title: Use of interrupted time-series method to evaluate the impact of cigarette excise tax increases in Pennsylvania, 2000-2009.
abstract: BACKGROUND
  Scientific evidence shows that cigarette price increases can significantly reduce smoking prevalence and smoking initiation among adolescents and young adults. However, data are lacking regarding the effectiveness of increasing Pennsylvania's cigarette tax to reduce smoking and/or adverse health effects of smoking. The objective of our study was to assess the impact of cigarette tax increases and resulting price increases on smoking prevalence, acute myocardial infarction (AMI) and asthma hospitalization rates, and sudden cardiac death (SCD) rates in Pennsylvania.
  
  
  METHODS
  We used segmented regression analyses of interrupted time series to evaluate the level and trend changes in Pennsylvania adults' current smoking prevalence, age-adjusted AMI and asthma hospitalization rates, age-specific asthma hospitalization rates, and age-adjusted SCD rates following 2 cigarette excise tax increases.
  
  
  RESULTS
  After the first excise tax increase, no beneficial effects were noted on the outcomes of interest. The second tax increase was associated with significant declines in smoking prevalence for people aged 18 to 39, age-adjusted AMI hospitalization rates for men, age-adjusted asthma hospitalizations rates, and SCD rates among men. Overall smoking prevalence declined by 5.2% (P = .01), with a quarterly decrease of 1.4% (P = .01) for people aged 18 to 39 years. The age-adjusted AMI hospitalization rate for men showed a decline of 3.87/100,000 population (P = .04). The rate of age-adjusted asthma hospitalizations decreased by 10.05/100,000 population (P < .001), and the quarterly trend decreased by 3.21/100,000 population (P < .001). Quarterly SCD rates for men decreased by 1.34/100,000 population (P < .001).
  
  
  CONCLUSIONS
  An increase in the price of cigarettes to more than $4 per 20-cigarette pack was associated with a significant decrease in smoking among younger people (aged 18-39). Decreases were also seen in asthma hospitalizations and men's age-adjusted AMI hospitalization and SCD rates. Further research and policy development regarding the effect of cigarette taxes on tobacco consumption should be cognizant of the psychological tipping points at which overall price affects smoking patterns.
authors.affiliation: Pennsylvania Department of Health, Bureau of Epidemiology, 625 Forster St, Room 1000, Harrisburg, PA 17120. E-mail: zma@pa.gov.
authors.forename: Zhen-qiang
authors.initials: ZQ
authors.lastname: Ma
authors.forename: Lewis H
authors.initials: LH
authors.lastname: Kuller
authors.forename: Monica A
authors.initials: MA
authors.lastname: Fisher
authors.forename: Stephen M
authors.initials: SM
authors.lastname: Ostroff
mesh_terms: D000293:Adolescent; D000328:Adult; D000375:Aging; D005260:Female; D006801:Humans; D008297:Male; D010414:Pennsylvania; D000074606:Smoking Prevention; D013660:Taxes; D013997:Time Factors; D062789:Tobacco Products / Q000191:economics*; D055815:Young Adult