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1.
Int J Behav Nutr Phys Act ; 20(1): 84, 2023 07 10.
Artigo em Inglês | MEDLINE | ID: mdl-37430305

RESUMO

BACKGROUND: The food system has a dynamic influence on disparities in food security and diet-related chronic disease. Community supported agriculture (CSA) programs, in which households receive weekly shares of produce from a local farmer during the growing season, have been examined as a possible food systems-based approach for improving diet and health outcomes. The purpose of this study was to estimate the cost of implementing and participating in a multi-component subsidized community supported agriculture intervention and calculate cost-effectiveness based on diet and food security impacts. METHODS: Using data from the Farm Fresh Foods for Healthy Kids (F3HK) randomized controlled trial in New York, North Carolina, Vermont, and Washington (n = 305; 2016-2018), we estimated programmatic and participant costs and calculated incremental cost-effectiveness ratios (ICERs) for caregivers' daily fruit and vegetable (FV) intake, skin carotenoids, and household food security from program and societal perspectives. RESULTS: F3HK cost $2,439 per household annually ($1,884 in implementation-related expenses and $555 in participant-incurred costs). ICERs ranged from $1,507 to $2,439 per cup increase in caregiver's FV intake (depending on perspective, setting, and inclusion of juice); from $502 to $739 per one thousand unit increase in skin carotenoid score; and from $2,271 to $3,137 per household shifted out of food insecurity. CONCLUSIONS: Given the known public health, healthcare, and economic consequences of insufficient FV intake and living in a food insecure household, the costs incurred to support these positive shifts in individual- and household-level outcomes via a F3HK-like intervention may be deemed by stakeholders as a reasonable investment. This work helps to advance a critical body of literature on the cost-effectiveness of subsidized CSAs and other economic and food system interventions for the sake of evidence-based allocation of public health resources. TRIAL REGISTRATION: ClinicalTrials.gov. NCT02770196. Registered 5 April 2016. Retrospectively registered. https://www. CLINICALTRIALS: gov/ct2/show/NCT02770196 .


Assuntos
Agricultura , Análise de Custo-Efetividade , Humanos , Carotenoides , Custos e Análise de Custo , Pobreza , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
J Econ Lit ; 60(3): 883-970, 2022 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-37075070

RESUMO

Tobacco regulation has been a major component of health policy in the developed world since the UK Royal College of Physicians' and the US Surgeon General's reports in the 1960s. Such regulation, which has intensified in the past two decades, includes cigarette taxation, place-based smoking bans in areas ranging from bars and restaurants to workplaces, and regulations designed to make tobacco products less desirable. More recently, the availability of alternative products, most notably e-cigarettes, has increased dramatically, and these products are just starting to be regulated. Despite an extensive body of research on tobacco regulations, there remains substantial debate regarding their effectiveness, and ultimately, their impact on economic welfare. We provide the first comprehensive review of the state of research in the economics of tobacco regulation in two decades.

3.
Health Econ ; 29(11): 1364-1377, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32779278

RESUMO

Electronic cigarettes are a less harmful alternative to combustible cigarettes. We analyze data on e-cigarette choices in an online experimental market. Our data and mixed logit model capture two sources of consumer optimization errors: overestimates of the relative risks of e-cigarettes and present bias. Our novel data and policy analysis make three contributions. First, our predictions about e-cigarette use under counterfactual policy scenarios provide new information about current regulatory tradeoffs. Second, we provide empirical evidence about the role consumer optimization errors play in tobacco product choices. Third, we contribute to behavioral welfare analysis of policies that address individual optimization errors. Compared with standard cost-benefit analysis, our behavioral welfare economics analysis leads to much larger estimates of the costs of policies that discourage e-cigarette use or the benefits of policies that encourage e-cigarette use.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Produtos do Tabaco , Humanos , Política Pública
4.
BMC Health Serv Res ; 19(1): 315, 2019 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-31096977

RESUMO

BACKGROUND: Rural women experience health disparities in terms of cardiovascular disease (CVD) risk compared to urban women. Cost-effective CVD-prevention programs are needed for this population. The objective of this study was to conduct cost analysis and cost-effectiveness analyses (CEAs) of the Strong Hearts, Healthy Communities (SHHC) program compared to a control program in terms of change in CVD risk factors, including body weight and quality-adjusted life years (QALYs). METHODS: Sixteen medically underserved rural towns in Montana and New York were randomly assigned to SHHC, a six-month twice-weekly experiential learning lifestyle program focused predominantly on diet and physical activity behaviors (n = 101), or a monthly healthy lifestyle education-only control program (n = 93). Females who were sedentary, overweight or obese, and aged 40 years or older were enrolled. The cost analysis calculated the total and per participant resource costs as well as participants' costs for the SHHC and control programs. In the intermediate health outcomes CEAs, the incremental costs were compared to the incremental changes in the outcomes. The QALY CEA compares the incremental costs and effectiveness of a national SHHC intervention for a hypothetical cohort of 2.2 million women compared to the status quo alternative. RESULTS: The resource cost of SHHC was $775 per participant. The incremental cost-effectiveness ratios from the payer's perspective was $360 per kg of weight loss. Over a 10-year time horizon, to avert per QALY lost SHHC is estimated to cost $238,271 from the societal perspective, but only $62,646 from the healthcare sector perspective. Probabilistic sensitivity analyses show considerable uncertainty in the estimated incremental cost-effectiveness ratios. CONCLUSIONS: A national SHHC intervention is likely to be cost-effective at willingness-to-pay thresholds based on guidelines for federal regulatory impact analysis, but may not be at commonly used lower threshold values. However, it is possible that program costs in rural areas are higher than previously studied programs in more urban areas, due to a lack of staff and physical activity resources as well as  availability for partnerships with existing organizations. TRIAL REGISTRATION: ClinicalTrials.gov identifier NCT02499731 , registered on July 16, 2015.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Análise Custo-Benefício , Serviços Preventivos de Saúde/economia , Serviços de Saúde Rural/economia , Adulto , Idoso , Doenças Cardiovasculares/economia , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Montana , New York , Sobrepeso , Anos de Vida Ajustados por Qualidade de Vida , Fatores de Risco , Redução de Peso
5.
Health Econ ; 25(4): 424-38, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-25721732

RESUMO

In this study, we use the Health and Retirement Study to test whether older adult smokers, defined as those 50 years and older, respond to cigarette tax increases. Our preferred specifications show that older adult smokers respond modestly to tax increases: a $1.00 (131.6%) tax increase leads to a 3.8-5.2% reduction in cigarettes smoked per day (implied tax elasticity = -0.03 to -0.04). We identify heterogeneity in tax elasticity across demographic groups as defined by sex, race/ethnicity, education, and marital status and by smoking intensity and level of addictive stock. These findings have implications for public health policy implementation in an aging population.


Assuntos
Fumar/economia , Impostos/legislação & jurisprudência , Produtos do Tabaco/economia , Fatores Etários , Idoso , Comportamento do Consumidor/economia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fumar/epidemiologia , Produtos do Tabaco/legislação & jurisprudência , Estados Unidos/epidemiologia
6.
J Natl Cancer Inst Monogr ; 2022(59): 28-41, 2022 07 05.
Artigo em Inglês | MEDLINE | ID: mdl-35788376

RESUMO

In the past 2 decades, the demand for information on health economics research to guide health care decision making has substantially increased. Studies have provided evidence that eliminating or reducing tobacco use; eating a healthy diet, including fruit and vegetables; being physically active; reducing alcohol consumption; avoiding ultraviolet radiation; and minimizing exposure to environmental and occupational carcinogenic agents should substantially reduce cancer incidence in the population. The benefits of these primary prevention measures in reducing cancer incidence are not instantaneous. Therefore, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention. This article provides an overview of health economics research related to primary prevention of cancer. We addressed the following questions: 1) What are the gaps and unmet needs for performing health economics research focused on primary prevention of cancer? 2) What are the challenges and opportunities to conducting health economics research to evaluate primary prevention of cancer? and 3) What are the future directions for enhancing health economics research on primary prevention of cancer? Modeling primary prevention of cancer is often difficult given data limitations, long delays before the policy or intervention is effective, possible unintended effects of the policy or intervention, and the necessity of outside expertise to understand key inputs or outputs to the modeling. Despite these challenges, health economics research has an important role to play in providing credible information to decision makers on the health and economic benefits of primary prevention of cancer.


Assuntos
Neoplasias , Raios Ultravioleta , Economia Médica , Humanos , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Neoplasias/etiologia , Prevenção Primária , Uso de Tabaco
7.
J Health Econ ; 79: 102512, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34428632

RESUMO

We exploit a quasi-experiment created when New York State began in 2011 to tax cigarettes sold on Native American Reservations. The regime change represents a unique opportunity to quantify brand loyalty because it almost doubled the price of premium-brand cigarettes, while Native brands were still untaxed. We use data from two different sources-the New York State Adult Tobacco Survey and the Nielsen Homescan Panel. We find that the increase in relative prices led to substantial declines in premium cigarette purchases. However, even among the premium consumers with the most to gain from switching, about three-quarters remained brand loyal.


Assuntos
Impostos , Produtos do Tabaco , Adulto , Comércio , Comportamento do Consumidor , Humanos , Fumar/epidemiologia
8.
J Risk Uncertain ; 60(3): 281-307, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34504389

RESUMO

We study the impact of new information on people's perceptions of the risks of e-cigarettes. In September 2019 the U.S. experienced an outbreak of e-cigarette, or vaping, associated lung injuries (EVALI). The EVALI outbreak created an information shock, which was followed by additional new information in a later CDC recommendation. We use data on consumer risk perceptions from two sets of surveys conducted before (HINTS survey data) and during the EVALI outbreak (Google Survey data). The empirical model examines changes in risk perceptions during the early crisis period when the CDC was warning consumers that they should avoid all vaping products and during a later period when the message was refined and focused on a narrower set of illegal vaping products that contain THC (the main psychoactive compound in marijuana). Econometric results suggest that the immediate impact of the first information shock was to significantly increase the fraction of respondents who perceived e-cigarettes as more harmful than smoking. As the outbreak subsided and the CDC recommendation changed to emphasize the role of THC e-cigarette products, e-cigarette risk perceptions were only partially revised downwards. Individuals who had higher risk perceptions showed a weaker response to the first information shock but were more likely to later revise their risk perceptions downwards. We conclude the paper by discussing the public policy issues that stem from having risk perceptions of e-cigarette relative to combustible cigarettes remain at these elevated levels where a substantial portion of consumers believe that e-cigarettes are more harmful than cigarettes.

9.
J Health Econ ; 68: 102227, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31581026

RESUMO

We provide the first causal evidence on whether e-cigarette advertising on television and in magazines encourages adult smokers to quit. We find the answer to be yes for TV advertising but no for magazine advertising. Our results indicate that a policy banning TV advertising of e-cigs would have reduced the number of smokers who quit in the recent past by approximately 3%. If the FDA were not considering regulations and mandates, e-cig ads might have reached the number of nicotine replacement therapy TV ads during that period. That would have increased the number of smokers who quit by around 10%.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina , Motivação , Abandono do Hábito de Fumar , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fumantes , Adulto Jovem
11.
Soc Sci Med ; 64(12): 2504-19, 2007 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-17418470

RESUMO

Although the prevalence of smoking has declined among US adults, an estimated 22.5% of the adult population (45.8 million adults) regularly smoked in 2002. Starting from this level, it will not be possible to achieve the Healthy People national health objectives of a reduction in the prevalence of smoking among adults to less than 12% by 2010 unless the rate of smoking cessation substantially rises from its current average of about 2.5%/year. To achieve that goal it is imperative that we better understand what factors are associated with successful quitting so that policies and resources can be better targeted. We describe the socioeconomic characteristics of smokers who attempt to and successfully quit and show how those characteristics differ across three methods they use in their cessation behavior. The results highlight socioeconomic differences across the methods smokers use and provide evidence that can be used to better target smoking cessation information and resources to smokers most likely to use particular methods. Better targeting is likely to lead to more quits. While it is unlikely that cessation rates can be raised by enough to achieve the reduction in national smoking prevalence that the Healthy People initiative has set, a better understanding of who chooses which method will move us closer to that goal.


Assuntos
Abandono do Hábito de Fumar , Classe Social , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Estados Unidos
12.
Food Nutr Bull ; 28(4 Suppl): S572-84, 2007 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-18297895

RESUMO

High iron needs and low-iron diets combine to make early childhood one of the highest risk periods for iron deficiency. Recommendations for iron supplementation for this age group have been based on positive effects on anemia and child development. In contrast, the evidence regarding growth and morbidity outcomes has been equivocal, with some evidence of risk. The new evidence from Nepal and Zanzibar is reviewed, and possible interpretations are discussed. The Zanzibar trial found significant adverse effects in the overall population with poor malaria services and substantial benefit to iron-deficient children (the majority) in an area where access to treatments was provided. Cost-effectiveness analysis suggests that targeting supplements to iron-deficient children in Zanzibar may not increase costs (relative to universal supplementation) and would increase benefit. Operations research is needed to test this. We conclude with three options for maximizing the benefits and minimizing the risks of iron supplements.


Assuntos
Anemia Ferropriva/tratamento farmacológico , Desenvolvimento Infantil/efeitos dos fármacos , Suplementos Nutricionais , Deficiências de Ferro , Ferro/administração & dosagem , Anemia Ferropriva/epidemiologia , Criança , Desenvolvimento Infantil/fisiologia , Pré-Escolar , Análise Custo-Benefício , Medicina Baseada em Evidências , Feminino , Humanos , Lactente , Ferro/efeitos adversos , Ferro/economia , Malária/epidemiologia , Malária/mortalidade , Masculino , Nepal/epidemiologia , Necessidades Nutricionais , Tanzânia/epidemiologia , Resultado do Tratamento
13.
Am J Prev Med ; 50(5 Suppl 1): S20-S26, 2016 05.
Artigo em Inglês | MEDLINE | ID: mdl-27102854

RESUMO

The question of how to evaluate lost consumer surplus in benefit-cost analyses has been contentious. There are clear health benefits of regulations that curb consumption of goods with health risks, such as tobacco products and foods high in fats, calories, sugar, and sodium. Yet, if regulations cause consumers to give up goods they like, the health benefits they experience may be offset by some utility loss, which benefit-cost analyses of regulations need to take into account. This paper lays out the complications of measuring benefits of regulations aiming to curb consumption of addictive and habitual goods, rooted in the fact that consumers' observed demand for such goods may not be in line with their true preferences. Focusing on the important case of tobacco products, the paper describes four possible approaches for estimating benefits when consumers' preferences may not be aligned with their behavior, and identifies one as having the best feasibility for use in applied benefit-cost analyses in the near term.


Assuntos
Comportamento Aditivo/economia , Análise Custo-Benefício/métodos , Modelos Econômicos , Controle Social Formal , Comportamento Aditivo/prevenção & controle , Humanos , Fumar/efeitos adversos , Fumar/economia , Abandono do Hábito de Fumar/economia , Produtos do Tabaco/economia
14.
Addiction ; 111(4): 734-44, 2016 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-26639526

RESUMO

AIMS: To estimate the effect of potential regulations of electronic nicotine delivery systems (ENDS) among adult smokers, including increasing taxes, reducing flavor availability and adding warning labels communicating various levels of risk. DESIGN: We performed a discrete choice experiment (DCE) among a national sample of 1200 adult smokers. We examined heterogeneity in policy responses by age, cigarette quitting interest and current ENDS use. Our experiment overlapped January 2015 by design, providing exogenous variation in cigarette quitting interest from New Year resolutions. SETTING: KnowledgePanel, an online panel of recruited respondents. PARTICIPANTS: A total of 1200 adult smokers from the United States. MEASUREMENTS: Hypothetical purchase choice of cigarettes, nicotine replacement therapy and a disposable ENDS. FINDINGS: Increasing ENDS prices from $3 to $6 was associated with a 13.6 percentage point reduction in ENDS selection (P < 0.001). Restricting flavor availability in ENDS to tobacco and menthol was associated with a 2.1 percentage point reduction in ENDS selection (P < 0.001). The proposed Food and Drug Administration (FDA) warning label was associated with a 1.1 percentage point reduction in ENDS selection (P < 0.05) and the MarkTen warning label with a 5.1 percentage point reduction (P < 0.001). We estimated an ENDS price elasticity of -1.8 (P < 0.001) among adult smokers. Statistically significant interaction terms (P < 0.001) imply that price responsiveness was higher among adult smokers 18-24 years of age, smokers who have vaped over the last month and smokers with above the median quitting interest. Young adult smokers were 3.7 percentage points more likely to choose ENDS when multiple flavors were available than older adults (P < 0.001). Young adult smokers and those with above the median cigarette quitting interest were also more likely to reduce cigarette selection and increase ENDS selection in January 2015 (P < 0.001), potentially in response to New Year's resolutions to quit smoking. CONCLUSIONS: Increased taxes, a proposed US Food and Drug Administration warning label for electronic nicotine delivery systems and a more severe warning label may discourage adult smokers from switching to electronic nicotine delivery systems. Reducing the availability of flavors may reduce ENDS use by young adult smokers.


Assuntos
Sistemas Eletrônicos de Liberação de Nicotina/legislação & jurisprudência , Sistemas Eletrônicos de Liberação de Nicotina/estatística & dados numéricos , Nicotina/administração & dosagem , Produtos do Tabaco/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Rotulagem de Medicamentos/legislação & jurisprudência , Sistemas Eletrônicos de Liberação de Nicotina/economia , Feminino , Aromatizantes , Humanos , Masculino , Nicotina/economia , Produtos do Tabaco/economia , Dispositivos para o Abandono do Uso de Tabaco/economia , Dispositivos para o Abandono do Uso de Tabaco/estatística & dados numéricos , Estados Unidos , Adulto Jovem
15.
Am J Health Promot ; 19(3 Suppl): 238-48, 2005.
Artigo em Inglês | MEDLINE | ID: mdl-15675538

RESUMO

PURPOSE: To examine the relationship between health risks and medical care expenditures in an employer setting in Japan. DESIGN: A cross-sectional, correlational study. SETTING: A large Japanese corporation. SUBJECTS: A total of 6543 employees of a large Japanese electronics company, for whom medical expenditures, lifestyle risks and biometric data were available, were included in the analysis. Seventy-six Percent were male, and subjects were primarily white-collar workers. MEASURES: Medical expenditure data were available for fiscal year 2000, including inpatient, outpatient, and total expenditures, measured in Japanese yen. Binary expenditure indicators for those having no claims and those having high claims (90th percentile) were also created. Risk measures included biometric assessment of high blood pressure and high body mass index (BMI, body weight and height) and self-reported stress, lack of exercise, excess alcohol consumption, poor nutrition, current smoking, and recent quitting. High cholesterol and high blood glucose measures were also available for some subjects from company physicals. RESULTS: Average total expenditures were 48,017 yen (US$445). The 90th percentile of the expenditure distribution was approximately 111,750yen (US$1037). The most commonly reported risk factors were lack of exercise (52.9%), current smoking (35 %), stress (33%), and poor nutritional habits (23.6%). Least common were recently quitting smoking (2%), high blood pressure (4.1 %), and high blood glucose (9.4 %). The prevalence of overweight or obesity was 15.9%. High blood pressure and recent quitting were consistently related to high expenditures, after adjusting for the influence of other predictors. Adjusted expenditures were 76 % higher for recent quitters and 22.6% higher for employees with high blood pressure. Males and younger employees had consistently lower expenditures. Current smoking poor nutrition, and alcohol risk were also associated with lower expenditures. Those with multiple cardiovascular risk factors had adjusted medical expenditures that were 128% higher than those with no cardiovascular risks. Those who had multiple risk factors for stroke had expenditures that were 13% lower than those without stroke risk factors. CONCLUSIONS: This paper represents a first step in examining the association between health risks and medical expenditures in Japanese employees. The investigation uncovered some significant levels of risk for lack of exercise, smoking, and stress. Although results indicate some significant associations between health risks and medical expenditures, several unexpected assocations were noted that require further study. Such information provides a solid foundation for health promotion efforts in Japan and direction for subsequent investigations of health risks and medical expenditures. Future studies should address important issues of health risk measurement, data collection, and research design.


Assuntos
Custos de Saúde para o Empregador , Gastos em Saúde , Serviços de Saúde do Trabalhador/economia , Medição de Risco , Adulto , Idoso , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Japão , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Fatores de Risco , Assunção de Riscos
16.
Addiction ; 98(9): 1307-13, 2003 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-12930218

RESUMO

AIMS: To investigate the reliability and validity of retrospectively reported information on smoking. DESIGN: Nationally representative retrospective data from longitudinal surveys and contemporaneous data from repeated cross-sectional surveys were used. PARTICIPANTS: Adult respondents to three of the four samples of the National Longitudinal Surveys Original Cohort 1966-68; the National Longitudinal Survey of Youth 1979; and various waves of the US National Health Interview Survey. MEASUREMENTS: Reliability was investigated by calculating kappa statistics for repeated measures of ever-smoking and annual-smoking status. Validity was investigated by comparing smoking prevalence rates generated by retrospective data with contemporaneously measured rates. FINDINGS: Kappa statistics indicated the repeated measures of ever-smoking status show substantial agreement; repeated measures of annual-smoking status show moderate agreement. Retrospective reports on smoking behavior produced prevalence rates that match reasonably well with those from contemporaneous reports of smoking behavior. CONCLUSIONS: Retrospective data on smoking can be an important resource for tobacco addiction research.


Assuntos
Fumar/epidemiologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Reprodutibilidade dos Testes , Estudos Retrospectivos
17.
Alcohol Health Res World ; 20(4): 230-238, 1996.
Artigo em Inglês | MEDLINE | ID: mdl-31798166

RESUMO

The issue of alcohol taxation can be viewed from several angles: public health, revenue generation, economic efficiency, fairness, and effects on employment. Conclusions about when an alcohol tax increase is appropriate or effective-or by how much a tax should be increased-differ widely, however, depending on which of these perspectives is taken. Policymakers trying to find a balance among the different perspectives must weigh the multiple trade-offs involved when a tax increase is proposed. Considerations include how different drinking populations respond to tax-induced higher alcohol prices, the equity of a tax for all members of society, and the effects of displacement for workers in alcohol-related industries.

19.
J Health Econ ; 32(6): 1130-41, 2013 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-24140760

RESUMO

We conduct an applied welfare economics analysis of cigarette tax avoidance. We develop an extension of the standard formula for the optimal Pigouvian corrective tax to incorporate the possibility that consumers avoid the tax by making purchases in nearby lower tax jurisdictions. To provide a key parameter for our formula, we estimate a structural endogenous switching regression model of border-crossing and cigarette prices. In illustrative calculations, we find that for many states, after taking into account tax avoidance the optimal tax is at least 20% smaller than the standard Pigouvian tax that simply internalizes external costs. Our empirical estimate that tax avoidance strongly responds to the price differential is the main reason for this result. We also use our results to examine the benefits of replacing avoidable state excise taxes with a harder-to-avoid federal excise tax on cigarettes.


Assuntos
Comportamento de Escolha , Comércio/legislação & jurisprudência , Impostos/legislação & jurisprudência , Produtos do Tabaco/economia , Adolescente , Adulto , Canadá , Pesquisa Empírica , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Estados Unidos , Adulto Jovem
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