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1.  Attitudes, Experiences, and Acceptance of Smoke-Free Policies Among US Multiunit Housing Residents 
American journal of public health  2012;102(10):1868-1871.
We assessed factors related to smoke-free policies among a cross-sectional, nationally representative, random-digit-dial sample (landline and cell phone) of US multiunit housing residents (n = 418). Overall, 29% reported living in smoke-free buildings, while 79% reported voluntary smoke-free home rules. Among those with smoke-free home rules, 44% reported secondhand smoke incursions in their unit. Among all respondents, 56% supported smoke-free building policy implementation. These findings suggest that smoke-free building policies are needed to protect multiunit housing residents from secondhand smoke in their homes.
PMCID: PMC3490662  PMID: 22897557
Cigarette taxation has been recognized as one of the most significant policy instruments to reduce smoking. Smoking and drinking are highly comorbid behaviors, and the public health benefits of cigarette taxation may extend beyond smoking-related outcomes to impact alcohol consumption. The current study is the first to test whether increases in cigarette taxes are associated with reductions in alcohol consumption among smokers using a large, prospective U.S. sample.
Our sample included 21,473 alcohol consumers from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC). Multiple linear regression analyses were conducted to evaluate whether increases in cigarette taxes between Waves I (2001–2002) and II (2004–2005) were associated with reductions in quantity and frequency of alcohol consumption, adjusting for demographics, baseline alcohol consumption, and alcohol price. Stratified analyses were conducted by sex, hazardous drinking status, and age and income group.
Increases in cigarette taxes were associated with modest reductions in typical quantity of alcohol consumption and frequency of binge drinking among smokers. Cigarette taxation was not associated with changes in alcohol consumption among non-smokers. In analyses stratified by sex, the inverse associations of cigarette taxes with typical quantity and binge drinking frequency were found only for male smokers. Further, the inverse association of cigarette taxation and alcohol consumption was stronger among hazardous drinkers (translating into approximately 1/2 a drink less alcohol consumption per episode), young adult smokers, and smokers in the lowest income category.
Findings from this longitudinal, epidemiological study suggest increases in cigarette taxes are associated with modest to moderate reductions in alcohol consumption among vulnerable groups. Additional research is needed to further quantify the public health benefits of cigarette taxation on alcohol consumption and to evaluate the potential broader crossover effects of cigarette taxation on other health behaviors.
PMCID: PMC3830619  PMID: 23930623
cigarette tax; alcohol; longitudinal; smokers; hazardous drinking; sex
3.  Intervention to Promote Smoke-Free Policies Among Multiunit Housing Operators 
To assess the efficacy of an intervention to encourage the adoption of smoke-free policies among owners and managers of multiunit housing.
A pretest-posttest quasi-experimental design was employed.
The study population included 287 multiunit housing operators (MUHOs) from across New York State who were recruited to complete a baseline survey designed to assess policies about smoking in the housing units that they owned and/or managed. Subjects were surveyed between March and July 2008 (n = 128 intervention, n = 159 control) and recontacted 1 year later to complete a follow-up survey (n = 59 intervention, n = 95 control).
An informational packet on the benefits of implementing a smoke-free policy was mailed to MUHOs in the New York State counties of Erie and Niagara between March and July 2008. For comparison purposes, a sample of MUHOs located outside of Erie and Niagara counties who did not receive the information packet were identified to serve as control subjects.
Main Outcome Measures
Logistic regression was used to assess predictors of policy interest, concern, and implementation at follow-up. Predictors included: intervention group, baseline status, respondent smoking status, survey type, government-subsidy status, quantity of units operated, and average building size, construction type, and age.
Multiunit housing operators who received the information packet were more likely to report interest in adopting a smoke-free policy (OR = 6.49, 95% CI = 1.44–29.2), and less likely to report concerns about adopting such a policy (OR = 0.16, 95% CI = 0.04–0.66) compared to MUHOs who did not receive the information packet; however, the rate of adoption of smoke-free policies was comparable between the groups.
Sending MUHOs an information packet on the benefits of adopting a smoke-free policy was effective in addressing concerns and generating interest toward smoke-free policies but was not sufficient in itself to generate actual policy adoption.
PMCID: PMC3419374  PMID: 21464678
intervention studies; public policy; smoking; tobacco smoke pollution
4.  Smoke-free policies in drinking venues predict transitions in alcohol use disorders in a longitudinal U.S. sample 
Drug and alcohol dependence  2012;128(3):214-221.
Smoke-free legislation prohibiting smoking in indoor public venues, including bars and restaurants, is an effective means of reducing tobacco use and tobacco-related disease. Given the high comorbidity between heavy drinking and smoking, it is possible that the public health benefits of smoke-free policies extend to drinking behaviors. However, no prior study has examined whether tobacco legislation impacts the likelihood of alcohol use disorders (AUDs) over time. The current study addresses this gap in the literature using a large, prospective U.S. sample.
Using data from the National Epidemiological Survey on Alcohol and Related Conditions (NESARC), we utilized logistic regression to examine whether the implementation of state-wide smoke-free legislation in bars and restaurants between Waves I (2001–2002) and II (2004–2005) predicted changes in DSM-IV AUD status (remission, onset, recurrence) in current drinkers at Wave I (n = 19,763) and participants who drank in public ≥once per month (n = 5913).
Individuals in states that implemented smoke-free legislation in drinking venues had a higher likelihood of AUD remission compared to participants in states without such legislation. Among public drinkers, smoke-free legislation was associated with a greater likelihood of AUD remission and a lower likelihood of AUD onset. These findings were especially pronounced among smokers, men, and younger age groups.
These results demonstrated the protective effects of smoke-free bar and restaurant policies on the likelihood of AUDs; furthermore, these findings call attention to an innovative legislative approach to decrease the morbidity and mortality associated with AUDs.
PMCID: PMC4052952  PMID: 22999418
Smoke-free policies; Alcohol use disorders; Longitudinal
5.  Secondhand Smoke Transfer in Multiunit Housing 
Nicotine & Tobacco Research  2010;12(11):1133-1141.
The home can represent a significant source of secondhand smoke (SHS), especially for individuals who live in close proximity to one another in multiunit housing (MUH). The objective of this study was to quantify real-time SHS transfer between smoke-permitted and smoke-free living units within the same MUH structure.
Air monitors were used to assess PM2.5, an environmental marker for SHS, in 14 smoke-free living units and 16 smoke-permitted units within 11 MUH buildings in the Buffalo, New York, area between July 2008 and August 2009. Air monitors were operated concurrently in both smoke-permitted and smoke-free units within each building. When feasible, additional monitors were stationed in shared hallways and on outdoor patios. Participants completed logs to document activities that could affect air quality.
Evidence of SHS transfer from smoke-permitted units was detected in 2 of the 14 smoke-free units and 6 of the 8 hallways. Real-time PM2.5 plots and participant logs suggest that SHS transfer is a function of many determinants, including ventilation and proximity between units. Following stratification by time of day, median PM2.5 levels were greatest between 4:00 PM and 11:59 PM but varied by location: 10.2 μg/m3 in smoke-free units, 18.9 μg/m3 in hallways, and 29.4 μg/m3 in smoke-permitted units.
This study documents SHS incursions from smoke-permitted units into smoke-free units and adjacent hallways within the same building. Since many factors appear to impact the amount of SHS transfer between these areas, the implementation of a smoke-free building policy represents the most effective way to ensure that residents of MUH units are not exposed to SHS.
PMCID: PMC3436457  PMID: 20889473
6.  Prevalence and predictors of smoke-free policy implementation and support among owners and managers of multiunit housing 
Nicotine & Tobacco Research  2009;12(2):159-163.
Exposure to secondhand smoke causes disease and premature death. Although many municipalities have instituted policies prohibiting smoking in public areas, personal living areas remain largely unregulated. Individuals who reside in multiunit housing (MUH) facilities where smoking is permitted are particularly susceptible to involuntary exposure. This study assessed the prevalence and predictors of smoke-free policy implementation and support among owners and managers of MUH throughout Western New York State.
A telephone survey was administered to a sample of owners and managers of MUH buildings in the Erie and Niagara counties, New York. A total of 127 respondents completed the survey between March and July 2008 (62% response rate). Logistic regression was used to assess predictors of policy implementation and support, while adjusting for participant smoking status, quantity of units owned/managed, government subsidy status, as well as building age, construction type, and size.
Only 13% of participants reported smoking restrictions within any of their buildings. Among those without a smoke-free policy, 75% would be interested in restricting smoking in at least one of their units, with interest being significantly higher among participants with government-subsidized units (odds ratio = 3.12, 95% CI = 1.14–8.52). Primary barriers to policy implementation included concern over increased vacancy (27%) and a decreased market base (21%).
Few Western New York MUH owners and managers have implemented smoke-free policies in their buildings, but most are receptive to doing so. Therefore, opportunities exist for interventions to enhance policy acceptance, implementation, and enforcement among these individuals.
PMCID: PMC3436436  PMID: 19959570
7.  Impact of smokeless tobacco packaging on perceptions and beliefs among youth, young adults, and adults in the U.S: findings from an internet-based cross-sectional survey 
Research demonstrates that tobacco packaging elements (including health warning labels, descriptive characteristics, and corporate branding) are associated with knowledge of health risks and product appeal with cigarettes. Yet, little research has assessed this with smokeless tobacco (SLT) packaging. This study evaluates the association between three SLT packaging elements with knowledge of health risks and perceptions of novelty and appeal. Additionally, we assess how effects of these messages may differ across age groups, including youth (14-17 years), young adults (18-25 years), and older adults (26-65 years).
1000 participants were administered a web-based survey in 2010 and shown three sets of SLT packs in random order, varied by descriptor (flavor descriptor vs. none), warning label format (graphic vs. text), and corporate branding (branded vs. plain packaging). Participants rated the packs compared with “no difference” on appeal, novelty, and risk perceptions associated with product use. Chi-square tests were used to test for significant differences in pack selections. Multinomial regression was employed to evaluate the association between effects of packaging elements and participant age.
More respondents selected the pack with the graphic warning label as the pack to make them consider the health risks associated with SLT use, attract their attention, and be least attractive to a smoker. The product with the text warning label was the product someone their age would want to be seen using and would appeal to peers. The SLT pack with the flavor descriptor was not associated with health risks associated with product use. The pack with corporate branding was selected as more appealing, to attract attention, and one they would want to be seen using; the plain pack was less attractive to smokers. Youth and young adults were more likely to indicate that pack elements affected their perceptions of appeal and risk associated with SLT products.
These results suggest that SLT pack characteristics have a measurable effect on perceptions of health risk and product appeal. Future research should assess these findings in the context of harm reduction. Specifically, research is needed to determine whether pack elements on SLT products can effectively convey risk and harm.
PMCID: PMC3942180  PMID: 24433301
Smokeless tobacco; Tobacco packaging; Health warning labels; Tobacco marketing
8.  Effectiveness of Stop-Smoking Medications: Findings from the International Tobacco Control (ITC) Four Country Survey 
Addiction (Abingdon, England)  2012;108(1):193-202.
To evaluate the population effectiveness of stop-smoking medications while accounting for potential recall bias by controlling for quit attempt recency.
Prospective cohort survey.
United Kingdom, Canada, Australia, and the United States.
7,436 adult smokers (18+ years), selected via random digit dialling and interviewed as part of the International Tobacco Control Four Country Survey (ITC-4) between 2002 and 2009. Primary analyses utilized the subset of respondents who participated in 2006 or later (N = 2,550).
Continuous abstinence from smoking for one month/six months.
Among participants who recalled making a quit attempt within one month of interview, those who reported using varenicline, bupropion, or the nicotine patch were more likely to maintain six-month continuous abstinence from smoking compared to those who attempted to quit without medication (adjusted OR (95% CI): 5.84 (2.12 – 16.12), 3.94 (0.87 – 17.80), 4.09 (1.72 – 9.74), respectively); there were no clear effects for oral NRT use. Those who did not use any medication when attempting to quit tended to be younger, to be racial/ethnic minorities, to have lower incomes, and to believe that medications do not make quitting easier.
Consistent with evidence from randomized controlled trials, smokers in the UK, Canada, Australia, and the US are more likely to succeed in quit attempts if they use varenicline, bupropion or nicotine patch. Previous population studies that failed to find an effect failed to adjust adequately for important sources of bias.
PMCID: PMC3500450  PMID: 22891869
9.  Smoke-Free Bar Policies and Smokers’ Alcohol Consumption: Findings from the International Tobacco Control 4 Country Survey 
Drug and alcohol dependence  2012;126(0):240-245.
Cigarette smoking and alcohol consumption are positively correlated, and the concurrent use of tobacco and alcohol exacerbates the health risks associated with the singular use of either product. Indoor smoke-free policies have been effective in reducing smoking, but little is known about any impact of these policies on drinking behavior. The purpose of this study was to evaluate the potential association between the implementation of smoke-free bar policies and smokers’ alcohol consumption.
A prospective, multi-country cohort survey design was utilized. Participants were nationally representative samples of smokers from the United Kingdom, Australia, Canada, and the United States, who were interviewed as part of the International Tobacco Control Four Country Survey (ITC-4) in 2005, 2007, or 2008 (N = 11914). Changes in the frequency and amount of alcohol consumption were assessed as functions of change in the presence of smoke-free bar policies over time.
Overall, changes in alcohol consumption were statistically indistinguishable between those whose bars became smoke-free and those whose bars continued to allow smoking. However, implementation of smoke-free policies was associated with small reductions in the amount of alcohol typically consumed by those who were classified as hazardous drinkers, along with small reductions in the frequency of alcohol consumption among heavy smokers.
Smoking bans in public places, which protect millions of non-smokers from the harmful effects of second-hand smoke, do not appear to be associated with sizable reductions in smokers’ alcohol consumption in general, but may be associated with small consumption reductions among subgroups.
PMCID: PMC3660989  PMID: 22704125
Smoke-free policies; alcohol consumption; International Tobacco Control Four Country Survey
10.  Accuracy of Self-Reported Tobacco Assessments in a Head and Neck Cancer Treatment Population 
Radiotherapy and Oncology  2011;103(1):45-48.
Prospective analysis was performed of self-reported and biochemically confirmed tobacco use in 50 head and neck cancer patients during treatment. With 93.5% compliance to complete weekly self-report and biochemical confirmatory tests, 29.4% of smokers required biochemical assessment for identification. Accuracy increased by 14.9% with weekly vs. baseline self-reported assessments. Data confirm that head and neck cancer patients misrepresent true tobacco use during treatment.
PMCID: PMC3327779  PMID: 22119370
tobacco; smoking; head/neck; radiotherapy; cotinine
11.  Smoking Adversely Affects Survival in Acute Myeloid Leukemia Patients 
Smoking adversely affects hematopoietic stem cell transplantation outcome. We asked whether smoking affected outcome of newly diagnosed acute myeloid leukemia (AML) patients treated with chemotherapy. Data were collected on 280 AML patients treated with high-dose cytarabine and idarubicin-containing regimens at Roswell Park Cancer Institute who had smoking status data at diagnosis. Patients’ gender, age, AML presentation (de novo vs. secondary), white blood cell (WBC) count at diagnosis, karyotype and smoking status (never vs. ever) were analyzed. Among the 161 males and 119 females with a median follow-up of 12.9 months, 101 (36.1%) had never smoked and 179 (63.9%) were ever smokers. The proportion of patients between never and ever smokers was similar with respect to age, AML presentation, WBC count at diagnosis or karyotype based on univariate analysis of these categorical variables. Never smokers had a significantly longer overall survival (60.32 months) compared to ever smokers (30.89; p=0.005). In multivariate analysis incorporating gender, age, AML presentation, WBC count, karyotype, and smoking status as covariates, age, karyotype and smoking status retained prognostic value for overall survival. In summary, cigarette smoking has a deleterious effect on overall survival in AML.
PMCID: PMC3202035  PMID: 21520043
12.  Tobacco sales in pharmacies: a survey of attitudes, knowledge and beliefs of pharmacists employed in student experiential and other worksites in Western New York 
BMC Research Notes  2012;5:413.
Pharmacies are venues in which patients seek out products and professional advice in order to improve overall health. However, many pharmacies in the United States continue to sell tobacco products, which are widely known to cause detrimental health effects. This conflict presents a challenge to pharmacists, who are becoming increasingly more involved in patient health promotion activities. This study sought to assess Western New York (WNY) area pharmacists’ opinions about the sale of tobacco products in pharmacies, and pharmacists’ opinions on their role in patient smoking cessation.
Participants responded to two parallel surveys; a web-based survey was completed by 148 university-affiliated pharmacist preceptors via a list based sample, and a mail-based survey was completed by the supervising pharmacist in 120 area pharmacies via a list-based sample. The combined response rate for both surveys was 31%. Univariate and bivariate analyses were performed to determine any significant differences between the preceptor and supervising pharmacist survey groups.
Over 75% of respondents support legislation banning the sale of tobacco products in pharmacies. Over 86% of respondents would prefer to work in a pharmacy that does not sell tobacco products. Differences between preceptor and supervising pharmacist groups were observed. Action regarding counseling patients was uncommon among both groups.
Pharmacists support initiatives that increase their role in cessation counseling and initiatives that restrict the sale of tobacco products in pharmacies. These data could have important implications for communities and pharmacy practice.
PMCID: PMC3492148  PMID: 22867129
Tobacco sales; Pharmacists; Preceptors; Public health policy; Survey research; Pharmacies
13.  Multiunit housing residents’ experiences and attitudes toward smoke-free policies 
Nicotine & Tobacco Research  2010;12(6):598-605.
Secondhand smoke (SHS) causes significant disease and death. A person’s home represents a prominent source of SHS, and the potential for exposure is elevated among those who live in close proximity to smokers in multiunit housing (MUH). This study assessed the prevalence and predictors of SHS exposure and smoke-free policy support among MUH residents.
Data were obtained from 5,936 MUH residents who participated in the New York State Adult Tobacco Survey between May 2007 and May 2009. Bivariate analyses were used to assess the prevalence of smoke-free home policies, SHS incursions, and support for smoke-free policies. Logistic regression was used to identify predictors of these measures while adjusting for gender, age, ethnicity, education, region, children in household, and housing type.
A total of 73.1% of respondents reported a personal smoke-free home policy in their home. Among these individuals, 46.2% indicated that SHS has ever entered their home in the past year, while 9.2% reported daily incursions. Overall, a majority of respondents (55.6%) support a policy that bans smoking in all areas of their building, including residential units; support was significantly higher among ethnic minorities and individuals who reside with children.
Nearly half of New York MUH residents with a smoke-free home policy have experienced a SHS incursion in their home. Since a majority of MUH residents support smoke-free policies and nearly three quarters already prohibit smoking in their home, opportunities exist for initiatives to promote smoke-free building policies.
PMCID: PMC3436441  PMID: 20395360
14.  How Do Price Minimizing Behaviors Impact Smoking Cessation? Findings from the International Tobacco Control (ITC) Four Country Survey 
This paper examines how price minimizing behaviors impact efforts to stop smoking. Data on 4,988 participants from the International Tobacco Control Policy Evaluation (ITC) Four-Country Survey who were smokers at baseline (wave 5) and interviewed at a 1 year follow-up were used. We examined whether price minimizing behaviors at baseline predicted: (1) cessation, (2) quit attempts, and (3) successful quit attempts at one year follow up using multivariate logistic regression modeling. A subset analysis included 3,387 participants who were current smokers at waves 5 and 6 and were followed through wave 7 to explore effects of changing purchase patterns on cessation. Statistical tests for interaction were performed to examine the joint effect of SES and price/tax avoidance behaviors on cessation outcomes. Smokers who engaged in any price/tax avoidance behaviors were 28% less likely to report cessation. Persons using low/untaxed sources were less likely to quit at follow up, those purchasing cartons were less likely to make quit attempts and quit, and those using discount cigarettes were less likely to succeed, conditional on making attempts. Respondents who utilized multiple behaviors simultaneously were less likely to make quit attempts and to succeed. SES did not modify the effects of price minimizing behaviors on cessation outcomes. The data from this paper indicate that the availability of lower priced cigarette alternatives may attenuate public health efforts aimed at to reduce reducing smoking prevalence through price and tax increases among all SES groups.
PMCID: PMC3108134  PMID: 21655144
tobacco; cessation; price; tax; policy; socio-economic status
15.  The Effectiveness of Tobacco Marketing Regulations on Reducing Smokers’ Exposure to Advertising and Promotion: Findings from the International Tobacco Control (ITC) Four Country Survey 
Exposure to tobacco product marketing promotes the initiation, continuation, and reuptake of cigarette smoking and as a result the World Health Organization Framework Convention on Tobacco Control (WHO FCTC) has called upon member Parties to enact comprehensive bans on tobacco advertising and promotion. This study examines the immediate and long term effectiveness of advertising restrictions enacted in different countries on exposure to different forms of product marketing, and examines differences in exposure across different socioeconomic status (SES) groups. Nationally representative data from the United Kingdom, Canada, Australia, and the United States, collected from adult smokers between 2002 and 2008 using the International Tobacco Control Four Country Survey (ITC-4), were used in this study (N = 21,615). In light of the specific marketing regulation changes that occurred during the course of this study period, changes in awareness of tobacco marketing via various channels were assessed for each country, and for different SES groups within countries. Tobacco marketing regulations, once implemented, were associated with significant reductions in smokers’ reported awareness of pro-smoking cues, and the observed reductions were greatest immediately following the enactment of regulations. Changes in reported awareness were generally the same across different SES groups, although some exceptions were noted. While tobacco marketing regulations have been effective in reducing exposure to certain types of product marketing there still remain gaps, especially with regard to in-store marketing and price promotions.
PMCID: PMC3084464  PMID: 21556189
tobacco control; marketing regulation; socioeconomic differences; public policy
16.  Socioeconomic Variation in the Prevalence, Introduction, Retention, and Removal of Smoke-Free Policies among Smokers: Findings from the International Tobacco Control (ITC) Four Country Survey 
Exposure to secondhand smoke causes premature death and disease in non-smokers and indoor smoke-free policies have become increasingly prevalent worldwide. Although socioeconomic disparities have been documented in tobacco use and cessation, the association between socioeconomic status (SES) and smoke-free policies is less well studied.
Data were obtained from the 2006 and 2007 Waves of the International Tobacco Control Four Country Survey (ITC-4), a prospective study of nationally representative samples of smokers in Canada, the United States, the United Kingdom, and Australia. Telephone interviews were administered to 8,245 current and former adult smokers from October 2006 to February 2007. Between September 2007 and February 2008, 5,866 respondents were re-interviewed. Self-reported education and annual household income were used to create SES tertiles. Outcomes included the presence, introduction, and removal of smoke-free policies in homes, worksites, bars, and restaurants.
Smokers with high SES had increased odds of both having [OR: 1.54, 95% CI: 1.27–2.87] and introducing [OR: 1.49, 95% CI: 1.04–2.13] a total ban on smoking in the home compared to low SES smokers. Continuing smokers with high SES also had decreased odds of removing a total ban [OR: 0.44, 95% CI: 0.26–0.73]. No consistent association was observed between SES and the presence or introduction of bans in worksites, bars, or restaurants.
The presence, introduction, and retention of smoke-free homes increases with increasing SES, but no consistent socioeconomic variation exists in the presence or introduction of total smoking bans in worksites, bars, or restaurants. Opportunities exist to reduce SES disparities in smoke-free homes, while the lack of socioeconomic differences in public workplace, bar, and restaurant smoke-free policies suggest these measures are now equitably distributed in these four countries.
PMCID: PMC3084469  PMID: 21556194
tobacco smoke pollution; smoking; public policy; socioeconomic factors; United States, Canada; Australia; United Kingdom
17.  Socio-Economic Variation in Price Minimizing Behaviors: Findings from the International Tobacco Control (ITC) Four Country Survey 
This paper examines how socio-economic status (SES) modifies how smokers adjust to changes in the price of tobacco products through utilization of multiple price minimizing techniques. Data come from the International Tobacco Control Policy Evaluation (ITC) Four Country Survey, nationally representative samples of adult smokers and includes respondents from Canada, the United States, the United Kingdom and Australia. Cross-sectional analyses were completed among 8,243 respondents (7,038 current smokers) from the survey wave conducted between October 2006 and February 2007. Analyses examined predictors of purchasing from low/untaxed sources, using discount cigarettes or roll-your-own (RYO) tobacco, purchasing cigarettes in cartons, and engaging in high levels of price and tax avoidance at last purchase. All analyses tested for interactions with SES and were weighted to account for changing and under-represented demographics. Relatively high levels of price and tax avoidance behaviors were present; 8% reported buying from low or untaxed source; 36% used discount or generic brands, 13.5% used RYO tobacco, 29% reported purchasing cartons, and 63% reported using at least one of these high price avoidance behaviors. Respondents categorized as having low SES were approximately 26% less likely to report using low or untaxed sources and 43% less likely to purchase tobacco by the carton. However, respondents with low SES were 85% more likely to report using discount brands/RYO compared to participants with higher SES. Overall, lower SES smokers were 25% more likely to engage in at least one or more tax avoidance behaviors compared to their higher SES counterparts. Price and tax avoidance behaviors are relatively common among smokers of all SES strata, but strategies differed with higher SES groups more likely to report traveling to a low-tax location to avoid paying higher prices, purchase duty free tobacco, and purchase by cartons instead of packs all of which were less commonly reported by low SES smokers. Because of the strategies lower SES respondents are more likely to use, reducing price differentials between discount and premium brands may have a greater impact on them, potentially increasing the likelihood of quitting.
PMCID: PMC3037072  PMID: 21318026
tobacco; policy; price; tax; socio-economic status

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