The relation between tobacco taxes and youth and young adult smoking: What happened following the 2009 U.S. federal tax increase on cigarettes?
Introduction
Tobacco use remains the leading preventable cause of death and disease in the United States (US DHHS, 2014). Data from the National Survey on Drug Use and Health (NSDUH) show that among youths aged 12 to 17 who had not smoked cigarettes prior to the past year (i.e., youths at risk for initiation), the incidence rate in 2012 was 4.8%. The prevalence of current cigarette smoking was 31.8% among young adults aged 18 to 25 (SAMHSA, 2013a). Both the rate of youth initiation to cigarette smoking and the prevalence of current smoking among young adults are well above the goals set by the U.S. Department of Health and Human Services in its Healthy People 2020 objectives (US DHHS, 2012a).
One of the most effective policies for reducing tobacco use is to increase the price of tobacco products, which is most commonly achieved by increasing state and federal excise taxes (Guide to Community Preventive Services, 2012). Several recent systematic reviews have found that higher cigarette prices lead to a reduction in smoking prevalence and intensity among youth and young adults (Bader et al., 2011, Chaloupka et al., 2011, International Agency for Research on Cancer (IARC), 2011, Rice et al., 2009). Tauras (2005) found that, among young adults, an increase in the price of cigarettes led to transitions from daily smoking to no smoking, from moderate daily to light daily smoking, and from heavy daily smoking to moderate daily smoking. Several studies also conclude that higher prices resulting from higher taxes increased the number of quit attempts and the probability of successful cessation among youth and young adults (DeCicca et al., 2008, Tauras, 2004, Tauras and Chaloupka, 2001, U.S. Department of Health and Human Services (US DHHS), 2012b, Zhang et al., 2006). Evidence suggests that youth and young adults are more sensitive to cigarette price and tax increases than adults (Chaloupka, 2001, Chaloupka et al., 2011, Chaloupka and Wechsler, 1997, Farrelly and Bray, 1998, U.S. Department of Health and Human Services (US DHHS), 2012b). While higher taxes and prices may not altogether prevent young adolescents from experimenting with cigarettes, regular uptake of smoking typically also occurs at younger ages. Higher taxes therefore do have the potential to reduce smoking rates in the longer term (Ross & Chaloupka, 2003).
This is the first study to examine changes in youth and young adult smoking behavior before and after the passage of the Children's Health Insurance Program Reauthorization Act of 2009, which raised the federal excise tax on a pack of cigarettes from $0.39 to $1.01 per pack, an increase of 158% (GPO, 2009). This represented the largest increase in U.S. federal excise taxes to date. As a result, cigarette prices jumped by 9.4% between March and April of 2009 (U.S. Department of Labor, 2009). The federal tax increase was also the only major tobacco control policy that affected smokers across the U.S. between 2008 and 2009. During this period, average state-level excise taxes on cigarettes remained more or less the same (CDC, 2009), and no other tobacco control policies were implemented uniformly across states.
The objective of our study was to estimate the effect of the federal cigarette tax increase on a wide range of smoking behaviors, including: (1) cigarette smoking initiation, (2) the prevalence of current cigarette use, (3) the number of days cigarettes were smoked among current smokers, (4) the average number of cigarettes smoked per day among current smokers, and (5) smoking cessation. We estimated the effect of the tax on youths aged 12–17 and young adults aged 18–25, by sex and race/ethnicity.
Section snippets
Sample
The National Survey on Drug Use and Health (NSDUH) was used to examine the smoking behavior of youth and young adults from 2002 to 2011. NSDUH is an annual cross-sectional, national- and state-based survey on the use of tobacco products, alcohol, illicit drugs, and mental health status among the U.S. civilian, non-institutionalized population aged 12 or older (SAMHSA, 2013a). The survey has been conducted since 1971 and collects data quarterly through face-to-face interviews. NSDUH employs a
Descriptive statistics
Table 1 contains the average rates of smoking initiation, past-month smoking and smoking cessation before and after the April 1, 2009 federal tax increase. Rates are shown separately for youth aged 12–17, young adults aged 18–25, and four subgroups. Table 1 also shows, for current smokers, the number of days smoked during the past month and the number of cigarettes consumed per day of smoking.
Smoking initiation rates among youth and young adults were lower after the April 1 2009 tax increase
Discussion
This study found that the April 1, 2009 federal cigarette excise tax increase of $0.62 per pack was associated with a decrease in smoking initiation among youth and decreases in past-month smoking, days smoked per month, and cigarettes per day among youths and young adults. There was no evidence that the tax increase was associated with a significant change in the likelihood of smoking cessation among youth and young adults.
Interestingly, the likelihood of smoking initiation among young adults
Disclaimer
The findings and conclusions of this study are those of the authors and do not necessarily reflect the views of the Substance Abuse and Mental Health Services Administration, the Centers for Diseases Control and Prevention, and the U.S. Department of Health and Human Services.
Role of funding sources
This study was funded by a contract from the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention to RTI International. Co-authors from these agencies played an active role in the interpretation of the data, writing the manuscript, and decision to publish.
Contributors
MVH, MP, and BRL designed the study, conducted the data analysis, interpreted the results, and wrote the manuscript. JK, BH, RSC, and JCG interpreted the results and provided comments on manuscript drafts. All authors have approved the final manuscript.
Conflict of interest statement
None to declare.
Acknowledgments
We thank Lance Couzens, Vincent Keyes and Susan Murchie at RTI International, Jeremy Bray at the University of North Carolina at Greensboro, and Frank Chaloupka at the University of Illinois at Chicago for their assistance with various aspects of this study.
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