北京大学学报(医学版) ›› 2024, Vol. 56 ›› Issue (3): 479-486. doi: 10.19723/j.issn.1671-167X.2024.03.015

• 论著 • 上一篇    下一篇

CPT在实现我国控烟目标中的应用探索

杨晓尘1,曹望楠1,林昊翔2,张蓝超1,林雨欣1,陈子砚1,常春1,*()   

  1. 1. 北京大学公共卫生学院社会医学与健康教育系,北京 100191
    2. 北京大学全球健康发展研究院,北京 100871
  • 收稿日期:2024-02-19 出版日期:2024-06-18 发布日期:2024-06-12
  • 通讯作者: 常春 E-mail:changchun@bjmu.edu.cn
  • 基金资助:
    国家自然科学基金(82173637)

Application of the cigarette purchase tasks in achieving China' s tobacco control goals

Xiaochen YANG1,Wangnan CAO1,Haoxiang LIN2,Lanchao ZHANG1,Yuxin LIN1,Ziyan CHEN1,Chun CHANG1,*()   

  1. 1. Department of Social Medicine and Health Education, Peking University School of Public Health, Beijing 100191, China
    2. Institute for Global Health and Development, Peking University, Beijing 100871, China
  • Received:2024-02-19 Online:2024-06-18 Published:2024-06-12
  • Contact: Chun CHANG E-mail:changchun@bjmu.edu.cn
  • Supported by:
    the National Natural Science Foundation of China(82173637)

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摘要:

目的: 采用卷烟购买任务(cigarette purchase task,CPT)对我国吸烟者的卷烟需求进行评价,并评估不同假设情境下的卷烟价格,以实现“健康中国2030”行动中降低吸烟率的目标。方法: 共计447名受试者通过问卷调查完成CPT,根据价格框架和对应的卷烟消费量拟合卷烟需求曲线,并得到5个相关指标,分别为强度(免费时的卷烟消费量)、断点(消费量降为0的价格)、最高消费额(maximum output, Omax)、最高价格(maximum price, Pmax, 最高消费额对应的卷烟价格)和弹性(消费量变化与价格变化的比率)。采用单因素分析探索CPT指标和社会人口学特征、吸烟特征的相关性。采用单相衰减模型拟合戒烟率-卷烟价格曲线,并确定一系列情境下能使吸烟率降到20%的最佳卷烟价格。结果: 从卷烟需求曲线得到吸烟者弹性为0.54,表明价格上涨10%可使吸烟率降低5.4%。收入越高的吸烟者对卷烟价格敏感性越低(弹性=-2.31, P=0.028)。CPT指标在常用卷烟价格、吸烟量和烟草依赖程度不同的吸烟者中差异有统计学意义,常用卷烟价格越高的吸烟者断点、最高消费额和最高价格均越高,弹性越低(P=0.001),烟草依赖程度越高的吸烟者强度、断点、最高消费额和最高价格均越高,而弹性越低(P=0.001),吸烟量更大的吸烟者强度、最高消费额更高,弹性更低(P < 0.001)。要实现将吸烟率降至20% 的目标,卷烟的价格至少为37.36元/包,调整受教育水平和收入水平后,卷烟价格分别至少为37.37元/包和37.84元/包。结论: CPT指标与收入水平和常用卷烟价格、吸烟量和烟草依赖程度显著相关,在研究影响吸烟行为的价格因素方面有应用空间;本研究模型拟合卷烟价格远超当前实际市场水平,应采取更有力的政策措施提高烟草税和卷烟零售价,以实现将吸烟率降低到20%的“健康中国2030”目标。

关键词: 卷烟需求, 卷烟购买任务, 烟草控制, 烟草税

Abstract:

Objective: To assess cigarette demand among Chinese smokers through a cigarette purchase task (CPT) and to evaluate cigarette prices under different hypothetical scenarios in order to meet the goals of smoking prevalence reduction in China. Methods: In the study, 447 participants completed a hypothetical CPT at baseline assessments of a trial, thus, cigarette demand curves were individually fitted for each participant using an exponentiated version of the exponential demand model. Typically, five demand indices were derived, intensity (consumption when free), breakpoint (first price at which consumption is suppressed to 0), maximum output (Omax), maximum price (Pmax, price at which Omax occurred), and elasticity (the ratio of the change in quantity demanded to the change in price). A one-way analysis of variance was used to explore the correlations between the cigarette purchase task indices and socio-demographic and smoking characteristics. The one-way decay model was employed to simulate the smoking cessation rates and determine optimal cigarette prices in a series of scenarios for achieving 20% smoking prevalence. Results: The price elasticity drawn from CPT was 0.54, indicating that a 10% price increase could reduce smoking by 5.4% in the participated smokers. Smokers with higher income were less sensitive to cigarette prices (elasticity=-2.31, P=0.028). Cigarette purchase task indices varied significantly among the smokers with different prices of commonly used cigarettes, tobacco dependence, and smoking volume. The smokers who consumed cigarettes of higher prices reported higher breakpoint, Omax and Pmax, but lower intensity (P=0.001). The smokers who were moderately or highly nicotine dependent reported higher intensity, breakpoint, Omax and Pmax, and they had lower intensity (P=0.001). The smokers who had a higher volume of cigarettes reported higher intensity and Omax, and lower intensity (P < 0.001). To achieve the goal of reducing smoking prevalence to 20% in mainland China, we estimated the desired increase on smoking cessation rate and prices accordingly in a series of scenarios, considering the gender variance and reduced smoking initiation. In scenario (a), to achieve a smoking prevalence goal of 20%, it would be necessary for 24.81% of the current smokers to quit smoking when there were no new smokers. Our fitting model yielded a corresponding value of 59.64 yuan (95%CI 53.13-67.24). Given the assumption in scenario (b) that only males quitted smoking, the desired cessation rates would be 25.82%, with a higher corresponding price of 62.15 yuan (95%CI 55.40-70.06) to induce desired cessation rates. In the proposed scenario (c) where 40 percent of the reduction in smoking prevalence came from reduced smoking initiation, and females and males equally quitted smoking due to increased cigarette prices, the price of a pack of cigarettes would be at least 37.36 yuan (95%CI 32.32-42.69) (equals to $ 5.20) per pack to achieve the cessation rate of 14.89 percent. In scenario (d) where only males quitted smoking due to increased cigarette prices considering the reduced smoking initiation, the respective smoking cessation rates should be 15.49% with the desired prices of 38.60 yuan (95%CI 33.53-44.02). After adjusting for education levels and income levels in scenario (c), the price of cigarettes would be at least 37.37 yuan/pack (equals to $ 5.20) (95%CI 30.73-44.94) and 37.84 yuan/pack (equals to $ 5.26) (95%CI 31.94-44.53), respectively. Conclusion: Cigarette purchase task indices are significantly associated with income levels and prices of commonly used cigarettes, levels of tobacco dependence, and smoking volume, which is inspiring in studying price factors that influence smoking behavior. It is suggested that higher cigarette prices, surpassing the current actual market level, is imperative in mainland China. Stronger policy stra-tegies should be taken to increase tobacco taxes and retail cigarette prices to achieve the Healthy China 2030 goal of reducing smoking prevalence to 20%.

Key words: Cigarette demand, Cigarette purchase task, Tobacco control, Tobacco tax

中图分类号: 

  • R193.3

表1

研究对象社会人口学和吸烟特征"

Variables Participants (n=447)
Age/years 37.7±9.14
Ethnicity, Han 437 (97.8)
Education level
  Junior high school or lower 190 (42.5)
  Senior high school 124 (27.7)
  Undergraduate or higher 133 (29.8)
Marital status, married 362 (81.0)
Income per month/yuan 6 000 (5 000, 8 000)
Diseases
  None 300 (67.1)
  1 disease 109 (24.4)
  2 diseases or more 38 (8.5)
Drinking conditions
  Drinking on special occasions or not drinking 345 (77.2)
  Drinking regularly 102 (22.8)
Cigarettes per day 16 (10, 20)
Nicotine dependence
  Minimally dependent 104 (23.3)
  Moderately dependent 265 (59.3)
  Highly dependent 78 (17.4)
Past quit attempts
  No 126 (28.2)
  No, but reduced consumption 151 (33.8)
  Yes 170 (38.0)
Cigarette prices/yuan
  ≤10 64 (14.3)
  >10-15 190 (42.5)
  >15-20 133 (29.8)
  >20 60 (13.4)
Intensity 20 (15, 20)
Breakpoint 9 (3, 31)
Omax 30 (18, 60)
Pmax 3 (1.75, 12.00)
Elasticity -2.21 ± 0.53

表2

CPT指标和社会人口学、吸烟特征的单因素分析"

Items Intensity P Breakpoint P Omax P Pmax P Elasticity P
Ethnicity 0.390 0.094 0.110 0.331 0.069
  Han 1.29±0.28 0.94±0.47 1.56±0.51 0.62±0.56 -2.20±0.53
  Else 1.36±0.24 1.22±0.47 1.89±0.58 0.85±0.72 -2.56±0.55
Education level 0.778 0.548 0.127 0.667 0.051
  Junior high school or lower 1.30±0.27 0.92±0.49 1.52±0.50 0.60±0.57 -2.15±0.53
  Senior high school 1.27±0.28 0.94±0.50 1.56±0.55 0.62±0.60 -2.20±0.56
  Undergraduate or higher 1.29±0.30 0.98±0.43 1.64±0.48 0.66±0.54 -2.30±0.50
Marital status 0.867 0.375 0.962 0.921 0.922
  Married 1.29±0.34 0.90±0.53 1.56±0.59 0.62±0.62 -2.20±0.64
  Else 1.29±0.27 0.96±0.46 1.57±0.49 0.62±0.55 -2.21±0.51
Income level 0.008 0.023 0.012 0.074 0.028
  Low 1.27±0.31 0.87±0.51 1.53±0.57 0.56±0.59 -2.16±0.59
  Mediate 1.25±0.22 0.98±0.46 1.51±0.46 0.62±0.55 -2.16±0.48
  High 1.35±0.30 1.00±0.43 1.67±0.46 0.71±0.54 -2.31±0.51
Diseases 0.405 0.189 0.242 0.580 0.202
  None 1.29±0.31 0.92±0.48 1.54±0.53 0.60±0.58 -2.18±0.56
  1 disease 1.26±0.19 1.02±0.42 1.63±0.42 0.67±0.51 -2.27±0.44
  2 diseases or more 1.33±0.29 0.93±0.53 1.63±0.58 0.62±0.65 -2.27±0.54
Drinking conditions 0.283 0.274 0.274 0.434 0.231
  Drinking on special occasions or not drinking 1.28±0.29 0.93±0.47 1.55±0.50 0.61±0.56 -2.19±0.54
  Drinking regularly 1.31±0.25 0.99±0.50 1.62±0.54 0.66±0.59 -2.26±0.52
Age (correlate) 0.043 0.366 -0.067 0.157 -0.094 0.046 -0.092 0.053 0.075 0.111
Cigarette prices/yuan 0.303 0.001 < 0.001 0.004 0.001
  ≤10 1.33±0.33 0.81±0.56 1.44±0.63 0.51±0.66 -2.03±0.66
  >10-15 1.26±0.28 0.89±0.48 1.50±0.51 0.55±0.58 -2.16±0.53
  >15-20 1.29±0.27 1.02±0.42 1.64±0.44 0.71±0.52 -2.27±0.48
  >20 1.32±0.27 1.09±0.41 1.76±0.44 0.78±0.48 -2.39±0.45
Nicotine dependence 0.003 0.024 < 0.001 0.009 0.001
  Minimally dependent 1.21±0.29 0.85±0.49 1.37±0.47 0.48±0.57 -2.05±0.50
  Moderately dependent 1.30±0.27 0.96±0.47 1.61±0.51 0.65±0.56 -2.23±0.52
  Highly dependent 1.35±0.29 1.04±0.45 1.69±0.50 0.72±0.56 -2.33±0.60
Cigarettes per day < 0.001 0.137 < 0.001 0.223 < 0.001
  ≤10 1.11±0.31 0.89±0.50 1.36±0.56 0.57±0.59 -2.00±0.57
  11-20 1.33±0.21 0.96±0.46 1.61±0.44 0.63±0.55 -2.25±0.47
  21-30 1.49±0.25 0.92±0.52 1.78±0.52 0.59±0.63 -2.39±0.58
  >30 1.64±0.24 1.13±0.42 2.08±0.41 0.83±0.59 -2.71±0.49
Past quit attempts 0.088 0.503 0.171 0.561 0.402
  No 1.30±0.29 0.96±0.50 1.64±0.55 0.66±0.58 -2.26±0.55
  No, but reduced consumption 1.25±0.27 0.97±0.45 1.53±0.47 0.63±0.54 -2.19±0.52
  Yes 1.32±0.28 0.91±0.48 1.54±0.51 0.59±0.58 -2.18±0.53

图1

总体戒烟率-卷烟价格拟合模型"

表3

不同假设情境及对应戒烟率和卷烟价格"

Scenarios Desired cessation rate/% Price per pack of cigarettes/yuan 95%CI
(a) no new smokers & females and males quit smoking equally 24.81 59.64 53.13-67.24
(b) no new smokers & only males quit smoking 25.82 62.15 55.40-70.06
(c) decreased initiation rates & females and males quit smoking equally 14.89 37.36 32.32-42.69
(d) decreased initiation rates & only males quit smoking 15.49 38.60 33.53-44.02
Adjusted (c) for education levels 14.89 37.37 30.73-44.94
Adjusted (c) for income levels 14.89 37.84 31.94-44.53

图2

戒烟率-卷烟价格拟合模型(调整受教育和收入水平)"

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