Cheap cigarettes contribute to the deaths of young children

26 September 2017

Interview with 

Filippos Filippidis, Imperial College London

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Budget cigarettes - that can be as much as 25% cheaper than mainstream brand - are undermining anti-smoking strategies and have contributed to the deaths of thousands of young children and babies across Europe. That's what scientists at Imperial College have found in a recent study looking at 23 European nations, including the UK. Chris Smith spoke with study author Filippos Filippidis…

Filippos - We know very well that increasing tobacco prices reduced consumption so smokers quit or they smoke less than they used to, and young people are less likely to start smoking. We also know that when pregnant women smoke, or when they are exposed to secondhand smoke, and when babies are exposed to it as well, it is more likely that infants will die.

So there is a link between prices of tobacco products, cigarettes in particular, and infant mortality. But what we didn’t know is if differences in prices between average priced cigarettes and cheap cigarettes are important in that sense and whether the ability of cheap cigarettes does have an effect on infant mortality.

Chris - So, if you jack the price up of a packet of cigarettes, then the argument goes, logically, fewer people will buy them because they are more expensive? But, on the other hand, if you got some, for want of a better phrase, cheap and nasty cigarettes which are nonetheless cigarettes, people may switch to those cheap cigarettes and so, in fact, it may undermine some of the benefit of putting the price up?

Filippos - Exactly. The ability of cheap cigarettes doesn’t happen by accident. The market is dominated by a hand full of transnational tobacco companies and they are able to load taxes, for example, onto their premium brands and keep cheap cigarettes at a low price so that poor people, or young people can buy cigarettes and become addicted to nicotine. And then, they hope that they might move onto different, more expensive brands.

Chris -You wanted to know what is the impact of this on infant mortality?

Filippos - Exactly. So we looked into the association between the differential in prices between averaged priced and cheap cigarettes, meaning the difference between minimum and average cigarette prices and infant mortality in the European Union. We found data for 23 European countries on tobacco prices, but also on mortality among babies up to their first birthday, for the period between 2004 and 2014.

Chris - What has changed between 2004 and 2014 in terms of price, and how has infant mortality altered over the same period?

Filippos - This period has seen a decline in infant mortality overall across the EU in essentially all countries. Also prices have increased because of taxation, but the increase in average price cigarettes has been different than minimum priced cigarettes. To be fair, because of high taxation there is less space now than it used to be for tobacco companies to manipulate prices. So the difference between averaged priced and cheap cigarettes was smaller in 2014 compared to 2004 but still, it was as big as 25% in some of the countries that we looked into.

Chris - What is the impact then of a very big differential in the price between if you’ve got a premium brand that’s expensive, but then you’ve got readily available cheap cigarettes sitting alongside it?

Filippos - What happens is that smokers instead of quitting or instead of reducing their consumption, they have the opportunity to switch to these cheaper cigarettes and, therefore, the effect of price increases is attenuated. And what we’ve seen in our study specifically between 2004 and 2014, having a big price differential was associated with more infant deaths than the subsequent year. Taking everything into account, we estimated that if there was no price differential between average priced and cheap cigarettes throughout this period in these 23 European countries, more than 3,000 infant deaths could have been avoided, which is a big number.

Chris - It is, isn’t it? What then is the best strategy for politicians, the taxman, to adopt in order to achieve the best possible outcome?

Filippos - One obvious way is to introduce higher taxation, which some countries like the UK have done. But also, I think governments should look into introducing specific taxes for cheap cigarettes or raising the floor of tobacco prices. I think that would maximise the benefits from increased taxation.

Chris: Filippos Filippidis from Imperial College London. And that work was published in the journal JAMA Paediatrics.

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