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Journal of Peking University (Health Sciences) ›› 2024, Vol. 56 ›› Issue (3): 479-486. doi: 10.19723/j.issn.1671-167X.2024.03.015

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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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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

CLC Number: 

  • R193.3

Table 1

Participants' socio-demographic and smoking characteristics"

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

Table 2

Associations between CPT indices and socio-demographic and smoking characteristics"

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

Figure 1

Fitting model of relationship between smoking cessation rates and cigarette prices"

Table 3

Fitting smoking cessation rates and cigarette prices in different scenarios"

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

Figure 2

Socioeconomic status adjusted fitting model of relationship between smoking cessation rates and cigarette prices A, adjusted for education levels; B, adjusted for income levels."

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