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Correspondence to Kelvin Choi, Division of Intramural Research, National Institute on Minority Health and Health Disparities, 9000 Rockville Pike Building 3 5W05, Bethesda, MD 20892, USA; [email protected]
Introduction
Tobacco use accounts for six million deaths worldwide annually, and is projected to claim eight million lives globally, which is 10% of all deaths, by 2030.1 Tobacco taxes are the most effective tobacco control strategy included in the Framework Convention for Tobacco Control.2 Two systematic reviews also indicated that tobacco tax increases could reduce tobacco use disparities.3 4 However, previous research has indicated that smokers engage in cigarette expenditure minimising strategies (CEMS) to reduce their cigarette expenditures in response to increasing cigarette prices. These strategies often include: buying a cheaper brand of cigarettes, using discount coupons/promotions, buying from a cheaper place, rolling own cigarettes, using another form of tobacco, buying by the carton instead of pack, cutting down on consumption and sharing fewer cigarettes with other smokers.5 6 For example, data from the 2006–2007 US Current Population Survey Tobacco Use Supplement showed that 27.6% of adult smokers purchased cigarettes by the carton, and 3.2% purchased cigarettes from a different state with lower prices to save money on cigarettes.7 Previously, we examined the use of CEMS in a cohort of smokers from a US Midwest state immediately after the 2009 federal cigarette tax increase (US$0.61) and found that smokers engaged in a variety of CEMS (eg, bought from a cheaper place, used coupons/promotions, purchased cigarettes by the carton instead of pack, bought a cheaper brand, rolled their own cigarettes, and used another form of tobacco).5
However, the use of CEMS may hinder cigarette smoking cessation, especially among lower income smokers. Based on our previous work, those who purchased cigarettes by the carton to save money were less likely to make a quit attempt.5 We also found that any use of CEMS and the number of CEMS used was negatively associated with subsequent reduction in the number of days smoked in the past 30 days, after accounting for demographic and smoking-related social environment.5 Moreover, we found that lower income smokers were more likely to use CEMS and to use a higher number of CEMS.5 Therefore, the negative association between...