Trends in Cigarette Affordability and Demographic Determinants of Cigarette Consumption in Vietnam From 2020 to 2024.

BACKGROUND: Despite various tobacco control efforts, cigarette affordability remains a significant challenge in Vietnam as rapid economic growth outpaces static excise tax rates. This study examined the determinants of smoking intensity, focusing on the comparative impact of absolute expenditure versus relative affordability. METHODS: Data from two waves of the Provincial Global Adult Tobacco Survey (PGATS 2020 and PGATS 2024) were analysed using multivariable linear regression and validated via Negative Binominal models to assess the association of the Relative Income Price (RIP), monthly cigarette expenditure, and sociodemographic characteristics with daily cigarette consumption. RESULTS: Between 2020 and 2024, the median price per pack of cigarettes rose slightly from 7,407 VND to 8,667 VND, yet the median RIP decreased from 0.90% to 0.75%, indicating increased affordability. Rural smokers reported higher daily consumption (13 vs. 10 sticks) despite paying lower prices than urban smokers. Regression analysis showed that RIP was a powerful predictor of consumption; a 1% increase in RIP was associated with a reduction of 0.68 cigarettes per day (p < 0.01). The affordability model demonstrated greater explanatory power than the expenditure model (R2 = 0.08 vs. 0.02). Demographic findings revealed that smoking intensity peaked among those aged 45-64 and was significantly lower among women and university graduates (p < 0.01). CONCLUSION: Relative affordability, rather than absolute price, was the primary economic determinant of smoking intensity in Vietnam. The continuous 15-year decline in RIP highlights a systemic failure of the current ad valorem tax structure to keep pace with sustained economic growth. Findings highlight an urgent need to transition to a hybrid tax system to ensure that price increases consistently outpace income growth.