What is the cost? Maintenance of smoking despite cigarette price rises among highly socioeconomically disadvantaged smokers

Background: Modelling studies show that taxation policies and increasing cigarette prices have the potential to reduce smoking rates across social groups. However, there is evidence that socially disadvantaged smokers experience higher levels of financial stress, and financial stress leads to a reduction in the likelihood of making quit attempts. Smokers from socially disadvantaged backgrounds spend a greater proportion of their income on tobacco than most other smokers. It is unclear what behaviours are modified in order to accommodate smoking maintenance despite rising tobacco prices among smokers experiencing financial hardship. Methods: Clients seeking welfare assistance from a Community Service Organisation in NSW, Australia were invited to complete a touchscreen computer survey. Questions covered smoking history, budgeting, financial stress and cigarette price-minimising behaviour. Highest price to encourage quitting was assessed. Results: Survey response rate was 76 %. N=400 smokers completed the survey (59 % female; mean age 38 years). The smoking rate in this sample was 65 % (daily and occasional). Most smokers had an income of less than AUD$400/week, had not completed high school and spent an average ofAUD$56 on tobacco each week. All smokers had experienced financial stress; half had experienced smoking-related deprivation. Smokers estimated they spent 20 % of their income on personal luxuries (e.g. tobacco and alcohol), and when faced with 10 % or 20 % price increases selected the following as the most popular response strategies: i) try to quit; ii) no change; iii) buy lower priced brands; iv) smoke fewer sticks; v) use loose tobacco. Smokers nominated $25 as the average price a25-pack of cigarettes needed to reach before they would quit. Conclusions: Severely disadvantaged smokers make use of numerous price-minimising strategies in order to sustain current smoking behaviours in spite of increases in taxation and product prices.