1047778

review-article2021
SJP0010.1177/14034948211047778Kjeld et al.Price elasticity of demand for cigarettes among youths

Scandinavian Journal of Public Health, 2023; 51: 35–43

Literature Review

Price elasticity of demand for cigarettes among youths

in high-income countries: a systematic review

Simone Gad Kjeld , Maja Bæksgaard Jørgensen,

Maria Aundal & Lotus Sofie Bast

National Institute of Public Health, University of Southern Denmark, Denmark

Abstract
Aims: Smoking in youth remains a major public health issue. As increasing tobacco prices is considered one of the most
effective prevention strategies, examining youth’s responsiveness to price changes on cigarettes will provide crucial
knowledge. This study aims systematically to review research examining the price elasticity of demand for cigarettes among
youths (<30 years of age) in high-income countries. Methods: Searches were conducted in three databases (Web of Science,
Pubmed and Scopus). Inclusion criteria were publications within the past 10 years (2011–2021) written in English and with
a population of youths below 30 years of age, concerning price elasticity of demand for cigarettes and from high-income
countries. Searches were screened by two independent reviewers and the quality of studies was assessed using a quality
assessment tool. Results: Four outcomes related to price elasticity of demand for cigarettes were examined in six studies
included in this review; that is, cigarette initiation, consumption, prevalence and cessation. Overall, findings indicate that
increasing tobacco prices affect youth tobacco use. The effect was associated with gender and age; young women were more
price sensitive concerning smoking initiation, whereas young men were more price sensitive concerning cigarette prevalence
and consumption. Moreover, younger age was associated with higher price elasticity. Conclusions: Estimates for price
elasticity varied across the included studies. This may be caused by differences in data sources, collection
methods used and country of origin. Most included studies were of older date. Therefore, to make reliable
predictions of the expected effects of increased tobacco prices, further examinations of up-to-date and locally
embedded measures are required.

Keywords: Systematic review, price elasticity of demand, youth, cigarettes, smoking, tobacco, high-income countries

Introduction After decades of falling smoking prevalences, some

Smoking is the leading cause of preventable deaths
and one of the largest health problems globally.
According to the World Health Organization (WHO),
more than 8 million people die every year from tobacco
use and 1.2 million die from second-hand smoking
[1]. In Denmark, more than 13,000 are expected to
die from a smoking-related disease annually [2], and
among those who smoke on a regular basis, up to two-
thirds are expected to die from a disease caused by
smoking [3, 4]. This makes smoking the single biggest
cause of illness and preventable deaths in Denmark.
measures indicate increasing smoking prevalences
among some youths [5, 6], while others indicate a
recent decrease in daily but not occasional smoking
among some parts of the youth [7, 8]. In 2020, about
20% of 15–29 year-olds were currently smoking ciga-
rettes, of which approximately half were smoking ciga-
rettes on a daily basis [9].
The health consequences of smoking increase
with earlier age of smoking initiation [10, 11]. For
example, cigarettes contain nicotine, which is addic-
tive, and especially the young brain seems to be
highly affected by early tobacco initiation [12].

Correspondence: Simone Gad Kjeld, National Institute of Public Health, Southern University of Denmark, Studiestræde 6, 1455 Copenhagen, Denmark.
E-mail: simk@sdu.dk

Date received 28 May 2021; reviewed 16 July 2021; accepted 2 September 2021

© Author(s) 2021
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DOI: 10.1177/14034948211047778
https://doi.org/10.1177/14034948211047778
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36    S.G. Kjeld et al.
Further, research has evidenced that earlier initiation
of cigarette smoking predicts continued use in adult-
hood, heavier use and difficulties with smoking ces-
sation [13]. Between 70% and 90% of current
smokers initiated their tobacco use before they
turned 18 years old [8, 14]. Therefore, to solve the
current tobacco issues, preventing children and
youths from starting to smoke is a main priority.
There exist numerous strategies to reduce smok-
ing. The WHO has developed a framework conven-
tion on tobacco control (FCTC), which is an action
and evidence-based plan to prevent and discontinue
smoking. This plan is called MPOWER and consists
of several initiatives, including monitoring tobacco
use and prevention policies; protecting people from
tobacco smoke; offering help to quit tobacco use;
warning about the dangers of tobacco; enforcing
bans on tobacco advertising, promotion and spon-
sorship; and raising taxes on tobacco [15]. In 2004,
Denmark became a part of the framework conven-
tion [16]. Research has found that price increases
on cigarettes is one of the most effective ways to
prevent and stop young people from smoking [17].
This may be explained by youths having lower dis-
posable incomes compared with adults, and thus
they are expected to be more affected by changes in
prices of cigarettes. Economic theory states that the
greater the share of one’s disposable income is used
on one good, the more responsive one will be to
price changes on that good [18]. In this connection,
existing research indicates that youths’ demand for
cigarettes is more price elastic compared with adults
[17–19].
In 2019, the Danish government presented a
national action plan against smoking among chil-
dren and youth. The plan consists of many actions,
one of which is increased taxes on all tobacco and
nicotine-containing products, starting with ciga-
rettes. In the Finance Act of 2020, the government,
along with other political parties, decided to increase
the average prices of a pack of cigarettes from EUR
5.50 to 8.05. The increased price comes from a per
unit tax and an ad valorem tax (i.e. the ad valorem
tax is 1%. The per unit tax for cigarettes has increased
from EUR 0.18 to EUR 0.23 by 1 April 2020 and
will increase to EUR 0.26 from 1 January 2022)
[20]. They agreed to increase the prices over two
rounds, such that a pack of cigarettes increases to
EUR 7.38 from 1 April 2020 and further to EUR
8.05 from 1 January 2022. Prices on cigars, cigaril-
los, snus and other smokeless tobacco products will
increase by approximately EUR 1.88 from 1 April
2020 and a further EUR 0.67 from 1 January 2022.
The liquids for e-cigarettes will increase by EUR
0.26 per 10 ml from 1 July 2022 [21]. In addition,
the new regulations of the action plan consist of neu-
tral packages and a stricter advertising ban; stricter
requirements for nicotine products; banning all
smoking in or around schools during school time;
increased control of the age limit; and restrictions on
taste in tobacco products.
Although several studies confirm that youths in
particular are sensitive to increases in price on
tobacco products, there is limited up-to-date and sys-
tematically reviewed knowledge about to what extent
youths in high-income countries are affected by price
increases on cigarettes, hence the price elasticity of
demand for cigarettes. Current systematic reviews on
price elasticity of tobacco among youths either
include studies of older date [22], primarily include
data from low and middle-income countries [23], or
concern other tobacco products than conventional
cigarettes [23]. As the tobacco market continues to
change and expand, knowledge about youths’ respon-
siveness to structural regulations on smoking; for
example, tax increases on cigarettes, is essential for
future preventive strategies, informed decision-mak-
ing and political actions against smoking. Moreover,
although several novel tobacco and nicotine-contain-
ing products have been introduced to the tobacco
market within the past decade, cigarette smoking
continues to be popular among the general popula-
tion as well as among the youth [6]. The evidence of
the detrimental health hazards associated with ciga-
rette smoking is solid [10, 11]. Moreover, most
research suggests that the use of diverse tobacco
products is highly interrelated; for example, users of
other tobacco products such as e-cigarettes and
smokeless tobacco are at higher risk of switching to
conventional cigarette smoking, dual use and contin-
ued use in adulthood [24-26]. Therefore, investigat-
ing youths’ responsiveness to price changes on
cigarettes is critical in a public health perspective. In
particular, updated and country-specific knowledge
is essential for future prevention efforts. Hence, in
the current study, we wished to examine the current
evidence on price elasticity of the demand for ciga-
rettes among youth in countries similar to Denmark
and Scandinavian countries; that is, high-income
countries, with the aim of informing current and
future strategies in relation to smoking prevention
among youths.
More specifically, the present study sought sys-
tematically to review current research examining the
price elasticity of the demand for cigarettes among
youths (<30 years of age) in high-income countries.
Further, the aim of mapping the current literature is
to evaluate and reveal the potential need for updated
and locally embedded knowledge on price elasticity
of tobacco among youths.
 Price elasticity of demand for cigarettes among youths   37
Methods
Eligibility criteria
The literature searches have been carried out based
on predefined inclusion and exclusion criteria. These
criteria have been applied at different stages of the
work process of the literature review. While some of
the criteria have been used in the search, others have
been used in the screening process. First, we describe
the inclusion and exclusion criteria that have been
used in the search process and, next, the specific cri-
teria that have been used in the screening process are
presented.
Inclusion criteria in the search process
• Year of publication: Studies published within the
past 10 years (01/01/2011 to 06/01/2021)
• Language: English.
Exclusion criteria
• Types of studies: Experimental lab studies and
opinion papers.
• Product: Other tobacco and nicotine-containing
products than conventional cigarettes; that is,
e-cigarettes, waterpipe, smokeless tobacco, etc.
Inclusion criteria in the screening process
• Purpose: Studies aimed at investigating the price
elasticity of the demand for cigarettes for people
below 30 years of age.
• Type of studies: Peer-reviewed journal articles
presenting original findings; for example, with a
cross-sectional study design, prospective cohort
studies, and randomised controlled trials (RCTs).
• Study population: Studies in which the main
emphasis of the study population is humans and
below 30 years of age.
• Cultural context: Studies including a study popu-
lation from high-income countries, defined as
countries with a gross national income (GNI)
higher than US$12,535.
• Product: Studies that examine the price elasticity
of cigarettes.
Data source and search strategy
We used the PICo model to define the search strat-
egy, and thus the search strategy was divided into
three search blocks as proposed by the model: P
(patient/problem/population), I (phenomenon of
interest), and Co (context). The population (P) was
youths below 30 years of age; the field of interest (I)
was price elasticity and the context (Co) was ciga-
rettes. A systematic literature search was conducted
using three scientific databases: Web of Science,
Pubmed and Scopus. Keywords (subject headings/
MeSH terms) and free text searches (title, keywords,
text) were used in the literature searches, and in the
three search blocks relevant synonyms were included
for the overall search terms. For the search term
youth, synonyms were, for example, adolescents and
young adults; for the price elasticity of demand, syn-
onyms were, for example, tax elasticity and price sen-
sitivity; and for cigarettes, synonyms were, for
example, smoking and tobacco.
Study selection; screening, quality assessment
and data extraction
The identified titles and abstracts from the systematic
literature searches were screened for eligibility by two
independent reviewers (MA and SGK) and next, eli-
gible full-text articles were read and assessed by the
same two reviewers independently. Conflicts about
the assessment of articles were resolved by a discus-
sion after each screening process was completed. The
two reviewers (MA and SGK) independently assessed
the methodological quality of the included studies
using the assessment tool the quality assessment tool
for quantitative studies (Effective Public Health
Practice Project, 1998) based on five components:
risk of selection bias, study design, confounders, data
collection methods, and drop out [27]. These compo-
nents were assessed for all included studies and
resulted in either a weak, moderate, or strong rating
for each study. Studies with two or more weak com-
ponents received an overall assessment of weak, while
studies with one weak component were rated overall
as moderate, and studies with no weak components
received a strong rating on the quality assessment.
Data were extracted from the included studies using a
standardised data extraction form that included infor-
mation about the origin of study, age, gender, popula-
tion size, study design and price elasticity outcomes
as well as the reported findings.
Results
Characteristics of included studies
Out of the 98 studies screened on abstract and title
level, 71 studies were assessed to be irrelevant based
on the exclusion criteria; for example, nine studies
were excluded based on the country’s GNI; thus,
these studies investigated price elasticity of the
demand for cigarettes but comprised data exclu-
sively from low or middle-income countries. Other
reasons for exclusion were study design, study
38    S.G. Kjeld et al.
population, topic and outcomes studied. In total, 27
full-text studies were assessed for eligibility, of which
six studies were considered relevant for the aims of
this systematic review [28-33] (Figure 1). In the
quality assessment, the studies were assessed based
on five components: risk of selection bias, study
design, confounders, data collection methods and
drop out. One study received an overall weak rating
due to weak ratings on two components: study
design and confounders [28]; four studies received a
moderate rating due to one weak rating on the study
design component [29–31, 33]; and one study
received a strong rating on the quality assessment
with no weak ratings on either of the five compo-
nents [32]. Two of the included studies were con-
ducted in Canada [28, 29], one was conducted in
the US [32], one in Chile [30] and two studies com-
bined data across several low, middle and high-
income countries [31, 33]. Most of the included
studies had a cross-sectional study design with
repeated measurements over time, while one utilised
a combination of longitudinal and cross-sectional
data [32].
The price elasticity of demand for cigarettes
among youth and young people
Table I summarises characteristics of the six included
studies along with reported findings concerning the
price elasticity of cigarettes among youths.
The price elasticity of cigarette initiation
Four studies examined the price elasticity of cigarette
initiation [29–32]. One study investigated the price
elasticity of cigarette initiation among Canadian
youths in grades 7–12 (approximately 13–18 year-
olds) in the schoolyear 2012/2013 [29]. They found
the overall price elasticity of cigarette initiation to be
−1.13, implying that if prices of cigarettes increased
by 1%, the proportion of young people expected to
initiate smoking decreased by 1.13%. Further, they
found the youngest subgroup (grades 7–9) to be
more price sensitive compared with older youths
(grades 10–12). The study by Kostova (2013) used
data from 48 countries across the world and exam-
ined the price elasticity of initiation among 8–15
year-olds from 1999 to 2006 [31]. Overall, they
found the price elasticity of initiation to be relatively
inelastic (−0.89), and when examining the price elas-
ticity separately for gender, male individuals were
more insensitive to increased prices (−0.49) com-
pared with female individuals (−1.55). The study by
Lillard et al. (2013) utilised three datasets in the US
to examine the price elasticity of initiation among
youths between 13 and 27 years [32] in the years
from 1986 to 2007. They examined the price elastic-
ity of initiation for the overall population and strati-
fied by two age subgroups: 13–17 and 13–22. Price
elasticities were estimated for each of the three data-
sets. The price elasticities across these three datasets
differed somewhat, with an overall price elasticity
ranging from −0.11 to −0.97. A consistent trend
across all three datasets was found; participants were
more inelastic to price changes with increasing age.
Finally, one study examined the price elasticity
among Chilean youths between 16 and 19 years of
age from 2001 to 2015 [30]. They found an overall
price elasticity of −0.40; hence, this group of youths
is relatively price inelastic concerning the initiation of
cigarette smoking. Further, they found that young
women were somewhat more price inelastic com-
pared with young men (−0.30 vs. −0.50).
The price elasticity of cigarette consumption
Three studies examined the price elasticity of ciga-
rette consumption [28, 29, 33]. One of these exam-
ined the price elasticity of cigarette consumption
among young Canadians between 15 and 19 years
from 1999 to 2005 [28]. This study found the overall
price elasticity (−0.50) to be insignificant. Further,
price elasticities were also insignificant across gender
and, therefore, they did not report estimates stratified
by gender. The study by Cui et al. (2019) examined
the price elasticity of cigarette consumption among
youth in the grades from 7 to 12 (approximately 13–
18 year-olds) in the schoolyear 2012/2013 in Canada
[29]. They found an overall price elasticity of −1.02;
hence, if cigarette prices increased by 1%, the con-
sumption of cigarettes was expected to fall by 1.02%.
Further, they examined the price elasticity in two
subgroups based on school grades. Here, they found
students in younger grades to be more price elastic
compared with older students (−1.93 vs. −0.76).
Finally, the study by Nikaj and Chaloupka (2014)
used data from 38 counties in the time period from
1999 to 2008 to examine the price elasticity of ciga-
rette consumption [33]. Youths between 11 and 19
years were investigated. Overall, the price elasticity of
cigarette consumption was −0.94. Further, female
individuals were found to be relatively more price
inelastic (−0.81) compared with male individuals
(−1.27). Hence, if the price of cigarettes increased by
1%, the cigarette consumption among female indi-
viduals was expected to fall by 0.81% and 1.27%
among male individuals.
The price elasticity of cigarette prevalence
Two studies examined the price elasticity of cigarette
prevalence [28, 33]. One study investigated the price
Table I.  Summary of included studies and their reported findings on the price elasticity of the demand for cigarettes among youths.

Author Country Population (size, Method Data sources Time Outcome: Smoking Outcome: Smoking Outcome: Outcome: Quality
age, gender) period consumption initiation Smoking Smoking assessment
cessation prevalence

Ahmed Canada 29,514, 15–18 Probit, The Canadian Tobacco 1999– Overall: −0.50 (n.s.) Overall: −0.30 Weak
et al. [28] years, 52% boys 2-part Use Monitoring Survey 2005 Female: n.s. Female: −0.48
model (CTUMS), evaluation of Male: n.s. Male: n.s.
retailer behaviour towards
certain youth access to
tobacco restrictions, and
Statistics Canada’s Cansim
database
Cui et al. Canada 41,057, grade 7–12 Probit, The 2012/2013 Canadian 2012/ All: −1.02 grades All: −1.13 grades 7–9: Moderate
[29] (13–18 years), 55% linear Youth Smoking Survey 2013 7–9: −1.93 −1.57 grades 10–12:
boys regression grades 10–12: −0.76 −0.82
model
Guindon, Chile 181,624, 16–19 Discrete Chilean School Population 2001– All: −0.40 Female: Moderate
et al. [30] years, 50% boys time hazard Survey 2015 −0.50
model
Kostova 48 467,304, 8–14 Duration Global Youth Tobacco 1999– All: −0.868 Female: All: 0.40 Moderate
[31] countries years, 49% boys model Survey 2006 −1.550 Male: −0.492 Female:
0.40 Male:
0.41
Lillard et al. US NLSY97 (PSID) Discrete The National Longitudinal 1986– NLSY97, (PSID), Strong
[32] [TUS-CPS]: time hazard Survey of Youth 1997 2007 [TUS-CPS]: 13–17
5779 (14,989) model (NLSY97), the Panel year-olds: −2.68
[500,548], 13–27 Study of Income Dynamics (−0.70) [−0.28]
years, 50% (46%) (PSID), and the Tobacco 13–22 year-olds: −0.97
[48%] boys Use Supplements to the (−0.66) [−0.17]
Current Population Survey 13–27 year-olds: −0.97
(TUS-CPS) (−0.58) [−0.11]
Nikaj and 38 593,588, 11–19 2-part Global Youth Tobacco 1999– All: −0.94 Girls: All: −0.56 Moderate
Chaloupka countries years, 54% boys model with Survey 2008 −0.81 Boys: −1.27 Female: −0.13
[33] two-way Male: −0.69
fixed effects
Price elasticity of demand for cigarettes among youths   39
40    S.G. Kjeld et al.
Figure 1.  Flowchart of the screening process.
elasticity of cigarette prevalence among youths between
15 and 19 years from 1999 to 2005 in Canada [28].
They found an overall price elasticity of −0.30. Hence,
if cigarette prices increased by 1%, the proportion of
youths that smokes was expected to decrease by 0.30%.
Further, they found the price elasticity for female indi-
viduals to be −0.48 while the association was insignifi-
cant for male individuals and, thus, the study did not
report an estimate for this group. The second study
utilised data from 38 counties among youths (11–19
year-olds) in the time period from 1999 to 2008 [33].
They found an overall price elasticity of −0.56. Further,
they found female individuals were less sensitive to
price increases compared with male indivisuals (−0.13
vs. −0.69). Thus, if the price of cigarettes increased by
1%, the proportion of young men who smoke would
decrease by 0.69%, while the proportion of young
women who smoke would decrease by 0.13%.
The price elasticity of cigarette cessation
Only one study examined the price elasticity of ciga-
rette cessation [31]. This study used data from 48
countries across the world among 8–15 year-olds in
the time period from 1999 to 2006 to examine the
price elasticity of cigarette cessation. They found an
overall price elasticity of 0.40, which implies that if
the price of cigarettes increased by 1%, the propor-
tion of youths expected to quit smoking increased by
0.40%. Further, they studied price elasticities strati-
fied by gender and found male and female individu-
als to be similarly affected by price increases in
relation to cigarette cessation (0.41 vs. 0.40).
Discussion
This systematic review reports on findings from six
studies assessing the price elasticity of the demand for
cigarettes among youths in high-income countries. The
number of included studies indicates the limited knowl-
edge about price elasticity among youths in high-
income countries; hence, only six studies were eligible
for inclusion. Four outcomes were examined in the
included studies; that is, cigarette consumption, initia-
tion, cessation and prevalence. As expected, most of the
included studies showed that increasing tobacco prices
 Price elasticity of demand for cigarettes among youths   41
was associated with youth tobacco use. More specifi-
cally, cigarette consumption was expected to decrease
between 0.94% and 1.02% when prices increased by
1%, cigarette initiation between 0.11% and 1.13%, and
cigarette prevalence between 0.30% and 0.56%. One
study examined cigarette cessation and found cigarette
cessation was expected to increase by 0.40% when
prices increased by 1%. Thus, youths who are exposed
to increases in cigarette prices are expected to smoke
less, be less susceptible to start smoking and more sus-
ceptible to quit smoking. Moreover, fewer youths are
expected to smoke overall (lower cigarette prevalence).
Findings also indicate that youth cigarette consumption
is relatively more affected by price increases compared
with the other outcomes investigated (i.e. cigarette
prevalence, initiation and cessation).
The size of effect seemed to vary with age and
gender. Hence, four studies examined the effect of
price increases in subgroups based on gender
[28, 30, 31, 33]. Findings indicated that female indi-
viduals are more price sensitive compared with male
individuals concerning initiation of cigarette smok-
ing. On the other hand, male individuals seemed to
be more price sensitive in relation to consumption of
cigarettes and prevalence of smoking. These results
are in line with findings from a previous meta-analy-
sis indicating that women are less sensitive to the
price changes of cigarettes [34]. However, other
research from the US found overall no gender differ-
ences concerning the responsiveness to changes in
cigarette prices [35]. We identified two studies that
examined price elasticity of the demand for ciga-
rettes stratified by age groups, and found youths of
younger age to be more price sensitive compared
with older youths in relation to cigarette consump-
tion and initiation [29, 32]. The present findings are
in line with previous research [34, 35] and with eco-
nomic theory stating that younger individuals are
more affected by price changes due to a relatively
lower disposable income [18]. The two outcomes of
cigarette cessation and prevalence were not studied
according to age groups.
Methodological considerations
Overall, we found estimates of price elasticities to vary
between and within the included studies. For example,
for cigarette initiation, estimates ranged from −0.11 to
−1.13. This may be due to differences in the data and
collection methods used but also because of country-
specific differences in the youth population investi-
gated in the included studies. For example, one
included study found that the price elasticity of ciga-
rette consumption was insignificant overall and when
stratified by gender [28]. Worth noting is that that
study was rated weak in the quality assessment due to
two factors: study design and confounders, which may
to some degree explain the diverse findings in the
study compared with other studies examining the
same outcome [29, 33]. Five out of six included stud-
ies used primarily cross-sectional data [28–31, 33],
which may be considered a weakness of the studies;
however, most of these used repeated measurements
over time which can be considered as an important
strength of the included studies.
Few of the included studies had investigated older
youths’ responsiveness to price changes on cigarettes.
Hence, only one study investigated youths up to 27
years of age, and in that study the group consisting of
13–27 year-olds was relatively more price inelastic
compared with the other groups of youths investigated
(13–17 year-olds and 13–22 year-olds, respectively)
[32]. Hence, future research may focus on examining
youth price elasticity based on and stratified by both
younger and older youths (<30 years of age).
Most of the included studies are based on relatively
old data; four out of six studies used data before 2010
and the remaining two studies used data from
2012/2013 and from 2001 to 2015, respectively
[29, 30]. Moreover, the study utilising the newest data
(until 2015) was conducted among Chilean youths
[30]. Although Chile is considered a high-income coun-
try based on its GNI, this country may not be compa-
rable with Scandinavian countries such as Denmark on
several parameters; for example, national tobacco legis-
lation, youth tobacco behaviours, etc. Therefore, newer
and more country-specific measures are essential for
understanding youths’ responsiveness to price changes
on cigarettes.
Although the aim of this review was to examine the
price elasticity of the demand for cigarettes among
youths in high-income countries, two studies included
data from both developing and developed countries
and based their calculation of price elasticities on: (a) all
countries; and (b) developing countries only [31, 33].
Thus, the results of these studies may not be generalis-
able to other high-income countries due to the inclu-
sion of developing countries in their overall estimate of
price elasticity. Nonetheless, the estimates of price elas-
ticity did not seem to differ markedly between develop-
ing countries and all countries in the estimated models.
Moreover, it seems that the estimates of price elasticity
derived from the included studies are overall in the
same direction – although with somewhat varying esti-
mates in between studies.
Implications
The results of this review revealed several implications
for future research as well as for policy and practice.
42    S.G. Kjeld et al.
Overall, the findings suggest a need for further exami-
nations of up-to-date and locally embedded measures
that can be used in a Scandinavian context. Although
the aim of the present study was to review the current
evidence on price elasticity of the demand for ciga-
rettes among youths in countries similar to Denmark
and other Scandinavian countries; that is, high-income
countries, no studies were identified within this con-
text. These will provide local policymakers with the
required knowledge for taking further actions in
tobacco control. Further, future studies may examine
price sensitivity in various subgroups based on, for
example, age, gender, or socioeconomic factors such
as education and income in order to reveal tendencies
that may require further political actions.
Conclusions
This review found varying estimates for price elastic-
ity of the demand for cigarettes among youths in
high-income countries. Nonetheless, the included
studies indicate that prices on cigarettes significantly
impact youth tobacco use, including cigarette initia-
tion, cessation, consumption and prevalence.
Further, it was evident that sensitivity to prices was
associated with gender and age, and especially for
age, a consistent gradient was found with youths of
younger age being more sensitive to price changes on
cigarettes. Most included studies were of older date,
and data sources, collection methods used and coun-
try of origin differed. There seems to be a need for
further examinations of up-to-date and locally
embedded measures to make reliable predictions of
the expected effects of increased tobacco prices fol-
lowing the tobacco regulations in Denmark.
Declaration of conflicting interests
The author(s) declared no potential conflicts of
interest with respect to the research, authorship, and/
or publication of this article.
Funding
The author(s) received no financial support for the
research, authorship, and/or publication of this
article.
ORCID iD
Simone Gad Kjeld https://orcid.org/0000-0001-
6883-8764
References
[1] World Health Organization. Tobacco. 2020. https://www.
who.int/health-topics/tobacco#tab=tab_1 (accessed 12 Sep-
tember 2021).
[2] Eriksen L, Davidsen M, Jensen H, et  al. Sygdomsbyrden i
Danmark – Risikofaktorer [Burden of sickness in Denmark
– risk factors]. National Institute of Public Health, 2016.
Copenhagen, Denmark.
[3] Doll R, Peto R, Boreham J, et al. Mortality from cancer in
relation to smoking: 50 years observations on British doc-
tors. Br J Cancer 2005;92:426–429.
[4] Banks E, Joshy G, Weber MF, et  al. Tobacco smoking and
all-cause mortality in a large Australian cohort study: find-
ings from a mature epidemic with current low smoking prev-
alence. BMC Med 2015;13:38.
[5] Jensen HAR, Udesen CH and Ekholm O. Den Europæiske
Rusmiddelundersøgelse (ESPAD) 2019 [The European School
Survey Project on Alcohol and Other Drugs (ESPAD) 2019].
Danish Health Authority, 2020. Copenhagen, Denmark.
[6] Hoffmann SH, Schramm S, Jarlstrup NS, et al. Danskernes
rygevaner: Udvikling fra 1994 til 2017. [Smoking habits among
Danish citizens. The development from 1994 to 2017]. National
Institute of Public Health, 2018. Copenhagen, Denmark.
[7] Brink A-L and Stage M. Røgfri Fremtids Ungeundersøgelse 2017–
2020 [The youth study of Smokefree Future 2017–2020]. Danish
Cancer Society and the TrygFoundation, 2021. Copenhagen,
Denmark.
[8] Danish Health Authority. Danskernes rygevaner 2020. Del-
rapport 1: Nikotinafhængighed [Smoking habits among Dan-
ish citizens 2020. Sub-report 1: Nicotine dependence]. Danish
Health Authority, 2021. Copenhagen, Denmark.
[9] Jarlstrup NS, Andersen MB, Kjeld SG, et  al. §RØG – En
undersøgelse af tobak, adfærd og regler [§SMOKE – A study of
tobacco, behavior and regulations]. National Institute of Public
Health, 2020. Copenhagen, Denmark.
[10] Hymowitz N. Cigarette smoking and lung cancer: pediatric
roots. Lung Cancer Int 2012;790841.
[11] US Department of Health and Human Services. The health
consequences of smoking – 50 years of progress: a report of the
Surgeon General. US Department of Health and Human
Services, Centers for Disease, 2014. Atlanta, GA.
[12] Leslie FM. Unique, long-term effects of nicotine on adoles-
cent brain. Pharmacol Biochem Behav 2020;173010.
[13] Chassin L, Presson CC, Sherman SJ, et al. The natural his-
tory of cigarette smoking: predicting young-adult smoking
outcomes from adolescent smoking patterns. Health Psychol
1990;9:701.
[14] Centers for Disease Control and Prevention. Youth and
tobacco use 2020. https://www.cdc.gov/tobacco/data_sta-
tistics/fact_sheets/youth_data/tobacco_use/index.htm
(accessed 12 September 2021).
[15] World Health Organization (WHO). MPOWER: a policy
package to reverse the tobacco epidemic. Geneva: WHO, 2008.
[16] Danish Health Authority. Lovgivning [Legislation]. Danish
Health Authority; 2020. https://www.sst.dk/da/viden/tobak/
lovgivning (accessed 12 September 2021).
[17] Chaloupka FJ, Straif K and Leon ME. Effectiveness of
tax and price policies in tobacco control. Tob Control
2011;20:235–238.
[18] Grossman M and Chaloupka FJ. Cigarette taxes: the straw to
break the camel’s back. Public Health Rep 1997;112:290–297.
[19] Chaloupka FJ. Contextual factors and youth tobacco use:
policy linkages. Addiction 2003;98:147–149.
[20] SKAT. Afgiften på tobaksvarer stiger fra 1. april 2020 [The tax on
tobacco products will increase from 1 April 2020]. 2020. https://skat.
dk/skat.aspx?oid=2294846 (accessed 12 September 2021).
[21] Ministry of Finance. Finansloven for 2020 [Finance Act
of 2020]. 2019. https://fm.dk/udgivelser/2020/februar/
finansloven-for-2020/ (accessed 12 September 2021).
[22] Wilson LM, Avila Tang E, Chander G, et al. Impact of tobacco
control interventions on smoking initiation, cessation, and
prevalence: a systematic review. J Environ Public Health 2012;
2012: 961724.
 Price elasticity of demand for cigarettes among youths   43
[23] Guindon GE, Paraje GR and Chaloupka FJ. The impact of
prices and taxes on the use of tobacco products in Latin Amer-
ica and the Caribbean. Am J Public Health 2015;105:e9–e19.
[24] Jawad M, Charide R, Waziry R, et  al. The prevalence and
trends of waterpipe tobacco smoking: a systematic review.
PloS ONE 2018;13:e0192191.
[25] Chapman S, Bareham D and Maziak W. The gateway effect
of e-cigarettes: reflections on main criticisms. Nicotine Tob
Res 2019;21:695–698.
[26] Grøtvedt L, Forsén L, Ariansen I, et  al. Impact of snus
use in teenage boys on tobacco use in young adulthood; a
cohort from the HUNT Study Norway. BMC Public Health
2019;19:1–10.
[27] Armijo-Olivo S, Stiles CR, Hagen NA, et al. Assessment
of study quality for systematic reviews: a comparison of
the Cochrane Collaboration Risk of Bias Tool and the
Effective Public Health Practice Project Quality Assess-
ment Tool: methodological research. J Eval Clin Pract
2012;18:12–18.
[28] Ahmed R, Diener A and Bahri S. Retailer compliance as a
predictor of youth smoking participant and consumption.
J Sch Health 2019;89:115–123.
[29] Cui Y, Forget EL, Zhu Y, et  al. The effects of cigarette
price and the amount of pocket money on youth smok-
ing initiation and intensity in Canada. Can J Public Health
2019;110:93–102.
[30] Guindon GE, Paraje GR and Chaloupka FJ. Association of
tobacco control policies with youth smoking onset in Chile.
JAMA Pediatrics 2019;173:754.
[31] Kostova D. A (nearly) global look at the dynamics of youth
smoking initiation and cessation: the role of cigarette prices.
Appl Econ 2013;45:3943–3951.
[32] Lillard DR, Molloy E and Sfekas A. Smoking initiation
and the iron law of demand. J Health Econ 2013;32:114–
127.
[33] Nikaj S and Chaloupka FJ. The effect of prices on cigarette
use among youths in the Global Youth Tobacco Survey. Nic-
otine Tob Res. 2014;16(Suppl_1):S16–S23.
[34] Gallet CA and List JA. Cigarette demand: a meta-analysis of
elasticities. Health Econ 2003;12:821–835.
[35] International Agency for Research on Cancer (IARC). IARC
Handbooks of Cancer Prevention: tobacco control. Effectiveness of
price and tax policies for control of tobacco. IARC, 2011. Lyon,
France.