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Curry L, Schmitt CL, Henes A, Ortega-Peluso C, Battles H. How Low-Income Smokers in New York Access Cheaper Cigarettes. Am J Health Promot 2018; 33:558-565. [PMID: 30301365 DOI: 10.1177/0890117118805060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE To understand the tobacco acquisition practices of low-income smokers in New York State in light of high cigarette prices due to high cigarette taxes. DESIGN Eight focus groups with low-income smokers were conducted in spring 2015 and 2016 (n = 74). SETTING New York City (NYC) and Buffalo, New York. PARTICIPANTS Low-income adults aged 18 to 65 who smoke cigarettes regularly. METHOD Qualitative analysis of focus group transcripts that explored differences and similarities by region. We used the interview guide-which covered the process of acquiring cigarettes and the impact of cigarette prices-as a framework for analysis to generate themes and subthemes (deductive coding). We also generated themes and subthemes that emerged during focus group discussions (inductive coding). RESULTS Some smokers in Western New York have switched to untaxed cigarettes from Native American reservations, whereas low-income smokers in NYC described convenient sources of bootlegged cigarettes (packs or loosies) in their local neighborhood stores, through acquaintances, or on the street. Familiarity with the retailer was key to accessing bootlegged cigarettes from retailers. CONCLUSIONS Smokers in this study could access cheaper cigarettes, which discouraged quit attempts and allowed them to continue smoking. The availability of lower priced cigarettes may attenuate public health efforts aimed at reducing smoking prevalence through price and tax increases.
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Affiliation(s)
| | | | - Amy Henes
- 2 RTI International, Research Triangle Park, NC, USA
| | | | - Haven Battles
- 3 New York State Department of Health, Albany, NY, USA
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Siahpush M, Farazi PA, Maloney SI, Dinkel D, Nguyen MN, Singh GK. Socioeconomic status and cigarette expenditure among US households: results from 2010 to 2015 Consumer Expenditure Survey. BMJ Open 2018; 8:e020571. [PMID: 29909369 PMCID: PMC6009464 DOI: 10.1136/bmjopen-2017-020571] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To examine (1) the association between household socioeconomic status (SES) and whether a household spends money on cigarettes and (2) socioeconomic variations in proportion of total household expenditure spent on cigarettes among smoking households. METHODS We pooled data from six consecutive years, 2010-2015, of the Consumer Expenditure Interview Survey. The interviews involved a structured questionnaire about household income, demographics and expenditures including expenditure on cigarettes. Households that reported cigarette expenditure in the previous 3 months were distinguished as smoking households. SES indicators were household poverty status, education and occupation of the head of household. Logistic regression was used to assess the association of household smoking status with SES. Fractional logistic regression was used to assess the association of cigarette expenditure as a proportion of total household expenditure with SES. The analysis sample size was 39 218. RESULTS The probability of spending money on cigarettes was higher among lower SES households. Households in poverty compared with those above 300% of poverty threshold had 1.86 (95% CI 1.61 to 2.16), households headed by a person with less than high school education compared with those headed by a person with at least a bachelor's degree had 3.37 (95% CI 2.92 to 3.89) and households headed by a blue-collar work compared with those headed by a person in a managerial occupation had 1.45 (95% CI 1.26 to 1.66) higher odds of spending money on cigarettes. Similarly, the proportion of total household expenditure spent on cigarettes was higher among lower SES smoking households. CONCLUSION Lower SES households are more likely to spend money on cigarettes and spend a larger proportion of their total expenditure on cigarettes. We recommend strategies effective in reducing smoking among low SES smokers.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Paraskevi A Farazi
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Shannon I Maloney
- Department of Health Promotion, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Danae Dinkel
- School of Health and Kinesiology, College of Education, University of Nebraska, Omaha, Nebraska, USA
| | - Minh N Nguyen
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Gopal K Singh
- U.S. Department of Health & Human Services, Office of Health Equity, Health Resources and Services Administration, Rockville, Maryland, USA
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Farley SM, Coady MH, Mandel-Ricci J, Waddell EN, Chan C, Kilgore EA, Kansagra SM. Public opinions on tax and retail-based tobacco control strategies. Tob Control 2015; 24:e10-3. [PMID: 24365700 DOI: 10.1136/tobaccocontrol-2013-051272] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND While tobacco taxes and smoke-free air regulations have significantly decreased tobacco use, tobacco-related illness accounts for hundreds of thousands of annual deaths. Experts are considering additional strategies to further reduce tobacco consumption. METHODS We investigated smokers' (n=2118) and non-smokers' (n=2210) opinions on existing and theoretical strategies, including tax and retailer-based strategies in New York City, across three cross-sectional surveys. RESULTS Compared with smokers, non-smokers were significantly more likely (p<0.05) to favour all tobacco control strategies. Overall, 25% of smokers surveyed favoured increasing taxes on cigarettes, climbing to 60% if taxes were used to fund healthcare programmes. Among non-smokers, 72% favoured raising taxes, increasing to 83% if taxes were used to fund healthcare programmes. 54% of non-smoking New Yorkers favoured limiting the number of tobacco retail licences, as did 30% of smokers. The most popular retail-based strategies were raising the minimum age to purchase cigarettes from 18 to 21, with 60% of smokers and 69% of non-smokers in favour, and prohibiting retailers near schools from selling tobacco, with 51% of smokers and 69% of non-smokers in favour. Keeping tobacco products out of customers' view, prohibiting tobacco companies from paying retailers to display or advertise tobacco products and prohibiting price promotions were favoured by more than half of non-smokers surveyed, and almost half of smokers. CONCLUSIONS While the support level varied between smokers and non-smokers, price and retail-based tobacco control strategies were consistently supported by the public, providing useful information for jurisdictions examining emerging tobacco control strategies.
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Affiliation(s)
- Shannon M Farley
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Micaela H Coady
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Jenna Mandel-Ricci
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Elizabeth Needham Waddell
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Christina Chan
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Elizabeth A Kilgore
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
| | - Susan M Kansagra
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, New York, USA
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Over EAB, Feenstra TL, Hoogenveen RT, Droomers M, Uiters E, van Gelder BM. Tobacco Control Policies Specified According to Socioeconomic Status: Health Disparities and Cost-Effectiveness. Nicotine Tob Res 2014; 16:725-32. [DOI: 10.1093/ntr/ntt218] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
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Choi K, Boyle RG. Minnesota smokers' perceived helpfulness of 2009 federal tobacco tax increase in assisting smoking cessation: a prospective cohort study. BMC Public Health 2013; 13:965. [PMID: 24134094 PMCID: PMC3853445 DOI: 10.1186/1471-2458-13-965] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2013] [Accepted: 10/14/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The cost of cigarettes has been cited as a motivating factor for smokers to quit smoking, and a cigarette tax increase is an effective way to increase the cost of cigarettes. Scholars have suggested that smokers may see cigarette tax increases as commitment devices to help them quit smoking. Little is known about whether smokers actually think cigarette tax increases help them quit, and whether this perception predicts subsequent smoking cessation behaviors. We used data from the Minnesota Adult Tobacco Survey Cohort Study collected after the 2009 federal tobacco tax increase to answer these questions. METHODS In 2009, 727 smokers were asked whether they thought the federal tobacco tax increase helped them to: (1) think about quitting, (2) cut down on cigarettes, and (3) make a quit attempt. We also collected data on demographics, number of cigarette price-minimizing strategies used, and cigarette consumption. In 2010, we assessed if these smokers had made a quit attempt, had cut down on their cigarette consumption, and had stopped smoking. Logistic regression models were used to assess the characteristics associated with the perceptions that the tax increase was helpful in assisting smoking cessation, and the association between these perceptions in 2009 and cessation behaviors in 2010. RESULTS Overall, 65% of the sample thought that the 2009 tax increase helped them think about quitting, 47% thought it helped them cut down on cigarettes, and 29% thought it helped them make a quit attempt. Lower education, lower income, lower cigarette consumption, and using more cigarette price-minimizing strategies were associated with the perceptions that the tax increase was helpful in assisting smoking cessation (p < 0.05). Smokers who perceived the tax increase as helpful in assisting smoking cessation were more likely than those who did not perceive the tax increase as helpful to report making a quit attempt in 2010 (p < 0.05). CONCLUSIONS A significant proportion of smokers in our sample thought the 2009 federal tobacco tax increase was helpful in assisting smoking cessation, particularly among smokers of lower socio-economic status. Health communication interventions to promote cigarette tax increases as an opportunity for smoking cessation may further assist quit attempts.
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Affiliation(s)
- Kelvin Choi
- Division of Epidemiology and Community Health, University of Minnesota, 1300 South Second Street # 300, Minneapolis, MN 55454, USA.
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Coady MH, Chan CA, Sacks R, Mbamalu IG, Kansagra SM. The impact of cigarette excise tax increases on purchasing behaviors among New York city smokers. Am J Public Health 2013; 103:e54-60. [PMID: 23597382 DOI: 10.2105/ajph.2013.301213] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the relationship between cigarette excise tax increases and tax-avoidant purchasing behaviors among New York City adult smokers. METHODS We analyzed data from the city's annual Community Health Survey to assess changes in rates of tax avoidance over time (2003-2010) and smokers' responses to the 2008 state cigarette tax increase. Multivariable logistic regression analysis identified correlates of buying more cigarettes on the street in response to the increase. RESULTS After the 2002 tax increase, the percentage of smokers engaged in tax-avoidant behavior decreased with time from 30% in 2003 to 13% in 2007. Following the 2008 tax increase, 21% of smokers reported buying more cigarettes from another person on the street. Low-income, younger, Black, and Hispanic smokers were more likely than respondents with other sociodemographic characteristics to purchase more cigarettes on the street. CONCLUSIONS To maximize public health impact, cigarette tax increases should be paired with efforts to limit the flow of untaxed cigarettes entering jurisdictions with high cigarette pack prices.
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Affiliation(s)
- Micaela H Coady
- Bureau of Chronic Disease Prevention and Tobacco Control, New York City Department of Health and Mental Hygiene, Queens, NY 11101, USA
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Farrelly MC, Nonnemaker JM, Watson KA. The consequences of high cigarette excise taxes for low-income smokers. PLoS One 2012; 7:e43838. [PMID: 22984447 PMCID: PMC3440380 DOI: 10.1371/journal.pone.0043838] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 07/30/2012] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To illustrate the burden of high cigarette excise taxes on low-income smokers. METHODOLOGY/PRINCIPAL FINDINGS Using data from the New York and national Adult Tobacco Surveys from 2010-2011, we estimated how smoking prevalence, daily cigarette consumption, and share of annual income spent on cigarettes vary by annual income (less than $30,000; $30,000-$59,999; and more than $60,000). The 2010-2011 sample includes 7,536 adults and 1,294 smokers from New York and 3,777 adults and 748 smokers nationally. Overall, smoking prevalence is lower in New York (16.1%) than nationally (22.2%) and is strongly associated with income in New York and nationally (P<.001). Smoking prevalence ranges from 12.2% to 33.7% nationally and from 10.1% to 24.3% from the highest to lowest income group. In 2010-2011, the lowest income group spent 23.6% of annual household income on cigarettes in New York (up from 11.6% in 2003-2004) and 14.2% nationally. Daily cigarette consumption is not related to income. CONCLUSIONS/SIGNIFICANCE Although high cigarette taxes are an effective method for reducing cigarette smoking, they can impose a significant financial burden on low-income smokers.
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Affiliation(s)
- Matthew C Farrelly
- Research Triangle Institute International, Research Triangle Park, North Carolina, United States of America.
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Siahpush M, Borland R, Yong HH, Cummings KM, Fong GT. Tobacco expenditure, smoking-induced deprivation and financial stress: results from the International Tobacco Control (ITC) Four-Country Survey. Drug Alcohol Rev 2012; 31:664-71. [PMID: 22404640 DOI: 10.1111/j.1465-3362.2012.00432.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION AND AIMS While higher tobacco prices lead to a reduction in smoking prevalence, there is a concern that paying more for cigarettes can lead to excess financial burden. Our primary aim was to examine the association of daily cigarette expenditure with smoking-induced deprivation (SID) and financial stress (FS). DESIGN AND METHODS We used data from wave 7 (2008-2009) of the International Tobacco Control (ITC) Four-Country Survey which is a survey of smokers in Canada, the USA, the UK and Australia (n = 5887). Logistic regressions were used to assess the association of daily cigarette expenditure with SID and FS. RESULTS In multivariate analyses, a one standard deviation increase in daily cigarette expenditure was associated with an increase of 24% (P = 0.004) in the probability of experiencing SID. While we found no association between daily cigarette expenditure and FS, we found that SID is a strong predictor of FS (odds ratio 6.25; P < 0.001). This suggests that cigarette expenditure indirectly affects FS through SID. Results showed no evidence of an interaction between cigarette expenditure and income or education in their effect on SID or FS. CONCLUSIONS Our results imply that spending more on tobacco may result in SID but surprisingly has no direct effect on FS. While most smokers may be adjusting their incomes and consumption to minimise FS, some fail to do so occasionally as indexed by the SID measure. Future studies need to prospectively examine the effect of increased tobacco expenditure on financial burden of smokers.
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Affiliation(s)
- Mohammad Siahpush
- Department of Health Promotion, Social and Behavioral Health, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198-4365, USA.
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Siahpush M. Commentary on Bryant et al. (2011): behavioral and population-level interventions for reducing disparities in tobacco use. Addiction 2011; 106:1586-7. [PMID: 21815922 DOI: 10.1111/j.1360-0443.2011.03558.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Socioeconomic differences in the effectiveness of the removal of the "light" descriptor on cigarette packs: findings from the International Tobacco Control (ITC) Thailand Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2011; 8:2170-80. [PMID: 21776224 PMCID: PMC3138019 DOI: 10.3390/ijerph8062170] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/08/2011] [Indexed: 11/30/2022]
Abstract
Many smokers incorrectly believe that “light” cigarettes are less harmful than regular cigarettes. To address this problem, many countries have banned “light” or “mild” brand descriptors on cigarette packs. Our objective was to assess whether beliefs about “light” cigarettes changed following the 2007 removal of these brand descriptors in Thailand and, if a change occurred, the extent to which it differed by socioeconomic status. Data were from waves 2 (2006), 3 (2008), and 4 (2009) of the International Tobacco Control (ITC) Thailand Survey of adult smokers in Thailand. The results showed that, following the introduction of the ban, there was an overall decline in the two beliefs that “light” cigarettes are less harmful and smoother than regular cigarettes. The decline in the “less harmful” belief was considerably steeper in lower income and education groups. However, there was no evidence that the rate of decline in the “smoother” belief varied by income or education. Removing the “light” brand descriptor from cigarette packs should thus be viewed not only as a means to address the problem of smokers’ incorrect beliefs about “light” cigarettes, but also as a factor that can potentially reduce socioeconomic disparities in smoking-related misconceptions.
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Martire KA, Mattick RP, Doran CM, Hall WD. Cigarette tax and public health: what are the implications of financially stressed smokers for the effects of price increases on smoking prevalence? Addiction 2011; 106:622-30. [PMID: 21054618 DOI: 10.1111/j.1360-0443.2010.03174.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIMS This paper models the predicted impact of tobacco price increases proposed in the United States and Australia during 2009 on smoking prevalence in 2010 while taking account of the effects of financial stress among smokers on cessation rates. METHODS Two models of smoking prevalence were developed for each country. In model 1, prevalence rates were determined by price elasticity estimates. In model 2 price elasticity was moderated by financial stress. Each model was used to estimate smoking prevalence in 2010 in Australia and the United States. RESULTS Proposed price increases resulted in a 1.89% and 7.84% decrease in smoking participation among low socio-economic status (SES) groups in the United States and Australia, respectively. Model 1 overestimated the number of individuals expected to quit in both the United States (0.13% of smokers) and Australia (0.36% of smokers) by failing to take account of the differential effects of the tax on financially stressed smokers. The proportion of low-income smokers under financial stress increased in both countries in 2010 (by 1.06% in the United States and 3.75% in Australia). CONCLUSIONS The inclusion of financial stress when modelling the impact of price on smoking prevalence suggests that the population health returns of increased cigarette price will diminish over time. As it is likely that the proportion of low-income smokers under financial stress will also increase in 2010, future population-based approaches to reducing smoking will need to address this factor.
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Affiliation(s)
- Kristy A Martire
- National Drug and Alcohol Research Centre, University of New South Wales, Sydney, Australia.
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Abstract
Economic studies of taxation typically estimate external costs of tobacco use to be low and refrain from recommending large tobacco taxes. Behavioral economics suggests that a rational decision-making process by individuals fully aware of tobacco's hazards might still lead to overconsumption through the psychological tendency to favor immediate gratification over future harm. Taxes can serve as a self-control device to help reduce tobacco use and enable successful quit attempts. Whether taxes are appropriately high depends on how excessively people underrate the harm from tobacco use and varies with a country's circumstances. Such taxes are likely to be more equitable for poorer subgroups than traditional economic analysis suggests, which would strengthen the case for increased tobacco taxation globally.
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Affiliation(s)
- Rajeev Cherukupalli
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, New York, NY 10006, USA.
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Ahrens D. Tobacco taxes and cigarette consumption in low income populations. Am J Public Health 2009; 99:6. [PMID: 19008496 PMCID: PMC2636615 DOI: 10.2105/ajph.2008.148684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2008] [Indexed: 11/04/2022]
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