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INTRODUCTION: Previous studies have identified pricing strategies that the tobacco industry employs to try to minimise the impact of tobacco taxation, but these studies are mostly about high-income countries. This research examines industry price responses to a recent cigarette tax increase in Mexico, including in the capsule cigarette segment that has expanded rapidly in Latin America. METHODS: Data of cigarette prices and sales in Mexico between October 2018 and September 2021 licensed from NielsenIQ were used following a quasi-experimental design to analyse price changes after excise tax increases with fixed effect models by product. To explore heterogeneous responses, estimates were disaggregated by cigarette attributes such as presence of capsules and market segment. Differential shifting was also assessed. RESULTS: Increasing the tobacco tax from 2011MX$0.35(≈US$0.02) to 2020 MX$0.4944(≈US$0.0283) in January 2020 was associated with an overall 8% cigarette price increase in real terms. However, some cigarette types, including premium to discount segments, exhibited price increases larger than the tax increase, which reduced the relative price of ultra-low-priced cigarettes. Instead of a single hike, prices were gradually raised throughout the first months of 2020 for all cigarette types. A combination of both pricing strategies was employed for capsule cigarettes. The 2021 smaller tax adjustment for annual inflation was fully passed onto consumer, maintaining real prices constant. CONCLUSIONS: The industry's ability to raise prices more than the tax increase and manage these price increases smoothly suggests that there was room for larger tobacco tax increases in Mexico. Future developments on tobacco taxes could consider a fully specific tax structure or minimum taxes to mitigate the adverse effects of market segmentation and differential shifting.
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Despite being the most cost-effective tobacco control policy, tobacco taxation is the least implemented of the WHO MPOWER package to reduce smoking worldwide. In Mexico, both smoking prevalence and taxation have remained stable for more than a decade. This study aims to provide evidence about the potential effects of taxation to reduce the burden of tobacco-related diseases and the main attributable social costs in Mexico, including informal (unpaid) care costs, which are frequently ignored. We employ a first-order Monte Carlo microsimulation model that follows hypothetical population cohorts considering the risks of an adverse health event and death. First, we estimate tobacco-attributable morbidity and mortality, direct medical costs, and indirect costs, such as labour productivity losses and informal care costs. Then, we assess the potential effects of a 50% cigarette price increase through taxation and two alternative scenarios of 25% and 75%. The inputs come from several sources, including national surveys and vital statistics. Each year, 63,000 premature deaths and 427,000 disease events are attributable to tobacco in Mexico, while social costs amount to MX$194.6 billion (US$8.5) -MX$116.2 (US$5.1) direct medical costs and MX$78.5 (US$3.4) indirect costs-, representing 0.8% of GDP. Current tobacco tax revenue barely covers 23.3% of these costs. Increasing cigarette prices through taxation by 50% could reduce premature deaths by 49,000 over the next decade, while direct and indirect costs averted would amount to MX$87.9 billion (US$3.8) and MX$67.6 billion (US$2.9), respectively. The benefits would far outweigh any potential loss even in a pessimistic scenario of increased illicit trade. Tobacco use imposes high social costs on the Mexican population, but tobacco taxation is a win-win policy both for gaining population health as well as reducing tobacco societal costs.
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Depression, suicidal behavior, excessive alcohol intake, and tobacco use are the main mental health problems in adolescents. To address these problems, it is necessary to understand the many factors associated with them, including parental factors. The aim of this study was to assess the associations between parental behavior and mental health problems in adolescents in Mexico. Data from the National Health and Nutrition Survey (ENSANUT) 2018-2019, representative for Mexico, were used. Households in which a parent-adolescent child pairing was identified (regardless of family type) were selected; n = 8758 households. The four outcomes of interest that were measured in the adolescents were: excessive alcohol intake, tobacco use, suicidal behavior, and depressive symptomatology. Logistic regression models using the adjusted odds ratio (AOR) and 95% confidence interval (95% CI) were estimated. Adolescents whose parents used alcohol or tobacco and reported depressive symptoms and suicidal behavior were more likely to present these behaviors themselves (AOR = 1.47, 95% CI: 1.17-1.85; AOR = 2.26, 95% CI: 1.51-3.39; AOR = 2.61, 95% CI: 1.88-3.61; AOR = 1.74, 95% CI: 1.16-2.61, respectively). Child sexual abuse was also strongly associated with the four outcomes of interest in adolescents (AOR = 1.89, 95% CI: 1.06-3.36 for excessive alcohol intake; AOR = 2.97, 95% CI: 1.49-5.91 for tobacco use; AOR = 5.15, 95% CI: 3.27-8.09 for depressive symptoms; AOR = 6.71, 95% CI: 4.25-10.59 for suicidal behavior). The family constitutes the central nucleus of care for children and adolescents; therefore, any effort to promote adolescent mental health must necessarily involve their parents and family.
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RESUMEN Objetivo. Estimar los beneficios económicos y en salud, por sexo y por quintil de ingreso, del incremento de los precios de los cigarros mediante impuestos en México. Métodos. Con un modelo de costo-efectividad extendido (ECEA, por su sigla en inglés) se estimaron los beneficios distributivos en mujeres y hombres con un escenario de incremento del precio de los cigarros de 44% (de 56,4 pesos mexicanos [MX$] a MX$81,2 por cajetilla), como resultado de triplicar el impuesto específico actual (de MX$0,49/cigarro a MX$1,49/cigarro). El modelo se calibró con fuentes oficiales de información nacional Resultados. Con el incremento del impuesto de un peso por cigarro, cerca de 1,5 millones de fumadores abandonarían el consumo (351 300 mujeres y 1,1 millón de hombres). Así, se evitarían aproximadamente 630 000 muertes prematuras atribuibles al tabaco. La reducción de la carga de enfermedad permitiría ahorros para el sector salud cercanos a MX$42 800 millones y evitaría que más de 250 000 personas (entre ellas, 50 200 mujeres fumadoras) cayeran en situación de pobreza. Además, se recaudarían MX$16 200 millones adicionales por año, de los cuales el quintil más bajo aportaría menos de 3% (1% en el caso de las mujeres de menores ingresos). Conclusiones. La epidemia de tabaquismo tiene patrones claramente diferenciados entre mujeres y hombres y reflejan un componente de género. Si bien los beneficios del impuesto al tabaco en México tendrían magnitudes relativas al estado actual de la epidemia en cada caso, estos podrían contribuir a un objetivo más amplio de justicia social mediante la reducción de las inequidades de género.
ABSTRACT Objective. Estimate economic and health benefits, by sex and income quintile, of tax-based cigarette price increases in Mexico. Methods. An extended cost-effectiveness analysis (ECEA) model was used to estimate distributional benefits for women and men in the scenario of a 44% increase in the price of cigarettes (from 56.4 Mexican pesos [MX$] to MX$81.2 per pack), as a result of tripling the current specific excise tax (from MX$0.49/cigarette to MX$1.49/cigarette). The model was calibrated with official national information sources. Results. With a tax increase of one peso per cigarette, about 1.5 million smokers would quit (351 300 women and 1.1 million men). This would prevent approximately 630 000 smoking-attributable premature deaths. Reducing the burden of disease would save the health sector close to MX$42.8 billion and prevent more than 250 000 people (including 50 200 women smokers) from falling into poverty. It would also result in an additional MX$16.2 billion in revenue per year, of which the lowest income quintile would contribute less than 3% (1% for low-income women). Conclusions. The tobacco epidemic has clearly differentiated patterns between women and men, reflecting a gender component. While the tobacco tax in Mexico would have great benefits with respect to the current state of the epidemic, this could also contribute to the broader goal of social justice by reducing gender inequities.
RESUMO Objetivo. Estimar os benefícios econômicos e de saúde, por sexo e quintil de renda, do aumento dos preços dos cigarros por meio de impostos no México. Métodos. Com um modelo de análise ampliada de custo-efetividade (ECEA, na sigla em inglês), foram estimados os benefícios distributivos em mulheres e homens com um cenário de aumento de 44% no preço dos cigarros (de 56,4 pesos mexicanos [MX$] para MX$ 81,2 por maço), como resultado da triplicação do imposto específico atual (de MX$ 0,49/cigarro para MX$ 1,49/cigarro). O modelo foi calibrado com fontes oficiais de informação nacional. Resultados. Com o aumento do imposto de um MX$ por cigarro, cerca de 1,5 milhão de fumantes abandonariam o consumo (351.300 mulheres e 1,1 milhão de homens). Assim, seriam evitadas aproximadamente 630.000 mortes prematuras atribuíveis ao tabaco. A redução da carga de doenças permitiria uma economia para o setor da saúde de cerca de MX$ 42,8 bilhões e evitaria que mais de 250.000 pessoas (incluindo 50.200 mulheres fumantes) caíssem na pobreza. Além disso, seriam arrecadados MX$ 16,2 bilhões adicionais por ano, dos quais o quintil mais baixo contribuiria com menos de 3% (1% no caso de mulheres de baixa renda). Conclusões. A epidemia de tabagismo tem padrões claramente diferenciados entre mulheres e homens e reflete um componente de gênero. Embora os benefícios do imposto sobre o tabaco no México tenham importância relativa no atual estado da epidemia em cada caso, poderiam contribuir para um objetivo mais amplo de justiça social ao reduzir as desigualdades de gênero.