CHAPTER I

INTRODUCTION

BACKGROUND OF THE STUDY:

Increasing taxation on cigarettes is among the most effective ways to prevent and

reduce smoking. Higher taxes are associated with lower cigarette consumption and higher

rates of quit attempts, particularly among low-income and younger smokers and among

racial/ethnic minorities.

According to the global report on trends in prevalence of tobacco smoking 2015 by

the World Health Organization (WHO), tobacco is the only legal drug that kills many of its

users when used exactly as intended by manufacturers. It is killing more than 7 million

people a year. Eighty-five percent of those deaths are directly related to tobacco use while

around the remaining percentage are the result of non-smokers being exposed to second-hand

smoke. It is expected to double by the year 2020.

Through the years, various global and local policies and strategic movements were

imposed on the sale, use, advertisement, distribution and taxation with an end goal of

smoking-related morbidity and mortality reduction. In February 2005, WHO Framework

Convention on Tobacco Control (WHO FCTC) entered into force. As of May 2017, it has

180 Parties covering more than 90% of the world's population. The WHO FCTC is an

evidence-based treaty that reaffirms the right of people to the highest standard of health,

provides legal dimensions for international health cooperation and sets high standards for

compliance.

In 2008, WHO introduced a practical, cost-effective way to scale up implementation

of the main demand reduction provisions of the WHO FCTC on the ground: MPOWER.

1
Each MPOWER measure corresponds to at least 1 provision of the WHO Framework

Convention on Tobacco Control. The 6 MPOWER measures are:

 Monitor tobacco use and prevention policies

 Protect people from tobacco use

 Offer help to quit tobacco use

 Warn about the dangers of tobacco

 Enforce bans on tobacco advertising, promotion and sponsorship

 Raise taxes on tobacco

In 2013, Under a UN mandate to address four noncommunicable diseases (NCDs),

the World Health Assembly established a global voluntary tobacco target to help reduce

prevent premature avoidable mortality from NCDs. A 30% relative reduction in prevalence

of current tobacco use in persons aged 15+ years was the agreed global tobacco target.

In the Philippines, several tax reforms for sin products was enacted in lieu for both

revenue and non-revenue goals. On July 23, 2012, a law that restructures the excise tax on

alcohol and tobacco products otherwise known as Republic Act 10351 or Sin Tax Law was

legislated. The law was implemented starting January 01, 2013 to which alcohol and tobacco

products are purchased on a higher price. Section 144 and 145 of law states that tobacco,

cigar and cigarettes shall be levied, assessed and collected an excise tax in accordance with a

corresponding annual schedule. The rates of tax imposed on tobacco shall be increased by

four percent (4%) every year thereafter effective on January 1, 2014. Meanwhile, the rates of

tax imposed for cigar and cigarettes shall be increased by four percent (4%) every year

effective on January 1, 2018.

On a study conducted by Prabhat Jha, et. al., price is considered the key determinant

of smoking uptake and cessation. The study added further that worldwide, a reduction of

2
about a third could be achieved by doubling the inflation-adjusted price of cigarettes, which

in many low- and middle-income countries like the Philippines could be achieved by tripling

the specific excise tax on tobacco. In principle, the excise tax on sin products is imposed for

the purpose of (1) raising revenues and (2) discouraging the consumption of the tobacco

products and alcoholic beverages (Manasan, et al., 2013).

Gender and Socio-economic status are two major determinants of tobacco and

cigarette consumption. It is more common in males than females. Among males, low socio-

economic income is identified as a top factor associated to smoking. Smoking is observed

commonly in adults but is initiated as early as 10 years old. Thus, this study seeks to describe

the role of Sin Tax on the smoking behavior of adult males before and after the enactment of

the law.

STATEMENT OF THE PROBLEM:

The purpose of the study is to describe role of Sin Tax Law on the smoking behavior

among adult males in Sta. Rita, Western Samar before and after the enactment of the law.

HYPOTHESIS:

Null Hypothesis:

There is no role of Sin Tax Law on the smoking behavior among adult males

in Sta. Rita, Western Samar before and after the enactment of the law.

Alternative Hypothesis:

There is a role of Sin Tax Law on the smoking behavior among adult males in

Sta. Rita, Western Samar before and after the enactment of the law.

3
OBJECTIVES OF THE STUDY:

The general objectives of this study is to describe the role of Sin Tax Law on the

smoking behavior among adult males in Sta. Rita, Western Samar before and after the

enactment of the law. Specifically, the study will be undertaken to:

1. Describe the socio-demographic profile of adult male smokers as to the

following:

a. Age

b. Educational Status

c. Marital status

d. Occupation

e. Monthly Income

f. Family Size

2. Identify the prevalence and smoking history of adult males as to:

a. Initiation of smoking

b. Factors to initiation of smoking

c. Reasons for smoking

3. Describe the awareness of adult males on Sin Tax Law’s effect on cigarette

4. Describe the smoking behavior among adult males before and during the

enactment of Sin Tax Law as to the following:

- Smoking frequency

- Number of sticks consumption within the day

- Brand of choice

- Source of Purchase

5. Determine the correlation between socio-demographic profile to smoking

behavior

4
SIGNIFICANCE OF THE STUDY:

The findings from this study are intended to inform LGU Officials, health educators,

planners and other health professionals in the municipality about the role of Sin Tax Law

implementation on smoking behavior among adult males in Sta. Rita, Samar.

Policy Makers

It is aimed that the results of this study will serve as a basis in formulating policies

and programs that will further modify the smoking behavior of adult males.

Other Researchers

This will serve as a reference for further studies that are related to smoking behavior

of adult males.

SCOPE AND LIMITATIONS OF THE STUDY:

The focus of the study is to describe the role of Sin Tax on the smoking behavior of

adult males in Sta. Rita, Western Samar before and after the enactment of the law.

Data will be gathered from adult males ages 18 years old and above who is a resident

of Sta. Rita, Western Samar. Data will be taken purely from the respondents’ answer to the

survey questionnaire. The questionnaire will be made by the researchers.

The main limitation of this study is the use of retrospective, self-reported measures in

adult male population which could introduce some reporting bias related to comprehension

of questions and decision-making issues or retrieval errors (especially for long periods of

time) and perceptions of confidentiality of the information. Other national and local tobacco

regulatory measures after the legislation of Sin Tax Law are not considered in this study. For

instance, the National Public Smoking Ban was initiated 4 years after the Sin Tax Law.

5
OPERATIONAL DEFINITION:

Active Smoker- an adult male who directly consumes cigarette or tobacco products by

inhaling its vapor regardless of amount and frequency.

Adult - males ages 18 years old and above who is a resident of Sta. Rita, Western

Samar.

Cigarette - a narrow cylinder of finely cut tobacco leaves that are rolled into thin paper

for smoking. In this research, it refers to commercial cigarette to which tax is charged.

Passive Smoker- a person who indirectly consumes cigarette or tobacco products by

inhaling its vapor regardless of amount and frequency.

Sin Tax Law - refers to Republic Act No. 10351 which is an act restructuring the excise

tax on alcohol and tobacco products. This was effective last January 1, 2013.

Smoking Behavior - refers to the consumption pattern of adult males as to their

smoking frequency per day, number of sticks consumed within the day and their

preferred brand of choice.

Sociodemographic Factors - refers to the age, educational status, marital status,

occupation, monthly income, family size, peer and family influences among adult males.

Tax - a mandatory financial charge or some other type of levy imposed upon a taxpayer

(an individual or other legal entity) by a governmental organization in order to fund

various public expenditures.

Tobacco - twisted by hand or reduced into a condition to be consumed in any manner

other than the ordinary mode of drying and curing.

6
 CHAPTER II

REVIEW OF RELATED LITERATURE:

This chapter present reviews of different literature from which empirical evidences

significant to this research are drawn. The reviews are presented to fully understand and

strengthen the foundation and the result of this study.

The International Agency for Research on Cancer studied the effectiveness of tax and

price policies in tobacco control in 2010 by assessing the evidence on the following topics

tax, price and aggregate demand for tobacco; tax, price and adult tobacco use, use among

young people and use among the poor; tax avoidance and tax evasion; and the economic and

health impact of tobacco taxation. The findings revealed that there was sufficient evidence of

effectiveness of increased tobacco excise taxes and prices in reducing overall tobacco

consumption and prevalence of tobacco use and improvement of public health, including by

preventing initiation and uptake among young people, promoting cessation among current

users and lowering consumption among those who continue to use.

In 2012, Coady, M. H., et. al., conducted a cross-sectional study on “The Impact of

Cigarette Excise Tax Increases on Purchasing Behaviors Among New York City Smokers”

using a multivariable logistic regression analysis. The findings confirm earlier research

suggesting that raising taxes on cigarettes produces increases in tax-avoidant behaviors. In

response to the 2008 tax increase among adults, more than half (61%) of smokers seriously

thought about quitting, 46% smoked fewer cigarettes, and 13% switched to a cheaper brand.

Smokers also engaged in tax-avoidant purchasing behaviors. About one fifth (21%) reported

buying more cigarettes from a person on the street, one fifth (21%) bought more cigarettes

7
outside New York State, on the Internet, through the mail, at a duty-free shop, or on an

Indian reservation, and 15% bought more loosies.

A meta-analysis conducted by Bader P. et. al. assessed the Effects of Tobacco

Taxation and Pricing on Smoking Behavior in High Risk Populations. It revealed that raising

cigarette prices is an effective tobacco control policy in reducing smoking among youth.

While most studies of young adults found that increased prices also result in reductions in

smoking behavior, the magnitude tends to be smaller than for youth. Chaloupka and Pacula

argue that because tobacco is an addictive substance, response to increased prices will occur

more slowly than for nonaddictive goods; therefore, long-term gains may be larger than

short-term gains. The impact of increased price on smoking initiation among youth and

young adults is less clear. Also, differential responses to price by youth and young adults

were associated with other determinants, including age (younger vs. older teens), gender,

income, school status, and peer and family influences. The majority of studies found that

persons of low socioeconomic status are more responsive to price than the general

population. This indicates that increased price has the potential to benefit disadvantaged

groups and thereby contribute to reducing health inequalities. The issue of whether or not

cigarette taxes are a regressive tax on the poor remains contentious. However, many studies

strongly agree on the importance of addressing poverty and social disparities for those who

continue to smoke. In other words, increased price needs to be accompanied by strategies to

mitigate adverse consequences of such taxes to low socioeconomic status populations. The

evidence from this knowledge synthesis strongly supports increasing cigarette prices through

tobacco taxation as a powerful strategy for achieving major reductions in smoking behavior

among youth, young adults and persons of low socioeconomic status.

Kengganpanich, M. et. al. assessed the impact of excise tax increase on

smoking behavior of daily smokers aged 15 years and over and to explore the association

8
between smokers' characteristics and smoking behavior prior and after excise tax increase.

The findings revealed that after the cigarette tax increase, 9.7% of daily smokers quitted

smoking and 48.0% reduced the amount of cigarettes and/or changed the brands and types of

tobacco, from manufactured cigarettes to hand-rolled cigarettes. After other covariance being

adjusted, the analysis revealed that the amount of cigarettes per day, the types of cigarettes

(manufactured and hand-rolled cigarettes), and the smokers' reaction towards the increased

price after the excise tax increase were respectively associated with the fact that the smokers

quitted smoking or reduced the amount of cigarettes (p < 0.05).

The National Cancer Institute (NCI) and World Health Organization (WHO)

concluded in their 2017 report, The Economics of Tobacco and Tobacco Control, “A

substantial body of research, which has accumulated over many decades and from many

countries, shows that significantly increasing the excise tax and price of tobacco products is

the single most consistently effective tool for reducing tobacco use. Significant increases in

tobacco taxes and prices reduce tobacco use by leading some current users to quit,

preventing potential users from initiating use, and reducing consumption among current

users.

The study of Azagba and Sharaf (2011) focused on the impact of cigarette taxes on

smoking participation using random effect Probit model. They used data from the Canadian

National Population Health Survey and the recent tax variation across Canadian provinces.

Their result shows that tax increases led to modest reduction in smoking participation, but

this result is not generalized the outcome for all groups. As a result segregated from different

groups, it shows that the participation tax elasticity is numerically larger and significant for

males and middle age group. The low income group is more responsive to taxes unlike with

the participation of high income group is not statistically significant. They concluded that

9
different sociodemographic characteristics of smokers respond differently to tax increase

designing appropriate measures will reduce smoking.

In November 2012, the Community Preventive Services Task Force, under the U.S.

Department of Health and Human Services, completed a thorough review of recent evidence

on the effectiveness of tobacco product price increases, including increasing tobacco taxes.

Based on that work, the Task Force “recommends interventions that increase the unit price of

tobacco products based on strong evidence of effectiveness in reducing tobacco use.

Evidence is considered strong based on findings from studies demonstrating that increasing

the price of tobacco products: Reduces the total amount of tobacco consumed; Reduces the

prevalence of tobacco use; Increases the number of tobacco users who quit; Reduces

initiation of tobacco use among young people; Reduces tobacco-related morbidity and

mortality.

Punzalan et.al, (2013) determined the prevalence of smoking according to (i) gender, (ii)

age, (iii) rural or urban residence, and (iv) educational attainment. Their study survey utilized

stratified multi-stage sampling design to represent each of the 17 regions in the country.

Their result shows that among were current smokers in the rural areas (33.1%) than urban

areas (28.9%) and there were more current and 9 former smokers respondents where

educational attainment was at the elementary any level (35.1% and 16.4%. respectively.

While there were more never smokers whose educational attainment was at least the tertiary

level (62.7%). Therefore, they concluded that the Tobacco use in the Philippines is still

prevalent at 31% and predominantly composed of male in the 20-29 age group. Current

smoking is highest among rural dwellers and among individuals w/ elementary, while

majority of Women College level respondents are never smokers.

In 2015, Maneja, K. et. al., described the effectiveness of Sin Tax and Anti-smoking

media campaign in regulating cigarette smokers in Davao City using descriptive and Logit

10
Regression analysis. Result revealed that current cigarette smokers are mostly male, age

group of 10-24, employed, single, smaller family size, urban and smokers having 8 to 11

years in school. The result from Logit Regression Analysis revealed that occupational status,

location and number of years in schooling are significant and having positive effects on their

cigarette consumption in response to Sin Tax. While gender, age, marital status, family size,

change in income, price of cigarette and price of rice are insignificant variables.

CONCEPTUAL FRAMEWORK:

The role of Sin Tax Law (independent variable) on the smoking behavior (dependent

variable) of adult males in terms of smoking frequency, number of cigarette consumption per

day and their decision to continue smoking depends on their socio-demographic

characteristics.

SIN TAX LAW

RA 10351

Socio-demographic
Factors:

-Age
-Educational Status
-Marital Status
-Occupation
-Monthly Income
-Family Size
-Peer and Family
Influences

Smoking
Behavior
11
 CHAPTER III

METHODOLOGY

This chapter discusses the method of research, setting of the study, research

respondents, instrumentation and the administration of the research tool.

RESEARCH DESIGN:

The study will utilize the descriptive and correlation research design using face-to-

face interviews with a structured questionnaire to describe the role of Sin Tax on the

smoking behavior of adult males in Sta. Rita, Western Samar before and after the enactment

of the law.

SETTING OF THE STUDY:

The study will be conducted in Sta. Rita, a fourth class municipality in the

Province of Samar, Philippines. In 2017, it has a total population of 41, 803 and is politically

subdivided into 38 barangays. All barangays are accessible by any means of transportation

like buses, jeepneys, motorcycles, tricycles and boats. The barangays are also accessible by

all means of communication through cellphones, internet, televisions and radios. The major

dialect used in this area is Waray-waray. The distance of the downtown to Eastern Visayas

Regional Medical Center (EVRMC), which is the nearest hospital is 49 km. Samar

Provincial Hospital on the other hand is 60 km away. The Rural Health Center is located

within the center of the municipality. It has 6 Barangay Health Station (BHS). The health

12
manpower includes 1 Municipal Health Officer (MHO), 2 Public Health Nurse, 6 Rural

Health Midwife, 1 Rural Sanitary Inspector, 1 dentist, and 1 medical technologist.

STUDY POPULATION:

Inclusion Criteria:

The target of this study are adult males aging 18 years old and above who who will

meet the following criteria:

 Resident of Sta. Rita Samar

 An active smoker of commercial cigarettes for at least one year before the

effectivity of the Sin Tax Law (2013)

 Willing to participate in the study.

Exclusion Criteria:

 Smoking initiated after the effectivity of Sin Tax Law

 Passive smoker

 Not willing to participate in the study

SAMPLING DESIGN:

The two stage random sampling design procedure will be used in this study. In the

first stage, the study will use the simple random sampling to select 50% of Non-GIDA

barangays. Fourteen (14) will be selected out of 28 barangays.

In the second stage, the researcher will do listing of adult 18 males who are smokers

at least a year before the effectivity of the Sin Tax Law among the randomly selected

barangays. For each barangay, adult males will be selected by random sampling.

13
INSTRUMENTATION:

The tool to be used will be made by the researchers. It will be composed of 4 parts.

The first part will examine the sociodemographic data of the respondents. The second part

will assess their smoking history. Third part will assess the awareness of the respondents

about Sin Tax Law. Part Four will inspect the consumption pattern of the respondents before

and after the implementation of Sin Tax Law in 2013.

DATA COLLECTION PROCEDURE

After a thorough review, the researcher-made instrument will be used to collect data.

The data will be collected by the researchers by interviewing the respondents using the

structured questionnaire. Community health workers will be trained to assist in the

interviews and to facilitate the flow of information.

The interview will be conducted in Waray-waray dialect. This will be collected at one

point in time and would take about 1 month to complete the survey.

DATA ANALYSIS:

The statistical procedure will be divided into two parts. The first part will be

descriptive analysis by showing the socio-demographic profile of smokers, perception and

attitude, awareness of Sin Tax Law and its effects. This will be presented in frequency,

proportion, means, standard deviations, and medians. The second part will provide the

empirical procedure in examining the responsiveness in terms of consumption before and

during the implementation of Sin Tax Law.

14
REFERENCES:

1. http://www.nejm.org/doi/pdf/10.1056/NEJMra1308383

2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755211/

3. http://www.who.int/mediacentre/factsheets/fs339/en/

4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4755211/

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3228562/

6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3698745/

15
 7. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093412

8. https://www.ncbi.nlm.nih.gov/pubmed/20232561

9. https://www.tobaccofreekids.org/assets/factsheets/0146.pdf

10. http://www.who.int/bulletin/volumes/94/4/15-164707/en/

11. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0093412

12. https://etd.auburn.edu/bitstream/handle/10415/663/

DUPONT_DE_25.pdf;sequence=1

13. http://phrc.lshtm.ac.uk/papers/PHRC_A2-06_Final_Report.pdf

14. http://www.hse.ie/eng/health/hl/change/QUIT/demandforcigarettes2011

15. https://www.ncbi.nlm.nih.gov/pubmed/21115556

16. https://www.investopedia.com/terms/l/law-of-supply-demand.asp

17. https://www.ukessays.com/essays/economics/the-relationship-between-supply-and-

demand-economics-essay.php

ROLE OF SOCIODEMOGRAPHIC FACTORS ON SMOKING BEHAVIOR

AMONG ADULT MALES IN STA. RITA, SAMAR BEFORE AND DURING

SINTAX LAW

SINTAX LAW AS A FACTOR TO THE SMOKING BEHAVIOR AMONG ADULT

MALES IN STA. RITA, SAMAR

16
SINTAX LAW: ITS ROLE ON THE SMOKING BEHAVIOR OF ADULT MALES

IN STA. RITA, SAMAR

SMOKING BEHAVIOR OF ADULT MALES IN STA. RITA, SAMAR BEFORE AND

AFTER SIN TAX LAW

A Post-Baccalaureate Research Proposal

Presented to the Faculty of Medicine
University of the Philippines-Manila School of Health Sciences

In Partial Fulfillment of the Requirements for the

Degree of Doctor of Medicine

Hanny Mae A. Boacon

Dexter A. Lendio
Manuel James S. Libres

17
 Researchers

N= Z (p(1-p))

d2

where:

n= the sample size

Z= z-statistics for the desired level of confidence

p= the estimate of expected proportion with the variable of interest in

the population

d= half with of the desired interval

In the barangay level, a sample of individuals per barangay will be obtained using the

following formula:

ni =n (Ni /N)

where:

n = desired sample size for the municipality

N = sum of the population (total adult males smoker) in the

municipality

Ni = individual population (total adult males smoker) of barangay

ni = number of individuals will be used as sample from barangay

18
Appendix

SURVEY FORM

APPENDIX E

SURVEY FORM

19
Title of the Study:

SMOKING BEHAVIOR……..

Proponents: Boacon, Hanny Mae A.; Lendio, Dexter A.; Libres, Manuel James S.

Medical Students of UPM School of Health Sciences

The purpose of this survey is to describe the role of Sin Tax on the smoking
behavior of adult males in Sta. Rita, Western Samar before and after the enactment of the
law. To achieve this objective, your assistance in this study is humbly requested by
answering the questionnaire. Your participation is voluntary and the information that you
will give will be held confidential and will not be part of your permanent record. By filling
out this survey form means your approval to the use of data for research purposes.

Date: _________________________________

Barangay: __________________________

Part 1: Demographics

Please tick the appropriate box or write on the space

1. Age:

( ) 18-20 ( ) 21-40 ( ) 40-60 ( ) above 60

2. Marital Status:

( ) Single ( ) Married ( ) Separated

3. Occupation

Part 2. Smoking Prevalence and History

20