How Do Price Minimizing Behaviors Impact Smoking Cessation? Findings from the International Tobacco Control (ITC) Four Country Survey

Abstract

This paper examines how price minimizing behaviors impact efforts to stop smoking. Data on 4,988 participants from the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey who were smokers at baseline (wave 5) and interviewed at a 1 year follow-up were used. We examined whether price minimizing behaviors at baseline predicted: (1) cessation, (2) quit attempts, and (3) successful quit attempts at one year follow up using multivariate logistic regression modeling. A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation. Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes. Smokers who engaged in any price/tax avoidance behaviors were 28% less likely to report cessation. Persons using low/untaxed sources were less likely to quit at follow up, those purchasing cartons were less likely to make quit attempts and quit, and those using discount cigarettes were less likely to succeed, conditional on making attempts. Respondents who utilized multiple behaviors simultaneously were less likely to make quit attempts and to succeed. SES did not modify the effects of price minimizing behaviors on cessation outcomes. The data from this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at to reduce reducing smoking prevalence through price and tax increases among all SES groups.

Cigarette Price Minimization Strategies in the United States: Price Reductions and Responsiveness to Excise Taxes

“…Similarly, individuals of low socioeconomic status (both low education attainment and low income) appear more likely to practice some uncontrolled price minimization strategies, which may include purchasing discount or deep discount cigarettes. This finding helps to rectify a discrepancy in the literature regarding if low socioeconomic status individuals practice cigarette price minimization strategies less frequently (Pesko et al, 2012) or more frequently than high socioeconomic status individuals (Choi et al, 2012;Licht et al, 2011). Including usage of discounted cigarettes is important in future research that analyzes the use of cigarette price minimization strategies by age or socioeconomic status.…”

“…This decrease may be a result of some potential smokers choosing not to smoke and more successful quit attempts among current smokers (Chaloupka et al, 2002;Chaloupka & Warner, 1999;Frieden et al, 2005;Hyland et al, 2005Hyland et al, , 2006Levy et al, 2000;Lewitt & Coate, 1982;Licht et al, 2011;McGoldrick & Boonn, 2010). Unfortunately, not all smokers will respond beneficially to tax increases, and some will continue their usual smoking behaviors by either using compensatory price minimization strategies (Choi, Hennrikus, Forster, & St Claire, 2012;DeCicca, Kenkel, & Liu, 2010;Fong et al, 2006;Frieden et al, 2005;Goolsble, Lovenheim, & Slemrod, 2010;Hyland, Higbee, Bauer, Giovino, & Cummings, 2004;Hyland et al, 2005Hyland et al, , 2006Licht et al, 2011;Pesko, Kruger, & Hyland, 2012; U.S. Department of Health and Human Services, 2000;White, Gilpin, White, & Pierce, 2005) or paying higher prices. Use of price minimization strategies, thus, mitigates the positive public health impact of cigarette price increases.…”

“…Use of price minimization strategies, thus, mitigates the positive public health impact of cigarette price increases. Such strategies include purchasing discount or deep discount brands, utilizing price promotions such as coupons, purchasing in cartons, purchasing from low or untaxed sources, and purchasing roll-your-own cigarettes (Frieden et al, 2005;Hanewinkel & Isensee, 2007;Hanewinkel, Radden, & Rosenkranz, 2008;Hyland et al, 2005Hyland et al, , 2006Kengganpanich, Termsirikulchai, & Benjakul, 2009;Licht et al, 2011;Luk et al, 2009;Shelley, Cantrell, Moon-Howard, Ramjohn, & VanDevanter, 2007).…”

“…However, these studies did not estimate price reductions from individual strategies while controlling for overlapping strategies. Given that individuals are likely to practice multiple price minimization strategies concurrently (Choi et al, 2012;Licht et al, 2011;White et al, 2005), price reductions may be overestimated for any individual strategy if not controlling for overlapping strategies. Independent estimates of the price reductions, which compensate for overlapping strategies where possible, are important to provide more accurate information in the ongoing policy debates surrounding cigarette price minimization strategies.…”

Association between use of contraband tobacco and smoking cessation outcomes: a population-based cohort study

“…28 A study conducted in 2 US counties located near American Indian reservations found that smokers who bought cigarettes on reserve were half as likely to attempt to quit, with a trend toward decreased cessation. 26 Previous literature using data from the International Tobacco Control study found that people purchasing low-tax or untaxed cigarettes were about 30% less likely to report attempting to quit, with no effect found on cessation.…”