The effect of tobacco tax increase on price‐minimizing tobacco purchasing behaviours: A systematic review and meta‐analysis

Abstract

AbstractBackground and aimsTobacco product excise taxes are a cost‐effective method for reducing tobacco consumption, but industry pricing and marketing strategies encourage consumers to engage in price‐minimizing behaviours (PMBs). We investigated the relationship between tobacco tax increases and PMBs, measuring whether PMBs intensify following tax increases, whether low‐income consumers with higher nicotine dependence are more likely to engage in PMBs and whether PMBs are negatively related to smoking cessation.MethodThis was a systematic review with meta‐analysis of cross‐sectional and longitudinal studies from seven databases up to March 2023, using studies that reported any product‐ and purchasing‐related smoking behaviours post‐tobacco tax increase in a general representative population. Sixty‐eight studies were quality‐assessed using the Newcastle–Ottawa scale. All studies were narratively synthesized, with five studies involving 13 068–26 575 participants providing data for pooled analyses on PMBs [purchasing lower‐priced brands, roll‐your‐own (RYO) tobacco and cartons] pre‐ and post‐tax increases using a random effects meta‐analytical model.ResultsFifty‐seven studies reported on legal PMBs, and 17 studies reported illicit cigarette purchasing. Meta‐analysis showed that consecutive tax increases were positively associated with purchasing RYO [odds ratio (OR) = 1.60, 95% confidence interval (CI) = 1.04–2.46], especially in higher tobacco taxing environments, with substantial heterogeneity (I2 = 96%). Lower income and higher nicotine dependence were associated with purchasing lower‐priced brands and RYO, whereas higher income and nicotine dependence were associated with purchasing cartons, large‐sized packs and cross‐border sales. Less evidence associated illicit tobacco purchases with tax increases or PMBs with smoking cessation.ConclusionsTobacco purchasers’ PMBs vary widely by state, country and time‐period within countries. Both legal and illegal PMBs, potentially influenced by industry pricing tactics, may exacerbate health inequalities and dilute the public health benefits of tobacco tax increases.