Title: Understanding the impact of tobacco tax increases and tobacco industry pricing on smoking behaviours and inequalities
Funder: Department of Health (England)

Abstract: BACKGROUND:Tobacco tax increases are the most effective & cost effective means of reducing tobacco use & inequalities in smoking yet recent work identifies concerns that this study aims to address:the public health impacts of tax increases are being undermined by tobacco industry(TI) pricing strategies;government willingness to increase taxes is constrained by fear that tax increases prompt tax evasion & avoidance. AIM:To evaluate the public health effectiveness of tobacco tax increases in reducing tobacco use & inequalities in tobacco use & the extent to which this is undermined by TI pricing strategies.RESEARCH QUESTIONS1.To what extent does the TI transfer tobacco tax increases to consumers & does this differ by product/price segment?2.What impact do tobacco tax increases moderated by TI pricinghave on smokers’ behaviour(consumptionquittingswitching)?3.What are the characteristics of smokers using cheap tobaccowhat impact do tobacco tax increases & TI pricing have on smoking inequalities& can TI pricing explain widening smoking inequalities?4.Do cheap tobacco products provide a market entry route for young smokers?5.What are the trends in & nature of & what impact do tobacco tax increases have on smokers’particularly disadvantaged smokers’tax avoiding & evading behaviours? 6.How can we improve the effectiveness of tobacco taxation as a public health intervention?SETTING & TARGET POPULATION:All adult smokers(12.5 million)in the UK.NON-NHS INTERVENTION:Annual tobacco tax increases implemented by HM Treasury & moderated by TI pricing strategies. FUNDING:No intervention funding required.OUTCOME MEASURES:The primary outcome measure is tobacco use measured via:cigarette consumption;quitting;use of cheap legal products(cheap cigarettesroll-your-own(RYO) tobacco);switching between one price segment & another;tax evasion & avoidance.DATA &SAMPLE SIZES1.International Tobacco Control(ITC) Survey:longitudinal study of ~2000 UK smokers & recent ex-smokers with f/u since 2002. 8 waves of data (2002-10) already obtained. Waves 9 & 10(2013 & 2014) available for project.2.Smoking Toolkit Study(STS):monthly repeated cross-sectional survey of ~1800 adults in England2006-2015.3.2008-14 Nielsen brand specific tobacco product price & sales data covering 94% of UK sales.Sample sizes have adequate statistical power for our analyses. ANALYSES RQ1:Literature review of TI price segmentation;analysis of Nielsen data to determine current TI pricing of both manufactured cigarettes & RYO tobacco & the extent to which the TI transfers tobacco tax increases to consumers. RQ2:Analysis of ITC data to explore the impact of tobacco tax increases as moderated by TI pricing on smokers’ behaviour & whether behavioural choices differ by previous product/price choice. RQ3:Analysis of ITC data to determine the characteristics of smokers in each product/price segment; whether behavioural responses vary by socio-economic status & whether cheap product use is linked to widening inequalities.RQ4:Analysis of ITC & STS data to determine young people’s brand & product choices over time.RQ5:Analysis of ITC & STS data to examine trends in & the nature of tax evasion & avoidance & relationship with increases in tobacco taxation/price.RQ6:Policy recommendations based on synthesis of 1-5.POTENTIAL IMPACTS:Development of more effective tobacco taxation policy to significantly reduce tobacco use particularly among the least well off


Research activity codes: 3.1 PRIMARY PREVENTION INTERVENTIONS TO MODIFY BEHAVIOURS OR PROMOTE WELL-BEING
Health categories: STROKE;RESPIRATORY;CANCER AND NEOPLASMS;CARDIOVASCULAR