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


What the CPSTF Found

About The Systematic Review

The CPSTF 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 CPSTF 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 CPSTF findings on increasing the unit price of tobacco to increase cessation pdf icon [PDF - 242 kB] and reduce initiation pdf icon [PDF - 221 kB].

Summary of Results

Detailed results from the systematic review are available in the CPSTF Finding and Rationale Statement pdf icon [PDF - 194 kB]

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).

Summary of 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).


  • Findings of the review should be broadly applicable to U.S. jurisdictions, populations, and intervention options.
  • In general, study samples were population-based, representative, and balanced for age (young people and adults) and gender.
  • A small number of studies targeted populations affected by health disparities which may be sensitive to changes in price, for example racial or ethnic minorities, or low income populations.

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the CPSTF recommendation is based.

Identified Evidence Gaps

Many studies from the updated search period evaluated the impact of specific intervention characteristics, but several questions remain for future research.


  • What are the effects of these interventions on other tobacco products besides cigarettes?
  • What are the effects of differential price, tax, and fee environments currently in place on the use of different tobacco products?
  • What are the effects of non-tax and non-fee price influencing interventions such as minimum price laws, coupon and voucher restrictions, and restrictions on price discount programs on tobacco use?
  • What are the synergistic effects between tobacco price interventions and revenue dedicated to support comprehensive tobacco prevention and control programs?


  • Are there additional data that evaluate the differences in price responsiveness by race and ethnicity?


  • What are the characteristics of local policies that successfully establish tobacco excise taxes and/or fees?


  • What are the costs associated with different tobacco policy (price) interventions?
  • What are the effects of tobacco product price increases on productivity?
  • What are the (estimated) economic effects of tobacco product price increases once differences in socio-economic status are accounted for?

Study Characteristics

Of the 116 included studies, 80 were conducted in the United States, and the remaining 36 evaluated price responsiveness of populations in other high-income countries.