Response: Smoking kills millions of people every year. It is well established that increasing tobacco prices is the most effective way to reduce tobacco consumption and hence mitigate the devastating effects of tobacco on health. Taxation on tobacco products is high in the European Union, which makes cigarettes less affordable. However, transnational tobacco companies are known to manipulate prices, ensuring that cheap or 'budget' cigarettes are still available. This is particularly important for younger smokers and those of low socioeconomic status who are more sensitive in price increases.
Smoking during pregnancy, as well as exposure of pregnant women and babies to cigarette smoke increase infant mortality. There is also evidence that increasing tobacco prices is associated with lower infant mortality. However, researchers typically use average or premium cigarette prices. We analysed 54 million births from 23 European Union countries to see if the differential between average priced and budget cigarettes (i.e. the availability of cigarettes much cheaper than average priced ones) is associated with infant mortality.
We found that increasing average cigarette prices by 1 Euro per pack was associated with 0.23 fewer deaths per 1,000 live births in the same year and an additional 0.16 fewer deaths per 1,000 live births in the following year. A 10% increase in the price differential between budget and average priced cigarettes was associated with 0.07 more deaths per 1,000 live births the following year. This means that 3,195 infant deaths could potentially have been avoided in these 23 countries if there was no price difference between cigarette products over the 10-year study period.
Response: Our study confirmed that increasing cigarette prices is associated with fewer infant deaths, most likely due to reductions in tobacco use and exposure to secondhand smoke. More importantly though, this is the first study to show that the availability of cigarettes much cheaper than average-priced brands can be associated with increased infant mortality. This shows how damaging budget cigarettes can be for public health, as they essentially attenuate the effects of tobacco tax increases. Therefore, governments should adopt taxation strategies that can minimise the price differences between cigarettes.
Response: Further research could focus on exploring the mechanisms behind the association we detected, including smoking during pregnancy and exposure to secondhand smoke. Also, the availability of cheaper tobacco products may encourage smokers to 'switch'. This may apply not only to cigarettes, but other tobacco products as well, such as roll-your-own tobacco, which is typically cheaper than manufactured cigarettes. This is also something of interest for researchers.
Response: The health effects of smoking are well known for decades and sometimes we tend to forget how devastating they are. Studies like this one may also serve as a reminder and a call to action against this entirely preventable cause of death and suffering. None of the authors of this study had any conflict of interest.
Filippos T. Filippidis et al.
This entry was posted in Author Interviews, JAMA, OBGYNE, Pediatrics, Smoking and tagged cigarettes, infant mortality, pediatrics, tobacco by Marie Benz MD FAAD. Bookmark the permalink.