Cigarette type 'switchers': a descriptive analysis.

Mecredy, Graham C. ; Bondy, Susan J. ; Brown, K. Stephen 等

Dear Editor:

Tobacco price increases, such as through taxation, are an effective strategy to reduce smoking prevalence, however this strategy is undermined by both discount and contraband tobacco. (1) The discount cigarette market has grown substantially since 2003, with discount cigarettes selling for approximately $10-15 less per carton than premium brands. (2) The illegal sale of contraband cigarettes has become increasingly common, providing an even cheaper source of cigarettes. (3) While the cost of cigarettes has been shown to influence smokers' decisions to switch cigarette types, (1,4,5) little is known about the nature and extent of switching, or factors that influence switching.

To examine the incidence of cigarette type switching and the characteristics of those who switch, we compared baseline to 12-month follow-up data from the Ontario Tobacco Survey, a population-based cohort of adult smokers. (6,7) Smokers' usual brand of cigarettes was categorized as premium, discount or contraband, according to a list of discount cigarette brands (8) and known contraband cigarettes in Ontario. (9) Patterns of switching were examined by cigarette type at baseline. Socio-demographic and smoking-related characteristics of switchers and non-switchers were examined, adjusting for the complex survey design.

Overall, 24% of smokers switched the category of cigarette they smoked over the one-year period. One in five premium smokers switched to a lower-cost cigarette type (Table 1). Similarly, about one in five discount smokers switched cigarette types, with slightly more switching to a premium brand (13%) than to contraband cigarettes (9%). Sixteen percent of contraband smokers switched, with almost half of switchers moving to a premium brand. With 70% of switchers moving from a more expensive to a less expensive cigarette type, the overall result was a considerable decrease in the number of premium smokers, and a substantial increase in the number of contraband cigarette smokers.

Those who switched to a less expensive category of cigarette were more likely to be under the age of 45 compared to those who switched to a more expensive brand (p<0.01) (Table 2). Those who switched cigarette type at either the 6- or 12-month follow-up were more likely to have less education (p<0.01). The type of cigarette smoked at baseline predicted (p=0.07) a change in cigarette type over the one-year period.

With approximately 1 in 4 smokers reporting that they switched the type of cigarette they smoked over a one-year period, cigarette type appears to be relatively fluid, considering the tobacco industry is known for its high brand loyalty. (10) Of note are the large number of smokers moving to contraband cigarettes, with the number of contraband smokers increasing by 45% over one year. Further, as the percentage of smokers remaining in the contraband category was highest (85%) among the three cigarette types, those who switch to contraband cigarettes are likely to remain in this group. If this pattern of switching persists, we would expect a continuing growth of the contraband cigarette market. Finally, the fact that 11% of lower-cost-cigarette smokers switched to a premium brand was unexpected. This may be attributable to the brand recognition and prestige associated with premium brands, offsetting the cost savings of the less expensive brands for some individuals. Limitations of this study include a lack of data regarding other factors that may influence an individual to change cigarette type, including changes in individual economic and social situations. While we found little difference in the socio-demographic or smoking characteristics between switchers and non-switchers, a larger-than-expected group of smokers appears unstable in the type of cigarette they smoke.

REFERENCES

(1.) Chaloupka FJ, Warner KE. The economics of smoking. In: Culyer AJ, Newhouse JP (Eds.), Handbook of Health Economics. New York, NY: Elsevier, 2000;1539-627.

(2.) Non-Smokers' Rights Association. Backgrounder on the Canadian tobacco industry and its market: 2009-10 Edition, March 2010. Available at: http://www.nsra-adnf.ca/cms/file/pdf/Backgrounder2009_10.pdf (Accessed April 13, 2011).

(3.) Royal Canadian Mounted Police. 2008 contraband tobacco enforcement strategy, 2008. Available at: http://www.rcmp-grc.gc.ca/pubs/tobac-tabac/tobacco-tabac-strat-2008-eng.htm (Accessed April 13, 2011).

(4.) Cummings KM, Hyland A, Lewit E, Shopland D. Discrepancies in cigarette brand sales and adult market share: Are new teen smokers filling the gap? Tob Control 1997;6(2):S38-S43.

(5.) Tsai YW, Yang CL, Chen CS, Liu TC, Chen PF. The effect of Taiwan's tax induced increases in cigarette prices on brand-switching and the consumption of cigarettes. Health Econ 2005;14:627-41.

(6.) Diemert L, Victor JC, Chaiton M, Bondy SJ. Ontario Tobacco Survey Technical Report 1: Baseline Data. Toronto, ON: Ontario Tobacco Research Unit, April 2010.

(7.) Diemert L, Victor JC, Chaiton M, Bondy SJ. Ontario Tobacco Survey Technical Report 2: Six and Twelve Month Data. Toronto: Ontario Tobacco Research Unit, April 2010.

(8.) Non-Smokers' Rights Association. Backgrounder on the Canadian tobacco industry and its market: 2007-08 Edition, March 2008. Available at: http://www.nsra-adnf.ca/cms/file/pdf/Backgrounder2007_2008.pdf (Accessed April 13, 2011).

(9.) Diemert LD, Cohen JE, Bondy SJ, Callaghan RC, Ferrence R, Garcia J, et al. Smoking low-cost cigarettes: Disparities evident. Can J Public Health 2011;102(1):73-74.

(10.) Pollay RW, Siddarth S, Siegel M, Haddix A, Merritt RK, Giovino GA, et al. The last straw? Cigarette advertising and realized market shares among youths and adults, 1979-1993. J Marketing 1996;60:1-16.

Correspondence: Graham Mecredy, Ontario Tobacco Research Unit, 33 Russell Street, Toronto, ON M5S 2S1, E-mail: graham_mecredy@camh.net

Graham C. Mecredy, MSc, [1] Susan J. Bondy, PhD, [1,2] K. Stephen Brown, PhD, [1,3] Joanna E. Cohen, PhD [1,2,4,5]

[1.] Ontario Tobacco Research Unit, Toronto, ON

[2.] Dalla Lana School of Public Health, University of Toronto, Toronto, ON

[3.] Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, ON

[4.] Centre for Addiction and Mental Health, Toronto, ON

[5.] Institute for Global Tobacco Control, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA Table 1. Cigarette Type at Baseline and One-year Follow-up (n=2243) Cigarette Type Cigarette Type at One Year at Baseline Premium Discount n * % n * % ([dagger]) n * ([dagger]) Premium 931 79.6 150 12.5 114 Discount 95 13.0 579 77.6 69 Contraband 20 6.9 27 8.6 258 Total 1046 756 441 Cigarette Type Cigarette at Baseline Type at One Year Contraband % Total ([dagger]) Premium 7.9 1195 Discount 9.4 743 Contraband 84.5 305 Total 2243 Bold figures indicate number and percentage of those who did not switch cigarette types. * Unweighted sample size. ([dagger]) Population weighted estimates. Note: Table 1 does not display the few 'switchers' who switched their cigarette type at the 6-month follow-up, only to revert back to their original type after 12 months; however, only 3% of the total population fit these criteria, with a non-differential distribution across cigarette types. Further, only 1% of the total sample switched to a different cigarette type at both the 6-month and the 12-month follow-ups. Table 2. Descriptive Statistics of Eligible Respondents at Baseline by Switching to More Expensive vs. Less Expensive Cigarettes (n=475), and by Cigarette Type Switching at 6- or 12-month Follow-up ('All Switchers') vs. Non-switchers (n=2243) Baseline Characteristic Switched to More Expensive * n % ([double [up arrow] dagger]) Sample size 142 100 Brand type Premium 0 0.0 Discount 95 71.1 Contraband 47 28.9 Age group (years) ([section]) 18-29 21 25.4 30-44 32 19.8 45-59 63 44.3 60+ 23 10.6 Sex Female 94 55.4 Male 48 44.6 Education ([parallel]) Less than high school 28 21.1 High school and some college 52 40.0 Completed college 61 38.9 Rurality Urban 107 84.5 Rural 33 15.5 Smoking status Daily smoker 131 94.7 Non-daily smoker 11 5.3 Heaviness of smoking index (HSI) Low (0-2) 40 28.7 Moderate (3,4) 62 51.4 High (5,6) 40 19.9 Quit intention No/Don't know 86 64.5 Yes 56 35.5 Lifetime number of quit attempts None 21 11.6 One 27 21.5 Two or more 94 66.8 Perceived addiction Not at all addicted 4 1.7 Somewhat addicted 41 31.6 Very addicted 97 66.7 Baseline Characteristic Switched to Less Expensive * n % ([double ([up arrow]) dagger]) Sample size 333 100 Brand type Premium 264 79.7 Discount 69 20.3 Contraband 0 0.0 Age group (years) ([section]) 18-29 44 17.4 30-44 120 41.7 45-59 124 30.8 60+ 42 10.0 Sex Female 173 43.1 Male 160 56.9 Education ([parallel]) Less than high school 71 20.8 High school and some college 161 49.3 Completed college 100 29.8 Rurality Urban 236 81.2 Rural 92 18.8 Smoking status Daily smoker 316 94.0 Non-daily smoker 17 6.0 Heaviness of smoking index (HSI) Low (0-2) 70 24.6 Moderate (3,4) 135 43.7 High (5,6) 125 31.7 Quit intention No/Don't know 212 63.2 Yes 121 36.8 Lifetime number of quit attempts None 40 14.3 One 67 18.7 Two or more 226 67.1 Perceived addiction Not at all addicted 9 6.3 Somewhat addicted 75 23.9 Very addicted 249 69.8 Baseline Characteristic All Switchers n % ([double [up arrow] dagger]) Sample size 547 100 Brand type Premium 299 55.7 Discount 193 36.0 Contraband 55 8.3 Age group (years) ([section]) 18-29 78 20.4 30-44 175 35.4 45-59 216 34.2 60+ 72 10.0 Sex Female 316 49.3 Male 231 50.7 Education ([parallel]) Less than high school 111 19.8 High school and some college 250 47.9 Completed college 184 32.4 Rurality Urban 393 81.5 Rural 147 18.5 Smoking status Daily smoker 516 94.0 Non-daily smoker 31 6.0 Heaviness of smoking index (HSI) Low (0-2) 129 27.7 Moderate (3,4) 219 43.0 High (5,6) 195 29.3 Quit intention No/Don't know 347 64.7 Yes 200 35.3 Lifetime number of quit attempts None 71 13.0 One 109 20.4 Two or more 367 66.6 Perceived addiction Not at all addicted 16 5.0 Somewhat addicted 137 28.5 Very addicted 394 66.6 Baseline Characteristic Non-switchers n % ([double ([dagger]) dagger]) Sample size 1696 100 Brand type Premium 896 57.9 Discount 550 30.4 Contraband 250 11.7 Age group (years) ([section]) 18-29 263 21.7 30-44 533 33.3 45-59 637 31.5 60+ 256 13.6 Sex Female 961 48.7 Male 735 51.3 Education ([parallel]) Less than high school 276 14.5 High school and some college 728 42.2 Completed college 691 43.3 Rurality Urban 1210 80.9 Rural 473 19.1 Smoking status Daily smoker 1589 92.8 Non-daily smoker 107 7.2 Heaviness of smoking index (HSI) Low (0-2) 464 32.5 Moderate (3,4) 699 37.9 High (5,6) 516 29.6 Quit intention No/Don't know 1054 65.0 Yes 642 35.0 Lifetime number of quit attempts None 249 16.7 One 380 23.3 Two or more 1064 60.0 Perceived addiction Not at all addicted 75 5.0 Somewhat addicted 428 28.5 Very addicted 1188 66.5 * Only includes individuals who switched cigarette type between baseline and 1 year. Unlike the 'All Switchers' column, these two columns do not include those who switched their cigarette type after 6 months, only to revert back to their original type after 1 year (n=72). ([dagger]) Unweighted sample size. ([double dagger]) Population weighted estimates. ([section]) Chi-square p<0.01 comparing switching to more expensive vs. less expensive. ([parallel]) Chi-square p<0.01 comparing all switchers vs. non-switchers.