Department of Medicine

Daily smoking has declined, but nondaily smoking is rising especially among young adults

Nondaily smokers make up 22-36% of adult smokers

Few studies examine the effects of tobacco control policy on nondaily smoking

New York City’s comprehensive tobacco control policies offer a case study to examine such effects

Because New York City has the nation’s highest pack price (average $11.35), we are interested in the effects of price on nondaily smoking

Nondaily smokers do not identify as “real smokers” and may not feel cessation interventions are relevant

Research is needed to address the impact of these policies and programs on nondaily smokers

The informal market in tobacco products in NYC offers a unique economic environment

Nondaily smokers weigh the impact of price upon smoking frequency and intentions to quit

Excise taxes may impact daily and nondaily smokers in distinct ways

Increasing cigarette taxes leads to the sale of “loosies” and illegally discounted packs

“Loosies” may prohibit quitting by providing an alternative for those who might otherwise quit

Alternatively, purchasing “loosies” may be an effective strategy to cut back on consumption

Nondaily smokers may be limited to menthols when purchasing “loosies”

Understanding the effects of taxes in NYC is useful as excise taxes are an key strategy outlined in Article 6 of the Framework Convention of Tobacco Control

Next steps:

Enrich data with additional qualitative and ethnographic research

Expand research on the purchase of illegally discounted packs

Explore cessation messaging that may more effectively reach nondaily smokers

Focus Group Methodology:

8 focus groups with 48 young adult nondaily smokers

Recruited from City University of New York college campuses in 2011

Qualitative and ethnographic data collected in NYC in September 2013

IRB approval provided through the NYC Department of Heath and Mental Hygiene, the City University of New York and the University of California, San Francisco

Inclusion criteria included

smoking at least 100 cigarettes in lifetime

currently smoking at least one cigarette per week most weeks

less than daily smoking

Focus group topics were not limited to price, but covered areas including identity, quit attempts and everyday experiences

Atlas TI and Transana software were used to analyze data

Used an inductive approach with codes generated through a review of themes of the data

INTRODUCTION

CONCLUSIONS

Nondaily Smokers’ Reactions to the Nation’s Highest TaxEmily Anne McDonald, Ph.D., Pamela M. Ling MD MPH, Nicolas Sheon, Ph.D.

Center for Tobacco Control Research and Education, Center for AIDS Prevention Studies,Divisions of General Internal Medicine and Cardiology

METHODS

Funding: The work was supported by the National Cancer Institute (U01 CA grant #154240 awarded to UCSF) and City Tax Levy funding from the New York City Department of Health and Mental Hygiene.

RESULTS: Nondaily smokers are price-sensitive

RESULTS: “Loosies” are an important factor in nondaily smoking

Nondaily smokers respond to high pack prices in multiple ways

Cutting down on number of cigarettes consumed

Purchasing illegally-sold discounted packs

Purchasing illegally-sold individual cigarettes (“loosies”)

Purchasing packs form neighboring states (NJ, CT)

Rolling cigarettes at home

Bumming cigarettes from strangers and friends

RESULTS: “Loosies” in NYC

RESULTS: The Loosie-Newport connection

RESULTS: Price is motivation for cessation

“Every time [I’m] thinking about quitting [it’s] because of the price.”

“I bet that I won't buy another pack for a while right now, because I really don't have a lot of money…so I try not to buy cigarettes, because it’s such a waste of money.”

“If I'm stressed out, then I'll grab it. But it’s like the cost of it is too expensive, so it’s like I don't really want to spend $13, $14 on a pack.”

“Maybe if there’s a huge jump in prices… it’s like $12, $13 bucks now…if they make them like $20…people that are still borderline will quit.”

Although sales of “loosies” are illegal, participants reported buying “loosies” at some point, with a quarter of participants reporting that they buy “loosies” exclusively

“Loosie” were purchased at corner stores known as bodegas

Other locations included Chinese restaurants, Laundromats and street peddlers

Average price for a “loosie” was $0.50 – $0.75

“I think those ‘loosies’ are contributing (to) nondaily smoking…because I would never buy a pack.”

“I mean, you could get them at Chinese take-out or from grocery stores…”

“I get them across the street from my house… it’s just (as available as) cigarettes.”

“…you go to the store and they have a pack, and then they’ll sell you one from the pack.”

“(with ‘loosies’) I don’t have temptation of a whole pack in my purse”

“I think it depends on your region, the area you're in, people who smoke around you. A lot of people smoke Newports in New York…. Newports are the only loosies they sell.”

“50 cents a pop… I don’t know how they can keep selling cigarettes for 50 cents.”

“Where I live, you can't really get American Spirits that often, so I'll probably like buy ‘loosies’ and stuff, and they're always Newports.”