Pengaruh Kenaikan Harga Rokok terhadap Perilaku Merokok pada Kelompok Usia Remaja: Literature Review

Cigarettes are one of the factors of world health issues that have not been resolved until now. The number of smokers in the world in 2015 reached 1.3 billion people, while Indonesia being the first billion smokers in ASEAN with 65 million smokers and 69 percent dominated by teenagers. The World Health Organization (WHO) has determined the reduction of cigarette consumption as one of the Global NCDs Targets to be achieved by 2025 by increasing the action of increasing the tax price of all cigarette products to reduce the demand for cigarettes. Indonesia applies the same thing by issuing the Peraturan Menteri Keuangan Republik Indonesia no. 198 Tahun 2020 concerning the policy on the price of cigarettes smoking 12.5 percent in order to reduce the prevalence of smoking in the 10-18 year age range from 9.1 percent to 5.4 percent in 2029 according to the RPJMN. The purpose of this study is to analyze research studies that have been conducted to describe the effect of rising cigarette prices on adolescent smoking behavior. The data used in this literature study are articles that are relevant to the inclusion and exclusion criteria that have been determined within a span of 10 years that have been published in selected databases, which are Proquest, Pubmed, and Google Scholar. Stages of selection using the PRISMA flow chart. Assessment of article quality used the Strengthening The Reporting of Observational Studies in Epidemiology (STROBE) checklist. The results of this literature study contained 7 (seven) articles that were analyzed. These articles describe the effect of increasing cigarette prices on decreasing smoking initiation, smoking consumption, and smoking prevalence. Abstrak: Rokok merupakan salah satu faktor masalah kesehatan dunia yang belum terselesaikan sampai saat ini. Jumlah perokok di dunia pada tahun 2015 diestimasikan mencapai 1,3 milyar orang di mana Indonesia menempati peringkat pertama perokok terbesar di ASEAN dengan jumlah 65 juta perokok dan 69 persen didominasi remaja. World Health Organization (WHO) menetapkan pengurangan konsumsi rokok sebagai salah satu Global NCDs Target yang akan dicapai pada tahun 2025 dengan prioritas aksi peningkatan harga pajak semua produk rokok untuk mengurangi permintaan rokok. Indonesia menerapkan hal serupa yaitu dengan mengeluarkan Peraturan Menteri Keuangan Republik Indonesia nomor 198 Tahun 2020 mengenai kebijakan harga rokok yang dinaikkan 12,5 persen guna menekan prevalensi merokok remaja rentang usia 10 – 18 tahun dari angka 9,1 persen menjadi 5,4 persen di tahun 2029 sesuai dengan RPJMN. Tujuan dari penelitian ini yaitu untuk menganalisis studi-studi penelitian yang telah dilakukan untuk menggambarkan pengaruh dari kenaikan harga rokok terhadap perilaku merokok remaja. Data yang digunakan dalam studi literatur ini merupakan artikel-artikel yang relevan dengan kriteria inklusi dan eksklusi yang telah ditentukan dengan rentang 10 tahun yang telah terpublikasi pada database pilihan yaitu Proquest, Pubmed, dan Google Scholar. Tahapan seleksi menggunakan PRISMA flow diagram. Penilaian kualitas artikel menggunakan Strengthening The Reporting of Observational Studies in Epidemiology (STROBE) checklist. Hasil pada studi literatur ini terdapat 7 (tujuh) artikel yang dianalisis. Artikel-artikel tersebut menggambarkan adanya pengaruh kenaikan harga rokok terhadap penurunan inisiasi merokok, konsumsi merokok, dan prevalensi merokok.

The impact of cigarette prices on smoking participation and tobacco expenditure in Vietnam

Vietnam is one of countries with the highest number of smokers in the world and the high smoking prevalence among men in the region. Although the real cigarette prices increased by around 4% during the 2010–2015 period, the prevalence of daily cigarette smoking among men decreased slightly from 31.3% to 30.7% during this period. This raises the question of whether cigarette consumption is sensitive to price. In this study, we estimated the effect of cigarette prices on smoking participation and tobacco expenditure in Vietnam. We found that a one-percent increase in the real cigarette price reduced the probability of cigarette smoking among males by 0.08 percentage points (95% CI from -0.06 to -0.10), equivalent to the price elasticity of the smoking prevalence at -0.26 (95% CI from -0.16% to -0.33%). Using this estimate, we predict that if the cigarette price is increased by 10%, the daily cigarette smoking prevalence among men would decrease from 30.7% to 29.9% and the number of male smokers would decline by around 270 thousand. Higher cigarette prices also reduced per capita tobacco expenditure of households. A one-percent increase in the cigarette price decreased per capita expenditure on tobacco consumption expenditure of households by 0.43 percent (the 95% CI from -0.029 to 0.822). This finding suggests that raising tobacco taxes and prices can be an effective measure to reduce tobacco use.

Brand-switching and tobacco taxation in Vietnam

BackgroundThe government of Vietnam is embarking on a radical tobacco excise tax reform, switching from the current pure ad valorem scheme to a mixed system by adding a specific component. There have been concerns raised by state-owned tobacco companies against this initiative that switching to a mixed scheme may shift consumption away from cheaper, domestic brands to more expensive, foreign brands (produced locally by joint ventures between multinational tobacco companies and domestic firms) and to illicit cigarettes, thus impairing the domestic industry, rather than reducing cigarette consumption effectively. Unfortunately, although this concern has been one of the biggest obstacles to the tobacco tax reform in the country, no study thus far has attempted to address it due mostly to the unavailability of relevant micro-market data with detailed information on brand choice.ObjectivesThis research attempts to study cigarette brand substitution patterns and quantify the potential effect of the proposed tax structure change on cigarette brand choice to inform tax policy discussions in Vietnam.MethodsA discrete choice experiment is conducted to collect data on smokers’ stated brand choice when cigarette prices change exogenously. Combined with data on their current cigarette consumption, random parameter logit models were estimated and then used to calculate brand-level price semielasticities as well as numerically simulate the impact of tax reforms on smoking.ResultsSmokers are more likely to substitute a low-priced domestic brand with another domestic brand than either with a foreign brand or with an illicit brand, both of which are more expensive. Furthermore, the opt-out is one of the closest substitutes to low-priced brands and also the most sensitive to a change in their prices, implying that smokers of low-priced brands are more likely to buy none of the studied brands when cigarette prices increase. This provides strong suggestive evidence that they appear more likely to stop smoking when faced with higher cigarette prices. Imposing a specific tax tends to reduce the market share for both low-priced and high-priced licit brands, although the estimated market share reduction is larger for the former. In response to specific tax increases, a large share of current smokers do not intend to switch to illegal cigarette brands, but rather choose none of the experimented brands, suggesting their intention to quit. Finally, the magnitude of substitution to illicit brands tends to be negatively related to change in their prices as a result of the specific excise tax hike.ConclusionContrary to the raised concern, smokers are more likely to substitute a domestic brand with another domestic brand than with a foreign brand. Moreover, the threat of illicit trade should not be exaggerated, and there are actions that the government of Vietnam can take to mitigate the threat effectively.

Cigarette prices in eight sub-Saharan African countries in 2018: a cross-sectional analysis

ObjectiveWhile the trend in smoking prevalence is decreasing worldwide, the number of male tobacco smokers is growing in Africa. This study compares the cigarette market in eight sub-Saharan African countries. This includes examining cigarette prices, pricing differentials, pack sizes and affordability at national and subnational levels.Design and settingA cross-sectional data analysis using data from the Data on Alcohol and Tobacco in Africa (DATA) Project. The DATA Project was centrally coordinated by project supervisors following a standardised protocol. University students were recruited to conduct data collection and a total of 22 347 retail cigarette price data points collected between June and August 2018 were analysed (including Botswana, Ethiopia, Lesotho, Namibia, Nigeria, South Africa, Zambia and Zimbabwe). Prices were converted to US$ and standardised to the price of a 20-cigarette pack.ResultsThis research found large price differentials within provinces/states, with the gap between medium and minimum prices per 20-cigarette pack exceeding 50% of the medium price in 18 out of 24 provinces/states. Single cigarettes were widely available, especially in Lesotho and Ethiopia. Results of multivariable regression suggest prices (per 20-cigarette pack) were lower for cigarettes sold in packs than single sticks (−US$0.27, 95% CI: −US$0.39 to −US$0.23) and lower in less populated areas (−US$0.28 in rural compared with urban settings, 95% CI: −US$0.41 to −US$0.15). Availability of cheaper single cigarettes (lower per unit price than packed cigarettes) were identified for Lesotho and South Africa.ConclusionsThese findings identify a varied picture in cigarette pricing in studied countries and suggest measures to tackle pricing differentials and availability of single sticks are warranted. These measures should counteract the potential health consequences of the increasing penetration of tobacco industry in these sub-Saharan African countries.

Effects of the Brazilian tax reform plans on the tobacco market

BackgroundThere has been an intense debate in the Brazilian National Congress on how to reform the country’s tax system on consumption. This paper investigates the effects of the tax reform under the Constitutional Amendment Bill 45/2019 on cigarette prices, consumption and tax collection. The reform will introduce a new goods and services tax (GST) and tobacco excise tax (TET).MethodsThe micro data from the National Household Sample Survey (PNAD) of 2008 and the National Health Survey (PNS) of 2013 are inputs in the simulation in order to determine the smoking behaviour and consumer responses to price changes as accurately as possible across the different Brazilian states. We developed three scenarios for the tobacco tax reform and their effects on cigarette prices, smoking behaviour and tax collection. We also estimate the size of the illicit cigarette market by Brazilian state and simulate the impacts of a 10% reduction in its market share.FindingsOverall, we found that a GST of 27% and a TET of either 51%, 56% or specific 3.89 BRL per pack would lead to considerably higher cigarette prices, lower cigarette consumption and, above all, an increase of cigarette tax collection between 8% and 27% depending on the state. A discretionary 10% reduction in the illicit market would add about 8.5% of extra tax collection per year to the country.ConclusionsThe simulated scenarios demonstrated that, to keep the cigarette prices at least at the same level as those in the current tax scheme, TET should be no less than 77.85% of the retail price. This means that any politically feasible tax reform should result in higher cigarette prices and a reduction in cigarette consumption. Considering the nationwide effect, in all scenarios, the total increase in tobacco tax revenue is around 8.5% or 1.5 billion BRL per year. This extra revenue is highly desirable in an environment of chronic fiscal imbalance and the COVID-19 pandemic crisis.

Cigarette Prices and Smoking Behavior in Israel: Findings from a National Study of Adults (2002–2017)

Tobacco taxation and price policies are considered the most effective for lowering demand for tobacco products. While this statement is based on research from numerous countries, scant evidence exists on this topic for Israel. Accordingly, we assessed the association between cigarette prices and smoking prevalence and intensity from a national sample of adults in Israel (2002–2017). Data on smoking behavior were derived from the Israeli Knowledge Attitudes and Practices (KAP) survey, a repeated cross-sectional survey. Price information is from the Economist Intelligence Unit (EIU) since it was not collected in the KAP survey. We used the price of a pack of 20 cigarettes for Marlboro and the local brand. These two price variables were the primary independent variables, and we adjusted for inflation. The dependent variables were current smoking (yes/no) and smoking intensity, defined as the number of cigarettes smoked per week. Multivariable analysis was employed using a two-part model while adjusting for covariates. The first step of the model utilized logistic regression with current smoking as the dependent variable. The second step examining smoking intensity as the dependent variable, used OLS regression. Price elasticity was estimated as well. Analysis revealed that a one-unit increase (Israeli currency) in the price of local brand of cigarettes was related to 2.0% (OR = 0.98; 95%CI 0.98, 0.99) lower odds of being a current smoker, adjusting for covariates including household income. Moreover, a one unit increase in the price of the local brand of cigarettes was related to consuming 1.49 (95% CI −1.97, −1.00) fewer weekly cigarettes, controlling for household income and covariates. Similar results were found with the Marlboro cigarette prices. The total price elasticity of cigarette demand, given by the sum of price elasticities of smoking prevalence and intensity, showed that a 10.0% increase in the price is associated with a 4.6–9.2% lower cigarette consumption among Israeli adults. Thus, increasing cigarette prices will likely lead to a reduction in cigarette smoking thereby improving public health in Israel.

[WITHDRAWN] The importance of increasing cigarette prices on National Health Insurance financing in Indonesia

Indonesia faces the combined challenges of a high prevalence of active smokers and an increased financial burden of smoking-related Non-Communicable Diseases (NCDs) on National Health Insurance (NHI). This study aims to assess the importance of increasing cigarette prices for NHI funding. It was a cross-sectional study conducted through a phone survey. The survey was administered to 1,000 respondents aged 18 and over from various telecommunications operators in Indonesia. We performed the multivariate analysis and the framework of the importance of increasing cigarette prices for funding NHI. The result shows that the majority of the public supports the increase of cigarette price for funding NHI except for active smokers at Odds Ratio=0.529. The importance of increasing cigarette prices for funding NHI is supported by society, able to reduce the prevalence of active smokers, and it raises the government’s tax income. With the current strong public support, cigarette prices should be increased which will then be tagged to fund the NHI consistently. This is also seen as a means to compensate the high NCD-related claims of the NHI which are caused by smoking behavior.JEL Classification H51; I13; I18

Public support for cigarette price increase in Indonesia

BackgroundThe current tobacco control policies in Indonesia are known to be ineffective in reducing tobacco consumption. Therefore, increasing cigarette prices is one of the effective instruments that should be supported by governments and society. This study aims to assess public support for cigarette price increases as well as to generate scientific evidence for the government and policymakers.MethodThis cross-sectional survey obtained data through telephone interviews with 1000 respondents aged ≥18 years old in Indonesia. The interviews started from 1 May 2018 to 31 May 2018.ResultRespondents were varied in terms of age, gender, level of education, income, occupation, area of living and smoking status. This study found that 87.9% of the respondents including 80% of smokers support cigarette price increase to prevent children from buying cigarettes. Approximately 74.0% of smokers said they would stop smoking if cigarette prices were Rp70 000 (US$5) per package. The multivariate analysis revealed that age, income, money spent on cigarettes per day and the perception of current cigarette prices are the factors influencing support for higher cigarette prices.ConclusionThe increase in cigarette prices is supported by society at large, including active smokers. The government must consistently adjust cigarette prices through an excise taxing and cigarette retail price mechanism. Governments, academicians, non-governmental organisations and tobacco control activists should generate a unified understanding that increasing cigarette prices will improve overall life quality.