Cutting tobacco taxes, endangering youth
CMAJ 1997;156:1377
In response to: N. Birkett
Dr. Birkett notes that we did not report age-specific smoking results. The analysis we reported is the initial step in a study funded by the National Health Research and Development Program in which we are studying the impact of a number of factors on cigarette smoking; these factors include tobacco taxes, age, education, income and family composition. Given the potential correlation among sociodemographic variables, we were reluctant to report age-specific results at this stage.
The survey indicates a difference of 0.25 percentage points in smoking uptake immediately after the 1994 tax rollbacks between adults (20 years of age and older) living in provinces with tax cuts and those living in provinces without tax cuts (1.77% v. 1.52%). In contrast, the difference in smoking uptake among youth (those 15 to 19) between provinces with and without tax cuts is 1.53 percentage points (5.62% v. 4.09%). Thus, the fact that this survey does not contain information on even younger Canadians may underestimate the overall impact of the tax cuts on smoking behaviour. However, we prefer to reserve judgement on this issue until we have had the opportunity to conduct an in-depth multivariate analysis.
Birkett is also concerned that repeated surveying of subjects may have caused them to be more reluctant to admit that they had started smoking in later rounds of the survey, leading to further underestimates of smoking behaviour. We know of no studies that identify such behaviour. In addition, this behaviour would have had to occur at systematically different rates in provinces with tax cuts and in those without tax cuts to bias our estimates. Birkett's claim that people who had started smoking in an earlier round would not be counted as new smokers if they quit and then started again during the survey is incorrect.
Although we found a decrease in smoking prevalence in all provinces during the survey, it was never our intention to understate the negative health implications of the 1994 tobacco tax rollback. Our results imply that the tobacco tax cuts slowed declines in Canadian smoking prevalence substantially. We also noted the importance of analysing the impact of these cuts on youth. As an initial examination of this issue, the descriptive statistics noted above certainly support Birkett's argument for more aggressive legislative actions to prevent children from starting to smoke.
Vivian H. Hamilton, PhD
Carey Levinton, MSc
Yvan St-Pierre, MSc
Centre for the Analysis of Cost-Effective Care
Division of Clinical Epidemiology
Montreal General Hospital
Montreal, Que.
Franque Grimard, PhD
Department of Economics
McGill University
Montreal, Que.
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