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U.S. will miss 5% smoking prevalence target by 2030 without more cigarette tax hikes

45 states need to impose annual cigarette excise rises of up to $1.37 a pack, finds analysis.

The U.S. will miss its goal is to reduce U.S. adult cigarette smoking prevalence to 5% by 2030, known as Healthy People 2030, without hiking taxes on cigarettes, finds an analysis by Nigar Nargis, PhD, scientific director, Tobacco Control Research. It was published online on Nov. 11 in the journal Tobacco Control.

Only five states and the District of Columbia (DC) are on track to meet this goal, and the other 45 states will need to raise excise taxes up to $1.37 a pack every year while continuing with other tobacco control measures if they are to do so, says the researcher.

Dr. Nargis wanted to find out if this goal is achievable through hikes in state cigarette excise taxes. She compared trends in smoking prevalence for each state between 2011 and 2019 with the desired trends for achieving 5% smoking prevalence. 

The current cigarette smoking prevalence varies widely, ranging from a low of around 7% in Utah to nearly 23% in West Virginia in 2021. The price-adjusted trend in cigarette smoking prevalence between 2011 and 2019 also varies widely from −1.13 percentage points (pp) in DC to 0.00 pp in Hawaii and Montana. The desired annual trends range from −0.23 pp in Utah to −1.97 pp in West Virginia. 

The gaps between price-adjusted and desired trends were used to calculate the systematic annual increases in state cigarette excise tax that would be needed, alongside other tobacco control measures, such as a ban on smoking indoors, mass media campaigns, and smoking cessation support.

The price-adjusted trends in smoking prevalence observed between 2011 and 2019 are on course to exceed the desired trends for achieving 5% smoking prevalence by 2030 in only five states, the analysis shows: Washington, Utah, Rhode Island, Massachusetts, Maryland, plus the DC. 

This suggests that most states and the U.S. overall will miss the target at the current rate of reduction in smoking, with 45 states needing systematic annual increases in cigarette excise tax rate, ranging from  $0.02 to $1.37 a pack between 2022 and 2030.

Only 22 states increased cigarette excise tax rates occasionally during 2011–2021, suggesting that "cigarette excise tax policy has remained a severely underused measure of tobacco control despite its proven effectiveness in reducing smoking and related health disparities.” 

The analysis also suggests that the desired state average price for a pack of 20 cigarettes in 2030 will range from $6.13 to $18.43.

Dr. Nargis acknowledges that there may be unintended and adverse financial consequences for the smokers who struggle to quit, specifically among those in the disadvantaged communities.

“It is, therefore, crucial to scale up non-tax tobacco control measures targeted to disadvantaged communities, harmonise tax and price across neighbouring states, and monitor and counter tobacco industry interference to mitigate these unintended consequences of tax and price increases,” she said.

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