Association of state tobacco control policies with active smoking at the time of intervention for intermittent claudication.

Active smoking among patients undergoing interventions for intermittent claudication (IC) is associated with poor outcomes. Notwithstanding, current levels of active smoking in these patients are high. State-level tobacco control policies have been shown to reduce smoking in the general US population. We evaluated whether state cigarette taxes and 100% smoke-free workplace legislation are associated with active smoking among patients undergoing interventions for IC. We queried the Vascular Quality Initiative database for peripheral endovascular interventions, infrainguinal bypasses, and suprainguinal bypasses for IC. Active smoking at the time of intervention was defined as smoking within one month of intervention. We implemented difference-in-differences analysis to isolate changes in active smoking owing to cigarette taxes (adjusted for inflation) and implementation of smoke-free workplace legislation. The difference-in-differences models estimated the causal effects of tobacco policies by adjusting for concurrent temporal trends in active smoking unrelated to cigarette taxes or smoke-free workplace legislation. The models controlled for age, sex, race/ethnicity, insurance type, diabetes, chronic obstructive pulmonary disease, state, and year. We tested interactions of taxes with age and insurance. Data were available for 59,847 patients undergoing interventions for IC in 25 states from 2011 to 2019. Across the study period, active smoking at the time of intervention decreased from 48% to 40%. Every $1.00 cigarette tax increase was associated with a 6-percentage point decrease in active smoking (95% confidence interval, -10 to -1 percentage points; P = .02), representing an 11% decrease relative to the baseline proportion of patients actively smoking. The effect of cigarettes taxes was greater in older patients and those on Medicare. Among patients aged 60 to 69 and 70 to 79 years, every $1.00 tax increase resulted in 14% and 21% reductions in active smoking relative to baseline subgroup prevalences of 53% and 29%, respectively (P < .05 for both); however, younger age groups were not affected by tax increases. Among insurance groups, only patients on Medicare exhibited a significant change in active smoking with every $1.00 tax increase (an 18% decrease relative to a 33% baseline prevalence; P = .01). The number of states implementing smoke-free workplace legislation increased from 9 to 14 by 2019; however, this policy was not significantly associated with active smoking prevalence. At follow-up (median, 12.9 months), $1.00 tax increases were still associated with decreased smoking prevalence (a 25% decrease relative to a 33% baseline prevalence; P < .001). Cigarette tax increases seem to be an effective strategy to decrease active smoking among patients undergoing interventions for IC. Older patients and Medicare recipients are the most responsive to tax increases.

Levin SR ，Hawkins SS ，Farber A ，Goodney PP ，Osborne NH ，Tan TW ，Malas MB ，Patel VI ，Siracuse JJ ... -  《-》

US state cigarette tax increases and smoke-free legislation in relation to cigarette expenditure across household socio-economic circumstances: a quasi-experimental study.

While research has focused on outcomes of tobacco control policies, less is known about the mechanisms by which policies may affect tobacco use. We estimated the associations of changes in cigarette taxes and smoke-free legislation with (1) any household cigarette expenditure and (2) the level of household expenditure on cigarettes, as well as (3) tested interactions with socio-economic circumstances. Difference-in-differences regression models to estimate the associations between changes in US state cigarette taxes and smoke-free legislation with changes in household expenditure on cigarettes. Forty US states and District of Columbia. From annual, cross-sectional surveys (with a longitudinal component) between 2000 and 2014, 128 138 households interviewed quarterly in the Consumer Expenditure Survey. Dependent measures included any household cigarette expenditure, expenditure in real dollars and budget share of cigarette expenditure. Policy measures included state cigarette taxes and 100% smoke-free legislation. Covariates included respondent age, race/ethnicity, sex; household education; poverty level; family structure; and number of children and adults. Every $1.00 cigarette tax increase was associated with a 1.5 percentage point (-0.028, -0.002) reduction in any cigarette expenditure and an increase of 0.1% (0.1%, 0.1%) budget share and $10.11 ($8.38, $11.84) absolute expenditure. The association with absolute expenditure was stronger among smoking households above poverty level ($10.73; $8.94, $12.51) than below ($4.72; $2.37, $7.07). The enactment of smoke-free legislation was associated with $2.33 (-$4.56, -$0.10) less expenditure, but not with any expenditure (0.1%; -1.6%, 1.8%) or budget share (-0.1%; -0.1%, 0.1%). The association with absolute expenditure was stronger among households above poverty level (-$2.62; -$4.95, -$0.29) than below (-$0.34; -$4.27, $3.58) CONCLUSION: Cigarette tax increases in the United States between 2000 and 2014 may have reduced smoking prevalence due to an absolute and relative increase in household tobacco expenditure while smoke-free policies appear to have led to a reduction in expenditure. Although tax increases had a stronger impact on absolute expenditure among households above the poverty level, impact on relative expenditure was similar, and consequences for socio-economic inequalities in smoking will vary based on the broader financial situation of households.

Hawkins SS ，Kull M ，Baum CF 《-》

Impact of Tobacco Control Policies on Adolescent Smoking.

Our aims were to examine the impact of cigarette taxes and smoke-free legislation on current adolescent smoking and smoking frequency overall as well as test whether there were differential policy effects by age. Using data on 717,543 adolescents from 43 states in the 1999-2013 Youth Risk Behavior Surveys, we used difference-in-differences regression models to evaluate the impact of tobacco control policies on current adolescent smoking (yes/no) and, separately, smoking frequency (defined as 0, 1-5, 6-29, 30+ days per month). We tested an interaction between age and cigarette taxes and, separately, smoke-free legislation. From 1999 to 2013, adolescent smoking decreased from 35.3% to 13.9% and 41 of 43 states increased their cigarette tax in real terms by an average of 257%. By the end of the study period, 29 of 43 states had 100% smoke-free restaurant legislation. Although we found no overall effect of cigarette taxes on current smoking, there was a significant interaction by age. Among 14- and 15-year olds, every $1.00 cigarette tax increase was associated with a 2.2 and 1.6 percentage point reduction in smoking, respectively. The enactment of 100% smoke-free restaurant legislation was associated with an overall reduction in adolescent smoking by 1.1 percentage points and there were no differences by age. Cigarette taxes and smoke-free legislation were also associated with decreased smoking frequency. The youngest adolescents are the most price sensitive, and cigarette taxes continue to be a successful approach to reduce adolescent smoking. Smoke-free legislation may also be an effective strategy to reduce smoking among all adolescents.

Hawkins SS ，Bach N ，Baum CF 《-》

Are lower income smokers more price sensitive?: the evidence from Korean cigarette tax increases.

The cigarette excise taxes and the price of a typical pack of cigarettes in Korea have not increased since 2005, and effective tax rate as a fraction of price and real price of cigarettes have both been falling. As smoking prevalence is higher among lower income people than among higher income people in Korea, the regressivity of cigarette excise taxes is often cited as a barrier to tobacco tax and price policy. While studies in several other high-income countries have shown that higher income individuals are less price sensitive, few studies have examined the differential impact of cigarette tax increases by income group in Korea. Most of the Korean literature has estimated the demand for cigarettes using time-series aggregate sales data or household level survey data, which record household cigarette expenditures rather than individual cigarette consumption. Studies using survey data often lack time-series variation and estimate cigarette demand using household expenditure data, while studies using time-series aggregate sales data lack cross-sectional variation. I examine differences in the effects of cigarette price on the cigarette consumption of various income groups using individual-level cigarette consumption records from the Korea National Health and Nutrition Examination Survey (KHNNES). I also analyse the implications of cigarette taxes and price increases on the relative tax burdens of different income groups. I use pooled data from the KNHNES for the 1998-2011 period to estimate the price elasticity of cigarette consumption of four income groups. Treating cigarette consumption as a latent variable, I employ an econometric procedure that corrects for non-random sample selection, or the fact that some non-smokers might have smoked at a low enough price, and estimate the price elasticity of cigarette consumption by income group. The estimated price elasticities include the responsiveness of potential smokers as well as current smokers. Lower income Korean smokers are more responsive to changes in the price of cigarettes. While the overall price elasticity of cigarettes is estimated to be -0.425, the price elasticity of the lowest income quartile is estimated to be -0.812, whereas that of the highest income quartile is estimated to be -0.325. The estimated price elasticities of different income groups imply that the cigarette tax and price increases in Korea would reduce smoking more in those with lower incomes. For a given price increase, the percentage reduction in cigarette consumption among smokers in the lowest income quartile is 2.5 times greater than among smokers in the top income quartile. The simulated tax burdens of different income groups show that the additional burden of a tax increase and the associated price rise is largely borne by higher income smokers.

Choi SE 《-》

Impact of state cigarette taxes on disparities in maternal smoking during pregnancy.

Hawkins SS ，Baum CF 《-》