What impact do cigarette taxes have on continued smoking and mortality?

By Dr. Liji Thomas, MDApr 17 2023Reviewed by Lily Ramsey, LLM

A recent study published in the Journal of Public Economics analyzed the effects of cigarette taxes experienced as a teenager on adult smoking participation and morality.

Study: Cigarette taxes, smoking, and health in the long run. Image Credit: SpeedKingz/Shutterstock.com

Introduction

Public health experts have concluded that cigarette smoking was associated with a higher risk of death due to cardiovascular disease, cancer, and respiratory disease dating back to the 1960s.

A variety of approaches has been adopted since that point to reduce smoking risk, though most of the evidence of such risk comes from correlation studies which typically ignore several confounding factors.

The current paper looks at how cigarette taxes affect smoking rates and mortality risk when imposed during the teens. The paper combines data from multiple sources to estimate the long-term effects of teenage tax on smoking outcomes as an adult.

Teenagers are more sensitive to cigarette tax and form the bulk of future adult smokers. Additionally, teenagers are most likely to take up the habit before reaching 20 years old, and teenage smoking is heavily associated with smoking later in life.

Thus, any action that reduces teenage smoking could potentially cause a significant difference in the lifetime risk of smoking.

The data came from the Tobacco Use Supplement to the Current Population Survey (TUS-CPS), combined with the annual tax rates for cigarettes from 1950 until now.

Adjusting for confounding factors, the researchers attempted to identify adult smoking participation rates following the teenage cigarette tax.

What did the study show?

The results of the current study seem to show that the rate of adult smoking drops significantly following cigarette taxation during a potential consumer's teenage years.

In particular, it is observed that an increase in cigarette tax by a single dollar between the ages of 14 and 17 years causes a decline in cigarette smoking among adults by two percentage points, or by 8% below the average.

In terms of health, the same tax is associated with a 4% reduction in mortality among adults, or by 20 per 100,000 population.

Most of this decline is due to smoking-related disease reduction, including diabetes, certain forms of heart disease, cancers, and respiratory diseases linked to smoking. It is especially strong for lung cancer and heart disease.

The decline in mortality compared to that caused by reduced smoking is predictable, given that multiple health-related impacts of smoking and adverse behavioral changes like drinking could also affect the death rates.

This is the first study to examine the long-term effects of cigarette taxes, and the scientist used historical data to find the mortality rate in adults concerning taxes at ages 14-17 years. Cigarette taxes before 11 years old fail to affect adult mortality in the same significant way as taxes applied at 20-24 or older ages.

What are the implications?

Taken together, our results suggest that cigarette tax increases in the 1950s through the late 1970s prevented adult smoking and, decades later, reduced mortality among older Americans. More broadly, they provide support for the notion that efforts to reduce teenage smoking—through cigarette taxes, raising the minimum legal purchase age, or other policies—will yield lifelong health benefits."

The researchers sought to strengthen evidence of any existing relationship between smoking and adult health by looking at cigarette taxes alone, an exogenous factor.

The results thus indicate a two-pronged impact of teenage cigarette taxes. Firstly, they reduce the chances of adult smoking rather than simply delaying it, thus changing a potentially lifelong habit.

This could be due to a smaller chance of tobacco initiation during adolescence, or conversely due to a lesser duration of smoking, or both factors, which the study does not examine in detail.

Secondly, cigarette taxation reduces adult mortality, whether directly linked to smoking-related diseases or otherwise. Unlike earlier correlational studies, the current paper proves that smoking is associated with adverse impacts on adult health and mortality.

The authors suggest that if the minimum legal age for cigarette purchase was raised to 21, adult mortality rates might substantially decline in a few decades.