Thanks for your work on this report; I look forward to reviewing it more carefully, but on a first pass, this seems comprehensive and great.
I just came to make a small point, which is that there seems to be good evidence regarding the non-linear health effects of smoking. For instance, here’s what UpToDate’s article on smoking cessation says:
”Data are inconsistent as to whether reducing cigarette smoking from higher to lower levels is associated with improved outcomes. At least two prospective cohort studies found that people who reduced smoking by at least 50 percent had no change in all-cause mortality, whereas those who quit smoking completely had decreased risks of all-cause mortality. However, another cohort study did find reduced risk for mortality associated with smoking reduction (HR 0.85, 95% CI 0.77-0.95); the benefit with smoking reduction was mainly seen in among those with heavy smoking use and was mainly due to a reduction in cardiovascular mortality. Nevertheless, consistent benefits in cardiovascular disease risk have not been seen with reduction in smoking short of quitting. This is because even low levels of tobacco smoke exposure increase cardiovascular risk. A separate cohort study found that a reduction in smoking may decrease the risk of lung cancer. One reason that a reduction in smoking may not consistently improve health outcomes is that people may compensate for smoking reduction with increased puffs, volume, or duration in order to maintain nicotine intake and forestall nicotine withdrawal symptoms.” (Thesearethecitedstudies.)
For me, this raises the question of whose behavior is primarily affected by higher cigarette taxes (non-smokers who don’t start, light smokers, or heavy smokers) and how (cutting back vs. quitting). You mention that taxes lower both smoking prevalence and intensity, but given the non-linear relationship, I’d expect them to be more effective if they primarily reduced prevalence.
Thanks for your work on this report; I look forward to reviewing it more carefully, but on a first pass, this seems comprehensive and great.
I just came to make a small point, which is that there seems to be good evidence regarding the non-linear health effects of smoking. For instance, here’s what UpToDate’s article on smoking cessation says:
”Data are inconsistent as to whether reducing cigarette smoking from higher to lower levels is associated with improved outcomes. At least two prospective cohort studies found that people who reduced smoking by at least 50 percent had no change in all-cause mortality, whereas those who quit smoking completely had decreased risks of all-cause mortality. However, another cohort study did find reduced risk for mortality associated with smoking reduction (HR 0.85, 95% CI 0.77-0.95); the benefit with smoking reduction was mainly seen in among those with heavy smoking use and was mainly due to a reduction in cardiovascular mortality. Nevertheless, consistent benefits in cardiovascular disease risk have not been seen with reduction in smoking short of quitting. This is because even low levels of tobacco smoke exposure increase cardiovascular risk. A separate cohort study found that a reduction in smoking may decrease the risk of lung cancer. One reason that a reduction in smoking may not consistently improve health outcomes is that people may compensate for smoking reduction with increased puffs, volume, or duration in order to maintain nicotine intake and forestall nicotine withdrawal symptoms.” (These are the cited studies.)
For me, this raises the question of whose behavior is primarily affected by higher cigarette taxes (non-smokers who don’t start, light smokers, or heavy smokers) and how (cutting back vs. quitting). You mention that taxes lower both smoking prevalence and intensity, but given the non-linear relationship, I’d expect them to be more effective if they primarily reduced prevalence.