systems thinking to the study of complex urban health phenomena as a complementary approach to standard epidemiological methods using specific examples and provides recommendations on how to better incorporate systems thinking methods in urban health research and practice.
Collapse
|
16
|
Guillory J, Johns M, Farley SM, Ling PM. Loose Cigarette Purchasing and Nondaily Smoking Among Young Adult Bar Patrons in New York City. Am J Public Health 2015; 105:e140-7. [PMID: 25880951 DOI: 10.2105/ajph.2014.302518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined loose cigarette (loosie) purchasing behavior among young adult (aged 18-26 years) smokers at bars in New York City and factors associated with purchase and use. METHODS Between June and December 2013, we conducted cross-sectional surveys (n = 1916) in randomly selected bars and nightclubs. Using multivariable logistic regression models, we examined associations of loose cigarette purchasing and use with smoking frequency, price, social norms, cessation behaviors, and demographics. RESULTS Forty-five percent (n = 621) of nondaily smokers and 57% (n = 133) of daily smokers had ever purchased a loosie; 15% of nondaily smokers and 4% of daily smokers reported that their last cigarette was a loosie. Nondaily smokers who never smoked daily were more likely than were daily smokers to have last smoked a loosie (odds ratio = 7.27; 95% confidence interval = 2.35, 22.48). Quitting behaviors and perceived approval of smoking were associated with ever purchasing and recently smoking loosies. CONCLUSIONS Loosie purchase and use is common among young adults, especially nondaily smokers. Smoking patterns and attitudes should be considered to reduce loose cigarette purchasing among young adults in New York City.
Collapse
Affiliation(s)
- Jamie Guillory
- At the time of the analysis and writing, Jamie Guillory was with the Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco. Michael Johns and Shannon M. Farley are with the New York City Department of Health and Mental Hygiene, New York, NY. Pamela M. Ling is with the Division of General Internal Medicine, Department of Medicine, and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Michael Johns
- At the time of the analysis and writing, Jamie Guillory was with the Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco. Michael Johns and Shannon M. Farley are with the New York City Department of Health and Mental Hygiene, New York, NY. Pamela M. Ling is with the Division of General Internal Medicine, Department of Medicine, and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Shannon M Farley
- At the time of the analysis and writing, Jamie Guillory was with the Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco. Michael Johns and Shannon M. Farley are with the New York City Department of Health and Mental Hygiene, New York, NY. Pamela M. Ling is with the Division of General Internal Medicine, Department of Medicine, and the Center for Tobacco Control Research and Education, University of California, San Francisco
| | - Pamela M Ling
- At the time of the analysis and writing, Jamie Guillory was with the Center for Tobacco Control Research and Education, Cardiovascular Research Institute, University of California, San Francisco. Michael Johns and Shannon M. Farley are with the New York City Department of Health and Mental Hygiene, New York, NY. Pamela M. Ling is with the Division of General Internal Medicine, Department of Medicine, and the Center for Tobacco Control Research and Education, University of California, San Francisco
| |
Collapse
|
17
|
Kurti M, von Lampe K, Johnson J. The intended and unintended consequences of a legal measure to cut the flow of illegal cigarettes into New York City: the case of the South Bronx. Am J Public Health 2015; 105:750-6. [PMID: 25713940 DOI: 10.2105/ajph.2014.302340] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the impact of a change in New York tax law on the numbers of untaxed cigarettes bootlegged from Native American reservations and resold in the South Bronx. METHODS Discarded cigarette packs were systematically collected in 30 randomized South Bronx census tracks before and after the amended tax law went into effect in 2011. Also, administrative data were gathered on the number of taxed cigarettes sold in New York State, including sales to Native American reservations. RESULTS Before the tax amendment, 42% of discarded cigarette packs collected in the South Bronx had no tax stamp. After the tax law went into effect, the percentage of cigarette packs without tax stamps declined to 6.2%. Simultaneously, the percentage of packs with out-of-state tax stamps rose from 18.3% to 66.3%. The percentage of packs with a combined New York State and New York City tax stamp did not change after the tax amendment. CONCLUSIONS After the tax amendment, the supply of contraband cigarettes appears to have quickly shifted from one lower-priced jurisdiction to another without a change in the overall prevalence of contraband cigarettes.
Collapse
Affiliation(s)
- Marin Kurti
- Marin Kurti is with the School of Criminal Justice, Rutgers University, Newark, NJ. Klaus von Lampe is with the Department of Law, Police Science and Criminal Justice Administration, John Jay College of Criminal Justice, New York, NY. Jacqueline Johnson is with the Department of Anthropology and Sociology, Adelphi University, Garden City, NY
| | | | | |
Collapse
|
18
|
Xu X, Malarcher A, O’Halloran A, Kruger J. Does every US smoker bear the same cigarette tax? Addiction 2014; 109:1741-9. [PMID: 24861973 PMCID: PMC4591540 DOI: 10.1111/add.12630] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 03/06/2014] [Accepted: 05/16/2014] [Indexed: 11/30/2022]
Abstract
AIMS To evaluate state cigarette excise tax pass-through rates for selected price-minimizing strategies. DESIGN Multivariate regression analysis of current smokers from a stratified, national, dual-frame telephone survey. SETTING United States. PARTICIPANTS A total of 16 542 adult current smokers aged 18 years or older. MEASUREMENTS Cigarette per pack prices paid with and without coupons were obtained for pack versus carton purchase, use of generic brands versus premium brands, and purchase from Indian reservations versus outside Indian reservations. FINDINGS The average per pack prices paid differed substantially by price-minimizing strategy. Smokers who used any type of price-minimizing strategies paid substantially less than those who did not use these strategies (P < 0.05). Premium brand users who purchased by pack in places outside Indian reservations paid the entire amount of the excise tax, together with an additional premium of 7-10 cents per pack for every $1 increase in excise tax (pass-through rate of 1.07-1.10, P < 0.05). In contrast, carton purchasers, generic brand users or those who were likely to make their purchases on Indian reservations paid only 30-83 cents per pack for every $1 tax increase (pass-through rate of 0.30-0.83, P < 0.05). CONCLUSIONS Many smokers in the United States are able to avoid the full impact of state excise tax on cost of smoking by buying cartons, using generic brands and buying from Indian reservations.
Collapse
Affiliation(s)
- Xin Xu
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Ann Malarcher
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Alissa O’Halloran
- Northrop Grumman, Contractor Support for NCCDPHP/NGIS, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Judy Kruger
- Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| |
Collapse
|