Objectives: To investigate the association between tobacco taxation and changes in tobacco consumption among adults. To synthesis the evidence regarding differential effect of tax on smoking in adults. From this review, some policy suggestions would be obtained to enhance the effectiveness of tobacco control. Methods and Results: Relevant studies published between 2008 and 2013 were searched and identified through PubMed, ISI web of knowledge and economics databases of IDEAS with combination of key words. Studies regarding the association between tobacco taxation and changes of smoking prevalence were included in this review. 162 articles were identified, 8 studies were found to be relevant with in this systematic review. All the studies were conducted in different areas with different sample size, study design, and outcome measurements. The results from these studies presented the negative association between tobacco taxation and smoking prevalence among adults. Based on the previous studies analyzed above, the reduction of tobacco use was varied by different prices increase according to the observational studies using the statistic analyze or modeling. Conclusion: Tobacco taxation has been proved to the most effectiveness approach to lower the prevalence of tobacco consumption among populations, which could reduce the adverse health outcome to relieve disease burden and increase government revenues as well. The tobacco tax policy should based on their national conditions, otherwise, the effectiveness of reduction tobacco consumption would decrease due to unsuitable implementation. / published_or_final_version / Medicine / Master / Master of Public Health

published_or_final_version / Politics and Public Administration / Master / Master of Public Administration

Tobacco use is the leading cause of preventable death in the world. Nevertheless, the global tobacco epidemic continues to spread throughout much of the world, particularly in developing countries. Previous research suggests that smoking status may be associated with a variety of social, economic, and cultural factors. This study examines the impact of development, tobacco taxation, and tobacco prices on estimates of global adult male smoking prevalence. Data for this study was obtained from the United Nations’ Human Development Indices: A Statistical Update, 2008 and the World Health Organization’s Report on the Global Tobacco Epidemic, 2009: Implementing Smoke-free Environments. Global adult male smoking prevalence was significantly associated with development, tobacco taxation, and tobacco prices. More rigorous examination of the link between male smoking prevalence and development, tobacco taxation, and tobacco prices is needed to strengthen tobacco control policies and interventions in developing and developed countries.

published_or_final_version / Public Health / Master / Master of Public Health

Not available / text

This dissertation contains three chapters that examine various behavioral responses to statutory tax policies. In the first chapter, I develop a framework to estimate the impact of the marriage tax on the likelihood of marriage that incorporates into one analysis all four distinct household alternatives: single, cohabit, married, and separated. This is in contrast to previous works that consider only one of three separate choices. Using data from the March CPS from 1989-1999, I estimate a bivariate probit model and find that the marriage tax has a small, but significant, effect on the likelihood of marriage. Furthermore, my results indicate that studies that do not include all four possible alternatives can overstate by as much as 200% the effect of the marriage tax on the likelihood of marriage. The second chapter considers the net distributional impact of the federal tax deduction for charitable donations. If itemizers, who tend to have higher income than non-itemizers, give to charities that provide goods that they directly use or benefit from (egoism), the government is essentially subsidizing the activities of the high-income donors. Conversely, if itemizers donate to organizations that benefit the needy (altruism), the tax deduction aids in a form of income redistribution. I estimate this tax responsiveness of giving using the Center on Philanthropy Panel Study (COPPS) module of the PSID in 2001 and 2003 for 11 types of charities. Donations by high income individuals to charities that benefit the poor are more price elastic than donations to charities that benefit themselves. I find evidence that the current tax deduction induces itemizers to donate more to charities that benefit the poor than they would have without the deduction. The third chapter estimates the economic incidence of the excise tax on tobacco. Using historical price and tax data from 1954-2005, I estimate what portion of the tax is shifted to consumers. I experiment with controls for border crossing and indoor smoking bans. I find that a 10-cent tax increase causes price to increase by 8 cents immediately and by 13 cents in the long run.

Heart disease, including principally coronary heart disease (CHD) remains the top cause of mortality in the United States among adults ages 35 and older. Disparities in CHD mortality between socially advantaged and disadvantaged groups, such as whites and blacks have persisted for decades. These social gaps persist despite advances in treatments, preventive measures, and decreases in population prevalence of smoking that have done much to reduce the burden of CHD overall. While these differences in disease burden have been well documented, there is a poor understanding of what interventions might narrow these differences. An equity-efficiency tradeoffs (EET) framework is a useful lens through which to consider this problem. Tradeoffs between equity of intervention efforts and efficiency of the returns on such efforts arise when public health interventions are deployed across groups of unequal socioeconomic position. While such interventions may achieve overall and intra-group improvement, this improvement may come at the expense of stable or widening inter-group differences. Aiming to add to this literature, we took three approaches. First, we critically assessed the literature in order to identify and summarize prior work on EETs across cardiovascular outcomes. We aimed to identify the questions that empirical studies should answer for a given policy, from an EET perspective. Second, recognizing both that tobacco taxation is an effective policy intervention on CHD, and that we have little evidence from United States based studies that it influences racial gaps in CHD we used as an example this policy intervention to examine the treatment efficiency inherent in raising tobacco taxes from an equity lens. We conducted an empirical study to estimate the treatment effectiveness of US tobacco taxation on smoking and CHD mortality. Third, we simulated the equity and treatment efficiency effects of pharmaceutical (Statins), taxation (tobacco) and early education interventions on CHD mortality, and racial gaps in CHD mortality. Our scoping review of EETs in cardiovascular disease (Chapter 2) yielded a very small number of studies (n=6), that explicitly engaged equity and efficiency, and provided information on their trade-offs in the context of CVDs. Despite a paucity of evidence, we identified 2 important lessons: (1) movement toward equity in the context of interventions on those with a high burden of CHD risk factors may be achieved by targeting deprived populations. Second, pairing these “high risk” with structural interventions can provide substantial movement toward not only efficiency, but also equity. Our nationally representative observational, state-level study of the effects of tobacco taxation on smoking prevalence and CHD mortality by race and gender (Chapter 3) showed that between 2005 and 2016, tobacco taxes were associated with reductions in both outcomes. The strongest reductions in smoking prevalence were observed among black non-Hispanic women, while an increase was observed among black non-Hispanic men. Our simulation study (Chapter 4) showed that the equity and efficiency effects of population health interventions in the context of reducing racial disparities in CHD may vary by gender. Among men, compared to no intervention, an education intervention was associated with the greatest reduction in racial disparities in CHD mortality, while among women, a $3 tobacco tax intervention was associated with the greatest reduction in racial disparities in CHD mortality. Additionally, among men, tobacco taxes were an equity lose intervention, while for women, in contrast, tobacco taxes were nearly always a win-win intervention. Conversely, compared to tobacco taxes, statins are in some cases a win-win intervention for men, and in all cases a lose-lose intervention for women. Our findings support the utility of an EET lens in the reduction of racial disparities in health, and point to the need for more scholarship and broader integration of this lens into public health practice. Consideration of the interplay between equity and efficiency in population health interventions offers a deeper understanding of intervention effects than the consideration of either dimension alone. In some cases, we need not trade equity for efficiency in the reduction of racial inequities in health.