Background:
Cigarette affordability, the price of tobacco relative to consumer income, is a key determinant of tobacco consumption.

Objective:
This study examined trends over 12 years in individualized cigarette affordability in the Netherlands, and whether these trends differed by sex, age, and education level.

Methods:
Data from 10 waves (2008–2020) of the International Tobacco Control (ITC) Netherlands Surveys were used to estimate individualized affordability, measured as the percentage of income required to buy 100 cigarette packs (Relative Income Price, RIP), using self-reported prices and income. The lower the RIP, the more affordable cigarettes are. Generalized estimating equation regression models assessed trends in individualized affordability over time and for the three subgroups.

Results:
Affordability decreased significantly over the 12 years, with RIP increasing from 1.89% in 2008 to 2.64% in 2020 (p≤0.001), although the year-on-year changes did not increase significantly. Lower affordability was found among subgroups: which on average had a lower income level, were female (vs male), were aged 18–24 and 25–39 years (vs ≥55 years), and of low or moderate educated level (vs high educated). Interactions between wave and education level (p=0.007) were found, but not with sex (p=0.653) or age (p=0.295). Decreasing affordability was found for those who were moderately (p=0.041) and highly educated (p=0.025), but not for those who had a low education level (p=0.149).

Conclusions:
Cigarettes in the Netherlands have become less affordable between 2008 and 2020, especially for people who had a low education level; yet this was mostly due to the decrease in affordability between 2008 and 2010. There is a need for more significant increases in tax to further decrease affordability.