Was there significant tax evasion after the 1999 50 cent per pack cigarette tax increase in California?

OBJECTIVES: Several states, including California, have implemented large cigarette excise tax increases, which may encourage smokers to purchase their cigarettes in other lower taxed states, or from other lower or non-taxed sources. Such tax evasion thwarts tobacco control objectives and may cost the state substantial tax revenues. Thus, this study investigates the extent of tax evasion in the 6-12 months after the implementation of California's 0.50 dollars/pack excise tax increase. DESIGN AND SETTING: Retrospective data analysis from the 1999 California Tobacco Surveys (CTS), a random digit dialled telephone survey of California households. MAIN OUTCOME MEASURES: Sources of cigarettes, average daily cigarette consumption, and reported price paid. RESULTS: Very few (5.1 (0.7)% (+/-95% confidence limits)) of California smokers avoided the excise tax by usually purchasing cigarettes from non- or lower taxed sources, such as out-of-state outlets, military commissaries, or the internet. The vast majority of smokers purchased their cigarettes from the most convenient and expensive sources: convenience stores/gas (petrol) stations (45.0 (1.9)%), liquor/drug stores (16.4 (1.6)%), and supermarkets (8.8 (1.2)%). CONCLUSIONS: Despite the potential savings, tax evasion by individual smokers does not appear to pose a serious threat to California's excise tax revenues or its tobacco control objectives.

Does cigarette price influence adolescent experimentation?

The economics literature generally agrees that state and federal excise taxes can play an important role in deterring adolescent smoking. Teens' apparent responsiveness to cigarette prices is puzzling, since the majority of adolescent smokers do not buy their cigarettes. Teens typically do not begin to purchase cigarettes until they have developed an established pattern of smoking. Previous studies have not had adequate measures of smoking experience to explore whether adolescents' price responsiveness may vary by smoking experience. This paper uses data from a 1993 national survey of youth smoking to explore this hypothesis.

Index for US state tobacco control initial outcomes.

Public health tobacco control efforts have increasingly targeted communities in addition to individuals. Before population smoking decreases, effectiveness might be detected from initial outcomes reflecting these efforts, such as higher cigarette prices or more workplace and home smoking restrictions. Presumably, these initial outcomes will eventually influence smoking behavior. State-specific estimates of percentages of the population working or living under smoking bans are available from the 1992-1993 tobacco use supplement to the Current Population Survey, conducted annually by the US Bureau of the Census. In addition, the tobacco industry reports the average state cigarette price yearly. The authors constructed a tobacco control initial outcomes index (IOI) by using values of these variables for each state and correlated it with state-specific adult (aged > or =25 years) and youth (aged 15-24 years) smoking prevalence computed from the Current Population Survey and per capita cigarette consumption data computed from sales and Census Bureau data. Both adult smoking prevalence (r = -0.70) and per capita consumption (r = -0.73) were significantly correlated with the IOI; youth smoking prevalence correlated less well (r = -0.34). Although the analysis is not definitive, deseasonalized 1983-1997 consumption trends for IOI-based tertile groups were divergent beginning in 1993, with the high IOI group showing the greatest decrease. A high relative IOI index may be predictive of future smoking decreases and should be considered when tobacco control efforts are evaluated.

Do movie stars encourage adolescents to start smoking? Evidence from California.

BACKGROUND: The purpose of this study was to examine the relationship between adolescents' favorite movie stars and their smoking status, controlling for variables associated with smoking initiation. METHODS: The 1996 California Tobacco Survey questioned 6,252 adolescents about their favorite stars, smoking history, exposure to smokers, rebelliousness, knowledge and attitudes regarding smoking, and cigarette advertising and promotion. The top 10 favorite stars were tested for differential preference between ever and never smokers, defined as those who had never puffed on a cigarette. Never smokers were categorized as susceptible or nonsusceptible to smoking. RESULTS: Favorite stars differed significantly among adolescent ever and never smokers. A majority of favorite stars of ever smokers smoked on and off screen compared to favorite stars of never smokers. In multivariate analyses, adolescent never smokers who preferred favorite stars of adolescent ever smokers were significantly more likely to be susceptible to smoking (OR = 1.35; 95% CI 1.12, 1.62), even after adjustment for known predictors of adolescent smoking and demographic variables. This effect was only slightly weaker than that of exposure to friends and family who smoke (OR = 1.45; 95% CI 1.13, 1.85). CONCLUSIONS: This study provides preliminary evidence that stars who smoke on and off screen may encourage youth to smoke.

The social costs of tobacco advertising and promotions.

Recent longitudinal evidence suggests that approximately 34% of all new tobacco experimentation occurs because of tobacco advertising and promotions. Based on this figure, in this paper we estimate the long-term impact on mortality and morbidity, as well as the economic and medical costs associated with smoking that is attributable to cigarette advertising and promotions in the United States. This study used several data sources, including the Teenage Attitudes and Practices Survey (TAPS), the 1993 and 1996 Adolescent California Tobacco Surveys (CTS), and the Food and Drug Administration's estimates of annual illness-related benefits of alternative effectiveness rates of banning tobacco advertising. Our resulting estimates are that in each year between 1988 and 1998, tobacco advertising and promotional activities generated approximately 193000 additional adult smokers who began smoking as adolescents because of advertisements and promotions. That decade of tobacco advertising and promotions will also result in approximately 46400 smoking-attributable deaths per year and 698400 years of potential life lost, which translates into costs of approximately $21.7 billion to $33.3 billion in total medical, productivity, and mortality-related costs. Even accounting for quitting behavior, each year of advertising-attributable smoking increases the number of smokers in the population. We conclude that annual costs can be expected to continue to increase if tobacco advertising and promotional activities are not effectively eliminated. If all tobacco industry advertising and promotional activities were banned for the next 25 years, nearly 60000 smoking-attributable deaths per year could be avoided, saving nearly 900000 life-years, $2.6 billion in excess medical expenses, and between $28 billion and $43 billion in mortality costs.

Can strategies used by statewide tobacco control programs help smokers make progress in quitting?

Many states have recently adopted programs to encourage smokers to quit. Here, we seek evidence that strategies generally used by these programs have the potential to influence smoking cessation. In California, 1,736 smokers from a population-based telephone survey were interviewed in 1990 and 1992. We examined the association of demographic and program-related variables (reporting of work area smoking bans; belief in the harmfulness of environmental tobacco smoke, including in-home smoking restrictions; and quitting assistance) with quitting progress. Smokers were categorized into levels in a previously developed Quitting Continuum, which considers their addiction level and quitting history. Smokers in each higher continuum category had an increased likelihood of future successful cessation. Smokers progressed if they were at a higher continuum level in 1992 than in 1990. College graduates showed 2.3 times more progress than did high school dropouts. Smokers reporting work area smoking bans showed 1.6 times more progress than did workers not reporting such restrictions. Smokers with the strongest beliefs (home smoking restrictions) regarding the harmfulness of environmental tobacco smoke showed 3.4 times more progress than smokers with no belief. Smokers who reported having some form of cessation assistance showed 3.0 times more progress. The more program-related factors were reported, the higher the rate of progress was: 13.1% for those reporting no factors, 23.4% for one factor, and 40.6% for two or more. These results suggest but do not prove that strategies promoted by statewide tobacco control programs can potentially be effective and that these efforts should be continued and expanded.

Tobacco industry promotion of cigarettes and adolescent smoking.

CONTEXT: Whether tobacco advertising and promotion increases the likelihood that youths will begin smoking has important public policy implications. OBJECTIVE: To evaluate the association between receptivity to tobacco advertising and promotional activities and progress in the smoking uptake process, defined sequentially as never smokers who would not consider experimenting with smoking, never smokers who would consider experimenting, experimenters (smoked at least once but fewer than 100 cigarettes), or established smokers (smoked at least 100 cigarettes). DESIGN: Prospective cohort study with a 3-year follow-up through November 1996. SETTING AND PARTICIPANTS: A total of 1752 adolescent never smokers who were not susceptible to smoking when first interviewed in 1993 in a population-based random-digit dial telephone survey in California were reinterviewed in 1996. MAIN OUTCOME MEASURE: Becoming susceptible to smoking or experimenting by 1996. RESULTS: More than half the sample (n=979) named a favorite cigarette advertisement in 1993 and Joe Camel advertisements were the most popular. Less than 5% (n=92) at baseline possessed a promotional item but a further 10%(n=172) were willing to use an item. While having a favorite advertisement in 1993 predicted which adolescents would progress by 1996 (odds ratio [OR] = 1.82; 95% confidence interval [CI], 1.04-3.20), possession or willingness to use a promotional item was even more strongly associated with future progression (OR=2.89; 95% CI, 1.47-5.68). From these data, we estimate that 34% of all experimentation in California between 1993 and 1996 can be attributed to tobacco promotional activities. Nationally, this would be over 700000 adolescents each year. CONCLUSION: These findings provide the first longitudinal evidence to our knowledge that tobacco promotional activities are causally related to the onset of smoking.

Trends in adolescent smoking initiation in the United States: is tobacco marketing an influence?

OBJECTIVE: To compare recent trends in smoking initiation by adolescents with trends in inflation-adjusted cigarette pricing and tobacco marketing expenditures. DESIGN: We examined smoking initiation trends in demographic subgroups of adolescents aged 14-17 years during the decade 1979-1989. Data on cigarette pricing and tobacco marketing expenditures were adjusted for inflation and plotted over this same period. SETTING: Large population surveys, United States. SUBJECTS: 140,975 ever-smokers aged 17-38 when surveyed in 1992 or 1993, who reported on age of smoking initiation during the decade 1979-1989. MAIN OUTCOME MEASURE: Initiation rate was calculated as the number in an age group who reported starting to smoke regularly in a year, divided by the number of never-smokers at the start of the year. Trends were evaluated by linear and quadratic models. RESULTS: From 1979 to 1984, adolescent initiation rates decreased, but increased thereafter, particularly among males, whites, and those who, as adults, reported never having graduated from high school. Cigarette price increased throughout the decade as did tobacco marketing expenditures, especially for coupons, value-added items, and promotional allowances. CONCLUSION: Availability of cheaper cigarettes is not likely to be a cause of increased smoking initiation by adolescents. Although other influences cannot be ruled out, we suspect that the expanded tobacco marketing budget, with its increased emphasis on tactics that may be particularly pertinent to young people, affected adolescent initiation rates.

Impact of the American Stop Smoking Intervention Study on cigarette consumption.

OBJECTIVE: To obtain an early estimate of the effectiveness of the American Stop Smoking Intervention Study (ASSIST). DESIGN, SETTING, AND PARTICIPANTS: Seventeen American states funded through ASSIST are compared with 32 others regarding per capita cigarette consumption from 1989 to 1995. California, which already had an extensive tobacco control programme, was omitted. ASSIST states were selected competitively (not randomly) based on their proposals' merit, state smoking prevalence, and geographical distribution. INTERVENTIONS: Comprehensive tobacco control programmes, emphasising policy interventions, were implemented in the ASSIST states beginning in 1993. MAIN OUTCOME MEASURES: Trends in aggregated per capita cigarette consumption and inflation-adjusted average price/pack of cigarettes in the intervention states were compared. Percentage change in per capita consumption is also compared with percentage change in inflation-adjusted cigarette price by state in each group from 1992 to 1994. RESULTS: Per capita consumption and inflation-adjusted cigarette price were nearly identical in both groups of states before 1993, when full funding for the ASSIST interventions began. However, by 1996 smokers in the intervention states were consuming about 7% less cigarettes per capita (P<0.05, beginning in 1994), and in 1994 the average price was over $0.12/pack higher in the intervention states. All but three states (all intervention) showed decreases in cigarette price. Nonetheless, 76% of the intervention and 55% of the comparison states showed some decrease in consumption despite decreases in price. The relationship between changes in price and consumption was considerably diminished in the intervention group. CONCLUSIONS: These interim results suggest that the ASSIST programme is associated with a substantial difference in tobacco consumption in a third of the United States, and that increased price from taxation may not be the only programme influence.

Low-cost cigarettes and smoking behavior in California, 1990-1993.

Low-cost generic cigarettes grew dramatically in market share between 1990 and 1993, raising concerns that some smokers might view generics as an alternative to quitting. We report sociodemographic predictors of generic brand choice among a cross-sectional sample of California smokers and investigate changes in brand choice in a longitudinal sample of California smokers between 1990 and 1992. We also focus on brand preferences among California adolescents. One third of smokers who switched cigarette brands between 1990 and 1992 switched to generics. Non-Hispanic whites, rural residents, and lower income smokers were twice as likely to buy generics as other smokers were. Heavy cigarette consumption was strongly associated with smoking generic cigarettes. Women appeared more price-sensitive in cigarette purchasing than men did, and generic brands were the most frequently purchased cigarettes for female smokers older than age 45. Generics were less popular among adolescents than among adults. Generic cigarettes provide a low-cost alternative to price-sensitive smokers, but further studies are needed to establish the role and influence of generic cigarettes on smoking prevalence and public health. Medical Subject Headings (MeSH): smoking, smoking cessation, adolescent behavior, women, prevalence.

Distribution of smokers by stage in three representative samples.

OBJECTIVES: A key variable for the design of individual and public health interventions for smoking cessation is Stage of Change, a variable which employs past behavior and behavioral intention to characterize an individual's readiness to change. Reactively recruited samples distort estimates of the stage distribution in the population because such samples attract a disproportionate number of late-stage participants. Three representative samples are described which provide accurate estimates of the stage distribution in the population. These samples are of adequate size to permit within-sample comparisons with respect to sex, age, Hispanic or non-Hispanic origin, race, and education level. The implications of using stage distribution as a tool for planning intervention is discussed. METHOD: The first sample of 4,144 smokers was from the state of Rhode Island and involved a random-digit-dial survey. The second sample of 9,534 smokers was from the state of California and involved a stratified random-digit-dial survey. The third sample of 4,785 smokers was from a total of 114 worksites located in four different geographic locations. RESULTS: The stage distributions were approximately identical across the three samples, with approximately 40% of the sample in Precontemplation, 40% in Contemplation, and 20% in Preparation. The stage distribution was generally stable across age groups with the exception of the 65 years and older group. Education level did affect the stage distribution with the proportion of the sample in Precontemplation decreasing as education level increased. In all three samples, minor differences in stage distribution were related to Hispanic origin and race, but the pattern was not consistent across the samples. CONCLUSIONS: The pattern of stage distribution has important implications for the design of interventions. Existing interventions are most appropriate for the Preparation stage, but the majority of the three samples were in the first two stages, resulting in a likely mismatch between the smoker and the intervention. The stability of distribution across age suggests that interventions that are appropriately matched to stage can be applied across all age groups. The differences found with respect to education, Hispanic origin, and race can serve as a guide to the tailoring of intervention materials.

Public objections to environmental tobacco smoke.

METHODS. A randomly selected sample of Californian adults was surveyed by telephone to assess their knowledge, attitudes, and behaviors with respect to tobacco use and its control. The questions asked of this sample were whether they had recently (in the past 12 months) asked someone not to smoke in certain situations and whether they would ever consider doing such a thing. RESULTS. Results of the survey indicated that 59.1% of nonsmokers and 44.4% of smokers had asserted themselves within the past 12 months, while another 28.2 and 29.1% of the nonsmokers and smokers, respectively, indicated that they would consider asking someone not to smoke. Only 12.7% of the nonsmokers and 26.4% of the smokers indicated that they would not consider doing such a thing. Those more likely to object publicly to tobacco smoke are generally younger, are more educated, and have anti-tobacco attitudes related to either a specific health belief or social influence.

The reliability of self-reported cigarette consumption in the United States.

To investigate the possibility that self-reported smoking is not a valid measure for assessing trends in smoking prevalence, we compared total self-reported cigarette consumption with the adjusted consumption data from cigarette excise taxes as reported by the US Department of Agriculture (USDA) for the period 1974 through 1985. Self-reported consumption was calculated by using data from the National Health Interview Surveys (NHIS) for adults and from the National Household Surveys on Drug Abuse for adolescents. For this period, the average ratio of self-reported cigarette consumption to the USDA estimate of consumption was 0.72 (range = 0.69 to 0.78). There was no statistical difference in this consumption ratio from year to year, indicating no apparent increase in the underreporting of cigarette smoking in these surveys. We conclude that cross-sectional surveys of self-reported smoking status remain a reliable surveillance tool for monitoring changes in population smoking behavior.

International comparisons of trends in cigarette smoking prevalence.

Data on smoking prevalence since 1974 are presented for the United States, Canada, Great Britain, Australia, Norway and Sweden. During this period, sex-specific prevalence has decreased in all the countries studied, with the exception of Norway, where women showed an increase. There was also a considerable decline in uptake of smoking by the young over this period, suggesting that the observed decline in prevalence is likely to continue. In the United States, the rate of decline in adult smoking prevalence has been linear. This linear pattern is probably similar in prevalence in most other countries studied, with the notable exception of Australia, which demonstrated no change for the majority of the period. Among the six countries studied, the United States had neither the lowest smoking prevalence nor the fastest rate of decline over the period. Differential patterns of change infer that the successful public health interventions in some countries are not being applied in others. While the lack of change in Australia prior to 1983 is surprising, this was followed by a sizable drop in smoking prevalence for both higher and lower educational groups in conjunction with the introduction of mass media-led antismoking campaigns. Most of the other countries report an ever increasing gap in prevalence between higher and lower educational groups. These findings suggest that all countries might benefit from a greater exchange of antismoking ideas and public health action.

Cigarette smoking in Australian schoolchildren.

Six thousand, four hundred and fifty-one schoolchildren who were aged nine to 15 years completed a questionnaire about their patterns of cigarette use, as part of the nation-wide Health and Fitness Survey of Australian Schoolchildren which was conducted in 1985. The survey yielded figures for the prevalence of cigarette smoking by age, sex, socioeconomic status and ethnic origin. It also provided data on the relationship between parental smoking and smoking in children. By the age of 15 years, 32.4% of the girls and 26.0% of the boys in the study sample had smoked at least one cigarette in the seven days before they were surveyed. In some of the age-groups, the average number of cigarettes that were consumed by girl smokers equalled or exceeded that of their male counterparts. There were no significant differences in the prevalence of current cigarette smoking with differences in socioeconomic status. This finding contrasts with the pattern of use in adults. Ethnic origin was a statistically-significant predictor of smoking behaviour in children. Significantly-fewer children of Asian ethnic origin were current smokers. Parental smoking status also appeared to be an important determinant of smoking behaviour in schoolchildren. This influence was more important for girls than for boys, particularly when the mother was a smoker. The over-all findings suggest that many features of the adult pattern of cigarette use are established by the age of 15 years. The findings also supported the trend towards increased cigarette consumption by girls compared with boys that was noted by earlier researchers. These findings should encourage a serious reappraisal of the role of cigarette advertising in the promotion of smoking in young persons.

Trends in cigarette smoking in the United States. Projections to the year 2000.

Data from National Health Interview Surveys from 1974 through 1985 are used to project cigarette smoking prevalence to the year 2000. Smoking prevalence in the United States has declined at a linear rate since 1974. If this trend continues, in the year 2000, 22% of the adult population (40 million Americans) will be smokers. By the year 2000, the major inequalities in prevalence will occur among educational categories. At least 30% of those who have not proceeded beyond a high school education will be smokers, whereas less than 10% of college graduates will smoke. Among the other sociodemographic subgroups, smoking prevalence is expected to decrease by the year 2000 to 20% among men, to 23% among women, to 25% among blacks, and to 21% among whites. Between 1974 and 1985, approximately 1.3 million persons per year became former smokers, indicating considerable success in public health efforts to encourage people to stop smoking. However, in the early 1980s, approximately 1 million new young persons per year were recruited to the ranks of regular smokers. This is equivalent to about 3000 new smokers each day. Public health efforts need to focus more on preventing young people from starting to smoke, and such prevention efforts should particularly target less educated socioeconomic groups.

Time to lower cholesterol: the potential effect of cholesterol reduction on the incidence of cardiovascular disease.

Cardiovascular disease imposes a major burden on our community through its high morbidity, mortality and health-care costs. Elevated cholesterol levels have been recognized increasingly as an important and modifiable risk factor for this disease. We assessed the impact of a reduction in cholesterol levels in our community and compared its importance with the reduction of another major risk factor for this disease, namely, smoking. Results from this analysis indicate that a greater proportion of cardiovascular disease can be attributed to elevated cholesterol levels compared with smoking in our population. This difference is due largely to the prevalence of elevated cholesterol levels in the community. Evidence from international studies indicates that a 5% reduction in the cholesterol level of Australians is a realistic health target for the population and that this reduction would lead to a major reduction in the burden of cardiovascular disease and to substantial economic savings. This paper provides further evidence to support the National Heart Foundation of Australia's recommendations for a reduction of cholesterol levels in the Australian population.