Impact of price and non-price policies on household cigarette consumption and nutrient intake in smoking-tolerant Indonesia

Abstract

ObjectiveTo examine the impact of cigarette price and smoking environment on allocation of household expenditure and its implication on nutrition consumption.DesignA cross-sectional study was conducted using the 2014 National Socioeconomic Survey (SUSENAS), the 2014 Village Potential Survey (PODES) and the 2013 Basic National Health Survey (RISKESDAS). SUSENAS and PODES data were collected by the Central Bureau of Statistics. RISKESDAS was conducted by National Institute of Health Research and Development (Balitbangkes), Indonesian Ministry of Health (MOH).Setting and participantsThe sample covered all districts in Indonesia; with sample size of 285 400 households. These households are grouped into low, medium and high smoking prevalence districts.Primary and secondary outcome measuresThe impact of cigarette price and smoking environment on household consumption of cigarette, share of eight food groups, as well as calorie and protein intake.Result1% increase in cigarette price will increase the cigarette budget share by 0.0737 points and reduce the budget share for eggs/milk, prepared food, staple food, nuts, fish/meat and fruit, from 0.0200 points (eggs/milk) up to 0.0033 points (fruit). Reallocation of household expenditure brings changes in food composition, resulting in declining calorie and protein intake. A 1% cigarette price increase reduces calorie and protein intake as much as 0.0885% and 0.1052%, respectively. On the other hand, existence of smoke-free areas and low smoking prevalence areas reduces the household budget for cigarettes.ConclusionA pricing policy must be accompanied by non-pricing policies to reduce cigarette budget share.

Cigarette Consumption and Nutrient Intake in Indonesia: Study of Cigarette-Consuming Households

“…2 shows that the average protein and energy intakes for lowest quintile are far below the MoH's RDA, this signifies that increasing cigarette consumption will further attenuate poorest households in meeting the recommended dietary allowance. This is consistent with the previous study finding in Indonesian context that the increase in cigarette consumption decreases household's allocation for food spending (Djutaharta et al, 2021).…”

“…Our findings also implied that cigarette consumption has a very high opportunity cost to household's food consumption. Due to budget constraints, higher spending on cigarette will decrease food consumption, especially among poorer households (Nugent et al, 2018;Djutaharta et al, 2021). While poorer households are more sensitive to food insecurity (Yaktiworo et al, 2017), a small decrease of food expenditure could have a substantial impact on poor household nutrition adequacy.…”

“…γ 1 is our parameter of interest capturing the possible relationship between cigarette consumption and nutrition adequacy. While the increase of household spending allocated for cigarette reduces the allocation of expenditure for remaining essential food items (Djutaharta et al, 2021), we expected that cigarette consumption would subsequently reduce household nutrition adequacy. Therefore, we expected the sign of γ 1 to be negative.…”

Factors Associated with Expenditure on Animal Protein among Indonesian Households

“…This is consistent with earlier research that found smoking has a negative effect on protein intake 31 . Another study also reports reduced budget allocations for eggs, milk, and meat due to increased cigarette use 32 . In other words, because of redistributing household expenses, dietary composition changes and protein intake decline.…”

Crowding-out effect of tobacco consumption in Indonesia

“…Previous studies have indicated that poor smoking households in Indonesia divert a substantial portion of an already limited resource to tobacco, reducing their dietary quantity and quality and consequently contributing to a lower nutritional intake among the smoking families. [4][5][6] Over the long run, this crowding-out effect might adversely affect human capital investment, as studies have shown that children living in smoking families in Indonesia are exposed to a higher risk of stunting. 7 The crowding-out effect of tobacco spending has been widely documented in other countries, such as India, Pakistan, Cambodia, Bangladesh, Turkey, South Africa, Zambia, Serbia and Vietnam.…”