摘要：Objectives. We examined the relationship between cigarette excise tax increases and tax-avoidant purchasing behaviors among New York City adult smokers. Methods. We analyzed data from the city’s annual Community Health Survey to assess changes in rates of tax avoidance over time (2003–2010) and smokers’ responses to the 2008 state cigarette tax increase. Multivariable logistic regression analysis identified correlates of buying more cigarettes on the street in response to the increase. Results. After the 2002 tax increase, the percentage of smokers engaged in tax-avoidant behavior decreased with time from 30% in 2003 to 13% in 2007. Following the 2008 tax increase, 21% of smokers reported buying more cigarettes from another person on the street. Low-income, younger, Black, and Hispanic smokers were more likely than respondents with other sociodemographic characteristics to purchase more cigarettes on the street. Conclusions. To maximize public health impact, cigarette tax increases should be paired with efforts to limit the flow of untaxed cigarettes entering jurisdictions with high cigarette pack prices. Increasing taxation on cigarettes is among the most effective ways to prevent and reduce smoking. 1 Higher taxes are associated with lower cigarette consumption and higher rates of quit attempts, 2–4 particularly among low-income and younger smokers 5 and among racial/ethnic minorities. 6–8 However, high cigarette prices also lead to increased tax-avoidant behaviors among smokers, 9,10 limiting the effectiveness of taxes in reducing tobacco use. 11,12 In response to tax hikes, smokers may seek untaxed sources of cigarettes in other jurisdictions, on the Internet, or from Native American reservations. 13–18 The availability of untaxed cigarettes from illegal vendors, such as individuals selling cigarettes on the street, allows tax-avoidant smokers to continue to smoke more cigarettes at a lower price 4,10,19 ; thus, trafficking of black market cigarettes across state or international lines into areas with high taxes is of particular concern. 10,18,20 We sought to better understand tax-avoidant behaviors in New York City, where city, state, and federal tax increases over the past decade have resulted in the highest cigarette pack price in the nation. In 2002, combined city and state tax increases raised the price of cigarettes by $1.81; in 2008, a state tax further increased the per-pack price by $1.25. We examined trends in tax-avoidant cigarette purchasing behaviors among adult smokers in the city between 2003 and 2010. We then assessed characteristics of smokers and the prevalence of tax avoidance among smokers in 2008. We also explored the impact of the 2008 tax increase on smoking behaviors. Finally, we used multivariable logistic regression analysis to identify correlates of buying more cigarettes on the street following the 2008 tax increase.
