Cutting tobacco taxes, endangering youth
CMAJ 1997;156:1378
See response from: V. Hamilton, et al
The article "The effect of tobacco tax cuts on cigarette smoking in Canada" (CMAJ 1997;156:187-91 [full text / résumé]), by Dr. Vivian H. Hamilton and associates, is an interesting attempt to address the impact on smoking of the major cuts in federal and provincial cigarette taxes in 1994. However, I am concerned that methodologic weaknesses in the survey conducted by Statistics Canada could have led to an underestimation of the impact of the cuts.
Starting smoking occurs predominantly during the teenage years. One major concern about the tax cuts was that they would make cigarettes more available to teenagers, especially to those younger than 15, whose smoking habits are more price-sensitive. As such, it is disappointing that Hamilton and associates did not present any age-specific smoking results. The reported incidences (in Table 3) represent an average of high rates of starting smoking in teenagers and of low rates in older respondents. It is also disappointing that the survey collected no data on children under age 15. Data from surveys such as the Ontario Health Survey suggest that up to 50% of smokers start smoking by that age.[1] Hence, the Statistics Canada survey may have missed important trends in the rates of starting smoking.
I am also concerned that the survey used a panel design rather than interviews of separate groups of subjects at each time point. The panel design has 2 implications. First, a bias may be introduced into the subjects' responses. For example, subjects may be more reluctant to admit having started smoking in later rounds because the repeated questions about smoking may have made them self-conscious about the fact that smoking is socially undesirable. Second, people who had started smoking in an earlier round would not be able to start again. Hence, the rates of starting smoking could underestimate the true rates in the Canadian population.
Because of these concerns, I think we should not be too reassured by the observation that smoking prevalence continued to drop despite the tobacco tax cut. The cautions proposed by Hamilton and associates need to be emphasized and more aggressive legislative actions pursued to prevent children from starting to smoke.
Nicholas Birkett, MD, MSc
Department of Epidemiology
and Community Medicine
University of Ottawa
Ottawa, Ont.
Reference
- Birkett NJ. Smoking prevalence in Ontario: a reconstructed cohort analysis of the 1990 Ontario Health Survey for people born between 1940 and 1975 [working paper]. Ontario Tobacco Research Unit; 1996.
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