Without tax hikes, US likely to miss public health target

Most U.S. states are at risk of missing the goal of reducing smoking rates to below 5% by 2030 without strong tax policies and complementary regulations to curb the tobacco epidemic, according to a study published in the journal Tobacco Control.

The goal of reducing tobacco prevalence in the United States to 5% by 2030 is part of one of the objectives of Healthy People 2030, a program launched by the US Department of Health in April 2020. The researchers worked on simulations of tobacco prevalence in all states, and compared the results with the desired objective. Depending on the gaps, the intensity of tobacco tax policies to be implemented could be identified.[1].

45 US states may not meet their goal by 2030

In 2018, the U.S. smoking rate was 13.7%, with significant geographic variation. While Utah is close to meeting the Healthy People 2030 goal, with an adult smoking prevalence of 7.1%, West Virginia is the furthest behind of all U.S. states, with 22.7% of its adult population currently smoking. Overall, nearly all of the United States is on track to miss its public health goal. For example, based on the current trajectory of the nation’s smoking prevalence, the simulation projects that only five states will have a smoking rate below 5%, and 45 will miss the goal. Laggard states include West Virginia, with a predicted smoking prevalence of 16.8% by 2030, and Louisiana, with a predicted smoking prevalence of 16.6% by 10 years. Nationwide, the predicted smoking prevalence by 2030 is 8.4%.

Tax increases, an effective tool abandoned by the American public authorities

According to the researchers, the delay in most American states is explained by the absence of a real ambitious tax policy on tobacco products, while the entire scientific literature demonstrates that tax increases, when significant and repeated, constitute the most effective and cost-effective lever for reducing tobacco consumption, starting with that of the younger generations and populations with low income levels. Of all 50 states, only 22 have occasionally increased tobacco taxes between 2011 and 2020. As a result, the price of tobacco remains particularly cheap in many states. In 15 of them, the price of a pack of cigarettes is less than $6, including Missouri, with a pack at €4.99. For example, the €6 mark for a pack of cigarettes was crossed in France in 2012.

Increase taxes sharply to achieve public health goals

Based on these results, and a calculation of the price elasticity of tobacco products, the researchers emphasize that a strong tax policy is necessary for these states to achieve the desired public health results. Given the great disparity in smoking situations in the United States, the intensity of the tax policies recommended by the study is also very variable. For example, in California, with an expected smoking prevalence of 5.2% in 2030, the researchers do not insist on the need to adopt a tax policy. On the other hand, the study emphasizes that an annual tax increase of $1.37 in West Virginia could be necessary, pushing the price of a pack of cigarettes above $18 by 2030. In total, to achieve their public health objective, six American states would have to introduce annual tax increases of more than $1 per pack of cigarettes.

Complementary tools to tax increases to increase their effectiveness

For the authors of the study, while taxation is a public health tool to be favored, it is not the only one that must be implemented. Indeed, beyond the tax component, the researchers emphasize the need to set up support for smokers to reduce social and economic inequalities in quitting smoking, particularly by targeting disadvantaged communities. Furthermore, due to the significant tax disparities between the different American states, the researchers call for the implementation of measures to limit interstate tobacco purchases, which could partly mitigate the effects of these public health measures. Finally, to ensure the implementation of an ambitious tax policy, public authorities are reminded of the need to protect themselves from interference from the tobacco industry, the main threat to the implementation of effective regulations.

FT

[1] Nargis N Healthy People Countdown 2030: reaching 5% cigarette smoking prevalence among US adults through state cigarette excise tax increases, Tobacco Control Published Online First: 05 November 2021. doi: 10.1136/tobaccocontrol-2021-056755