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Gary King, PhD, Robyn K. Mallett, MS, Lynn T. Kozlowski, PhD and Robert B. Bendel, PhD

Gary King, Robyn K. Mallett, and Lynn T. Kozlowski are with Pennsylvania State University, University Park. Gary King and Lynn T. Kozlowski are with the Department of Biobehavioral Health. Robyn K. Mallett is with the Department of Psychology. Robert B. Bendel is with the College of Nursing, Washington State University, Spokane.

Correspondence: Requests for reprints should be sent to Gary King, PhD, 315 Health and Human Development East, Pennsylvania State University, University Park, PA 16802 (e-mail: gxk14{at}psu.edu).

	ABSTRACT

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 

Objectives. This study examined African Americans’ opinions regarding cigarette excise taxes and other tobacco control issues.

Methods. A stratified cluster sample of US congressional districts represented by African Americans was selected. African Americans from 10 districts were interviewed.

Results. Forty-seven percent of respondents stated that taxes on tobacco products should be increased, whereas about 30% believed that they should be reduced. Almost 75% disagreed that raising taxes on tobacco products is unfair to African Americans, and 57.9% reported that they would not be opposed to increasing taxes on cigarettes even if low-income smokers would be hit the hardest.

Conclusions. The present results indicate substantial support for cigarette excise taxes among African Americans.

	INTRODUCTION

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Considerable discussion has taken place within African American communities regarding tobacco control issues.¹ Notably, these topics include excess smoking prevalence rates among certain groups (e.g., African American males, individuals with low incomes),^2,3 high rates of morbidity and mortality from smoking-related diseases,² factors protecting teenagers from early initiation,⁴ cigarette promotion and sales especially to African American youths,^5–7 culturally effective intervention strategies,^8,9 anti-tobacco activism,^2,10 the 1998 Master Settlement Agreement, and the role of the tobacco industry in supporting community organizations.^10,11

Studies have shown that increasing excise taxes on cigarettes decreases smoking prevalence rates^12–14 and can generate revenue for tobacco cessation and prevention programs.^15,16 Although a tax increase is attractive to many tobacco control advocates and policymakers, it has been argued that the burden of increased costs of purchasing cigarettes will be disproportionately borne by low-income persons,¹⁴ many of whom are African American. Moreover, African Americans may be more likely than Whites to be sold single cigarettes, which are both illegal and more costly than standard pack sales.¹⁷ Additionally, as some studies have shown, minors in minority neighborhoods^6,17 and in both minority and non-minority low income urban areas⁷ have greater opportunities to procure single cigarettes as a result of regulatory violations by merchants. The issue of increasing excise taxes is particularly germane to African Americans precisely because it raises the question of fairness or equity (e.g., the regressive nature of cigarette taxes).^18–20

Others have noted that an increase in cigarette excise taxes might instead help those who most need it (and thus potentially be "progressive"), because low-income individuals would benefit more than others from reductions in smoking-related morbidity and mortality.^21,22 Farrelly and Bray²³ found, in their study of National Health Interview Survey data from 1976 to 1993, that African Americans and Hispanics, especially those between the ages of 18 and 24 years, exhibited a more pronounced response (i.e., in terms of reducing the number of cigarettes they consumed and quitting) than did Whites to an increase in the price of cigarettes.

Although there has been a good deal of speculation, little systematic research has been conducted regarding African Americans’ opinions on tobacco control issues. An exception is the work of Becker and colleagues,²⁴ who found that African Americans residing in Maryland were largely in favor of restrictive policies regarding tobacco and that these restrictions were more acceptable to nonsmokers than to smokers. Another study, conducted in the late 1980s, showed that African Americans were as likely as or more likely than Whites to agree with policies restricting the promotion and use of cigarettes.²⁵ However, neither of these studies reported findings related to cigarette taxation. Results of a recent study based on the 1999 California Tobacco Survey revealed that half of African American respondents supported a $0.50-per-pack cigarette excise tax, compared with 55.3% of non-Hispanic Whites, 61.1% of Asians, and 65.9% of Hispanics.²⁶

To our knowledge, the present study is the first to provide a detailed analysis of the opinions of a nationally dispersed sample of African Americans regarding cigarette taxation. Moreover, we investigated the suggestion that the viewpoints of African Americans regarding social and political issues in American society are associated with their opinions about increasing cigarette excise taxes. In this connection, we examined perceptions concerning the political efficacy of African American legislators, the ease with which youths can purchase cigarettes in their communities, and the perceived prevalence of smoking among African Americans.

	METHODS

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Sample Design
A cross-sectional sample of US congressional districts represented by African Americans was selected. The design consisted of a stratified cluster sample in which the 4 US census geographic regions represented the strata and African American congressional districts were purposely chosen (n = 4) or selected at random (n = 6) from the number of qualified districts in a given region. Each of the 10 districts constituted a cluster wherein a simple random sample of approximately 100 households was selected. Weighting was used to adjust for multiple telephone lines, and poststratification was employed to adjust the weights so that the sample composition reflected the African American age–sex distribution according to 1997 US Bureau of the Census estimates.

Certain restrictions were imposed on the sampling procedures. First, only a single district could be sampled from each state, and 1 state (Oklahoma) was not represented because of its small number of African American residents. Second, 3 districts were selected with certainty (Georgia 5th, Illinois 1st, New York 10th). Also, 1 of 2 districts (1st congressional district of North Carolina) was chosen at random so that the largest tobacco-producing state would be represented in the survey.

Regions were defined as follows: Northeast (New York; New Jersey; Pennsylvania; Washington, DC; Maryland), Midwest (Illinois, Missouri, Michigan, Ohio), West (California), Tobacco South (North Carolina, South Carolina, Tennessee, Virginia, Georgia), and NonTobacco South (Alabama, Louisiana, Texas, Mississippi, Florida). Six districts were randomly selected (Washington, DC; Michigan 14th; Tennessee 9th; California 32nd; Alabama 7th; Texas 30th). With the exception of the designated regional sampling selection, the sample represented a simple random sample obtained without replacement. When appropriate statistical weighting is applied, the results can be considered reflective of all US congressional districts with African American representatives.

Data Collection
Approximately 100 African American adults (18 years or older) residing in noninstitutionalized settings were randomly selected from each of the 10 study congressional districts (n = 1000). Computer-assisted telephone interviewing methodology was used, and data were collected between October 2000 and February 2001 by the Center for Opinion Research of Millersville University, Millersville, Pa. A crosssectional screening method was used to determine the eligibility of each selected telephone number (i.e., whether any member of the household was an African American adult). Persons who indicated that they were not African American or who were younger than 18 years were not selected as participants. However, a few questions were asked of nonqualifying adults to justify our posing the screening questions to all individuals who were called.

Most of the interviewing took place during weekday evenings (between 5 and 9 pm) and weekends (Saturdays and Sundays between 1 and 9 pm). In certain cases, daytime interviews were attempted when households could not be reached at other times. Average interview length was approximately 19 minutes.

Two focus groups (n = 5–10 persons in each group) that comprised broad segments of the local African American populations were conducted in Philadelphia and Atlanta. The primary aim of these focus groups was to discuss and elicit questionnaire topics related to tobacco control issues in African American communities. Data from the focus groups and other preexisting study questionnaires were used to develop a survey instrument consisting of 79 items related to demographics, community issues, smoking, political involvement, legislators, the tobacco industry, and other related topics. Two separate pretests of the instrument were conducted with African American respondents (n = 50 and n = 15 for the first and second pretests, respectively), and the questionnaire was subsequently revised. Using the American Association of Political Opinion Research guidelines for calculating survey cooperation rates, we calculated our cooperation rate as 41%, which compares favorably with other random-digit dialing (RDD) studies involving urban African American populations.^27,28

Study Variables
We examined the cigarette taxation issue employing 3 items focusing on different aspects of the issue. The key study question relating to public policy was "Do you think that the government taxes on tobacco products should be reduced, stay the same, or be increased?" Additional items measured respondents’ beliefs about the fairness of raising excise taxes ("Raising taxes on tobacco products is unfair to African Americans") and the regressive nature of cigarette taxes ("I would be opposed to raising taxes on cigarettes if doing so would hit low-income smokers the hardest"). We hypothesized that those who were opposed to raising taxes for either reason would be least likely to favor raising excise taxes. Respondents were asked to indicate the extent to which they agreed with these items according to an index ranging from strongly agree (1) to strongly disagree (5). In the case of some items, the neutral category contained few responses and was not included.

Demographic predictors of the attitudes just described included age (18–24, 25–34, 35–44, 45–54, 55–64, 65 years or older), sex, home ownership, education level (i.e., less than high school, high school, some college or college, advanced degree), marital status (i.e., married, unmarried), and geographic region based on congressional district (Midwest, Northeast, Non-Tobacco South, Tobacco South, and West). In terms of smoking status, individuals were defined as current smokers (i.e., those who smoked every day as well as those who smoked on some days), former smokers (i.e., those who had smoked at least 100 cigarettes in their lifetime but had quit), and nonsmokers.

In addition, we examined the following questionnaire items and tobacco control hypotheses related to opinions about African American community and political issues:

• "African Americans elected to office really don’t have the power to change very much in this country" (strongly agree, agree, disagree, or strongly disagree). Individuals who agree with this statement will be less inclined to support increasing excise taxes on cigarettes because of a belief that African Americans are not adequately represented in the political process that determines issues related to taxation.
  
• "African Americans should have influence over the government and economy in mostly Black communities" (strongly agree, agree, disagree, or strongly disagree). Because this statement appears to reflect greater control by African Americans over generating and distributing public revenue, respondents who indicate agreement will be more likely to favor increasing cigarette excise taxes.
  
• "In your opinion, how easy is it for minors to buy cigarettes and other tobacco products in the community in which you live?" (very easy, somewhat easy, somewhat difficult, or very difficult). People who believe that it is fairly easy for minors to purchase cigarettes in their residential community will be more inclined to favor increasing taxes on cigarettes as a means of reducing adolescent smoking.
  
• "Do you think that cigarette smoking among African Americans is increasing, decreasing, or has remained the same?" (no or yes). Respondents who perceive that smoking is increasing among African Americans will be more likely to favor increasing taxes as a means of reducing tobacco use.
  

Statistical Analysis
Descriptive statistical analyses included cross tabulations intended to assess strength of relationships (² tests) and types of relationships (linear vs nonlinear). In the multivariate analysis, we treated the response variable as a 3-category ordinal response using a cumulative logit model (proportional odds model)²⁹; attendant comparisons with a multinomial logit model were used to assess proportional odds assumptions. Three nonlinear models—logit, probit, and complementary log–log—were tested. The logit model’s concordance level (Kendall ) was slightly better than the concordance levels of the other 2 models, and this was the model of choice. SPSS (SPSS Inc, Chicago, Ill) was used in computing descriptive statistics and in conducting the multinomial logit analysis, whereas SAS (SAS Institute Inc, Cary, NC) was used in conducting the mixed-model analysis (SAS PROC MIXED) and the cumulative logit analysis (SAS PROC LOGISTIC). Because the clustering effect within the study congressional districts was small, survey data analysis programs such as SUDAAN or Stata were not needed.^30–34

Sample Design, Weighting, and Analysis
In calculating weights, employing the terminology and procedures of Lee et al.,³¹ we computed "relative weights" with the constraints that the sum of these weights was equal to the sample size and that households with more than 1 nonbusiness telephone had a relative weight of one half³² that of households with only 1 nonbusiness telephone. Poststratification was accomplished by first estimating the ages of individuals with missing information on age (less than 5%) by means of a multiple regression prediction equation with "number of years in this state" as the primary predictor (multiple R = 0.64). The "adjustment factor" (ratio of population proportion to sample proportion) was computed to adjust the relative weights so that the sample composition reflected the composition of the 1997 census age by sex distribution.

In preliminary analyses, the Score statistic³³ was found to be significant (P = .004) in the full multivariate model, indicating that the proportional odds assumption was not met. However, in reduced models involving only significant predictors, the proportional odds assumption was met (P > .05). Following Allison,³³ and because the results were similar for both the multinomial logit and the cumulative logit models, the cumulative logit model was selected as the more parsimonious model.

In other preliminary analyses, we used SAS PROC MIXED to compare district-to-district variance components with subject-to-subject variance components so that we could assess the magnitude of within-district clustering, as determined by the intraclass (intradistrict) correlation coefficient.³⁴ In the case of the response variable, government taxes on cigarettes, the district-to-district variance component was 0.01455, the subject-to-subject variance component was 0.7266, and the intradistrict correlation was 0.02. When large sample variance estimates were used, the district-to-district variance component was not significantly different from zero, implying that the same was true for the intradistrict correlation. Hence, the individual was the principal source of variation and was used as the unit of analysis, and thus SUDAAN and Stata were not needed.

	RESULTS

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
Table 1 presents weighted sample distributions of sociodemographic characteristics and attitudes toward community and tobacco control issues. The mean age of the respondents was 42.2 years (men: 41.5 years; women: 42.5 years). Approximately 41% of the respondents reported that they had a high school diploma; 53.7% were homeowners; and slightly less than 30% resided in congressional districts located in southern tobacco-producing states. The sample smoking prevalence rate was 20%, somewhat below the national rate (23.2%) for African Americans in 2000.³⁵

Specifically considering issues of tobacco control, approximately 47% of respondents believed that government taxes on tobacco products should be increased. Almost 75% of respondents disagreed with the statement that raising taxes on tobacco products is unfair to African Americans, and 57.9% reported that they would not be opposed to increasing taxes on cigarettes, even if such a policy would hit low-income smokers the hardest.

Table 2 reveals that attitudes regarding taxes on tobacco products were associated with age, education, and smoking status. These attitudes were also related (P .05) to the perceived ease with which minors could purchase cigarettes, beliefs about the prevalence of smoking among African Americans, and the fairness to African Americans of raising cigarette taxes. Younger African Americans and those at higher education levels were more likely (P < .01) to favor increasing excise taxes than were older adults and those with less education.

In the cumulative multivariate logistic regression analysis, region, education, smoking status, opinions about the fairness to African Americans of raising cigarette taxes, and the regressive nature of cigarette excise taxes were statistically significant predictors of attitudes toward increasing excise taxes on cigarettes (Table 3). Respondents from the Midwest, Northeast, and West were more than twice as likely as residents from the Tobacco South to favor government tax increases on tobacco products.

	DISCUSSION

TOP ABSTRACT INTRODUCTION METHODS RESULTS DISCUSSION References

 
To our knowledge, this is the first study to present data on African Americans’ opinions regarding various aspects of the cigarette tax excise issue. The importance of this tobacco control issue extends beyond individual opinions, because it has implications for regulatory policies shown to reduce smoking prevalence rates and the social costs associated with tobacco consumption.^11–23 These policies remain at the forefront of political debates, as highlighted in media articles regarding recent cigarette tax increases.^11,35–37 Moreover, the health burden of cigarette smoking has affected African Americans disproportionately in relation to Whites, in terms of higher lung cancer rates, more premature deaths, and increased smoking-related morbidity.²

Our findings revealed that slightly fewer than half of African Americans believed that taxes on tobacco products should be increased and that approximately 30% believed that they should be reduced. About three quarters of the respondents did not view tax increases on tobacco products as principally unfair to African Americans, and 57.9% reported that they would not be opposed to increasing taxes on cigarettes even if lowincome smokers were the group most affected. Similar to results obtained by other researchers, current smokers in our study were more opposed than were nonsmokers to raising excise taxes.^24,26,38 Respondents living outside the Tobacco South and highly educated individuals were more likely to favor increasing taxes on cigarettes. Our multivariate analysis showed that age, home ownership, and sex were not significant predictors of opinions about excise taxes on tobacco products, suggesting that African Americans’ opinions are relatively consistent across these important demographic sectors.

There was no support in our findings for the hypothesis that African Americans may be less receptive to increasing cigarette excise taxes because of the regressive impact on economically disadvantaged groups and the high proportions of both smokers and low-income individuals who reside in African American communities. To the contrary, our data indicate that most African Americans support raising taxes on cigarettes, even if the impact would disproportionately affect low-income smokers, many of whom are African American.

Also, the hypothesis that respondents who believed that raising taxes would be unfair to African Americans would be less likely to be in favor of increasing taxes was not substantiated by our results. As might be expected, respondents from non-tobacco-producing regions were more supportive of increasing excise taxes than were those who resided in the Tobacco South. Finally, we did not find evidence in the multivariate analysis validating an association between support for excise taxes and perceptions of the political efficacy of African American legislators, regarding political and economic control or influence in Black communities, about smoking prevalence among African Americans, or of the ease with which minors might purchase cigarettes.

Our results demonstrate that African Americans have varied opinions about issues related to tobacco control but indicate substantial support for taxation policies designed to reduce cigarette consumption. These data are not supportive of the position advanced by some advocates that few African Americans are in favor of increasing excise taxes on cigarettes.^11,37,38 The results of this study may be valuable in promoting tobacco control efforts. For example, they may influence local, state, and congressional legislative bodies to enact anti-tobacco laws and may generate greater African American community interest in tobacco control issues. They may also promote increases in the diversity of antismoking coalitions, development of alliances involving African American political and civic organizations, and a broader understanding of African Americans’ opinions regarding tobacco control policies.

In addition, in light of evidence indicating that African Americans are likely to change their smoking behavior in response to changes in the price of cigarettes,¹⁸ our results may have strong implications for policyrelated initiatives. Finally, our findings may have implications for health topics other than tobacco control (e.g., alcohol use rates and fast food consumption patterns) that are relevant to African Americans as a group.

The limitations of our study include the use of RDD sampling procedures,²⁷ which could have resulted in an undercount of low-income smokers not accessible through this method. This has been a notably persistent problem in other community health studies involving African Americans^27,28 and may have more implications for men than for women, in that men have been shown to be less reachable.²⁷ Generally, rates of nonresponse in RDD studies have been increasing among all segments of the US population^39–41; however, results of surveys involving low response or cooperation rates are not necessarily significantly different from results of surveys involving higher rates.^39–41 Moreover, we partially addressed this issue through our use of poststratification weighting procedures to adjust our sample according to representation of African Americans in congressional districts (by sex and age).

In addition, some investigators have found that self-report measures of smoking status underestimate smoking prevalence rates among African Americans.^42,43 A degree of caution must be exercised in interpreting certain of our results, such as smoking prevalence rates, as generalizable to the overall population of African Americans, because we did not include geographic areas in which there were no African American congressional representatives. However, about 68% of all African Americans reside in the 37 congressional districts represented by the study sample.

In summary, our findings provide empirical evidence suggesting that African Americans believe, even after considering social and political issues important to their communities, that the use of taxation policies to control and reduce tobacco consumption is appropriate. Although additional research is needed to address other aspects of this topic, policymakers and tobacco control advocates should consider these findings in deliberations and debates about the regressive impact of cigarette excise taxes on minority populations.

	Acknowledgments

 
This work was supported through a grant from the Robert Wood Johnson Foundation Substance Abuse Policy Research Program.

We would like to acknowledge the valuable assistance of Dr David Johnson, Berwood Yost, Steve Maczuga, and the anonymous reviewers.

G. King contributed to the study design, directed the study, participated in the data analysis, and contributed to the writing and revision of the article. R. K. Mallett coordinated the study, conducted the data analysis, and participated in the writing and revision of the article. L. T. Kozlowski contributed to the study design and to review and revision of the article. R. B. Bendel participated in the study design, facilitated the statistical analysis, and helped to write and revise the article.

Human Participant Protection
Institutional review board approval was obtained from the Pennsylvania State University Office of Research Compliance in regard to all elements pertaining to data collection.

	Footnotes

 
Peer Reviewed

Accepted for publication December 9, 2002.

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