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Cigarette affordability

Data source. The 2016 measure of cigarette affordability, originally developed by Blecher

and van Walbeek,[11, 12] was obtained from the WHO’s report on global tobacco epidemic 2017, Table 9.6.0 “Affordability of the most sold brand of cigarettes” (...
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cigarette excise taxes, was also based on Goodchild et al. (2016).[13] First, we calculated the

number of daily cigarette smokers aged 15 or above, which was to multiply the population esti-

mates for aged 15 or older by the adult cigarette smoking prevalence. Next, we assumed that

the price elasticity for cigarette smoking prevalence is -0.15, -0.2, and -0.25 in high, middle,

and low-income countries respectively. If the cigarette excise taxes were increased by I$1, the

reduction in the number of daily cigarette smokers (S) in the 2016 adult population (aged 15

or above) was calculated as S × ΔP × p in which S is the baseline number of smokers, ΔP is the

percentage change in retail prices, and p is the prevalence elasticity.

In order to estimate the number of smoking-attributable deaths averted due to the I$1 tax

increase, we followed Goodchild et al. (2016) and assumed a relatively low risk of smoking-

attributable death, which is 33% for conservative estimates. Another assumption made by this

method is that 95% of smokers aged 15–29 who quit will avoid an early death. This percentage

would drop to 75% for smokers aged 30 to 39, to 70% for those aged 40 to 49, to 50% for those

aged 50 to 59, and to 10% for those aged 60 or above. This assumption leads to a global adjust-

ment factor that is 74% based on the 2015 age profile of the world population. Finally, the

number of smoking-attributable deaths averted was calculated using the following formula

33%×74%×ΔS (the reduction in the number of daily cigarette smokers).

Data sources. Population estimates for people aged 15 (in total and by age groups) or

above came from the Institute for Health Metrics and Evaluation (IHME) and the United

Nation Population Division. Cigarette smoking prevalence among adults came from a variety

of sources, including the 2016 prevalence estimates by the Euromonitor International, and the

most recent tobacco use/smoking prevalence estimates compiled by the WHO’s report on

global tobacco epidemic 2017. For countries where the most recent tobacco use survey was

conducted before 2011, the daily cigarette smoking prevalence estimates (defined as the per-

centage of population who smoke every day) came from the WHO global report on trend in

tobacco smoking 2000–2025. In addition, some countries only reported estimates of cigarette

smoking prevalence and tobacco smoking prevalence, rather than daily cigarette smoking

prevalence. In those cases, we used the proportion of daily cigarette smoking among these

more broadly defined smoking activities at the country level as an adjustment factor. This

adjustment factor (proportion) can be derived using the country-level estimates reported in

the WHO global report on trend in tobacco smoking 2000–2025. If the proportion adjustment

factors were not available for the country, we then assumed that 85% of tobacco smokers were

cigarette smokers, among whom 85% were smoking daily, which was chosen because most

derived adjustment factors center around these numbers.

The WHO FCTC implementation cost of best-but policies for the next 15

years

Method. In order to estimate the total cost of implementing the four best-buy policies rec-

ommended by the WHO FCTC for the next 15 years, we used the NCDs Costing Tool devel-

oped by the WHO (...
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estimates, and government spending as a percentage of total health spending were obtained

from the World Bank database and represented recent estimates that we obtained from 2014

to 2016, as described above. Enforcement scores were updated using the WHO’s report on

global tobacco epidemic (MPOWER dataset).

Results

Country-specific estimates of the five indicators can be found in the Excel attachment (S1 File

Tool), which can be used as a tool to simulate changes in retail cigarette prices, annual cigarette

consumption, excise tax revenue, daily cigarette smoking prevalence and number of smoking-

attributable deaths. The 2016 country-level information is given in the tool, with the modules

showing all parameters used in the simulation. Moreover, this Excel tool also allows for juxta-

posing important indicators regarding financing sources and costs, such as excise tax revenue

and the implementation costs of four best-buy policies for the next 15 years. Although the cost

estimation module is not directly built-in in the current Excel tool, it can be calculated using

the already published cost estimation tool by the WHO.[14]

Overall, the requirement of inputs depends on the goal of usage. If the 2016 information is

sufficient, the tool can be taken as given. In the future, users will be able to use updated docu-

ments such as the WHO’s report on global tobacco epidemic and population estimates to easily

conduct simulation in retail cigarette prices and excise tax revenue based on the method in

Goodchild et al, by coping and pasting future tax and price information to the tool. The users

can also change fixed parameters such as price elasticity as needed. The updated cigarette con-

sumption and daily smoking prevalence estimates may be obtained from the open data sources

such as WHO reports and Tobacco Atlas.

Table 1 shows by income groups the five indicators that we consider are relevant to current

WHO FCTC implementation and financing environment, which are the cigarette affordabil-

ity, policy status measured by MPOWER scores, smoking-attributable deaths, cigarette excise

tax revenue, and implementation cost of best-buy policies. The affordability indicators suggest

that, on average, 18%, 6%, and 2% of 2016 GDP per capita were required to purchase 100

packs (2000 sticks) of cigarettes in LICs, MICs, and HICs, respectively. The average MPOWER

scores for the three income groups were 17.5, 21 and 23, indicating that the level of policy

implementation was below the recommended best-buy practices. The total number of smok-

ing-attributable deaths among people who were alive in 2016 was estimated to be 9, 707, 230 in

LICs; 262,509,500 in MICs; and 62,188,200 in HICs. In 2016, the estimated cigarette excise tax

revenue totaled 2,683 million (I$) for LICs, 342,286 million (I$) for MICs, and 226,185 million

(I$) for HICs. The combined policy implementation cost for the next 15 years is estimated to

be 2,676 million (I$) for LICs, 30,812 million (I$) for MICs, and 13,971 million (I$) for HICs.

Table 1. Indicators related to tobacco control environment, policy implementation, costs, and financing, 2016.

Variable LIC MIC HIC

Affordability (Average; N = 183) 18% 6% 2%

MPOWER score

(Average; N = 183)

17.46 20.97 23

Smoking-attributable deaths in thousands (Total; N = 169) 9,707.23 262,509.5 62,188.20

Cigarette excise tax revenue, millions of I$ (N = 172) 2,682.80 342,286.19 226,185.19

Implementation cost for the next 15 years, millions of I$ (N = 136) 2,676.07 30,811.94 13,970.05

Note: Among 183 countries, 28 were LICs, 102 were MICs, and 53 were HICs.

...
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human exposure. Sci Total Environ. 2016; 573:1607–14. ...
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