Responsible researcher: Bruno Benevit
Original title: Cigarette taxes and smoking among sexual minority adults
Authors: Christopher S. Carpenter and Dario Sansone
Intervention Location: United States
Sample Size: 3.3 million adults
Sector: Public Sector Economy
Variable of Main Interest: Cigarette consumption
Type of Intervention: Tax increase
Methodology: DID, DDD
Summary
The application of taxes on cigarettes has historically been used as a tool to encourage a reduction in consumption among the population. However, little attention has been paid to the impacts of this policy on the same-sex population. In this sense, this study carried out a quasi-experiment with data from 1996 to 2018 to evaluate the effect of applying taxes on cigarette consumption in the United States in families of same-sex couples. The results revealed that the impact of taxation on men in same-sex couples was considerably greater compared to that observed for men in heterosexual couples. No significant effects of replacing cigarettes with other risk behaviors were found, nor were any impacts on current generations identified.
Cigarette consumption is a major vector of chronic diseases for the general population, causing consequences for both consumers and the health system of countries. Thus, the application of taxes on cigarettes is commonly adopted as a way of discouraging smoking among the population. In general, economic literature corroborates the effectiveness of this public policy strategy adopted (DECICCA; KENKEL; LOVENHEIM, 2022), although the magnitude of this effect varies between different studies (CARPENTER; SANSONE, 2021).
The analysis of social strata also becomes relevant, taking into account the specificities associated with each reality of different demographic subgroups in society. In addition to young people, a subgroup of special interest in understanding smoking since the majority of individuals start smoking before the age of 18, researchers also analyzed the impacts of this type of policy on the behavior of older adults, pregnant women and different racial and ethnic minorities (CARPENTER; SANSONE, 2021). In this context, little attention was paid to the effect of increased cigarette taxes on the population of homosexual minorities.
Sexual orientation can influence the effectiveness of cigarette taxes due to several factors. Sexual minorities, such as gay men, lesbian women, and bisexual individuals, have significantly higher smoking rates, often linked to “minority stress” caused by stigmatization and discrimination (CARPENTER; SANSONE, 2021). This can lead these populations to use cigarettes as a coping mechanism, making taxation less effective in reducing consumption. Furthermore, people in these communities have less access to health plans and smoking cessation services, which makes it difficult to adopt health-related policies. Factors such as lower income among gay men or higher educational level among lesbian women can also influence how these populations respond to tobacco tax policies, prompting greater attention from public policy makers for this population.
Taxation on cigarettes is applied with the aim of reducing tobacco consumption, increasing the cost for consumers. As the price of cigarettes rises, the idea is that individuals will reduce or stop smoking due to the greater financial impact. This type of policy is part of a set of tobacco control measures that aim to minimize damage to public health. The effectiveness of this strategy depends on the price elasticity of demand, that is, how much consumption varies in response to price increases. However, its effectiveness may vary depending on socioeconomic and demographic factors, being directly influenced by dynamics linked to price elasticity of demand and income.
In the United States, cigarette taxes are applied at the federal, state, and local levels. Consistent with most prior literature, and given that public-use Behavioral Risk Factor Surveillance System (BRFSS) data does not contain detailed geographic information below the state level over the entire sample period, this analysis focuses on taxes state data on cigarette consumption. Furthermore, tobacco tax increases have been implemented in almost every state: in the period considered in our main empirical analysis, only two states—Missouri and North Dakota—did not increase their tobacco tax. The other forty-eight states, plus the District of Columbia, have approved 160 cigarette tax changes since 1996. Most states have increased their taxes more than once.
According to US data from the Centers for Disease Control and Prevention (CDC, 2018), gay men, lesbian women, and bisexual women have significantly higher smoking rates (20.3%) than heterosexual adults (13.7%). %). The difference in smoking rates among sexual minorities, of 6.6 percentage points (pp), exceeds that observed between men and women (3.6 pp), among young people aged 18 to 24 and adults over 65 years old (2 .2 pp), between white and black adults (0.3 pp points), between the regions of the United States with the highest (Midwest) and lowest (West) smoking rates (5.9 pp), and among adults single and married (2pp).
The database used in the study was the BRFSS, a nationally representative health survey conducted by the United States CDC. BRFSS collected information through annual telephone interviews with more than 400,000 non-institutionalized adults, ages 18 and older. The interviews addressed health risk behaviors, chronic conditions and the use of preventive services. Additionally, the BRFSS included demographic data such as age, ethnicity, education, and marital status. As of 2011, the BRFSS began to include calls to cell phones, which increased the representativeness of the sample. Methodological changes in the calculation of sampling weights were also implemented to ensure the accuracy of the results. The study used BRFSS data between 1996 and 2018 to assess the impact of taxation on cigarette consumption among same-sex and heterosexual couples.
The identification of same-sex couples in the BRFSS was carried out indirectly, based on information provided about the number of adult men and women in the household. When there were exactly two adult men and no women, the individuals were classified as belonging to a male same-sex couple. Likewise, female same-sex couples were identified when the household had exactly two women and no adult men. Heterosexual couples, on the other hand, were defined by the presence of an adult man and woman in the household. This approach made it possible to identify same-sex couples without the need for interviewees to explicitly declare themselves as part of a sexual minority, which helped avoid problems of selective disclosure.
Despite being an indirect technique, the identification of same-sex couples using the BRFSS was validated by comparisons with the optional sexual orientation and gender identity (SOGI) modules, introduced in 2014 in some states. These modules confirmed that men and women in same-sex households were more likely to identify as non-heterosexual. On average, 11% of women and 28% of men in same-sex households identified as belonging to a sexual minority, compared to just 1% in heterosexual households. Furthermore, men in same-sex homes reported a higher frequency of HIV testing and condom use to prevent disease, corroborating the reliability of BRFSS data in research on health behaviors and sexual orientation.
The method used to estimate the impact of increasing cigarette taxes on tobacco consumption was based on a technique called difference-in-difference (DID). This approach compares variation in smoking behavior between two groups: one affected by the tax increase and one not. The central idea is to verify how cigarette consumption changed in states after the tax was applied compared to states that did not experience this change, estimating differences between individuals and states before and after the increase. The constructed model controlled for fixed factors for each state and period, such as demographic characteristics of individuals (age, race, ethnicity and education) and variations over time in states in population and employment rates. Additionally, the impacts were also verified for different marital structures and time horizons (1993–2018, 1996–2010 and 2011–2018), verifying the hypothesis that smokers from younger generations are less sensitive to rising prices.
Furthermore, the study also presents a triple-difference model (DDD). Similar to the DID method, the DDD method considers the relationship of differences between groups of distinct observations within the sample, adding a new group to identify the causal effect through differences after the intervention. Therefore, the DDD model incorporated the difference between individuals in same-sex couples in relation to different-sex couples. This approach allows us to identify whether cigarette taxes had a greater differential effect on individuals from same-sex families.
Finally, to verify the hypothesis that greater risk behavior by same-sex individuals is due to historical discrimination suffered by this population, the study also carried out analyzes regarding the presence of policy effects on a possible substitution mechanism between smoking and other risk behaviors. Thus, the effect of increasing cigarette taxes on alcohol consumption, body weight, physical exercise, HIV or AIDS tests was estimated.
The results indicated that a one-dollar increase in cigarette taxes reduced the likelihood of daily smoking among individuals in same-sex households. For women, this reduction was 0.6 pp, but the effect was not statistically significant in all models. For men, the impact was more significant, with a 1.8 pp reduction in the probability of being a daily smoker, remaining statistically significant. Furthermore, it was observed that the increase in taxes also decreased the likelihood of current smoking, especially among men. These results demonstrated that cigarette taxes were effective in reducing consumption, especially among men in same-sex couples.
Regarding the effects considering different time horizons, the robustness tests carried out confirmed that the impact of taxes on cigarettes was consistent for men. For men, the effects were stronger in the period from 1996 to 2010, indicating that the impact of taxes may have diminished in more recent years. When the analysis was restricted to never-married individuals or those living with unmarried partners, an even more pronounced effect was observed in men.
The results indicated that increasing taxes on cigarettes reduced daily smoking among both women and men in heterosexual households. The reduction was 0.6 pp for women and 0.4 pp for men, replicating previous findings on the impact of taxes on cigarette consumption in the general population. However, for men in same-sex homes, the impact was more pronounced. The one-dollar tax increase was 0.9 pp more effective in reducing smoking among these men, suggesting that, without the tax increase, the difference in smoking rates between heterosexual and homosexual men would have been greater.
Regarding the effects on other risk behaviors, increases in cigarette taxes did not generate significant impacts on alcohol consumption, exercise practices, body weight or HIV tests among men in same-sex homes. This indicated that the reduction in smoking was not replaced by other harmful behaviors. However, increasing cigarette taxes significantly improved these men's self-rated health. The odds of reporting excellent or very good health increased, while the odds of reporting fair or poor health decreased, suggesting an overall improvement in well-being.
In this article, the authors investigated how increased cigarette taxes influenced cigarette consumption among different groups of individuals, especially in relation to men and women in same-sex households. The results showed that the tax increase led to a significant reduction in daily cigarette consumption among men in same-sex households, with a more pronounced effect compared to men in different-sex households. For women in same-sex homes, the reduction was less relevant.
These findings indicate that increased cigarette taxes had a stronger impact on consumption among men in same-sex households, which suggests that taxation policies can be adjusted to better meet the specific needs of different groups. For policymakers, these results highlight the importance of considering variations in the drinking behavior of different subgroups when designing tobacco control strategies. Implementing policies that take these differences into account can potentially increase the effectiveness of tobacco consumption reduction measures.
References
CARPENTER, CS; SANSONE, D. Cigarette taxes and smoking among sexual minority adults. Journal of Health Economics , 2021.
CDC, 2018, 2017. Tobacco Product Use Among Adults: United States. Morb. Mortal. Wkly. Rep. 67, 1-8
DECICCA, P.; KENKEL, D.; LOVENHEIM, MF The Economics of Tobacco Regulation: A Comprehensive Review. Journal of Economic Literature , vol. 60, no. 3, p. 883–970, 2022.
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