Tobacco This approach was started in Saudi Arabia by

Tobacco use is on huge rise in several developing countries.

Results from Global Adult Tobacco Survey show that approximately half of males in 14 developing countries are tobacco smokers and that women starting to smoke at younger age. (Steakley, 2012). (1) The consumption of tobacco is a major risk factor for morbidity and mortality (Lim et.

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al, 2012). (2) In 2002, the Ministry of health in Saudi Arabia started a national tobacco control program with massive efforts after joining the World Health Organization (WHO) Framework Convention for Tobacco Control (FCTC) in 2005. (Munif MA. Report 2009). (3)   According to the World Health Organization (WHO) report on the global tobacco epidemic, in 2017 on Saudi Arabia; the prevalence of tobacco uses from the latest survey results in 2016 among youth both males and females aged 13-15 years is 14.9% with 8.9% are current cigarette smokers. Moreover, the prevalence of current tobacco uses among adults both sex aged older than 15 years is 15.

6% with 11.9% cigarette smokers  (4). In order to reduce tobacco, which causes the death of more than seven million smokers every year, taxation on tobacco price is a cost-efficient way for young and poor people in particular (WHO, 2017) (5). This approach was started in Saudi Arabia by raising the cigarette price 100% in Jun 2017. Following this decision, no studies have been conducted to investigate the effect of raising cigarette price among smokers, which is important to measure the success of such decision. In this study, the primary objective is to measure the effect of raising the cigarette price on the consumption and quitting among Saudi population. Moreover, the study will identify the factors that motivate smokers to quit.

  Kostova et al. (2016), investigate the effect of high cigarette prices on smoking initiation and cessation. They found that cigarette prices lead to significant decline on initiation of smoking. As the price increase by 10%, the smoking initiation would fall by 9.

5%. However, the response to cessation in China was minimal due to brand switching options (6). Moreover, Chen et al. (2013) investigated the impact of cigarette taxes on consumption with choice between reducing consumption and switching brands. The study results indicate that only 23.29% decrease in consumption after 2 years of taxation. Smokers with low income and higher levels of education chose brand switching rather than reduce consumption. Consequently, Chen et al.

(2013) found that, increasing the price of cigarettes alone does not lead to effective reduction in cigarette consumption (7). In contrast Hasselt et.al. (2015), investigated the effect of increasing tobacco taxes among youth aged (12-25 years) on quitting smoking where the taxed increased from $0.39 to $1.01.

The study discovers that increasing federal tax of $0.62 per pack results in decrease initiation among smokers, past-month smoking, number of days smoked per month, and numbers of cigarettes per day in both youths and young adults. (8) In 2015, Singh et al.

examined the effect of increase in tobacco prices on smokers’ consumption and stores sales. They acknowledged that when tobacco products taxation increased by 20%, the average increase in retail price in the shopkeeper survey was 19.0% for cigarette, 21.

3% for bidi, and 68% for chewing. Moreover, the reduction in consumption of cigarette was 15.2%, of bidi was 13.2%, and of chewing was 20.7%. Additionally, at the stores level, the sale reduction was also associated with the increase on tobacco products price. The study concluded that when tobacco price increase 10% the reduction in cigarette consumption will be 8%, and the reduction in bidi will be 6.2% (9).

In addition, Lee. (2008), investigated the relationship between cigarette consumption and large increase in cigarette tax. The study reveals that the 44% increase in the price of cigarettes cause significant response in women, low-income smokers, moderately addicted smokers, and smokers who regularly purchase low-price cigarettes. This resulting in 14.86 packs (12.87%) reduction in cigarette consumption in Taiwan. Therefore, a huge increase in cigarette tax will be a useful way to reduce cigarette consumption (10).

Smokers particularly with different income and/or educational levels usually have different responses for increasing cigarette price. Huang et al. (2015): assayed the different response between people with different income and/or educational levels. The study concluded that regardless of participants’ characteristics, when the cigarette price increase by 10%, the cigarette consumption will decrease by 1.2–1.4% in adult urban Chinese smokers. (11)   Cavazos-Rehg, et al.

(2012), investigated the different impacts of increasing cigarette price with person’s changes in smoking behaviours for smokers of different intensity levels. In the first wave, the average cigarettes number smoked per day was sixteen, which was reduced to fourteen cigarettes per day at the second wave. Additionally, people who smoked more cigarettes had more reduction in daily smoking. Furthermore, at the second wave, 16.

3% of smokers quit smoking. The quitting rate was higher in low consumption levels smokers, and lower in higher consumption levels. This study realizes that when the person smokes high number of cigarettes before the taxation, their smoking reduction will be more (12). Furthermore, Ross et al. (2010), assayed the influence of increase cigarette prices, nicotine dependence and health knowledge in the smoking cessation and motivation to quit among adult smokers in Canada and US. They found that Canadian and US have a similar effect of cigarette taxes on quit behaviour. Moreover, smokers with high nicotine dependence are less likely motivated to quit.

On the other hand, health Knowledge increases significantly both the quit motivation and the likelihood of smoking cessation.  Furthermore, age is associated negatively to both the potential for initial cessation and quitting. The study concluded that smokers who live in areas with higher cigarette prices are significantly more motivated to quit; therefore, the higher the price of cigarettes positively affects the motivation to stop smoking and smoking cessation (13). Additionally, in 2016, Tabuchi et al. examined the differential influence of rising tobacco price in smoking behaviour in the population and different subgroups. The study has 8 waves, the current smokers in the first survey were 30.5%, which were decreased to 24.

3% in the eighth survey. In all subgroups, a significant effect on cessation observed during the period ‘2009–2010 ” between the fifth and sixth surveys” which is the period after a large tobacco price increase. Moreover, more stopping and less relapsing were observed during this period than during other periods. This study concluded that when the tobacco price increase, there will be a significant increase in cessation in smokers and less relapse among quitters (14). Cowie et al. (2014) also investigated the impact of high cigarette tax on smoking behaviours in smokers. They found that the relationship between tobacco tax and consumption is inversely related and directly related to increase repeated attempts to quit smoking in socioeconomically deprived communities.

 (15) Siahpush et al. (2016) prospective study appraised the effect of exposure to point-of-sale (POS) tobacco marketing on smoker’s attempt, and success to quit in the United States. Quit attempt, and quit success were reported at both baseline and six-month follow-up. As a result, 39.

9% of smokers have attempted to quit, and 21.8% of them succeeded.  The study concluded that exposure to POS decreases the probability of successfully quitting smoking. (16) In 2013, guillaumier et al. examined the effect of presumptive increase in cigarette prices by 10% and 20% on financial stress, price-minimization strategy, and motivation to quit in socioeconomically deprived smokers. The study realized that more smokers are trying to quit in response to increasing price; but resistant smokers have a firm intention not to quit (17). Besides, Rosenthal et al.

(2013) explored the barriers and stimulus that lead to smoking cessation for daily smokers. The study finds that the most common barriers smokers reported were that it is difficult, and they are not willing to quit. Moreover, financial cost, social aid, and social impact were also having high influence across both barriers and stimulus. (18) Consequently, in 2014, Gigliotti, et al. examined the expected response of presumptive raising in price of cigarettes to smokers in Brazil. The study concluded that increasing price and taxes of cigarettes have a higher probability to increase motivation to quit smoking or decrease consumption in young smokers and smokers of low educational level in Brazil. Moreover, as increasing cigarette price is a new phenomenon in Saudi Arabia; there are no studies conducted to investigate the effect of increasing the price among smokers of different ages.

 (19). Al-Mohrej et al. (2014), wondered if future increase in cigarette price will decrease its consumption in Saudi population. The study finds that when cigarette price increase from 2.

67 US dollars to 8.27 US dollars, it is expected that smoker’s consumption will decrease. (20)