Introduction:
Tobacco taxation is an effective tobacco control measure because of its impact on increasing quitting and reducing consumption. Some smokers, however, may instead use price-minimising strategies, such as purchasing less-expensive brands. This study examined whether smokers’ responses to a major tobacco tax increase differed by age, income, and education. We also examined whether price played a role in quitters’ decision to quit.

Material and Methods:
Cross-sectional data was analysed from the 2020 International Tobacco Control (ITC) Netherlands Survey, conducted 6 months after a tax increase that increased prices by circa 13%. Responses to the tax increase by smokers (N=1790) were categorised as intended (reducing consumption to reduce spending) or unintended (using only price-minimising behaviours to reduce spending). We also examined whether price was reported by quitters as a reason for quitting (N=125). We used multinomial and logistic regression to examine whether responses varied by equity variables (e.g., income) and nicotine dependence.

Results:
In response to the tax increases, 35.6% of smokers reduced consumption and 19.3% engaged only in price-minimising behaviours. 82.1% of quitters stated that price influenced their decision to quit. Low-income individuals were more likely to reduce consumption or quit due to price, but also to purchase less expensive brands. Highly dependent smokers were less likely to reduce consumption and more likely to use price-minimising behaviours.

Conclusions:
Increasing taxation has a positive public health benefit: four out of five quitters said price influenced their decision to quit, and more than one-third of smokers reduced their consumption, with low-income smokers being more likely to reduce consumption or quit smoking, providing further evidence that increasing tobacco taxes can reduce health inequalities caused by smoking. Price-minimising strategies were most common among highly dependent smokers.