Washington State has shown legislative courage on tobacco control gets results. Smoking declines have exceeded the national average, thanks to a comprehensive state program that included a statewide public smoking ban and tax increases. The estimated return on investment was more than $5 for every $1 spent.
Four proven strategies, if pursued aggressively, could nearly wipe out cigarette smoking. The only barrier is political will. The policies with documented success: increasing tobacco taxes, expansion of public smoking bans, anti-smoking advertising campaigns, and banning methods of cigarette marketing.
State excise taxes on a pack of cigarettes range from 17 cents in Missouri to $4.35 in New York. By comparison, Norway taxes cigarettes by more than $11. Tobacco has long been a significant contributor to U.S. government coffers. Alexander Hamilton first proposed tobacco excise taxes in 1794, and they were eventually implemented in the 1860s. By 1880, the taxes accounted for nearly one-third of federal tax receipts.
Steep tax increases would hit two groups especially hard: low-income households and people with chronic mental illness or substance-abuse disorders. Both groups have a disproportionate share of heavy smokers, despite the fact that it has become a very expensive habit. For example, more than 40 percent of U.S. smokers also have alcohol, drug or mental disorders. More than 60 percent of alcohol abusers are smokers. People with these disorders consume 44 percent of the cigarettes sold in the U.S. However, a 10 percent increase in cigarette prices would cut their smoking by an estimated 18 percent.
Cigarette tax increases would be a double victory for cash-strapped states. An analysis by a coalition of several anti-tobacco organizations concluded that a $1 tax increase per pack would:
- Increase state revenues by more than $9 billion annually.
- Prompt 1.2 million adult smokers to quit.
- Prevent more than 2.3 million adolescents from acquiring the habit.
- Forestall more than 1 million premature deaths; and
- Save nearly $53 billion in health-care costs.
Two-thirds of voters would support the $1 increase, according to a national poll released in conjunction with the report.
However, cigarette manufacturers would fight back. They use coupons and discounts to neutralize tax increases. In 2009, tobacco companies spent nearly three-quarters of their marketing and promotion budgets on retail-price reduction.
Smoking bans continue their relentless advance nationwide. Nearly two-thirds of Americans are subject to comprehensive smoke-free laws. At one time, it was common that states would not allow local governments to enact anti-smoking laws that were more stringent – known as state pre-emption laws. The number of states that pre-empt local action against smoking melted from 19 in 2005 to 12 in 2010.
The bans have measured effects on public health. Fatal heart attacks decreased 7 percent in Massachusetts after the state outlawed smoking in workplaces. Studies in other states and nations that have imposed bans reaffirm that effect.
Bars and restaurants frequently oppose smoke-free laws, fearing that cigarette-smoking customers will go elsewhere. However, research consistently has shown that the bans do not harm sales and, in many cases, actually increase business.
An Oklahoma study found that the average particulate level in bars and restaurant smoking rooms was beyond the “hazardous” level established by the U.S. Environmental Protection Agency (EPA) for outdoor air. Tobacco smoke levels were tested based on very fine particulate matter. The EPA considers air containing 250 micrograms per cubic meter or more to be hazardous outdoor air pollution, labeling it as emergency conditions. Restaurant rooms contained an average of 380 micrograms. Bars averaged 655.
Secondhand smoke annually kills 600,000 people worldwide. More than 1 in 4 of those deaths is a child under 5 years old. Smokers are at additional risk of their own secondhand smoke. For someone who smokes 14 cigarettes a day, his or her own secondhand smoke yields the risk of having smoked 2.6 more cigarettes.
The residue from secondhand smoke – called thirdhand smoke – can leave cancer-causing toxins on furniture, carpets, walls and drapes. The chemical, called tobacco-specific nitrosamines, can mix with dust or stick to the fingers of children or infants.
It is not surprising that nearly all children – 98 percent – who live with a smoker have measurable tobacco toxins in their bodies.
Anti-smoking campaigns are effective, but the recession and more pressing financial needs have decimated state tobacco-control programs. States spent $517 million on anti-tobacco programs in 2011, which is 28 percent less than in 2008 and just 14 percent of the $3.7 billion recommended by the Centers for Disease Control. Tobacco companies spend about $25 on marketing for every $1 the states spend to fight tobacco use.
Countries that have completely outlawed tobacco advertising have been effective in reducing tobacco use. Nations with limited policies, such as the United States, have not had much impact.