This is possibly one of the first studies conducted in Latin American that examined smokers’ responses to a hypothetical cigarette price increase, and to compare the responses to reduce consumption with that aimed to reduce the expenditure on cigarettes while maintaining their consumption level. Furthermore, in the English literature, few studies with similar objectives were conducted previously, all in developed countries [24–26]. The results presented here are especially important because cigarette prices in Brazil will be increased by 50 centavos per year, starting in 2014. This is still a modest increase, and will require further attention to ensure that it impacts smoking consumption properly .
The present study suggests that smokers’ preferred choice for facing a hypothetical price increase would be to quit, and that other alternatives could minimize the cessation effect of prices increases, but would not neutralize this effect. This finding is consonant with results in a previous study conducted in Brazil and in another 19 countries, when smokers were asked to give their reasons to think about stopping smoking . Together with the United States of America, Brazil was the first in the ranking with 74.4% of the smokers responding that the price would be a reason for stopping smoking.
Given that the intention of quitting has been shown as an important predictor of smoking cessation, the findings from the present study reinforce the expectation that a progressive taxes-and-prices policy has great potential for reducing tobacco consumption and smoking prevalence in Brazil [22, 28]. These results are particularly important, considering that this is one of the few effective tobacco control measures that is not developed at its full potential in the country .
The high prevalence rates of smokers who responded that they would look for a place that would sell the same brand they usually smoke but cheaper is a matter for concern. Since the price of different brands of cigarettes follows a prescribed price table within each state, the only alternative for obtaining cigarette brands at lower prices is the illegal market, especially through street-sellers, scattered across the country. In fact, during the 1990s, a tendency towards an increased market share for illegal products, was observed after an increase in cigarette prices . However, the results from the present study suggest that seeking illegal products may reduce the impact of increased taxes, but does not eliminate it . Studies in Brazil suggest that increasing the real price of cigarettes has historically led to reductions in total consumption, despite the presence of an illegal market [14, 15].
Regarding the observed percentages of smokers who reported that they would change to a cheaper brand, this result was similar to what was found in a study conducted in California among around 5,000 smokers . A series of cross-sectional studies conducted in Germany showed that although this was a less frequently mentioned option among smokers, in the event of a hypothetical price increase, the percentage of smokers who actually used this strategy to adjust their budgets was more evident after the price increase .
It was noteworthy that after controlling for all other variables studied, having a low schooling level was the only variable that remained as a predictor for all the possible hypothetical responses to cigarette price increases, irrespective of whether the responses related to reduced consumption or to alternatives that might minimize the impact of the prices increases. Studies have shown that poor smokers with low schooling levels respond more positively to taxes and prices increases if the illegal market was brought under proper control . This is also the subgroup with the greatest likelihood of buying cigarettes in the illegal market, which is in line with the findings of a high percentage mentioning that they would “look for a place that sells the brand smoked with cheaper prices”. This shows the importance of measures to combat the illegal market that can undermine the effectiveness of tax and prices policies. The illegal trade protocol of the WHO Framework Convention on Tobacco Control was recently adopted and Brazil will certainly benefit from becoming a Party to the Protocol .
Both in uni- and multivariate analyses, individuals with lower levels of dependence were more likely to say that they would respond to a hypothetical price increase by trying to stop smoking or even by reducing the number of cigarettes when compared with individuals with greater levels of dependence. A stronger association with attempts to quit smoking was found. The degree of nicotine dependence is inversely related to attempts to stop smoking [28, 30]. A previous study also observed that people who smoke fewer cigarettes per day are more likely to affirm that they would respond by quitting and/or reducing consumption when compared with those who smoke more cigarettes per day . However, in the present study, smoking a smaller number of cigarettes per day was only a predictor for smokers mentioning that they would reduce the number of cigarettes smoked per day.
It is worth noting that after controlling for stages of change for cessation, the population subgroups that had the greatest likelihood of saying that they would respond to price increases by considering stopping smoking or by diminishing the number of cigarettes (i.e., individuals who presented lower dependence levels and those with lower schooling levels) are the same as the largest proportion of smokers in Brazil. Based on analysis of the Heaviness of Smoking Index among participants in the Global Adult Tobacco Survey (conducted in 2009), 81.3% of Brazilian smokers had low-to-moderate dependence . Given also that the greatest proportion of this subgroup belongs to the lower socioeconomic level strata, it can be supposed that many low-income smokers will try to stop smoking after cigarette taxes and prices have been increased, which will have a double health and economic benefit.
Regarding the analysis according to age group, it should be highlighted that younger smokers did not seem to be the subgroup that would respond to taxes and prices increase policies with cessation. However, being young (14–19 years) was the main independent predictor for individuals to say that they would smoke fewer cigarettes. Despite a lack of statistical significance, an association with alternative responses to the hypothetical price increase that would minimize the impact of this measure was also observed. These findings are supported by the literature. A recent review on the effectiveness of taxes and prices policies for controlling smoking showed that there was sufficient evidence that such policies reduced the consumption among young people, but that there was no evidence to show that this subgroup would stop smoking through this policy. Nevertheless, these studies showed that taxes and prices increases would prevent conversion of young experimenters into regular smokers who might then become dependent on nicotine, through reducing accessibility, given the low purchasing power of this age group [2, 3].
As a cross-sectional study conducted before tax and price increases, potential future reactions were estimated. We are aware of the inherit limitation of this approach and the data will neither necessarily reflect actual reactions nor independent choices. Nonetheless, given the lack of any other data in Brazil estimating smokers’ reactions to price changes, we believe that the study will contribute to the body of knowledge and guide a future longitudinal study.