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May 31, 2014 Cigarette Prices and Smoking Prevalence After a Tobacco Tax Increase

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May 31, 2014 Cigarette Prices and Smoking Prevalence After a Tobacco Tax Increase Morbidity and Mortality Weekly Report Weekly / Vol. 63 / No. 21 May 30, 2014 Cigarette Prices and Smoking World No Tobacco Day — Prevalence After a Tobacco Tax May 31, 2014 Increase — Turkey, 2008 and 2012 The global tobacco epidemic contributed to 100 million Deliana Kostova, PhD1, Linda Andes, PhD1, Toker Erguder, MD2, deaths worldwide during the 20th century and continues to 2 3 3 kill nearly 6 million persons each year, including approxi- Ayda Yurekli, PhD , Bekir Keskinkılıç, MD , Sertaç Polat, MD , Gönül Çulha, MD3, Evin Aras Kilinç, MD3, Enver Taştı, MS4, mately 600,000 from secondhand smoke. If current trends Yılmaz Erşahin, MS4, Mehmet Özmen, MS4, Ramazan San, MS4, persist, an estimated 500 million persons alive today will Hilal Özcebe, MD, PhD5, Nazmi Bilir, MD, PhD5, die from the use of tobacco products. By 2030, tobacco use Samira Asma, DDS1 (Author affiliations at end of text) will result in approximately 8 million deaths worldwide each year. About 80% of these preventable deaths will occur in Raising the price of tobacco products has been shown to low- and middle-income countries (1,2). reduce tobacco consumption in the United States and other Sponsored by the World Health Organization and high-income countries, and evidence of this impact has been observed worldwide on May 31 each year, World No growing for low- and middle-income countries as well (1,2). Tobacco Day highlights the health risks of tobacco use and Turkey is a middle-income country surveyed by the Global promotes effective actions to reduce tobacco consumption. Adult Tobacco Survey (GATS) twice in a 4-year period, in This year, World No Tobacco Day calls on countries to 2008 and 2012. During this time, the country introduced a raise taxes on tobacco (2). policy raising its Special Consumption Tax on Tobacco and Increasing the price of tobacco products by raising tobacco implemented a comprehensive tobacco control program ban- taxes is one of the most powerful and cost-effective means ning smoking in public places, banning advertising, and intro- to prevent and reduce tobacco use, but it is an underused ducing graphic health warnings. The higher tobacco tax took strategy (3,4). Research shows that higher taxes can reduce effect in early 2010, allowing sufficient time for subsequent the relative affordability of tobacco products, encourage changes in prices and smoking to be observed by the time of smokers to quit, reduce cigarette consumption, and dis- the 2012 GATS. This report uses data from GATS Turkey courage young persons from smoking initiation. It also to examine how cigarette prices changed after the 2010 tax generates government revenues, which can be invested in increase, describe the temporally associated changes in smoking effective tobacco control efforts that will further reduce tobacco use (3,4). References INSIDE 1. Eriksen M, Mackay J, Ross H. The tobacco atlas. 4th ed. Atlanta, GA: 462 Million Hearts: Prevalence of Leading Cardiovascular American Cancer Society; New York, NY: World Lung Foundation; 2012. Disease Risk Factors — United States, 2005–2012 2. World Health Organization. World No Tobacco Day: 31 May 2014. 468 Progress Toward Polio Eradication — Worldwide, Geneva, Switzerland: World Health Organization; 2014. 3. International Agency for Research on Cancer. IARC handbooks of 2013–2014 cancer prevention, tobacco control. Volume 14: effectiveness of tax 473 Announcements and price policies for tobacco control. Lyon, France: International 474 QuickStats Agency for Research on Cancer; 2011. 4. World Health Organization. WHO report on the global tobacco epidemic, 2013: enforcing bans on tobacco advertising, promotion and sponsorship. Geneva, Switzerland: World Health Organization; 2013. Continuing Education examination available at http://www.cdc.gov/mmwr/cme/conted_info.html#weekly. U.S. Department of Health and Human Services Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report prevalence, and learn whether this smoking prevalence changed FIGURE. Average cigarette prices* (in Turkish lira) and smoking † more in some demographic groups than others. From 2008 to prevalence — Global Adult Tobacco Survey, Turkey, 2008 and 2012 2012, the average price paid for cigarettes increased by 42.1%, 6.0 32 cigarettes became less affordable, and smoking prevalence 30 decreased by 14.6% (Figure). The largest reduction in smoking 5.0 was observed among persons with lower socioeconomic status 28 (SES), highlighting the potential role of tax policy in reducing § 4.0 health disparities across socioeconomic groups. 26 Percentage GATS is an ongoing, nationally representative household survey of noninstitutionalized adults aged ≥15 years. The 3.0 24 survey uses a multistage geographically clustered sample 22 design. The indicators described in this report were obtained Price (Turkish lira) 2.0 by summarizing the individual responses of participants in 20 GATS Turkey 2008 (9,030 completed interviews) and 2012 1.0 (9,851 completed interviews). Response rates for GATS Turkey 18 were 90.1% in 2012 and 93.7% in 2008. Smoking prevalence estimates were based on self-reported current smoking, which 0.0 16 included both daily and less-than-daily smoking. Prices paid 2008 2012 2008 2012 Cigarette price Smoking prevalence per 20 cigarettes were calculated from the responses of current * Average price paid per 20 manufactured cigarettes in constant 2012 Turkish lira. smokers of manufactured cigarettes, which provide data on † Prevalence of current smoking of manufactured cigarettes. amounts spent and quantities purchased during the most recent § 95% confidence interval. cigarette purchase. Price indicators for 2008 were adjusted for inflation to be comparable with 2012 values. The cigarette education, and wealth. The wealth index category for each price indicators in this report are not brand-specific, but rep- respondent was created based on self-reported ownership of resent the average amount spent per 20 cigarettes across the certain core household items in GATS (3). range of brand choices in each year. The examined indicators Changes in cigarette affordability during the study period and their relative change from 2008 to 2012 were stratified were evaluated using the relative-income price of cigarettes, by demographic characteristics including sex, age, urbanicity, which represents prices adjusted for country income level (4). The MMWR series of publications is published by the Center for Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention (CDC), U.S. Department of Health and Human Services, Atlanta, GA 30329-4027. Suggested citation: [Author names; first three, then et al., if more than six.] [Report title]. MMWR 2014;63:[inclusive page numbers]. Centers for Disease Control and Prevention Thomas R. Frieden, MD, MPH, Director Harold W. Jaffe, MD, MA, Associate Director for Science Joanne Cono, MD, ScM, Director, Office of Science Quality Chesley L. Richards, MD, MPH, Deputy Director for Public Health Scientific Services Michael F. Iademarco, MD, MPH, Director, Center for Surveillance, Epidemiology, and Laboratory Services MMWR Editorial and Production Staff (Weekly) Charlotte K. Kent, PhD, MPH, Acting Editor-in-Chief Martha F. Boyd, Lead Visual Information Specialist John S. Moran, MD, MPH, Editor Maureen A. Leahy, Julia C. Martinroe, Teresa F. Rutledge, Managing Editor Stephen R. Spriggs, Terraye M. Starr Douglas W. Weatherwax, Lead Technical Writer-Editor Visual Information Specialists Donald G. Meadows, MA, Jude C. Rutledge, Writer-Editors Quang M. Doan, MBA, Phyllis H. King Information Technology Specialists MMWR Editorial Board William L. Roper, MD, MPH, Chapel Hill, NC, Chairman Matthew L. Boulton, MD, MPH, Ann Arbor, MI Timothy F. Jones, MD, Nashville, TN Virginia A. Caine, MD, Indianapolis, IN Rima F. Khabbaz, MD, Atlanta, GA Jonathan E. Fielding, MD, MPH, MBA, Los Angeles, CA Dennis G. Maki, MD, Madison, WI David W. Fleming, MD, Seattle, WA Patricia Quinlisk, MD, MPH, Des Moines, IA William E. Halperin, MD, DrPH, MPH, Newark, NJ Patrick L. Remington, MD, MPH, Madison, WI King K. Holmes, MD, PhD, Seattle, WA William Schaffner, MD, Nashville, TN 458 MMWR / May 30, 2014 / Vol. 63 / No. 21 Morbidity and Mortality Weekly Report The relative-income price was calculated as the ratio of the On average, cigarettes in Turkey became less affordable average price paid per 2,000 cigarettes in each GATS year to during 2008–2012. Cigarette affordability, represented by the that year’s gross domestic product (GDP) per capita (4). relative-income price, falls when the growth in cigarette prices After adjusting for inflation, the average real price paid per outpaces the growth in GDP per capita. The relative-income 20 cigarettes in Turkey increased by 42.1% during 2008–2012, price of cigarettes in Turkey increased by approximately 30% from 4.0 to 5.7 Turkish lira (Table 1). The increase in the pur- from 2008 to 2012 (Table 1), indicating that during this period chasing price varied across demographic groups; for instance, cigarette prices in Turkey increased faster than the country’s it was estimated to be smaller among younger smokers and per capita income, corresponding to a significant reduction among smokers with less wealth. As the cost of cigarettes in affordability. increased, the average smoking rate dropped by 14.6% dur- Discussion ing 2008–2012, from 30.1% to 25.7% (Table 2). The largest decrease in smoking occurred among persons of lower SES, After the 2010 increase in tobacco taxes in Turkey, the aver- who were in the lowest wealth and education categories age price paid for cigarettes increased, cigarettes became less (Table 2). The relative reduction in smoking among those in affordable, and a statistically significant drop in smoking rates the bottom tercile of the wealth index (-30.3%) was twice as occurred. The reduction in smoking was substantially larger large as among those in the middle wealth tercile (-13.9%), among persons with lower SES. These findings document the and nearly three times larger than among those in the top presence of an inverse relationship between cigarette prices wealth tercile (-11.1%).
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