**Table 1 – Tobacco Prevalence, by Age and Sex, %**

|_Age_|_Men_|_Women_|_Total_|
|---|---|---|---|
|18–29|45|7.4|27|
|30–44|48|6.6|29|
|45–59|42|4.0|22|
|60–69|31|1.8|16|
|18–69|44|5.6|25|

_Source:_ World Health Organization, 2014, “Prevalence of Noncommunicable Disease Risk Factors in the Republic of Moldova, STEPS 2013,” Regional Office for Europe, World Health Organization, Copenhagen.

Other surveys have been designed to assess tobacco use in Moldova, though their results are not necessarily comparable as they use different questionnnaires and sample frames. Nonetheless, results are aligned with the WHO findings. According to Krasovsky (2016),[29] the 2005 Moldova Demographic and Health Survey (DHS) indicates that 51.1 percent of men (between 15 and 59 years old) and 7.1 percent of women (between 15 and 49 years old) were current smokers, whereas the 2012 Multiple Indicator Cluster Survey (MICS) showed that 48.5 percent of men (between 15 and 49 years old) and 8.2 percent of women (between 15 and 49 years old) smoked. Finally, a national cross-sectional survey on risk factors of noncommunicable diseases conducted between September 2013 and May 2014 showed that among men 15 years and older, 43.6 percent smoked (and 40.6 percent were dailty smokers) and 5.6 percent of women smoked (with 4.6 percent being daily smokers).

# **Deaths attributable to tobacco**

Several health conditions and causes of death are attributable to tobacco consumption. In the European region of the World Health Organization (WHO), tobacco accounts for 297 age-adjusted deaths per 100,000 population, less than half relative to Moldova. In Moldova, the tobacco-attributed mortality rate narrowed from 763 age-standardized deaths per 100,000 population in 2010 to 613 in 2015, similar to the rate in Ukraine in 2004[28]. Tobacco-attributed deaths represent more than 50 percent of the total age-adjusted deaths in Moldova.

# **4. The Model**

The study estimates the impact of the tobacco tax in Moldova using an extended cost-benefit analysis, similar to the approach of other studies described in the literature.[25, 30] It estimates how tobacco taxes would change household incomes through an analysis of two factors: (1) the rise in tobacco expenditures because of the tax increase and (2) the reduction in medical expenses because of less tobacco consumption. The aggregated effect of the tax policy is estimated as follows: Income effect = change in tobacco expenditure (A) + lower medical expenses (B) (1) The study baseline scenario is derived from the 2015 household budget survey. The survey is used to measure general consumption and tobacco consumption. Data limitations do not allow a simulation of the exact price increases by brand, but this may be accomplished through the aggregate prices paid by households.

A partial equilibrium model allows the distributional effects of the tobacco tax to be assessed, resulting in an estimation of the first-order effects of these policies. The study then uses a partial equilibrium approach and evaluates the change in prices by relying mainly on household expenditure patterns. This implies that only the first-order response is being assessed and that additional behavioral changes among economic agents, such as the increase in the consumption of other goods, are not included. These assumptions imply that the model uses 5