{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,10]],"date-time":"2026-10-10T01:05:39Z","timestamp":1791594339358,"version":"4.3.4"},"reference-count":44,"publisher":"Public Library of Science (PLoS)","issue":"3","license":[{"start":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T00:00:00Z","timestamp":1647388800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosglobalpublichealth.org"],"crossmark-restriction":false},"short-container-title":["PLOS Glob Public Health"],"abstract":"<jats:p>Previous studies on the associations between cigarette taxes and infant survival have all been in high-income countries and did not examine the relative benefits of different taxation levels and structures. We evaluated longitudinal associations of cigarette taxes with neonatal and infant mortality globally. We applied country-level panel regressions using 2008\u20132018 annual mortality and biennial WHO tobacco taxation data. Complete data was available for 159 countries. Outcomes were neonatal and infant mortality. We conducted analyses by type of taxes (i.e. specific cigarette taxes, ad valorem taxes, and other taxes, import duties and VAT) and the income group classification of countries. Covariates included scores for other WHO recommended tobacco control policies, socioeconomic, health-care, and air quality measures. Secondary analyses investigated the associations between cigarette tax and cigarette consumption. We found that a 10 percentage-point increase in total cigarette tax as a percentage of the retail price was associated with a 2.6% (95% Confidence Interval [CI]: 1.9% to 3.2%) decrease in neonatal mortality and a 1.9% (95% CI: 1.3% to 2.6%) decrease in infant mortality globally. Estimates were similar for both excise and ad valorem taxes. We estimated that 231,220 (95% CI: 152,658 to 307,655) infant deaths could have been averted in 2018 if all countries had total cigarette tax at least 75%. 99.2% of these averted deaths would have been in low- and middle-income countries (LMICs). The secondary analysis supported causal interpretation of results by finding that a 10 percentage-point increase in taxes was associated with a reduction of 94.6 (95% CI: 32.7 to 156.5) in annual cigarette consumption per capita. Although causal inference is precarious due to the quasi-experimental design, we used a robust analytical approach and focused on within-country changes. Limitations include an inability to include data on roll-your-own tobacco, other forms of tobacco use, and reliance on taxation data only for the cigarette brands most sold in each country. In line with limited existing evidence conducted in HICs, we found that raising taxes on tobacco was associated with a reduction in neonatal and infant mortality globally. Implementing recommended levels of taxation in LMICs should be a priority since this is where the lowest levels of taxation and the largest potential infant mortality benefits exist.<\/jats:p>","DOI":"10.1371\/journal.pgph.0000042","type":"journal-article","created":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T17:29:38Z","timestamp":1647451778000},"page":"e0000042","update-policy":"https:\/\/doi.org\/10.1371\/journal.pgph.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cigarette taxation and neonatal and infant mortality: A longitudinal analysis of 159 countries"],"prefix":"10.1371","volume":"2","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1676-5951","authenticated-orcid":true,"given":"M\u00e1rta K.","family":"Rad\u00f3","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1318-8439","authenticated-orcid":true,"given":"Anthony A.","family":"Laverty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0703-6973","authenticated-orcid":true,"given":"Thomas","family":"Hone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6716-3400","authenticated-orcid":true,"given":"Kiara","family":"Chang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1051-2136","authenticated-orcid":true,"given":"Mohammed","family":"Jawad","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0793-9884","authenticated-orcid":false,"given":"Christopher","family":"Millett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jasper V.","family":"Been","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2101-2559","authenticated-orcid":true,"given":"Filippos T.","family":"Filippidis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,3,16]]},"reference":[{"key":"pgph.0000042.ref001","volume-title":"Global Burden of Disease Study 2017","year":"2018"},{"key":"pgph.0000042.ref002","doi-asserted-by":"crossref","first-page":"1345","DOI":"10.1016\/S0140-6736(17)32366-8","article-title":"Global, regional, and national comparative risk assessment of 84 behavioural, environmental and occupational, and metabolic risks or clusters of risks, 1990\u20132016: a systematic analysis for the Global Burden of Disease Study 2016","volume":"390","year":"2017","journal-title":"Lancet"},{"key":"pgph.0000042.ref003","unstructured":"The Health Consequences of Smoking\u201450 Years of Progress: A Report of the Surgeon General (U.S. Department of Health and Human Services, Centers for Disease Control and Prevention)."},{"key":"pgph.0000042.ref004","article-title":"Secondhand smoke and adverse fetal outcomes in nonsmoking pregnant women: A meta-analysis","author":"J Leonardi-Bee","year":"2011","journal-title":"Pediatrics"},{"key":"pgph.0000042.ref005","article-title":"Reducing tobacco smoking and smoke exposure to prevent preterm birth and its complications.","author":"M Wagijo","year":"2017","journal-title":"Paediatric Respiratory Reviews."},{"key":"pgph.0000042.ref006","first-page":"11","article-title":"The health, poverty, and financial consequences of a cigarette price increase among 500 million male smokers in 13 middle income countries: compartmental model study.","volume":"361","author":"Global Tobacco Economics Consortium","year":"2018","journal-title":"BMJ"},{"key":"pgph.0000042.ref007","unstructured":"United Nations. The Sustainable Development Goals. Available at https:\/\/www.un.org\/sustainabledevelopment\/ Last accessed 29th January 2021."},{"key":"pgph.0000042.ref008","unstructured":"World Health Organization (2019). WHO report on the global tobacco epidemic 2019: offer help to quit tobacco use https:\/\/www.who.int\/publications\/i\/item\/who-report-on-the-global-tobacco-epidemic-2019-offer-help-to-quit-tobacco-use Last accessed 1 June 202."},{"key":"pgph.0000042.ref009","article-title":"Impact of population tobacco control interventions on socioeconomic inequalities in smoking: a systematic review and appraisal of future research directions.","author":"CE Smith","year":"2020","journal-title":"Tob Control"},{"key":"pgph.0000042.ref010","doi-asserted-by":"crossref","first-page":"e420","DOI":"10.1016\/S2468-2667(17)30144-5","article-title":"Effect of tobacco control policies on perinatal and child health: a systematic review and meta-analysis","volume":"2","author":"T Faber","year":"2017","journal-title":"Lancet Public Heal"},{"key":"pgph.0000042.ref011","article-title":"Estimating the effects of cigarette taxes on birth outcomes.","author":"A Sen","year":"2011","journal-title":"Can Public Policy."},{"key":"pgph.0000042.ref012","doi-asserted-by":"crossref","first-page":"e20152901","DOI":"10.1542\/peds.2015-2901","article-title":"Cigarette tax increase and infant mortality","volume":"137","author":"SW Patrick","year":"2016","journal-title":"Pediatrics"},{"key":"pgph.0000042.ref013","doi-asserted-by":"crossref","first-page":"1100","DOI":"10.1001\/jamapediatrics.2017.2536","article-title":"Association of cigarette price differentials with infant mortality in 23 european union countries","volume":"171","author":"FT Filippidis","year":"2017","journal-title":"JAMA Pediatr"},{"key":"pgph.0000042.ref014","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1086\/671020","article-title":"Tobacco Control Policies, Birth Outcomes, and Maternal Human Capital.","volume":"7","author":"S Markowitz","year":"2013","journal-title":"J Hum Cap"},{"key":"pgph.0000042.ref015","article-title":"Associations of tobacco control policies with birth outcomes","author":"SS Hawkins","year":"2014","journal-title":"JAMA Pediatr"},{"key":"pgph.0000042.ref016","article-title":"Tobacco use in pregnant women: Analysis of data from Demographic and Health Surveys from 54 low-income and middle-income countries","volume":"2","author":"R Caleyachetty","year":"2014","journal-title":"Lancet Glob Heal"},{"key":"pgph.0000042.ref017","doi-asserted-by":"crossref","first-page":"1029","DOI":"10.1016\/S0140-6736(15)60312-9","article-title":"Exposing and addressing tobacco industry conduct in low-income and middle-income countries","volume":"385","author":"AB Gilmore","year":"2015","journal-title":"Lancet"},{"key":"pgph.0000042.ref018","article-title":"Evaluation of research on interventions aligned to WHO \u201cBest Buys\u201d for NCDs in low-income and lower-middle-income countries: A systematic review from 1990 to 2015.","author":"LN Allen","year":"2018","journal-title":"BMJ Global Health."},{"key":"pgph.0000042.ref019","doi-asserted-by":"crossref","DOI":"10.3402\/gha.v7.25326","article-title":"Disease burden due to biomass cooking-fuel-related household air pollution among women in India.","volume":"7","author":"M Sehgal","year":"2014","journal-title":"Glob Health Action."},{"key":"pgph.0000042.ref020","article-title":"Secondhand smoke exposure during pregnancy: A cross-sectional analysis of data from Demographic and Health Survey from 30 low-income and middle-income countries.","author":"S Reece","year":"2019","journal-title":"Tobacco Control"},{"key":"pgph.0000042.ref021","article-title":"One Hundred Years in the Making: The Global Tobacco Epidemic.","author":"H Wipfli","year":"2016","journal-title":"Annual Review of Public Health"},{"key":"pgph.0000042.ref022","doi-asserted-by":"crossref","first-page":"l2231","DOI":"10.1136\/bmj.l2231","article-title":"Cigarette consumption estimates for 71 countries from 1970 to 2015: systematic collection of comparable data to facilitate quasi-experimental evaluations of national and global tobacco control interventions","volume":"365","author":"SJ Hoffman","year":"2019","journal-title":"BMJ"},{"key":"pgph.0000042.ref023","unstructured":"World Health Organization Data Portal https:\/\/www.who.int\/data\/maternal-newborn-child-adolescent-ageing Last accessed 1 June 2021."},{"key":"pgph.0000042.ref024","unstructured":"https:\/\/data.worldbank.org\/."},{"key":"pgph.0000042.ref025","unstructured":"Poirier, Mathieu JP; Guindon, G Emmanuel; Sritharan, Lathika; Hoffman, Steven J, 2019, \u201cInternational Cigarette Consumption Database v1.0\u201d, https:\/\/doi.org\/10.5683\/SP2\/AOVUW7, Scholars Portal Dataverse, version 1.0 https:\/\/dataverse.scholarsportal.info\/da."},{"key":"pgph.0000042.ref026","author":"World Health Organization","year":"2017","journal-title":"WHO report on the global tobacco epidemic 2017"},{"key":"pgph.0000042.ref027","author":"World Health Organisation","year":"2015","journal-title":"WHO Report on the Global Tobacco Epidemic, 2015: Raising Taxes on Tobacco"},{"key":"pgph.0000042.ref028","volume-title":"WHO report on the global tobacco epidemic, 2013: Enforcing bans on tobacco advertising, promotion and sponsorship","author":"World Health Organization","year":"2013"},{"key":"pgph.0000042.ref029","author":"World Health Organization","year":"2011","journal-title":"WHO report on the global tobacco epidemic, 2011: Warning about the dangers of tobacco"},{"key":"pgph.0000042.ref030","author":"World Health Organization","year":"2009","journal-title":"WHO report on the global tobacco epidemic, 2009: Implementing smoke-free environments"},{"key":"pgph.0000042.ref031","article-title":"Investigating the effects of comprehensive smoke-free legislation on neonatal and infant mortality in Thailand using the synthetic control method.","author":"MK Rad\u00f3","year":"2020","journal-title":"EClinicalMedicine"},{"key":"pgph.0000042.ref032","unstructured":"World Bank. World Bank Open Data. Available at: https:\/\/bit.ly\/2yUZmdS Last accessed 1 June 2021."},{"key":"pgph.0000042.ref033","unstructured":"International Agency for Research on Cancer (IARC). (2011) Effectiveness of tax and price policies for tobacco control: IARC handbook of cancer prevention volume 14. www.iarc.fr\/en\/publications\/pdfs-online\/prev\/handbook14\/index.php."},{"key":"pgph.0000042.ref034","article-title":"Worldwide burden of disease from exposure to second-hand smoke: A retrospective analysis of data from 192 countries","author":"M \u00d6berg","year":"2011","journal-title":"Lancet"},{"key":"pgph.0000042.ref035","volume-title":"WHO technical manual on tobacco tax administration","author":"World Health Organization","year":"2010"},{"key":"pgph.0000042.ref036","article-title":"The association between tax structure and cigarette price variability: Findings from the ITC Project.","author":"C Shang","year":"2015","journal-title":"Tob Control"},{"key":"pgph.0000042.ref037","article-title":"Prices and Illicit Trade of Cigarettes in the European Union: A Cross-sectional Analysis","author":"FT Filippidis","year":"2020","journal-title":"Nicotine Tob Res"},{"key":"pgph.0000042.ref038","article-title":"Does the availability of single cigarettes promote or inhibit cigarette consumption? perceptions, prevalence and correlates of single cigarette use among adult Mexican smokers.","author":"JF Thrasher","year":"2009","journal-title":"Tob Control"},{"key":"pgph.0000042.ref039","doi-asserted-by":"crossref","first-page":"e102","DOI":"10.1136\/tobaccocontrol-2018-054826","article-title":"Analysis of tobacco industry pricing strategies in 23 European Union countries using commercial pricing data.","volume":"28","author":"MCI van Schalkwyk","year":"2019","journal-title":"Tob Control."},{"key":"pgph.0000042.ref040","doi-asserted-by":"crossref","first-page":"488 LP","DOI":"10.1136\/tobaccocontrol-2017-053891","article-title":"Tobacco industry strategies undermine government tax policy: evidence from commercial data.","volume":"27","author":"R Hiscock","year":"2018","journal-title":"Tob Control"},{"key":"pgph.0000042.ref041","unstructured":"The World Bank. Mortality rate data, under-5s (per 1000 live births) https:\/\/data.worldbank.org\/indicator\/SH.DYN.MORT Accessed 29th January 2021."},{"key":"pgph.0000042.ref042","doi-asserted-by":"crossref","first-page":"172 LP","DOI":"10.1136\/tobaccocontrol-2011-050417","article-title":"Tobacco taxes as a tobacco control strategy.","volume":"21","author":"FJ Chaloupka","year":"2012","journal-title":"Tob Control"},{"key":"pgph.0000042.ref043","article-title":"Smoke-free legislation and neonatal and infant mortality in Brazil: Longitudinal quasi-experimental study.","volume":"29","author":"T Hone","year":"2020","journal-title":"Tob Control"},{"key":"pgph.0000042.ref044","article-title":"Health, health inequality, and cost impacts of annual increases in tobacco tax: Multistate life table modeling in New Zealand.","author":"T Blakely","year":"2015","journal-title":"PLoS Med"}],"container-title":["PLOS Global Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000042","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,3,16]],"date-time":"2022-03-16T17:30:30Z","timestamp":1647451830000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pgph.0000042"}},"subtitle":[],"editor":[{"given":"Ransome","family":"Eke","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,3,16]]},"references-count":44,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2022,3,16]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pgph.0000042","relation":{},"ISSN":["2767-3375"],"issn-type":[{"value":"2767-3375","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,3,16]]}}}