title: Purchasing patterns and smoking behaviors after a large tobacco tax increase: a study of Chinese Americans living in New York City.
abstract: OBJECTIVE
  Tobacco taxes are one of the most effective policy interventions to reduce tobacco use. Tax avoidance, however, lessens the public health benefits of higher-priced cigarettes. Few studies examine responses to cigarette tax policies, particularly among high-risk minority populations. This study examined the prevalence and correlates of tax avoidance and changes in smoking behaviors among Chinese American smokers in New York City after a large tax increase.
  
  
  METHODS
  We conducted a cross-sectional study with data for 614 male smokers from in-person and telephone interviews using a comprehensive household-based survey of 2,537 adults aged 18-74 years. Interviews were conducted in multiple Chinese dialects.
  
  
  RESULTS
  A total of 54.7% of respondents reported engaging in at least one low- or no-tax strategy after the New York City and New York State tax increases. The more common strategies for tax avoidance were purchasing cigarettes from a private supplier/importer and purchasing duty free/overseas. Higher consumption, younger age, and number of years in the U.S. were consistently associated with engaging in tax avoidance. Younger and heavier continuing smokers were less likely to make a change in smoking behavior in response to the tax increase. Despite high levels of tax avoidance and varying prices, nearly half of continuing smokers made a positive change in smoking behavior after the tax increase.
  
  
  CONCLUSIONS
  Expanded legislation and enforcement must be directed toward minimizing the availability of legal and illegal low- or no-tax cigarette outlets. Public education and cessation assistance customized for the Chinese American community is key to maximizing the effectiveness of tobacco tax policies in this population.
authors.affiliation: Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY 10032, USA. mjc68@columbia.edu
authors.forename: Jennifer
authors.initials: J
authors.lastname: Cantrell
authors.forename: Dorothy
authors.initials: D
authors.lastname: Hung
authors.forename: Marianne C
authors.initials: MC
authors.lastname: Fahs
authors.forename: Donna
authors.initials: D
authors.lastname: Shelley
mesh_terms: D000293:Adolescent; D000328:Adult; D002681:China / Q000208:ethnology; D003132:Commerce; D003430:Cross-Sectional Studies; D015438:Health Behavior; D006801:Humans; D008297:Male; D008875:Middle Aged; D009519:New York City; D012907:Smoking / Q000191:economics / Q000208:ethnology*; D000074606:Smoking Prevention; D013660:Taxes