TOBACCO TAXES AND CIGARETTE CONSUMPTION IN LOW INCOME POPULATIONS

Abstract

In their letter in response to Franks et al.’s analysis of the failure of tobacco taxes to effectively reduce smoking among lower socioeconomic status smokers,1 Farrelly and Engelen assert that concerns about the regressivity of tobacco can “easily be addressed…by earmarking revenue from cigarette excise taxes to evidence based smoking cessation interventions targeted to low income populations with the highest smoking rates.”2(p582) This is a noble sentiment, but optimistic, given political reality. After a decade of more than 100 separate state increases in tobacco taxes and strong efforts by public health advocates, there have been few instances of such an earmark attached to a bill to increase taxes. Indeed, the actual record of tobacco tax increases (just as for the billions of dollars secured by the Master Settlement Agreement in 1998) is one of state governments using the funds for nearly every purpose but tobacco control, let alone cessation services for impoverished smokers. It is well established that disparities between economic classes in regard to the prevalence of smoking have increased in the past decade, and currently, low-income smokers are twice as likely to smoke as those with high incomes.3 Data from the US Current Population Survey (1995–2002)4 on self-reported cigarettes consumed per day indicate that adult smokers with lower educational attainment also smoked more cigarettes per day and are reducing consumption more slowly than those with college degrees (Figure 1). During this period, the average price per pack more than doubled, from $1.80 in 1995 to $3.72 in 2002.5 FIGURE 1 Cigarettes per day for adult smokers 25 years and older, by educational attainment: United States, 1995-1996, 1998–1999, 2001–2002 The Center for Tobacco Free Kids, an advocate of higher tobacco taxes, estimates that only 3% of the Master Settlement Agreement and tobacco excise taxes is used for tobacco control.6 Inclusion of the additional $7 billion from the federal excise tax would diminish the proportion spent on tobacco control to 2%.6 Furthermore, only a fraction of those funds are used to assist low-income smokers to help quit smoking. For tens of millions of smokers who want to quit, poorly funded tobacco control programs offer little assistance. Unfortunately, many of these same programs advocate for tobacco taxes under the misguided notion that high prices will economically coerce poor smokers to quit. If we are to believe our own science, that smoking is addictive, we must recognize the extent to which the primary result of highly priced tobacco products further impoverish a substantial portion of low-income tobacco users. This should be as much of a concern of public health advocates as the ongoing tobacco epidemic among the lower classes.