Chinese smokers’ behavioral response toward cigarette price: individual and regional correlates

This study suggests smoking prevalence was 30.6 % (27.6 %–33.5 %). This study found most smokers used self-paying cigarettes, and 5.9 % used cigarettes given to them by others. This phenomenon is special in China culture. It is common to give cigarettes to guests or friends or to give cigarettes as gifts for services received [22]. Our analysis found the prevalence of not self-paying cigarettes is higher among professionals than other types of occupational groups. This may be because professionals provide valuable technical services and resources, and cigarettes are given to them in return for their services. Consequently, professionals are less sensitive to cigarette price, which may minimize the impact of increased cigarette price on consumption.

This study also found 67 % of smokers bought cigarettes in cartons, which is higher than reported by earlier researchers [23]. This indicates that currently the cigarette sales system in China is very convenient for buying cigarettes, and people can easily purchase cigarettes in the community, at work, or other places [15]. They choose to buy in cartons because they pay significantly lower prices than when purchasing in packs. This indicates that some consumers have to consider the question of price for cigarettes consumption.

This study shows 37.9 % of smokers indicated a little decrease in usage with the current cigarette price, and only 5.2 % of smokers decreased consumption some or more extent. This may be due to both market and consumer forces [1, 24]. This indicates that at the current retail price level smokers do not feel enough financial pressure when buying cigarettes to lead to a change their behavior [16], while another possibility is that Chinese smokers was not be enough sensitive enough to the overall price, which is consistent with Huang,s report [7]. Huang and his colleagues found that Cigarette consumption among low-income smokers did not decrease after a price increase, they reported that relative to other low-income and middle-income countries, cigarette consumption among Chinese adult smokers is not very sensitive to changes in cigarette prices [7]. Of course, this is a very complex phenomenon, many factors may contribute this phenomenon, the price-reducing behaviors, such as brand switching, trading down, and cigarette smuggling, and so on should be taken into account.

This study found that the random effects between-cities components in the null model were not significant but individual level variation test was significant in PBR analysis. This indicates that the cigarette consumption decreasing related to the price are influenced by individual variables, not environmental variables. After adding individual-level variables to form the null model for estimating the final model the fixed effect declined but retained its significance, which indicated some individual variables included can partly explain variations, but there are some potential individual variables that need to be explored. Different from PBR analysis, the random effects between-cities component in the null model were significant in SPBR analysis, which indicated there are significant differences in inter-city variation in this price response, and it was not significant in full model. This indicates some environmental variables included in this analysis can explain variations between-cities. Similarly the individual level variation test was significant in the null model, the fixed effect declined but retained its significance, which indicated some individual variables included in this analysis can partly explain variations, but there are some potential individual variables that need to be explored.

We noted some striking correlates of the price behavioral response. Whether PBR or SPBR minority groups were less sensitive than in the Han, which is consistent with studies about smoking behavioral, this difference may lie in their health awareness [10, 13, 16]. Smoking is a male norm and predominant practice in China, but this study found that males have more sensitive SPBR than females,which is not consistent with other studies [10, 25]. Our research underscores the importance of cultural norms in the diffusion of smoking and calls attention both to an opportunity and imperative to prevent the spread among Chinese females. This study found those with higher education attainment associated with higher PBR, when facing their perceived higher cigarette prices. A plausible reason is that they have greater health awareness in general as well as better knowledge of the health risks of tobacco smoking and advanced quitting skills [26, 27]. The SPBR associated with occupation status, which operations and students more sensitive to the price than reference. This may be because they have lower affordability for cigarettes due to their lower economic level [13, 24]. However, unlike other studies about cigarette consumption, also not consistent with economic theory: A dults with lower income are more price-responsive than adults with higher income [25, 28], income was not associated with price sensitivity in this study, but it was consistent with another a study from China [7]. PBR and SPBR were positively associated with occasional smoking, apparently this is related to nicotine dependence, where higher nicotine dependence prevents behavior change [14, 26]. Occasional smokers have lower nicotine dependence than daily smokers so they can easily change their behavior. This study found that more cigarettes number and higher cigarette price used associated with higher PBR, apparently, this phenomenon relates to the burden from cigarette consumption, which the demand for cigarettes was influenced by cigarettes price and the consumption amount [24]. About two-third (65.1 %) of current smokers in the study were found to smoke with other and this was associated with lower PBR and SPBR. This may be reason that social situations and peer influences are important smoking reasons and barriers to smoking behavior change in this Chinese population [27].

Our study found that that regional cigarette production is associated with the price sensitivity. This is unsurprising for many reasons, including the focus on regional economic development by government at the expense of addressing smoking problems or instituting tobacco control [1, 15], and the adversarial role of the tobacco industry as manifested in tobacco advertising and strong resistance to tobacco control measures [1, 29]. Currently in China, smokers and the tobacco industry are routinely depicted in a variety of overwhelmingly negative ways in everyday discourse and through the mass media. Tobacco advertising, promotion, sponsorship, and marketing are omnipresent in areas with heavy tobacco cultivation and cigarette production [1]. Tobacco companies also target consumers and potential consumers with culturally tailored cigarette brands [13]. These may make smokers less sensitive to the price.

Some studies found that news media coverage was associated with smoking behaviors and SHS exposure [11, 30]. This study is first to provide evidence about the influence of regional media coverage on the price sensitivity in a multilevel framework. This result suggest that the news media may influence people’s belief, awareness, and behaviors about smoking and tobacco control to make smokers more sensitive to cigarettes price. In common with findings for many other middle income and poorer countries, the overall public awareness of the hazards of smoking in China is low. This lack of awareness induces lower price sensitivity. Using the mass media is a powerful means for disseminating information about the adverse health effects of smoking to the general public and smokers, as reinforced by the regional findings of this study. Thus, a key challenge for China is to fortify efforts to harness the power and influence of the media to disseminate tobacco control messages, especially when they help to diminish the effects of tobacco advertising upon smoking.

Exposure to tobacco smoke in the workplace is correlated with increased risk for heart disease and lung cancer among adult nonsmokers [31]. Smoke-free workplaces not only protect nonsmokers from deleterious effects, but also decrease smoking prevalence [11, 32]. In our study, workplace restrictions were associated with the price sensitivity at the city-level. This finding likely reflects social norm change, and improvements in tobacco control awareness and beliefs due to the introduction of smoke-free workplaces which leads to more sensitivity to cigarettes price [13, 33, 34].

This study provided new information about a profile of price sensitivity, with several individual-level and regional variables contributing to smokers’ response behaviors to the price of cigarettes. This means that price sensitivity can be modified by changing the conditions conducive to smoking. We contend that although Chinese smokers appear less sensitive to cigarette prices than those in many other countries, this relationship is amenable to amelioration. Rarely have studies of the economics of smoking consumption considered price sensitivity to be modifiable. This study explored price sensitivity from an economic behavioral perspective. Our principal message is that price sensitivity is not just a problem at the individual level, but it also has an environmental context. Intervening at the regional level, through implementing workplace smoking restrictions, curbing cigarette production, and using news coverage may be able to change the price sensitivity of smokers. It is important to understand the price sensitivity issue, which has important implications for tobacco control policy in China. Increasing smoker sensitivity to cigarette prices will require stronger tobacco control and public education campaigns.

An important limitation of our study is its cross-sectional study design. Therefore, we cannot infer a causal link between these variables and price sensitivity. However, our study employed a large sample, and our findings satisfy several criteria for assuming causal inference, including strength of some associations, their consistency, and plausibility of effect. Future studies need to compile longitudinal surveillance data on cigarette price sensitivity. A second limitation is that only urban residents were included in our survey. Thus, our results are not generalizable to the overall population of China, which has a very substantial rural component. Thirdly, media coverage is reflected by Baidu search results, which could be biased as public service advertisements on television are not in Baidu. Third, we only concerned the behavioral response toward cigarettes price among smokers in this study, prior smokers (smokers quitted) did not include. So that our measure for the price behavioral response did not have quitting as an option. Further study should get information from both smokers and the quitters to fully understand the price sensitivity of cigarettes.