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Effect of policy changes on cigarette sales: the case of Turkey

Charles W. Warren, Toker Erguder, Juliette Lee, Veronica Lea, Ann Goding Sauer, Nathan R. Jones, Nazmi Bilir
DOI: http://dx.doi.org/10.1093/eurpub/ckr157 712-716 First published online: 31 March 2012

Abstract

Background: In 1996, Turkey made tobacco control a health priority. The tobacco control effort was extended in July 2009 with the expansion of the smoke-free law to include all enclosed workplaces and public places and, in January 2010, with a 20% increase in the Special Consumption Tax on Tobacco. Methods: Sales data were averaged, by month, for the period January 2005 through June 2009 to establish an ‘expected’ monthly sales pattern. This was the period when no new tobacco control measures were implemented. The overall monthly average was then calculated for the same period. The expected monthly sales pattern was then graphed against the overall monthly sales average to delineate a seasonal sales pattern that was used to evaluate the divergence of actual monthly sales from the ‘expected’ pattern. Results: A distinct seasonal pattern was found with sales above average from May through August. Comparison of actual cigarette sales to the ‘expected’ monthly sales pattern following the implementation of the expanded smoke-free law in July resulted in a 5.2% decrease. Cigarettes sales decreased by 13.6% following the January 2010 Special Consumption Tax. Since the implementation of the expanded smoke-free law in July 2009 and the tax increase in January 2010, cigarette sales in Turkey decreased by 10.7%. Conclusion: The effect of recent Turkish tobacco control policies could contribute to a reduction in the number of premature deaths related to tobacco use. Evidence has shown that periodic tax increases and strong enforcement of all tobacco control policies are essential to further decrease tobacco consumption.

Introduction

Worldwide, approximately one-fourth of adults currently smoke tobacco.1 In Turkey, ∼31% of adults currently smoke cigarettes; men (47.8%) are more than three times as likely as women (15.1%) to smoke.2 More than 90% of current cigarette smokers in Turkey smoke manufactured cigarettes (92.6% men; 98.0% women). On average, men who smoke daily consume almost a pack (19.3) of manufactured cigarettes each day, compared with slightly more than half a pack (12.2) each day for women.

In 1996, Turkey made tobacco control a health priority by passing Law 4207: ‘Preventing the Hazards of Tobacco Products.’3 Law 4207 prohibited smoking in many public places, such as health and education institutions and public transportation. In 2004, Turkey's government ratified the World Health Organization (WHO) Framework Convention on Tobacco Control (FCTC).4 Since ratifying the WHO FCTC, Turkey has implemented two important tobacco control measures: (i) expanded smoke-free environments to include all enclosed workplaces and public spaces (19 July 2009); and (ii) increased the Special Consumption Tax on tobacco products by 20% (January 2010). These interventions are among the six effective tobacco control strategies identified by WHO, which can be used by the countries to help develop comprehensive tobacco control programmes.1 The six strategies are: (i) monitoring tobacco use and prevention policies; (ii) protecting people from tobacco smoke; (iii) offering help to quit tobacco use; (iv) warnings about the dangers of tobacco; (v) enforcing bans on tobacco advertising, promotion and sponsorship; and (vi) raising taxes on tobacco. The WHO FCTC includes specific articles related to each of these six strategies.4

The purpose of this paper is to compare monthly cigarette sales data pre- and post- implementation of recent Turkish expanded tobacco control laws and to discuss possible contributing factors of divergence from the expected sales.

Methods

Monthly manufactured cigarette sales data from January 2005 through December 2010 were available from the Turkish Tobacco and Alcohol Market Regulatory Authority (TAPDK)5 (table 1). Sales data were averaged, by month, for the period January 2005 through June 2009 (table 1). This time period reflected cigarette sales when no new tobacco control measures were implemented in Turkey. The overall monthly average was then calculated for the same period (8982 million sticks/month). The monthly averages were then graphed against the overall monthly average to determine whether a seasonal pattern existed (figure 1). A seasonal pattern was delineated and it was used as the ‘expected’ monthly pattern, which was then graphed against the actual monthly sales from July 2009 through December 2010 (the period when new tobacco control measures were implemented) (figure 2). Divergence by the actual sales pattern from the expected pattern was then discussed.

Figure 1

Monthly pattern of tobacco consumption

Figure 2

Actual monthly cigarette sales compared with expected monthly cigarette sales, 2009–10

View this table:
Table 1

Cigarettes sold (in millions), by month and year

Month200520062007200820092010Monthly average
January7747775186847940862368608149
February8861713692697915778359628193
March8617875162558475917976048255
April8929825580988743889576928584
May9398974393689443921783299434
June10 15210 4399420959211 417869010 204
July10 33910 31910 70010 1809628868110 385
August946410 03210 67810 2228082718310 099
September9266853274438206799783738362
October6823800510 4399394920780148665
November8218941188149105850279958887
December8903953482878644902079988842
Total1 06 7171 07 908107 455107 8591 07 55093 3819005
  • The overall average monthly sale from January 2005 through June 2009 was 8982 million cigarettes

  • Source: TAPDK5

Results

Trends

The number of manufactured cigarettes sold annually increased from ∼96 billion cigarettes in 1996 to almost 112 billion in 2001; however, from 2005 to 2009, sales were relatively constant at ∼107 billion cigarettes/year (table 1). In 2010, annual sales of cigarettes decreased to 93 billion; a decrease of >13%.

The monthly pattern from January 2005 to June 2009 is shown in figure 1. The average monthly number of cigarettes sold during January 2005 to June 2009 was above average from May through August, with sales peaking in July (figure 1). Of the 54 months during this period, monthly sales were above the overall average (8982 million sticks/month) in 26 months and 18 of those months were during May–August (table 1).

Impact of comprehensive smoke-free legislation

Turkey expanded its smoke-free legislation in July 20096 to include all enclosed workplaces and public spaces, with partial compliance as noted by WHO.1 Using the monthly pattern (shown in figure 1) as an indicator of expected sales, monthly sales of cigarettes were below expectation in 4 of the 6 months (figure 2 and table 1) with an overall decrease of 5.1% during July–December 2009.

Combined effect of comprehensive smoke-free legislation and tax increase

Turkey passed a 20% increase in the Special Consumption Tax on tobacco in January 2010.7 During January–December 2010, sales of cigarettes decreased by 13.6%, with monthly sales below the expected value for 11 of the 12 months (figure 2). Since implementation of the expanded smoke-free law (July 2009) and the increase in taxes (January 2010), cigarette sales in Turkey have decreased by 10.7%, with monthly sales below the expected value in 15 of the 18 months.

Discussion

Second-hand smoke

According to WHO, restrictions on smoking in public places decrease the social acceptability of tobacco use, which leads to decreased prevalence and incidence of tobacco use and increased public support for tobacco control.8 In addition, the World Bank has concluded that smoking restrictions can reduce overall tobacco consumption by 4–10%.9 A 2002 study concluded that a strong smoke-free workplace policy can result in a 4% decrease in prevalence.10 After Ireland implemented a smoke-free workplace policy, 59% of smokers reported that they had reduced the number of cigarettes they smoked per day because of the law, and 46% reported that the law made them more likely to quit.11

Turkey began its effort to become smoke free with the passage of Law 4207 in 1996.3 Law 4207 included provisions to ban smoking in public places, such as health and education establishments and public transportation. In 2008, Turkey amended Law 4207 with Law 5727 that expanded the list of smoke-free areas to also include: indoor areas of public workplaces; indoor areas of buildings (education, health, commercial, social, cultural, sports or entertainment); mass transit vehicles, including private taxis; indoor and outdoor areas accepted as premises of pre-school education institutions; primary and secondary schools, including private schools; restaurants and entertainment establishments (cafes, cafeterias and bars).6 Law 5727 was implemented in two phases. On 19 May 2008, provisions in Law 5727 prohibited smoking in workplaces and public places, such as in the metro, shops and airports. In July 2009, Turkey further expanded the smoke-free law to include all enclosed workplaces and public places such as, hospitality workplaces, restaurants, bars and teahouses. Turkey is one of five European countries that are considered ‘smoke-free’.12 Results from our analysis suggest that the initial effect of the expanded smoke-free legislation on cigarette sales has resulted in a decrease of 5.1% during the 6-month period (July–December 2009). However, as Bilir and Ozcebe13 noted ‘Long term positive effects of smoke free implementation will be expected in several years. The Turkish Ministry of Health recognizes that despite having comprehensive smoke-free legislation these laws need to be enforced by the municipalities and other agencies at the local level to reduce prevalence in tobacco use’.

Taxation

A recent International Agency for Research on Cancer (IARC) monograph14 evaluated the effectiveness of tax and price policies to prevent and reduce tobacco use. The monograph concluded, ‘… there was sufficient evidence of effectiveness of increased tobacco excise taxes and prices in reducing overall tobacco consumption.’14 Earlier studies concur that taxation on tobacco products is one of the most important strategies for smoking cessation and preventing smoking initiation and consumption.1518 For every 10% increase in the price of cigarettes, youth smoking reduces by ∼7%, and overall cigarette consumption reduces by ∼4%.19 In Europe, smoking consumption decreased by 5–7% when the real price of cigarettes increased by 10%.20 In January 2010, Turkey increased the Special Consumption Tax on Tobacco by 20%. This increase resulted in the total tax on tobacco in Turkey reaching 79% of the retail price, which meets both the European Union and WHO minimum standards of ≥75% of the retail price.

In 1994, researchers in Turkey reported that a 10% increase in the retail price of cigarettes reduced consumption by 4.1%21, and it was reported in a 2003 study that a 10% increase in retail price reduced consumption by 10% among poor households and 5.1% among rich households.22 Between July 2009 and December 2010 tobacco sales in Turkey decreased by 10.7%. A recent study suggested four possible outcomes resulting from a tax increase. These outcomes included (i) that consumption could likely decrease; (ii) smokers could potentially stockpile cigarettes prior to enactment of the tax increase; (iii) smokers would switch brand preference to lower priced/discount cigarette brands; and (iv) increase cigarettes sold/purchased illicitly.23

In the interpretation of our results, we are unable to disentangle the influence of the expansion of smoke-free laws and the Special Consumption Tax. We recognize that other factors may have influenced cigarette sales during this period of time.

Several issues not addressed by this study could be considered for future research. To gain further insight into the effect of secondhand smoke policies, raising taxes and price changes on cigarette sales future research is needed to determine the independent effect or the interactive influence of each policy. The Global Adult Tobacco Survey (GATS) was conducted in Turkey in November 2008 among adults aged ≥15years. Data from GATS can be used as a baseline for self-reported cigarette consumption and a repeat round of GATS could be useful to determine if self-reported consumption shows a decrease consistent with the sales data. Questions could also be included to determine the independent effect of the smoke-free policy and the tax increase. In addition, the impact of implementation of pictorial warning labels (another of the six tobacco control measures) in January 2011 as an inhibitor to tobacco use could be evaluated.

Turkey made great strides in tobacco control in 2009 and 2010. Cigarette sales have decreased >10%. The effect of the policies (comprehensive smoke free and increase in taxes) could contribute to a reduction in the number of premature deaths related to tobacco use. Before 2009, more than 100 000 Turkish adults were estimated to die of tobacco-related diseases each year.19 Evidence has shown that periodic tax increases and strong enforcement of all tobacco control policies are essential to further decrease tobacco consumption.21

Conflicts of interest: None declared.

Key points

  • A distinct seasonal pattern was found for the average sale of manufactured cigarettes per month in Turkey with sales above average from May through August.

  • When the comprehensive smoke-free law was implemented, sales of cigarettes decreased by 5.1% (July–December 2009) and there was a 13.6% decrease in sales for January–December 2010, post implementation of both tobacco control policies in Turkey.

  • Since Turkey's implementation of the expanded smoke-free law and the tax increase, cigarette sales have decreased by 10.7%.

References

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