Up in Smoke: A Longitudinal Study of the Impact of Tobacco Tax on Health, 2003 to 2013

Background and purpose.  Tobacco use is the leading cause of preventable death.   It is no small problem, as approximately 19.3% of adults and 13.4% of youth report using tobacco regularly in 2013. Tobacco tax is not simply a revenue generator, but also a force that decreases use and, and consequently, increases health and reducing death due to smoking.  The purpose of this study was to determine the impact of tobacco tax on tobacco use and health for youth and adults from 2003 through 2013.  It was hypothesized that tobacco tax and its increase from 2003 through 2013 would be associated with less use, which in turn, would lead to better health, and fewer deaths due to tobacco.

Method

            Design. This is a longitudinal study from 2003 to 2014, and the units of analysis are each state in the USA.  Data were collected from state and federal databases.

            Measures.  Tobacco tax was defined by the dollar amount of taxes per state in 2003 and 2013.  Health was defined by the health status of each state, the average number of days impaired by physical health, and deaths due to cancer.  Tobacco use was defined by the percentage of youth and adults in each state who used tobacco.

Results.  For adults, the results supported the hypothesis that higher taxes would be associated with less tobacco use in 2003 and 2013 (r = -.42 and .51, respectively), and that more use would be associated with poorer health (r = -.68 and -.76); there was no association with higher deaths due to cancer (r = ns), which is probably due to the notion that 10 years of use is insufficient to cause death.  As expected, tobacco tax was associated with health, but had no association when controlling of use (r = ns).  The hypothesis was also supported for tobacco use for youth where the 2003 and 2013 tax rates were associated with less use (r = -.42 & -.45, respectively), and more use was associated with poorer heath (r = .49).  There was no association with smoking related death due to tobacco, chiefly because these young smokers have not used sufficient amounts of tobacco to cause death; at least, not yet!  The rate of tax increase over the 10 year period was 92¢ and increase was associated with less use for adults (r = .45) and youth (r = .37), resulting in19, 812,256 few adult smokers and 9,847,805 fewer youth smokers.

Implications.  The results support the model that taxes impact use, which in turn, predicts good health and poor health.  A simple .92 cent increase in taxes reduced tobacco use by 8.08%.  The fiscal policy implications will be discussed, and clearly increasing tobacco tax is good for Americans and good for America.