Evaluating the impact of a tobacco tax increase on smoking cessation outcomes: A seven-year retrospective study from a regional teaching hospital in Taiwan

Po-Hsun Yang; Yuan-Shan Chien; Dih-Ling Luh; Po-Hsun Yang; Yuan-Shan Chien; Dih-Ling Luh

doi:10.3934/publichealth.2026001

AIMS Public Health

2026, Volume 13, Issue 1: 1-21. doi: 10.3934/publichealth.2026001

Previous Article Next Article

Research article Topical Sections

Evaluating the impact of a tobacco tax increase on smoking cessation outcomes: A seven-year retrospective study from a regional teaching hospital in Taiwan

1.
The Department of Public Health, Chung Shan Medical University, Taichung, Taiwan
2.
The Department of General Affairs, Taichung Tzu Chi Hospital, Taichung, Taiwan
3.
Disease Control Devision, Changhua County Public Health Bureau, Changhua, Taiwan
4.
The Department of Family and Community Health, Chung Shan Medical University Hospital, Taichung, Taiwan

Received: 07 October 2025 Revised: 04 November 2025 Accepted: 11 November 2025 Published: 05 January 2026

Objective
This study assesses the impact of Taiwan's 2017 tobacco tax increase on smoking cessation outcomes using data from a regional teaching hospital between 2013 and 2019. It focuses on the treatment completion rates for pharmacotherapy and health education interventions.
Methods
This retrospective study involves a secondary data analysis conducted at a regional teaching hospital. The analysis included preventive healthcare and smoking cessation service records from the National Health Insurance Administration database and the hospital's own records. The effectiveness of smoking cessation programs was assessed via follow-up records at three and six months, which were categorized into four groups: failure (smoking-smoking), relapse (not smoking-smoking), delay (smoking-not smoking), and successful cessation (not smoking-not smoking). A multinomial logistic regression model was applied for the multivariate analysis.
Results
No statistically significant difference was observed in the effectiveness of smoking cessation services before and after the tobacco tax increase. However, the participants who failed to complete both the pharmacotherapy and the health education counseling had a markedly higher likelihood of cessation failure compared with those who completed both interventions (OR = 4.84, 95% CI: 2.69–8.70).
Conclusion
While the 2017 tobacco tax increase did not significantly improve cessation outcomes, service completion was strongly associated with success. Efforts to support full participation in smoking cessation services may enhance the treatment's effectiveness.
- tobacco tax,
- smoking cessation service,
- smoking cessation treatment,
- health education consultation,
- smoking cessation effectiveness,
- Taiwan
Citation: Po-Hsun Yang, Yuan-Shan Chien, Dih-Ling Luh. Evaluating the impact of a tobacco tax increase on smoking cessation outcomes: A seven-year retrospective study from a regional teaching hospital in Taiwan[J]. AIMS Public Health, 2026, 13(1): 1-21. doi: 10.3934/publichealth.2026001

Related Papers:

Abstract

Objective

This study assesses the impact of Taiwan's 2017 tobacco tax increase on smoking cessation outcomes using data from a regional teaching hospital between 2013 and 2019. It focuses on the treatment completion rates for pharmacotherapy and health education interventions.

Methods

This retrospective study involves a secondary data analysis conducted at a regional teaching hospital. The analysis included preventive healthcare and smoking cessation service records from the National Health Insurance Administration database and the hospital's own records. The effectiveness of smoking cessation programs was assessed via follow-up records at three and six months, which were categorized into four groups: failure (smoking-smoking), relapse (not smoking-smoking), delay (smoking-not smoking), and successful cessation (not smoking-not smoking). A multinomial logistic regression model was applied for the multivariate analysis.

Results

No statistically significant difference was observed in the effectiveness of smoking cessation services before and after the tobacco tax increase. However, the participants who failed to complete both the pharmacotherapy and the health education counseling had a markedly higher likelihood of cessation failure compared with those who completed both interventions (OR = 4.84, 95% CI: 2.69–8.70).

Conclusion

While the 2017 tobacco tax increase did not significantly improve cessation outcomes, service completion was strongly associated with success. Efforts to support full participation in smoking cessation services may enhance the treatment's effectiveness.

Authors' contributions

Conceptualization, D.L.L., P.H.Y.; methodology, D.L.L., P.H.Y.; validation, D.L.L.; investigation, P.H.Y.; data Curation, Y.S.C.; formal analysis, Y.S.C., P.H.Y.; writing—original draft preparation, P.H.Y.; writing—review and editing, D.L.L.; visualization, P.H.Y.; supervision, D.L.L. All authors have read and agreed to the published version of the manuscript.

Conflicts of interest

The authors declare no conflicts of interest.

References

[1]	Cummings KM, Proctor RN (2014) The changing public image of smoking in the United States: 1964–2014. Cancer Epidemiol Biomarkers Prev 23: 32-36. https://doi.org/10.1158/1055-9965.EPI-13-0798
[2]	Bodansky D The Framework convention/protocol approach/Daniel Bodansky (1999). [cited 2021 May 01]. Available from: https://apps.who.int/iris/handle/10665/65355
[3]	WHOTobacco: poisoning our planet (2022). [cited 2022 October 01]. Available from: https://www.who.int/publications/i/item/9789240051287
[4]	(2003) WHOWHO framework convention on tobacco control. Geneva, Switzerland: World Health Organization. [cited 2023 January 05]. Available from: https://iris.who.int/server/api/core/bitstreams/264104b3-241a-4e48-88f9-aa7120779ffc/content.
[5]	(2021) HPATaiwan tobacco control annual report 2021. Health Promotion Administration. [cited 2023 January 05]. Available from: https://www.hpa.gov.tw/EngPages/Detail.aspx?nodeid=1070&pid=14658
[6]	Biener L, Aseltine RH, Cohen B, et al. (1998) Reactions of adult and teenaged smokers to the Massachusetts tobacco tax. Am J Public Health 88: 1389-1391. https://doi.org/10.2105/AJPH.88.9.1389
[7]	Finance M.o.Tobacco and alcohol tax act (2017). [cited 2023 January 05]. Available from: https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=G0330010
[8]	WelfareTobacco hazards prevention act (2007). [cited 2023 January 05]. Available from: https://law.moj.gov.tw/LawClass/LawAll.aspx?pcode=L0070021
[9]	Fiore MC, Novotny TE, Pierce JP, et al. (1990) Methods used to quit smoking in the United States: Do cessation programs help?. JAMA 263: 2760-2765. https://doi.org/10.1001/jama.1990.03440200064024
[10]	No authors.A clinical practice guideline for treating tobacco use and dependence: A US public health service report. The tobacco use and dependence clinical practice guideline panel, staff, and consortium representatives. JAMA (2000) 283: 3244-3254. https://doi.org/10.1001/jama.283.24.3244
[11]	Fu SS, Partin MR, Snyder A, et al. (2006) Promoting repeat tobacco dependence treatment: Are relapsed smokers interested?. Am J Manag Care 12: 235-243.
[12]	Ferguson J, Bauld L, Chesterman J, et al. (2005) The English smoking treatment services: One-year outcomes. Addiction 100 Suppl 2: 59-69. https://doi.org/10.1111/j.1360-0443.2005.01028.x
[13]	Koçak ND, Eren A, Boğa S, et al. (2015) Relapse rate and factors related to relapse in a 1-year follow-up of subjects participating in a smoking cessation program. Respir Care 60: 1796-1803. https://doi.org/10.4187/respcare.03883
[14]	Chaiton M, Diemert L, Cohen JE, et al. (2016) Estimating the number of quit attempts it takes to quit smoking successfully in a longitudinal cohort of smokers. BMJ Open 6: e011045. https://doi.org/10.1136/bmjopen-2016-011045
[15]	Hermanson B, Omenn GS, Kronmal RA, et al. (1988) Beneficial six-year outcome of smoking cessation in older men and women with coronary artery disease. Results from the CASS registry. N Engl J Med 319: 1365-1369. https://doi.org/10.1056/NEJM198811243192101
[16]	Li L, Borland R, Cummings KM, et al. (2020) Are health conditions and concerns about health effects of smoking predictive of quitting? Findings from the ITC 4CV survey (2016–2018). Tob Prev Cessat 6: 60. https://doi.org/10.18332/tpc/127471
[17]	Ampatzidou F, Ioannidis R, Drosos O, et al. (2021) Smoking behavior after coronary artery bypass surgery: Quit, relapse, continuing. Ann Card Anaesth 24: 56-61. https://doi.org/10.4103/aca.ACA_63_19
[18]	Choi K, Boyle RG (2013) Minnesota smokers' perceived helpfulness of 2009 federal tobacco tax increase in assisting smoking cessation: A prospective cohort study. BMC Public Health 13: 965. https://doi.org/10.1186/1471-2458-13-965
[19]	Chaloupka FJ, Straif K, Leon ME (2011) Effectiveness of tax and price policies in tobacco control. Tob Control 20: 235-238. https://doi.org/10.1136/tc.2010.039982
[20]	Tabuchi T, Fujiwara T, Shinozaki T (2017) Tobacco price increase and smoking behaviour changes in various subgroups: A nationwide longitudinal 7-year follow-up study among a middle-aged Japanese population. Tob Control 26: 69-77. https://doi.org/10.1136/tobaccocontrol-2015-052804
[21]	Chaloupka FJ, Tauras JA (2011) The power of tax and price. Tob Control 20: 391-392. https://doi.org/10.1136/tobaccocontrol-2011-050235
[22]	Tsai YW, Yen LL, Yang CL, et al. (2003) Public opinion regarding earmarked cigarette tax in Taiwan. BMC Public Health 3: 42. https://doi.org/10.1186/1471-2458-3-42
[23]	Felsinger R, Groman E (2022) Price Policy and Taxation as effective strategies for tobacco control. Front Public Health 10: 851740. https://doi.org/10.3389/fpubh.2022.851740
[24]	Gao W, Sanna M, Branston JR, et al. (2019) Exploiting a low tax system: Non-tax-induced cigarette price increases in Taiwan 2011–2016. Tob Control 28: e126-e132. https://doi.org/10.1136/tobaccocontrol-2018-054908
[25]	Ross H, Blecher E, Yan L, et al. (2011) Do cigarette prices motivate smokers to quit? New evidence from the ITC survey. Addiction 106: 609-619. https://doi.org/10.1111/j.1360-0443.2010.03192.x
[26]	Stevens VL, Diver WR, Stoklosa M, et al. (2017) A prospective cohort study of cigarette prices and smoking cessation in older smokers. Cancer Epidemiol Biomarkers Prev 26: 1071-1077. https://doi.org/10.1158/1055-9965.EPI-16-0690
[27]	Lee B, Seo DC (2021) Effects of an 80% cigarette price increase on quit attempts, successful quitting and smoking intensity among Korean adult smokers: Results from nationally representative longitudinal panel data. Tob Control 30: 336-343. https://doi.org/10.1136/tobaccocontrol-2019-055518
[28]	Reed MB, Anderson CM, Vaughn JW, et al. (2008) The effect of cigarette price increases on smoking cessation in California. Prev Sci 9: 47-54. https://doi.org/10.1007/s11121-008-0081-1
[29]	Wendau C, YW Y, Chorngsonq C, et al. (2007) One-year follow-up results of outpatient smoking cessation therapy at a medical center in central Taiwan. Taiwan J Fam Med 17: 38-52.
[30]	Hsueh KC, Chen CY, Yang YH, et al. (2010) Smoking cessation program in outpatient clinics of Family Medicine Department in Taiwan: A longitudinal evaluation. Eval Health Prof 33: 12-25. https://doi.org/10.1177/0163278709356185
[31]	Huang WH, Hsu HY, Chang BC, et al. (2018) Factors correlated with success rate of outpatient smoking cessation services in Taiwan. Int J Environ Res Public Health 15: 1218. https://doi.org/10.3390/ijerph15061218
[32]	Wen YW, Wang IT, Hu YT, et al. (2021) Duration of varenicline prescription and efficacy of smoking cessation treatment: An observational study in Taiwan. Prev Med 161: 107091. https://doi.org/10.1016/j.ypmed.2022.107091
[33]	Raupach T, Shahab L, Neubert K, et al. (2008) Implementing a hospital-based smoking cessation programme: Evidence for a learning effect. Patient Educ Couns 70: 199-204. https://doi.org/10.1016/j.pec.2007.10.005
[34]	Siahpush M, Shaikh RA, McCarthy M, et al. (2015) Association between duration of use of pharmacotherapy and smoking cessation: Findings from a national survey. BMJ Open 5: e006229. https://doi.org/10.1136/bmjopen-2014-006229
[35]	2008 PHS Guideline Update Panel, Liaisons, and Staff.Treating tobacco use and dependence: 2008 update U.S. Public Health Service Clinical Practice Guideline executive summary. Respir Care (2008) 53: 1217-22.
[36]	Hajek P, Stead LF, West R, et al. (2005) Relapse prevention interventions for smoking cessation. Cochrane Database Syst Rev 2005: Cd003999. https://doi.org/10.1002/14651858.CD003999.pub2
[37]	Jordan CJ, Xi ZX (2018) Discovery and development of varenicline for smoking cessation. Expert Opin Drug Discov 13: 671-683. https://doi.org/10.1080/17460441.2018.1458090
[38]	Ashare RL, Lerman C, Tyndale RF, et al. (2017) Sleep disturbance during smoking cessation: withdrawal or side effect of treatment?. J Smok Cessat 12: 63-70. https://doi.org/10.1017/jsc.2016.11
[39]	Tonkin SS, Williams TF, Simms LJ, et al. (2020) Withdrawal symptom, treatment mechanism, and/or side effect? Developing an explicit measurement model for smoking cessation research. Nicotine Tob Res 22: 482-491. https://doi.org/10.1093/ntr/nty262
[40]	Cheng HY, Lee RP (2009) Smoking cessation behavior and self-efficacy in subjects of a smoking cessation clinic. Formos J Med 13: 223-30.
[41]	Hitchman SC, Fong GT, Zanna MP, et al. (2014) The relation between number of smoking friends, and quit intentions, attempts, and success: Findings from the International Tobacco Control (ITC) Four Country Survey. Psychol Addict Behav 28: 1144-1152. https://doi.org/10.1037/a0036483
[42]	Zhao Y, Yong HH, Borland R, et al. (2022) Do number of smoking friends and changes over time predict smoking relapse? Findings from the international tobacco control four-country survey. J Subst Abuse Treat 138: 08763. https://doi.org/10.1016/j.jsat.2022.108763
[43]	Bohadana A, Nilsson F, Rasmussen T, et al. (2003) Gender differences in quit rates following smoking cessation with combination nicotine therapy: Influence of baseline smoking behavior. Nicotine Tob Res 5: 111-116. https://doi.org/10.1080/1462220021000060482
[44]	Scharf D, Shiffman S (2004) Are there gender differences in smoking cessation, with and without bupropion? Pooled- and meta-analyses of clinical trials of Bupropion SR. Addiction 99: 1462-1469. https://doi.org/10.1111/j.1360-0443.2004.00845.x
[45]	Smith PH, Kasza KA, Hyland A, et al. (2015) Gender differences in medication use and cigarette smoking cessation: Results from the International Tobacco Control Four Country Survey. Nicotine Tob Res 17: 463-472. https://doi.org/10.1093/ntr/ntu212
[46]	Marqueta A, Nerín I, Jiménez-Muro A, et al. (2013) Predictors of outcome of a smoking cessation treatment by gender. Gac Sanit 27: 26-31. https://doi.org/10.1016/j.gaceta.2011.12.011
[47]	Walker NJ, van Woerden HC, Kiparoglou V, et al. (2016) Gender difference and effect of pharmacotherapy: Findings from a smoking cessation service. BMC Public Health 16: 1038. https://doi.org/10.1186/s12889-016-3672-y
[48]	Fidler J, Ferguson SG, Brown J, et al. (2013) How does rate of smoking cessation vary by age, gender and social grade? Findings from a population survey in E ngland. Addiction 108: 1680-1685. https://doi.org/10.1111/add.12241
[49]	Chang YC, Huang WH, Tsai CY, et al. (2019) Comparisons of early and delayed abstainers and its effects on long-term smoking cessation in Taiwan. Subst Abuse Treat Prev Policy 14: 31. https://doi.org/10.1186/s13011-019-0218-1
[50]	Chang YY, CL S, Huang HL (2013) A preliminary study of the factors influencing smoking cessation among the elderly. Taiwan Geriatr Gerontol 8: 160-171.
[51]	Messer K, Trinidad DR, Al-Delaimy WK, et al. (2008) Smoking cessation rates in the United States: A comparison of young adult and older smokers. Am J Public Health 98: 317-322. https://doi.org/10.2105/AJPH.2007.112060
[52]	Lin YA, Tsai AC (2011) Predictors of smoking cessation among older male smokers in Taiwan. Taiwan J Public Health 30: 36-44.
[53]	El-Khoury Lesueur F, Bolze C, Melchior M (2018) Factors associated with successful vs. unsuccessful smoking cessation: Data from a nationally representative study. Addict Behav 80: 110-115. https://doi.org/10.1016/j.addbeh.2018.01.016
[54]	Hyland A, Li Q, Bauer JE, et al. (2004) Predictors of cessation in a cohort of current and former smokers followed over 13 years. Nicotine Tob Res 6 Suppl 3: S363-S369. https://doi.org/10.1080/14622200412331320761
[55]	Hsueh K, Tu M, Ger L, et al. (2006) The effectiveness of the smoking cessation in a medical center clinic. Taiwan J Fam Med 16: 1-12.
[56]	Wu-Shyong Chien LC, Tung TH, Lai XF, et al. (2010) Evaluation of the smoking cessation clinic in a Regional Hospital in Northern Taiwan. Taiwan J Fam Med 20: 181-191.
[57]	Vangeli E, Stapleton J, Smit ES, et al. (2011) Predictors of attempts to stop smoking and their success in adult general population samples: A systematic review. Addiction 106: 2110-2121. https://doi.org/10.1111/j.1360-0443.2011.03565.x
[58]	Chen CY, Wang RH, Chang CS, et al. (2020) Inpatient vs. outpatient: Influences of setting on successful rate of 3-month smoking cessation. Taiwan J Fam Med 30: 225-234. https://doi.org/10.3966/168232812020123004004
[59]	Kim SH, Lee JA, Kim KU, et al. (2015) Results of an inpatient smoking cessation program: 3-month cessation rate and predictors of success. Korean J Fam Med 36: 50-59. https://doi.org/10.4082/kjfm.2015.36.2.50
[60]	Rigotti NA, Tindle HA, Regan S, et al. (2016) A post-discharge smoking-cessation intervention for hospital patients: Helping hand 2 randomized clinical trial. Am J Prev Med 51: 597-608. https://doi.org/10.1016/j.amepre.2016.04.005

Reader Comments

Your name:*

Email:*
© 2026 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)