The impact of tobacco tax increases on cost-minimising behaviours and subsequent smoking cessation in Australia: an analysis of the International Tobacco Control Policy Evaluation Project

Ara Cho; Michelle Scollo; Gary Chan; Pete Driezen; Andrew Hyland; Ce Shang; Coral E Gartner

doi:10.1136/tc-2024-058776

The impact of tobacco tax increases on cost-minimising behaviours and subsequent smoking cessation in Australia: an analysis of the International Tobacco Control Policy Evaluation Project

Tob Control. 2024 Aug 27:tc-2024-058776. doi: 10.1136/tc-2024-058776. Online ahead of print.

Authors

Ara Cho^{1

2}, Michelle Scollo³, Gary Chan⁴, Pete Driezen⁵, Andrew Hyland⁶, Ce Shang⁷, Coral E Gartner²

Affiliations

¹ Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia [email protected].
² The NHMRC Centre of Research Excellence on Achieving the Tobacco Endgame, School of Public Health, The University of Queensland, Herston, Queensland, Australia.
³ Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia.
⁴ Centre for Youth Substance Abuse Research, University of Queensland, Brisbane, Queensland, Australia.
⁵ Department of Psychology, University of Waterloo, Waterloo, Ontario, Canada.
⁶ Department of Health Behavior, Roswell Park Cancer Institute, Buffalo, New York, USA.
⁷ Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA.

PMID: 39191503
DOI: 10.1136/tc-2024-058776

Abstract

Objective: We examined the relationship in Australia from 2007 to 2020 between tobacco tax increases and use of cost-minimising behaviours (CMBs) when purchasing tobacco and: (1) tobacco expenditure and (2) smoking cessation attempts and quit success.

Methods: We used data collected from adults who smoked factory-made and/or roll-your-own (RYO) cigarettes in nine waves (2007-2020) of the International Tobacco Control Policy Evaluation Project Australia Survey (N_sample=4975, N_observations=10 474). CMBs included buying RYO tobacco, cartons, large-sized packs, economy packs, or tax avoidance/evasion, smoking reduction and e-cigarette use. Logistic regression, fit using generalised estimating equations, estimated the CMB-outcome association for quit attempts and quit success at the next wave follow-up (N_subsample=2984, N_observations=6843).

Results: Over half of respondents used a CMB for tobacco purchase (P-CMB) at baseline (57.1% in 2007-2008), increasing to 76.8% (2018) post-tax increases. Participating in any P-CMB was associated with having higher weekly tobacco expenditure. Engaging in any P-CMB was negatively associated with attempting to quit (aOR=0.82, 95% CI 0.69-0.98). Purchasing RYO tobacco or cartons was associated with making no quit attempts (aOR=0.66, 95% CI 0.52-0.83; aOR=0.72, 95% CI 0.59-0.89, respectively). Among respondents smoking cigarettes who made quit attempts, there were no significant associations between all P-CMBs and quit success. Neither smoking reduction nor vaping were significantly associated with quit attempts.

Conclusion: P-CMBs are associated with reduced smoking cessation. Reducing opportunities for industry to promote purchasing-related CMB options, such as by standardising pack sizes and reducing the price differential between RYO and manufactured cigarettes could increase the effectiveness of tax increases.

Keywords: Addiction; Cessation; Hand-rolled/RYO tobacco; Price; Taxation.