Racial and Ethnic Differences in What Smokers Report Paying for Their Cigarettes

Abstract

Introduction: Smoking rates and tobacco-related health problems vary by race and ethnicity. We explore whether cigarette prices, a determinant of tobacco use, differ across racial and ethnic groups, and whether consumer behaviors influence these differences. Methods: We used national Tobacco Use Supplement data from 23 299 adult smokers in the United States to calculate average reported cigarette pack prices for six racial and ethnic groups. Using multivariate regression models, we analyzed the independent effect of race and ethnicity on price, and whether these effects changed once indicators of carton purchasing, menthol use, Indian reservation purchase, and state market prices were incorporated. Results: American Indians and whites pay similar amounts and report the lowest prices. Blacks, Hispanics, and Asians reported paying $0.42, $0.68, and $0.89 more for a pack of cigarettes than whites. After accounting for differences in consumer behaviors, these gaps shrunk to $0.27, $0.29, and $0.27, respectively, while American Indians paid $0.38 more than whites. Pack buying was associated with $0.99 higher per-pack prices than carton buying, which was most common among whites. Additionally, people who purchased off an Indian reservation reporting paying $1.54 more than those who purchased on reservation. Conclusions: Average reported cigarette prices vary by race and ethnicity, in part due to differences in product use and purchase location. Tobacco price policies, especially those that target low prices for multipack products or on Indian reservations may increase the prices paid by whites and American Indians, who smoke at the highest rates and pay the least per pack. Implications: This study examines differences in reported prices paid by different racial and ethnic groups, using recent, national data from the United States. Results indicating that racial and ethnic groups that smoke at the highest rates (American Indians and whites) also pay the least are consistent with evidence that price is a key factor in cigarette use. Additional analysis finds that cigarette purchasing behaviors, especially carton buying and purchasing on Indian reservations, partially account for the documented price differences, and suggest that policies focused on bulk purchases (carton, multipack) and reservation prices have strong tobacco control potential.

Design-based single-mediator approach for complex survey data

“…Specifically, among diverse racial/ethnic populations in the U.S., non-Hispanic (NH) American Indian/Alaska Native (AIAN) and NH White adult smokers purchase cigarettes, on average, at lower prices than the other adult smokers (Golden, Kong, and Ribisl 2016). Analyses controlling for additional factors related to consumer behaviors resulted in less pronounced differences in average prices but also indicated that NH AIAN adult smokers, on average, paid $0.38 more per pack than did NH White adult smokers (Golden et al 2016). These discrepancies could be explained in part by different consumer behaviors.…”

On Statistical Assessments of Racial/Ethnic Inequalities in Cigarette Purchase Price among Daily Smokers in the United States: Non-Hispanic Whites Pay Least

“…In this chapter, we discuss statistical methods for comparing multiple populations relative to one population (termed "reference"). These types of multiple comparisons commonly arise in behavioral science, for example, when multiple racial/ethnic groups are compared to non-Hispanic (NH) White smokers in terms of tobacco-use-related behaviors [1][2][3][4]. When the statistical parameter of interest is the mean difference, the most common study goal is one of the following two goals.…”

“…Such adjustments may help reduce the effect of confounding factors and therefore, improve estimation [31,32]. For example, Golden et al examined how much smokers pay for a pack of cigarettes, on average, in the United States using data from the 2010-2011 Tobacco Use Supplement to the Current Population Survey (TUS-CPS) [1]. Among several design-based multiple linear regression models for the mean purchase price per pack (PPP) used in the study, one model adjusted for smokers' sociodemographic and smoking-related characteristics, cigarette purchase attributes, and the survey wave [1].…”

“…We consider a study of racial and ethnic disparities in cigarette purchase prices conducted to demonstrate that W daily smokers, on average, purchase cigarettes at lower prices than do AIAN, ASIAN, BAA, H, HPI, and MULT daily smokers in the United States. This goal was motivated by results of a prior study revealing that BAA, H, and ASIAN/HPI (ASIAN and HPI combined) smokers paid higher PPP, on average, relative to W smokers, in the United States in the period from 2010 to 2011 [1].…”

Point-of-sale cigarette purchase patterns among U.S. adult smokers—National Adult Tobacco Survey, 2012–2014

“…Cornelius et al (2014) reported on a range of tobacco outlets used by U.S. adult smokers by a limited number of sociodemographic characteristics. Moreover, Golden and colleagues (Golden et al, 2016) reported differences in where cigarettes are purchased on and off Indian reservations by racial/ethnic groups, but did not assess other purchase locations. To address this gap in the literature, this study used recent data from the National Adult Tobacco Survey (NATS) to assess patterns of cigarette purchase by retail locations and sociodemographics among a nationally representative sample of U.S. adults.…”