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Reducing Tobacco Use and Secondhand Smoke Exposure: Interventions to Increase the Unit Price for Tobacco Products

Task Force Finding

The Community Preventive Services Task Force recommends interventions that increase the unit price of tobacco products based on strong evidence of effectiveness in reducing tobacco use. Evidence is considered strong based on findings from studies demonstrating that increasing the price of tobacco products:

  • Reduces the total amount of tobacco consumed
  • Reduces the prevalence of tobacco use
  • Increases the number of tobacco users who quit
  • Reduces initiation of tobacco use among young people
  • Reduces tobacco-related morbidity and mortality

Public health effects are proportional to the size of the price increase and the scale of implementation. Based on results of the review on which this recommendation is based, an intervention that increases the unit price for tobacco products by 20% would reduce overall consumption of tobacco products by 10.4%, prevalence of adult tobacco use by 3.6%, and initiation of tobacco use by young people by 8.6%. Evidence also indicates these interventions are effective in reducing tobacco-related disparities among income groups and may reduce disparities by race and ethnicity. Economic evidence shows that raising the unit price of tobacco products substantially reduces healthcare costs and in addition can reduce productivity losses.

Read the full Task Force Finding and Rationale Statement for details including implementation issues, possible added benefits, potential harms, and evidence gaps.

Intervention Definition

Interventions to increase the unit price for tobacco products include public policies at the federal, state, or local level that increase the purchase price per unit of sale. The most common policy approach is legislation to increase the excise tax on tobacco products, though legislative actions and regulatory decisions may also be used to levy fees on tobacco products at the point of sale. Other policies that might influence tobacco product prices were not considered in this review.

About the Systematic Review

The Task Force finding is based on evidence from 116 studies, including 103 studies identified in two systematic reviews (IARC 2011, search period: 1982-February 2010; Wilson et al. 2012, search period: 1998-January 2012) combined with more recent evidence (13 studies, search period: 2009-July 2012). The systematic review was conducted on behalf of the Task Force by a team of specialists in systematic review methods, and in research, practice and policy related to tobacco use and secondhand smoke exposure. The finding updates and replaces two previous Task Force findings on increasing the unit price of tobacco to increase cessation and reduce initiation.

Results

Fifty-four of the included studies provided 90 measurements in the form of price elasticity. Effectiveness of the tobacco price interventions are captured by price elasticity estimates, which measure the change in quantity demanded corresponding to a 1% increase in price. For example, a price elasticity of demand of -0.25 means that a 20% increase in tobacco unit price would be expected to reduce tobacco demand by 5.0%.

Total demand estimates capture overall changes in both the use of tobacco products and the amount consumed.

Young people in this review refers to people under 30 years of age (youth: 13-18; young adults: 19-29), although individual studies used different age criteria.

  • Total Demand (changes in use and consumption of tobacco products)
    • A 20% increase in tobacco unit price would be associated with:
      • 7.4% median reduction in demand among adults (16 studies, median price elasticity estimate: -0.37; Interquartile Interval [IQI]: -0.47 to ‑0.29)
      • 14.8% median reduction in demand among young people (13 studies, median elasticity of -0.74; IQI: -1.13 to -0.57)
  • Prevalence of Tobacco Use
    • A 20% increase in tobacco unit price would be associated with:
      • 3.6% median reduction in the proportion of adults who use tobacco (26 studies, median elasticity of -0.18; IQI:-0.31 to -0.11)
      • 7.2% median reduction in the proportion of young adults who use tobacco (22 studies, median elasticity of -0.36; IQI: -0.73 to -0.24)
  • Cessation of Tobacco Use
    • A 20% increase in tobacco unit price would be associated with:
      • 6.5% increase in cessation among adults (1 study, elasticity=0.375)
      • 18.6% median increase in cessation among young people (5 studies, median elasticity of 0.93; IQI: 0.37 to 1.00)
  • Initiation of Tobacco Use
    • A 20% increase in tobacco unit price would be associated with:
      • 8.6% median reduction in initiation among young people (7 studies, median elasticity of -0.43; IQI: -0.90 to -0.00)

Sixty-two of the included studies provided other measurements of change regarding tobacco use and health outcomes.

  • Thirty-nine studies found generally favorable effects of a change in unit price:
    • Reduced total demand for tobacco products among adults and young people (6 of 7 studies)
    • Reduced smoking prevalence among adults and young people (8 of 11 studies)
    • Increased smoking cessation among adults and young people (10 of 11 studies)
    • Reduced smoking initiation among young people (6 of 10 studies)
  • Reductions in mortality rates from respiratory cancer and cardiovascular disease were seen in three studies that evaluated the effect of the intervention by modeling relationships with population-based data.
  • Thirteen studies generated elasticity estimates based on the excise tax, not the overall change in price.
    • Favorable effects were seen on total demand, prevalence, cessation, or initiation of tobacco use among adults and young people in nine studies; the remaining four studies showed mixed or no effects.
  • The remaining seven studies evaluated interventions by income and race/ethnicity and are included in the results below.

Fifteen of the included studies examined intervention effects on tobacco use by income and race/ethnicity.

  • Greater reductions in both total demand and prevalence of tobacco use were found among low-income tobacco users when compared with higher-income users (10 studies).
  • Studies that controlled for income differences showed price elasticity estimates for total demand and prevalence were greatest for Hispanics, followed by African-Americans, and white tobacco users (5 studies).

Economic Evidence

Eight studies were included in the review. Four studies were conducted within a U.S. context, three were set within a European environment, and one considered all high-income countries as a group. All studies used simulation to estimate changes in healthcare and productivity costs. Monetary values are reported in 2011 U.S. dollars.

Interventions that increase the unit price of tobacco products generate substantial healthcare cost savings and can also generate additional savings in the form of productivity losses averted.

  • Estimated healthcare costs savings from a 20% price increase for tobacco products ranged from -$0.14 to $90.02 per person per year (7 studies).
    • Four studies conducted in the U.S. found mean annual per capita healthcare (or healthcare and productivity) savings of $73.00.
    • Some studies included additional healthcare costs incurred by living longer after quitting (or avoiding initiation of) tobacco use.
  • Price increases were also associated with averted productivity losses (3 studies).

Supporting Materials

Publications

Contreary KA, Chattopadhyay SK, Hopkins DP, Chaloupka FJ, Forster JL, et al. Economic impact of tobacco price increases through taxation: a Community Guide systematic review Adobe PDF File [PDF - 277 kB]. American Journal of Preventive Medicine 2015;49(5):800-8.

Read other Community Guide publications about Reducing Tobacco Use and Secondhand Smoke Exposure in our library.

Promotional Materials

Community Guide News

More promotional materials for Community Guide reviews about Reducing Tobacco Use and Secondhand Smoke Exposure.

References

International Agency for Research on Cancer. IARC Handbooks of Cancer Prevention: Tobacco Control Volume 14. Effectiveness of price and tax policies for control of tobacco. Lyon, France: International Agency for Research on Cancer; 2011.

Wilson LM, Avila Tang E, Chander G, et al. Impact of tobacco control interventions on smoking initiation, cessation, and prevalence: a systematic review. Journal of Environmental and Public Health 2012;2012:1-36.




Disclaimer

The findings and conclusions on this page are those of the Community Preventive Services Task Force and do not necessarily represent those of CDC. Task Force evidence-based recommendations are not mandates for compliance or spending. Instead, they provide information and options for decision makers and stakeholders to consider when determining which programs, services, and policies best meet the needs, preferences, available resources, and constraints of their constituents.

Sample Citation

The content of publications of the Guide to Community Preventive Services is in the public domain. Citation as to source, however, is appreciated. Sample citation: Guide to Community Preventive Services. Reducing tobacco use and secondhand smoke exposure: interventions to increase the unit price for tobacco products. www.thecommunityguide.org/tobacco/increasingunitprice.html. Last updated: MM/DD/YYYY.

Review completed: November 2012