The Association of California's Proposition 56 Tobacco Tax Increase with Smoking Behavior Across Rac
Thursday, July 15, 2021
Posted by: Natalia Gromov
Keeler
C, Wang Y, Max W, Yao T, Gu D, Sung HY.
The Association of
California's Proposition 56 Tobacco Tax Increase with Smoking Behavior Across
Racial and Ethnic Groups and by Income.
Nicotine Tob Res. 2021 Jun 17:ntab130. doi: 10.1093/ntr/ntab130. Epub ahead of
print. PMID: 34137859.
Introduction.
On April 1, 2017, California Proposition 56 (Prop 56) was implemented,
increasing the excise tax on cigarettes by $2/pack. This study compares the
association of Prop 56 with smoking prevalence and smoking intensity across
racial/ethnic groups, further examining distinctions across income subgroups
within each racial/ethnic group.
Methods.
The study used pooled cross-sectional data from the 2012-2018 California
Behavioral Risk Factor Surveillance System. We examined two outcomes: current
smoking prevalence and smoking intensity conditional on current smoking. A
two-part econometric model was used to estimate the association of Prop 56 with
smoking prevalence and intensity using multiple logistic regression and
multiple linear regression, respectively. The two-part model was run separately
for all adults (full sample) and each racial/ethnic group. Within each
racial/ethnic group, we ran stratified analyses by income subgroups.
Results.
The results indicated that Prop 56 was negatively associated with smoking
prevalence among full-sample, Hispanic, White, and African American adults; and
negatively associated with smoking intensity among full-sample and White
smokers. Stratified analyses by race/ethnicity and income showed that Prop 56
was negatively associated with smoking prevalence among low-income full-sample
and White adults and among middle-income smokers in the full, Hispanic, White, African
American, and Asian samples. Prop 56 was negatively associated with smoking
intensity among middle-income Hispanic and high-income White smokers. The
association between Prop 56 and smoking intensity was positive among
high-income African American smokers.
Conclusion.
Prop 56 was associated with a reduction in smoking prevalence across multiple
racial/ethnic groups, particularly within the low- and middle-income subgroups.
Policy implications.
Our findings indicate that the reduction in smoking prevalence immediately
following the implementation of California Proposition 56 tobacco tax increase
was significant across a variety racial/ethnic groups, particularly low- and
middle-income subgroups. We found differential responses in smoking prevalence
across income groups among Whites but not among racial/ethnic minorities. We
found no evidence of any significance association between Proposition 56 and
smoking intensity among minorities and economically vulnerable populations,
except for middle-income Hispanics. Researchers, policymakers, and advocates
should consider additional merits of targeted, community-based, non-economic
tobacco control interventions in reaching low- and middle-income groups within
racial/ethnic minorities.
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