如何戒烟是个让广大医务工作者和吸烟者家属关心的问题！

如果二手烟无害的话，吸烟者可能是这世界最可爱的人群之一。他们为世界主要国家大概贡献了约20%的税（这是全世界最大的单一税种！）。而且，他们还心甘情愿平均少活五年！。现在ASCO会议上还有研究表示他们应该为买烟付出更多的钱，原因是随着烟草价格升高吸烟人数下降！

ASCO2018会议上，有个研究显示：烟草税可以提高戒烟率，随着价格升高，吸烟人数下降。作者在结论中认为提高烟草税是有效的。
然而，仔细分析，令人惊讶的发现是，烟草税的提高对于低收入人群却不敏感，吸烟率仍然很高，甚至在升高！提示对于吸烟这种成瘾性行为，仅提高价格是不足的！提高烟草税，可能根本就与吸烟者是否戒烟没有关系。恐怕是收入高的人群接受了恰当的教育和引导，而且他们的工作环境要求他们戒烟，才使这个人群的戒烟率升高了。而收入低的人群，往往是户外工作，工作环境不要求戒烟，而且，他们更少受到教育和辅导。

美国近年来吸烟人数下降，与有关戒烟的宣传和运动，辅助戒烟乃至戒烟治疗方面的进展是分不开的。烟草税可能只是其中影响较小的一个方面。

作者：杨学宁

【参考文献】

Cigarette price, smoking behaviors, and lung cancer mortality in Indiana.
Authors:Ryan Nguyen, Nasser H. Hanna; Indiana University School of Medicine, Indianapolis, IN; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IN

Abstract Disclosures

Background:
Increasing tobacco costs have been proven to be one of the most effective interventions of decreasing tobacco use. The relationship between tobacco cost and lung cancer mortality has not been as well established. We investigated the relationship of cigarette price with smoking prevalence, cigarette consumption, and lung cancer incidence and mortality in Indiana and nationally.

Methods:
We obtained average cigarette pack prices, cigarette pack sales, smoking prevalence, and lung cancer incidence and mortality rates in Indiana and nationally from 1995-2015. Average cigarette pack prices were inflation adjusted to 2015 then assessed for Pearson correlation coefficient (r) with cigarette pack sales, smoking prevalence, and lung cancer incidence and mortality. Cigarette price was also correlated with smoking prevalence among state-level characteristics that included gender, age, ethnicity, education, and income.

Results:
From 1995 to 2015, average cigarette pack price in Indiana rose from $2.29 to $5.41. Increasing cigarette price in Indiana was associated with decreasing cigarette consumption (r= -0.91, p < 0.001) and decreasing overall smoking prevalence (r= -0.72, p < 0.001). However, those in the lowest income level had higher smoking prevalence associated with rising cigarette price (r= 0.67, p = 0.001). Increasing cigarette price correlated with decreasing lung cancer mortality both in Indiana (r= -0.79, p < 0.001) and nationally (r= 0.96, p < 0.001).

Conclusions:
Increasing tobacco taxes and subsequent increasing cigarette prices were associated with decreased smoking prevalence, cigarette consumption, and lung cancer mortality in Indiana. Lower socioeconomic populations in Indiana may not be as price-responsive as similar populations nationally. Policies aimed at increasing tobacco prices should prioritize diverting revenues towards health programs and tobacco-cessation initiatives for lower-income individuals.