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Paediatr Child Health. 1998 Mar-Apr; 3(2): 97–98.
PMCID: PMC2851278

Effect of changes in the price of cigarettes on the rate of adolescent smoking

Cigarettes and other tobacco products are among the most commonly consumed recreational chemicals used in Canada. Use of cigarettes has been associated with an increased risk of heart disease, lung cancer, emphysema and other chronic lung diseases, and with low birth weight (1). Reduction in the rate of cigarette smoking is one of the few proven interventions to reduce the rate of heart disease and lung cancer (2). The potential impact of reducing smoking can be quite profound; it has been estimated that a decrease in smoking frequency in Canada to 10% of adults (from 52% in 1989) would result in an annual decrease of 21,000 smoking-attributable deaths (3). Although the smoking frequency in Canada among adults has declined since 1989, it appears to have levelled out at a stable rate of 30% (4).

The vast majority of adults who smoke cigarettes began smoking as teens, with 80% of adult smokers having started regular tobacco consumption before their 18th birthday (5). Adolescent smokers usually follow a common pattern, in which the first several years of smoking experience are marked by exploratory behaviour, but in the majority of adolescent smokers addiction is established after three years of smoking. Efforts to reduce smoking once addiction is established are difficult and frequently fail. It is important to note that 80% of adult smokers express the wish that they had not started smoking as adolescents. Equally significant is that approximately half of all adolescents who smoke on a regular basis will have their lives shortened by a tobacco-associated illness (6). An alarming fact is that adolescents appear to begin smoking earlier; currently 85% of smokers start smoking before age 16 years and almost 30% start before age 13 years (4). It has been demonstrated that adolescents who smoke have increased rates of respiratory illness, including asthma, than nonsmokers (7,8).

A key element of public policy aimed at reducing the impact of tobacco-related illness, therefore, should be directed at preventing adolescents from smoking. Several approaches to prevent smoking have been attempted. Educational programs have been used, with variable success rates. Limiting access to tobacco products by legislation limiting sale of these products to those above a defined minimal age has been attempted, with little evidence that these policies actually reduce use or access. Public awareness programs and restriction of advertising may have some effect on rates of cigarette smoking, although this requires considerable initial and on-going effort (7). Increasing the price of tobacco products through taxation has been associated with a decline in the use of tobacco products, primarily cigarettes, by adolescents (912).

This decline has occurred over a time when, in addition to price impact, other societal changes are likely to have influenced the rate of adolescent smoking. In this respect, Canada has historically taken a leadership role internationally in restricting tobacco advertising and requiring warning labels on tobacco products (5). However, recent reductions in cigarette taxation have demonstrated that price of cigarettes is a prime determinant of smoking rates among women and adolescents. It appears that smoking rates among women of all ages, including adolescents, respond more to increases in price of cigarettes than to educational campaigns (12).

In 1994 the Canadian federal government, under considerable pressure related to widespread crossborder smuggling of cigarettes, substantially reduced cigarette taxes, with a consequent substantial decline in the retail price of cigarettes. The decline in cigarette prices in Canada has been accompanied by an increase in the rate of cigarette smoking among Canadian adolescents and a relative increase in smoking rates among women in Canada, notably among adolescent women (Table 1).

TABLE 1:
Rate of smoking among Canadian adolescents

Smoking has been and remains a major public health problem. The greatest opportunity available to reduce the severity and rate of tobacco-related illness is to decrease the number of people who start smoking, which most commonly occurs during adolescence (13). Government and society must consider approaches that will reduce the incidence of cigarette smoking among adolescents if a meaningful reduction in the burden of tobacco-related illness is to be achieved.

RECOMMENDATIONS TO REDUCE SMOKING BY ADOLESCENTS

  • Because price appears to be a major determinant of the frequency of smoking during adolescence, the current taxation policy with respect to cigarettes and other tobacco products should be reviewed on an urgent basis. Tobacco taxation policy should aim to produce cigarette prices that are sufficiently high to deter regular smoking among adolescents.
  • Tax rates should apply equally to all tobacco products, including alternates to commercially purchased cigarettes such as ‘roll-your-own’ cigarettes and smokeless tobacco products such as chewing tobacco and snuff.
  • Governments should take appropriate measures to discourage unlawful movement of cigarettes across provincial and national boundaries.
  • Educational campaigns regarding lifestyle, behaviour and the untoward health effects of smoking should continue and should be targeted at preadolescents, adolescents and women of reproductive age.
  • Research to address the need for development of effective educational programs aimed at presmokers should be fostered. Such research should also improve our understanding of adolescent motivation in adopting the use of tobacco products.
  • Stringent restrictions on tobacco advertising should continue to be applied, notably with respect to television and other media that influence preadolescents and adolescents.
  • Health professionals and all concerned Canadians should continue to counsel government against allowing tobacco-related sponsorship of high profile sporting and artistic entertainment events.

Footnotes

DRUG THERAPY AND HAZARDOUS SUBSTANCES COMMITTEE

Members: Drs Stuart M MacLeod, Father Sean O’Sullivan Research Centre, St Joseph’s Hospital, Hamilton, Ontario (Chair); Benoit Bailey, Montreal, Quebec; Prashant Joshi, Fort Erie, Ontario; John C LeBlanc, IWK-Grace Health Centre, Halifax, Nova Scotia; Doreen M Matsui, Children’s Hospital of Western Ontario, London, Ontario; Margaret Jane Stockwell, Medical Services Branch, Health Canada, Ottawa, Ontario; Milton Tenenbein, Children’s Hospital, Winnipeg, Manitoba (director responsible)

Consultant: Dr Natalie Dayneka, Children’s Hospital of Eastern Ontario, Ottawa, Ontario

Liaison: Dr Gideon Koren, The Hospital for Sick Children, Toronto, Ontario (Canadian Society for Clinical Pharmacology)

Principal author: Dr Michael J Rieder, Children’s Hospital of Western Ontario, London, Ontario

The recommendations in this Clinical Practice Guideline do not indicate an exclusive course of treatment or procedure to be followed. Variations, taking into account individual circumstances, may be appropriate.

REFERENCES

1. Gidding SS, Schydlower M. Active and passive tobacco exposure: A serious pediatric health problem. Pediatrics. 1994;94:750–1. [PubMed]
2. United States Department of Health and Human Services. The Health Consequences of Smoking: 25 Years of Progress A Report of the Surgeon General. Atlanta: United States Department of Health Human Services; 1989.
3. Buske L. Smoking levels settle on a high plateau. Can Med Assoc J. 1998;158:152. [PMC free article] [PubMed]
4. Health Canada Tobacco kills. Today’s Parent. 1995;12:117.
5. Mao Y, Gibbons L, Wong T. The impact of the decreased prevalence of smoking in Canada. Can J Public Health. 1992;83:413–6. [PubMed]
6. Villeneuve P, Morrison H. Health consequences of smoking in Canada: an update. Chronic Dis Canada. 1994;15:102–4.
7. United States Department of Health and Human Services. Preventing Tobacco Use Among Young People A Report of the Surgeon General. Atlanta: United States Department Health Human Services; 1994.
8. Royal College of Physicians of London Smoking and the Young: A Report of the Working Party of the Royal College of Physicians. Oxford; Royal College of Physicians of London: 1992.
9. Laugesen M, Meads C. Advertising, price, income and publicity effects on weekly cigarette sales in New Zealand supermarkets. Br J Addict. 1991;86:83–9. [PubMed]
10. Kaiserman MJ, Rogers B. Tobacco consumption declining faster in Canada than in the US. Am J Public Health. 1991;81:902–4. [PubMed]
11. Laugesen M, Meads C. Tobacco advertising restrictions, price, income and tobacco consumption in OCED countries, 1960–1986. Br J Addiction. 1991;86:1343–54. [PubMed]
12. Townsend J, Roderick P, Cooper J. Cigarette smoking by socioeconomic group, sex and age: Effects of price, income, and health publicity. Br Med J. 1994;309:923–7. [PMC free article] [PubMed]
13. Ontario Ministry of Health. Opportunities for Health: A Report on Youth from the Chief Medical Officer of Health. Toronto: Queen’s Printer for Ontario; 1992.

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