The Effect of Combustible Tobacco Tax Changes on Smoking Behaviours Among Young Adults: A Systematic Review

Abstract Introduction Tobacco use is considered the leading preventable cause of mortality and morbidity. Young adults are particularly susceptible to tobacco use. This review aims to identify and synthesise evidence on the effect of changes in combustible tobacco tax on smoking behaviours, including smoking prevalence, initiation, consumption levels and cessation, among young adults aged 18-25. Methods A search was conducted across Medline, Embase, Scopus and EconLit, covering the period from January 1, 2004, to April 30, 2024. We included publications where more than 50% of the sample were aged 18-25 years or where results for this age group were specifically presented. We excluded single-time-point cross-sectional studies, modelling studies, reviews, and meta-analyses. Data were summarised qualitatively using a narrative synthesis method. This study is registered with PROSPERO (CRD42024554045). Results We identified 6,580 publications. Following screening by two independent reviewers, we included 21 publications. Seven publications were specific to young adults, and 14 publications included adults and young adults, but reported findings separately. Findings suggest that tax increases result in an overall reduction in smoking prevalence and consumption levels among users. Results for smoking initiation were mixed. Regarding cessation, tax increases were associated with higher quit attempts and successful quitting rates in most studies. Conclusions The included studies consistently showed that combustible tax increases were associated with lower smoking prevalence and consumption levels and with higher quitting rates among young people in a variety of settings.