Abstract
OBJECTIVES: To evaluate the impact of changes in cigarette taxes on smoking for youths aged 15–18 in Canada during the time of the Federal Tobacco Control Strategy (FTCS).
METHODS: We used a difference-in-differences framework and leveraged the variation in cigarette taxes across Canada and over time. We used regression models with province and year fixed effects, and individual-level and provincial-level covariates on 2002–2012 data from the Canadian Tobacco Use Monitoring Survey.
RESULTS: Tax increases generally did not affect smoking outcomes. Each increase of CAD $1.00 (adjusted to year 2000 dollars) in excise cigarette taxes per package of 20 was associated with a 0.2 percentage point (95% CI: −1.8; 2.2) change in smoking prevalence, and a change of 0.3 in mean cigarettes smoked in the past week (95% CI: −1.2; 1.8).
CONCLUSION: From 2002 to 2012, smoking prevalence and mean smoking frequency were in steady decline among youths in Canada. This decline, however, was evident even among provinces with stable or decreasing cigarette tax levels. Tobacco taxes have mostly increased since the 1980s, and so, tax levels were already quite high by the launch of the FTCS. Province fixed effects and common temporal changes accounted for 83.7% of the variation in smoking prevalence. We derived similar results for smoking frequency. The cumulative tax increase during our study period was at least $1.00 for only three provinces. Thus, our findings suggest that factors driving down tobacco use among youths in all provinces appear to outweigh any impact of small tax increases at already high tax levels.
Key Words: Tobacco, taxes, adolescent, smoking, Canada
Résumé
OBJECTIFS: Évaluer l’impact des changements aux taxes sur les cigarettes sur le tabagisme des jeunes de 15 à 18 ans au Canada à l’époque de la Stratégie fédérale de lutte contre le tabagisme (SFLCT).
MÉTHODE: Nous avons utilisé un cadre de différences dans la différence en nous servant de la variation des taxes sur les cigarettes à divers endroits du Canada et au fil du temps. Nous avons utilisé des modèles de régression à effets fixes pour la province et l’année et des covariables au niveau des particuliers et au niveau provincial pour les données 2002–2012 de l’Enquête de surveillance de l’usage du tabac au Canada.
RÉSULTATS: Les augmentations de taxes n’ont généralement pas eu d’effet sur le tabagisme. Chaque hausse de 1 $ CAN (en dollars de 2000) des taxes d’accise sur les cigarettes par paquet de 20 était associée à un changement de 0,2 point de pourcentage (IC de 95 %: −1,8; 2,2) dans la prévalence du tabagisme, et à un changement de 0,3 point de pourcentage dans le nombre moyen de cigarettes fumées au cours de la semaine antérieure (IC de 95 %: −1,2; 1,8).
CONCLUSION: De 2002 à 2012, la prévalence du tabagisme et la fréquence moyenne du tabagisme étaient en baisse soutenue chez les jeunes au Canada. Cette baisse s’est toutefois manifestée même dans les provinces où les niveaux de taxation des cigarettes ont été stables ou ont diminué. Les taxes sur le tabac ont principalement augmenté depuis les années 1980; les niveaux de taxation étaient donc déjà assez élevés lors du lancement de la SFLCT. Les effets fixes pour les provinces et les changements temporels courants ont représenté 83,7 % des variations de la prévalence du tabagisme. Nous avons dérivé des résultats semblables pour la fréquence du tabagisme. L’augmentation cumulée des taxes durant la période de l’étude a été d’au moins 1 $ dans trois provinces seulement. Nos constatations portent donc à croire que les facteurs à l’origine de la baisse du tabagisme chez les jeunes dans l’ensemble des provinces l’emportent sur tout effet de légères augmentations de taxes, ces taxes étant déjà à des niveaux élevés.
Mots Clés: tabac, impôts, adolescent, tabagisme, Canada
Footnotes
Statement of Funding: This study was supported by an operating grant TO3-120314 from the Canadian Institutes of Health Research.
Conflict of Interest: None to declare.
References
- 1.Health Canada. Federal Tobacco Control Strategy 2001–2011: Horizontal Evaluation Final Report. Ottawa, ON: Public Health Agency of Canada; 2012. [Google Scholar]
- 2.Minister of Justice. Tobacco Act. 1997. [Google Scholar]
- 3.Chaloupka FJ, Straif K, Leon ME. Effectiveness of tax and price policies in tobacco control. Tob Control. 2011;20(3):235–38. doi: 10.1136/tc.2010.039982. [DOI] [PubMed] [Google Scholar]
- 4.Chaloupka FJ. Maximizing the public health impact of alcohol and tobacco taxes. Am J Prev Med. 2013;44(5):561–62. doi: 10.1016/j.amepre.2013.02.008. [DOI] [PubMed] [Google Scholar]
- 5.Reid JL, Hammond D, Burkhalter R, Rynard VL, Ahmed R. Tobacco Use in Canada: Patterns and Trends. Waterloo, ON: Propel Centre for Population Health Impact, University of Waterloo; 2013. [Google Scholar]
- 6.Canadian Tax Foundation. Finances of the Nation. 2014. [Google Scholar]
- 7.Bader P, Boisclair D, Ferrence R. Effects of tobacco taxation and pricing on smoking behavior in high risk populations: A knowledge synthesis. Int J Environ Res Public Health. 2011;8:4118–39. doi: 10.3390/ijerph8114118. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 8.Thomas S, Fayter D, Misso K, Ogilvie D, Petticrew M, Sowden A, et al. Population tobacco control interventions and their effects on social inequalities in smoking: Systematic review. Tob Control. 2008;17(4):230–37. doi: 10.1136/tc.2007.023911. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 9.Wilson L A, Tang E, Chander G, Hutton HE, Odelola OA, Elf JL, et al. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: A systematic review. J Environ Public Health. 2012;2012:961724. doi: 10.1155/2012/961724. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 10.Azagba S, Sharaf M. Cigarette taxes and smoking participation: Evidence from recent tax increases in Canada. Int J Environ Res Public Health. 2011;8:1583–600. doi: 10.3390/ijerph8051583. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 11.Nghiem N, Wilson N, Genç M, Blakely T. Understanding price elasticities to inform public health research and intervention studies: Key issues. Am J Public Health. 2013;103(11):1954–61. doi: 10.2105/AJPH.2013.301337. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Gruber J, Sen A, Stabile M. Estimating price elasticities when there is smuggling: The sensitivity of smoking to price in Canada. J Health Econ. 2003;22(5):821–42. doi: 10.1016/S0167-6296(03)00058-4. [DOI] [PubMed] [Google Scholar]
- 13.Non-Smokers’ Rights Association. Provincial and Territorial Smoke-Free Legislation Summary. Toronto, ON: Non-Smokers’ Rights Association; 2012. [Google Scholar]
- 14.Canadian Cancer Society. Cigarette Package Health Warnings: International Status Report. Toronto, ON: Canadian Cancer Society; 2012. [Google Scholar]
- 15.Huang J, Chaloupka FJ, Fong GT. Cigarette graphic warning labels and smoking prevalence in Canada: A critical examination and reformulation of the FDA regulatory impact analysis. Tob Control. 2014;23(Suppl1):i7–12. doi: 10.1136/tobaccocontrol-2013-051170. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 16.Statistics Canada. Canadian Tobacco Use Monitoring Survey, Annual 1999–User Guide. 1999. [Google Scholar]
- 17.DeCicca P, McLeod L. Cigarette taxes and older adult smoking: Evidence from recent large tax increases. J Health Econ. 2008;27(4):918–29. doi: 10.1016/j.jhealeco.2007.11.005. [DOI] [PubMed] [Google Scholar]
- 18.DeCicca P, Kenkel D, Mathios A. Cigarette taxes and the transition from youth to adult smoking: Smoking initiation, cessation, and participation. J Health Econ. 2008;27:904–17. doi: 10.1016/j.jhealeco.2008.02.008. [DOI] [PubMed] [Google Scholar]
- 20.Statistics Canada. Table 282–0002–Labour Force Survey Estimates (LFS), by Sex and Detailed Age Group. 2014. [Google Scholar]
- 21.Irvine I, Nguyen HV. Retail Tobacco Display Bans. 2014. [DOI] [PubMed] [Google Scholar]
- 22.Cragg JG. Some statistical models for limited dependent variables with application to the demand for durable goods. Econometrica. 1971;39(5):829–44. doi: 10.2307/1909582. [DOI] [Google Scholar]
- 23.Belotti F, Deb P, Manning WG, Norton EC. twopm: Two-part models. Stata J. 2015;15(1):3–20. doi: 10.1177/1536867X1501500102. [DOI] [Google Scholar]
- 24.Korn EL, Graubard BI. Analysis of Health Surveys. Hoboken, NJ: John Wiley & Sons, Inc.; 1999. Sample weights and imputation. [Google Scholar]
- 25.Efron B, Tibshirani R. Bootstrap methods for standard errors, confidence intervals, and other measures of statistical accuracy. Stat Sci. 1986;1(1):54–75. doi: 10.1214/ss/1177013815. [DOI] [Google Scholar]
- 26.Statistics Canada. Canadian Tobacco Use Monitoring Survey, Annual 2011–User Guide. 2011. [Google Scholar]