Impact of Tobacco Control Program Expenditures on Tobacco Use

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Impact of Tobacco Control Program Expenditures on
Tobacco Use

• Maya Vijayaraghavan, Ph.D.
• Office on Smoking and Health
• National Conference on Tobacco or Health
• November 19-21, 2002

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Outline of Presentation

• Purpose of the studies
• Overview
• Sources of data
• Review of two studies
• Expenditures and Aggregate Cigarette Sales
• Expenditures and Individual Cigarette Use
• Implications for policy

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Purpose of the studies

• Do changes in Tobacco Control Program (TCP)
  expenditures influence the
• Prevalence of smoking
• Consumption of cigarettes
• independent of other factors that influence the
  demand for cigarettes

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Overview

• Aggregate-level analysis impact of TCP
  expenditures on aggregate cigarette consumption
• Individual-level analysis impact of TCP
  expenditures on the
• prevalence
• intensity of smoking

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Sources of Data

• Policy Variables
• TCP Expenditures
• CDCs IMPACT
• NCIs ASSIST
• RWJ Smokeless States
• State TCP
• Cigarette Excise Taxes
• The Tax Burden on Tobacco (The Tobacco Institute,
  1998)

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Sources of Data

• Other variables
• Tax-paid Cigarette Sales
• The Tax Burden on Tobacco (The Tobacco Institute,
  1998)
• Population and Demographics
• United States Census Bureau
• Aggregate income
• United States Bureau of Economic Analysis
• Individual-level data
• Behavioral Risk Factor Surveillance System
  (BRFSS)

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TCP Expenditures and Aggregate Cigarette Sales
(1981-1998)
Methods

• Data cigarette sales and TCP expenditures over
  time for all the states
• Controlled for cigarette excise taxes,
  cross-border cigarette sales, demographics and
  income
• Multivariate econometric analysis

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TCP Expenditures and Aggregate Cigarette Sales
(1981-1998)
Results

• Consistent evidence that TCPs have decreased
  aggregate consumption of cigarettes
• Effect in states with comprehensive TCPs
  (Arizona, California, Massachusetts, Oregon) was
  10-50 times greater than for the US overall

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TCP Expenditures and Aggregate Cigarette Sales
(1981-1998)
Results

• Programs that secure ? 1 in per capita funding
  had lower per capita sales than those
• Programs funded above 6 per capita may result in
  greater declines in sales
• At 1 to 6 funding levels, the effect was larger
  one year after reaching this level of funding

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TCP Expenditures and Aggregate Cigarette Sales
(1981-1998)
Results

• Increases in expenditures had their greatest
  impact when tobacco use was relatively high
• Increases in excise taxes had the same impact
  regardless of level of cigarette consumption
• States with higher taxes than neighboring states
  had fewer tax-paid sales

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TCP Expenditures and Individual Cigarette Use
(1985-1998)
Methods

• Data smoking prevalence, quantity smoked, and
  TCP expenditures over time
• Controlled for cigarette excise taxes, income,
  demographics
• Multivariate econometric analysis to estimate
  prevalence and consumption

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TCP Expenditures and Individual Cigarette Use
(1985-1998)
Results

• Increases in expenditures - declines in smoking
  prevalence and number of cigarettes smoked
• Past expenditures continued to contribute to
  declines for more than a year
• More smokers quit rather than reducing the
  quantity smoked

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TCP Expenditures and Individual Cigarette Use
(1985-1998)
Race/Ethnicity

• TCPs most effective in reducing smoking among
  Hispanics and whites
• For all ethnicities, program effects declined
  with age
• Increases in cigarette prices effective in
  reducing quantity smoked among Whites only
• No impact found for African-Americans

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TCP Expenditures and Individual Cigarette Use
(1985-1998)
Age

• Older smokers less likely to change behavior due
  to increase in price
• TCPs most effective among 18-24 year olds
• Impact declined with age

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TCP Expenditures and Individual Cigarette Use
(1985-1998)
Gender

• TCPs more successful at curbing smoking among
  women of all ages than among men
• Women of all ages more price sensitive than men

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Implications for Policy

• TCPs work!
• TCPs are more effective, dollar for dollar, when
  implemented on a larger scale
• Appropriate funding levels lead to reduced
  consumption of cigarettes
• Lag effect of TCP expenditures means funding
  levels must be maintained

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Implications for Policy

• Regardless of prevalence, increasing excise taxes
  leads to reduced consumption of cigarettes
• Focus on prevention and early intervention may be
  more cost-effective than targeting older smokers
• Past approaches may have to be revisited to
  ensure that they are appropriately tailored to
  various populations

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References
Farrelly M, Pechacek T, Chaloupka F, 2001. The
Impact of Tobacco Control Program Expenditures on
Aggregate Cigarette Sales 1981-1998 National
Bureau of Economic Research Working Paper 8691.
Farrelly M, Nimsch C, Cowell A, 2001.
Coordinated Evaluation of Statewide Tobacco
Control Programs in the US, Phase Two Impact of
Tobacco Control Program Expenditures on
Individual Tobacco Use1985-1998 Behavioral Risk
Factor Surveillance Systems. Unpublished draft
report.
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CDCOffice on Smoking and Health

• www.cdc.gov/tobacco
• 770.488.5309