American Cancer Society, 555 11th Street NW, Suite 300, Washington, DC 20004, USA.
School of International Trade and Economics, University of International Business and Economics, Beijing 100029, China.
Int J Environ Res Public Health. 2019 Apr 3;16(7):1205. doi: 10.3390/ijerph16071205.
China is world's largest market of machine-made cigarettes. In 2015, more than 315 million or around 26.9% of the adult population in China were smokers-50.6% among men and 2.2% among women. Growing affordability of cigarettes led to increased cigarette consumption in China to the detriment of public health. This study investigated whether the level and growth in cigarette affordability in China was equally shared by smokers from all demographic and socio-economic statuses (SES) and across all price tiers of cigarette brands. The data came from the urban smoker sample (≥18 years) of the International Tobacco Control China Surveys conducted in five waves over 2006-2015. Cigarette affordability was measured by Relative Income Price-percentage of per capita household income needed to purchase 100 cigarette packs of the last purchased brand. Overall and group-specific trends in affordability by age, gender, SES (e.g., income, education, and employment status), and price tiers were analyzed using generalized estimating equations method. Cigarette affordability was higher among older, female, and higher-SES smokers, and for cheaper brands. It increased overall and across all groups over time. The increase was significantly larger among younger and lower-SES smokers, a trend that poses an added challenge to tobacco control and health equity. To reduce cigarette affordability and consumption among these vulnerable groups, a uniform specific excise system should be introduced in place of the existing tiered ad valorem excise. The specific excise should be periodically adjusted to inflation and per capita income growth observed among younger and lower-SES people, who can potentially experience faster income growth than the national average. The excise tax policy can also be complimented with minimum price regulations and restrictions on price promotions.
中国是世界上最大的机制卷烟市场。2015 年，中国有超过 3.15 亿人（约占成年人口的 26.9%）吸烟——其中 50.6%为男性，2.2%为女性。香烟可负担性的提高导致中国香烟消费的增加，从而损害了公共健康。本研究旨在调查中国香烟可负担性水平及其增长是否在所有年龄、性别、社会经济地位（SES）和所有价格层次的吸烟者中均等共享。该研究的数据来自于国际烟草控制中国调查（ITC 中国项目）2006-2015 年五个波次的城市吸烟者样本（≥18 岁）。香烟可负担性通过相对收入价格衡量，即购买上一次购买品牌的 100 包香烟所需的人均家庭收入的百分比。使用广义估计方程方法分析了按年龄、性别、SES（如收入、教育和就业状况）和价格层次划分的总体和特定群体的可负担性趋势。结果显示，香烟的可负担性在年龄较大、女性和 SES 较高的吸烟者以及较便宜品牌中更高。随着时间的推移，香烟的可负担性整体呈上升趋势，并且在所有群体中均呈上升趋势。在较年轻和 SES 较低的吸烟者中，这种上升趋势更为显著，这对烟草控制和健康公平构成了额外的挑战。为了降低这些弱势群体的香烟可负担性和消费，应引入统一的特定消费税制度，以取代现行的分层从价消费税制度。特定消费税应定期根据较年轻和 SES 较低的人群的通胀和人均收入增长进行调整，这些人群的收入增长速度可能快于全国平均水平。还可以通过最低价格规定和限制价格促销来补充消费税政策。
