More smokers quit after big hike in California tobacco tax
When tobacco taxes go up, more people quit, especially when the increase is big
Researchers from University of California San Diego and UC San Francisco have found that Proposition 56, a major tobacco tax increase that was overwhelmingly approved by California voters in 2016, was associated with a significant increase in smoking cessation over the next three years. The study, published in the Journal of the National Cancer Institute, also reported significant differences in state tobacco spending and the proportion of people smoking daily.
“California’s tax increase was over 200%, and tobacco companies largely passed the increase on to their customers,” said Shu-Hong Zhu, Ph.D., a professor at the Herbert Wertheim School of Public Health and Human Longevity Science at UC San Diego and lead author of the study. “The resulting price hike likely motivated a lot of smokers to quit.”
Though the health impacts are well known, in 2022, 49.2 million (19.8%) — or nearly 1 in 5 — U.S. adults reported actively using tobacco. One strategy that many states have used to incentivize people to stop smoking is to increase taxes on tobacco products.
California Proposition 56 increased the state tobacco tax by $2 per cigarette pack, and much of the additional revenue generated through the tax was funneled back into the state’s tobacco prevention efforts.
To analyze the impact of the tax, the researchers utilized data from the Behavioral Risk Factor Surveillance System at the U.S. Centers for Disease Control and Prevention to determine smoking cessation rates before and after the tax. Cessation rate, also known as quit rate, was defined as the percentage of survey respondents who smoked within the last year, but had quit for at least three months.
They found that:
- The three-month quit rate in California increased from 11.5% in the three years prior to the passage of Proposition 56 to 14.2% in the three years after.
- Smoking quit rates were nearly unchanged in the 18 other states (including the District of Columbia) that raised their tobacco taxes at least once during the study period.
- In the 32 states that did not raise tobacco taxes, quit rates declined significantly, from 9.5% to 9.0%.
- California saw a 271.9% increase in tobacco prevention spending per capita in the study period. In contrast, other states that raised taxes saw a 12.8% decrease in spending, while states that did not raise taxes saw an 11.2% decrease.
- Even among those who did not quit, the percentage of daily smokers decreased.
The researchers hypothesize that the large increase in cessation in California is a result of the price change in cigarettes after the tax. In the three years following Proposition 56, the average price of cigarettes in California was 30.8% higher than in the three years before the initiative passed, after adjusting for inflation. In contrast, prices only increased by 6.3% on average across the 18 other states that raised their taxes.
However, the researchers also note that these two factors are interrelated, so it’s difficult to parse out the precise reason for the change.
“We don’t know what’s more responsible for the increase in quitting in California, whether it’s the tax increase itself or the increased spending on prevention that the tax enabled,” added Zhu.
Either way, the results in California are promising and speak to the impact of tobacco tax increases on public health.
“Many Californians have advocated for years to increase the tobacco tax and shore up funding for tobacco prevention,” said Michael Ong, M.D., Ph.D., a professor of medicine and health policy and management at UCLA and chair of the Tobacco Education and Research Oversight Committee, which advises the California Tobacco Prevention Program. “This study shows one of the many ways we are reaping the rewards of that effort in California — by meaningfully increasing successful quitting.”
On the other hand, the researchers suggest that the results from other states offer a cautionary message: that creating meaningful change in tobacco usage requires a significant commitment by state governments.
“Raising tobacco excise taxes is one of the main public health tools for reducing smoking prevalence,” Zhu explained. “But to achieve a measurable increase in quitting on a population level, you may have to go big.”
Read the full study.
Additional study authors include Christopher Anderson and Yue-Lin Zhuang at UC San Diego Moores Cancer Center, Hai-Yen Sung at the Institute of Health and Aging at UC San Francisco, and Anthony Gamst at the Computational and Applied Statistics Laboratory in the San Diego Supercomputer Center and Department of Mathematics at UC San Diego.
This research was funded by the California Department of Public Health (contract #CDPH-22-1008).
Disclosures: The authors report no competing interests
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Journal
JNCI Journal of the National Cancer Institute
COI Statement
The authors report no competing interests.
Smoking leaves lasting mark on teeth, research reveals
Researchers from Northumbria University have discovered that smokers have tell-tale signs of their smoking habits ingrained deep within their teeth, which remain even after a person has quit
Northumbria University
image:
Example of smoking damage in an archaeological tooth. The magnified image shows variations in the tooth's cementum rings caused by smoking
view moreCredit: Dr Ed Schwalbe, Northumbria University
Evidence of the permanent impact of smoking on people’s teeth has been uncovered by researchers for the first time.
Researchers from Northumbria University have discovered that smokers have tell-tale signs of their smoking habits ingrained deep within their teeth, which remain even after a person has quit.
Their findings, which are now published in the scientific journal PLOS One, could help to shine new insights on forensic and historical investigations.
Teeth consist of three main hard tissues: enamel, dentine and cementum. Cementum, which covers the tooth root, develops characteristic “rings” that grow each year as we age – much like tree rings.
The research team had initially set out to see if these rings could be used to predict the age of an individual in a forensic setting, such as identifying disaster victims or for situations when an individual’s DNA is not on a DNA database.
After examining a total of 88 teeth provided by both living dental patients and from archaeological remains, they were surprised to find signs of disruption in the cementum rings of some teeth, but not in others.
The disruption appeared as variations in the thickness and regularity of the rings within the teeth.
The researchers realised that these disruptions were associated with those who had identified as current or ex-smokers.
Their study revealed evidence of smoking damage in the teeth of 70% of ex-smokers and 33% of current smokers, compared to just 3% of non-smokers.
They also found that the cementum is thicker in ex-smokers. They believe this is a result of the cementum returning to its normal levels when smoking ceases, leaving ‘stronger’ deposits on top of the damaged rings which makes them thicker, whereas current smokers continue to have disruption to their cementum levels.
“Our research shows that it’s possible to tell if someone was a smoker just by examining their teeth,” said Dr Ed Schwalbe, Associate Professor in Northumbria University’s Department of Applied Sciences.
“We found that the regular annual deposition of rings was disrupted for some individuals and realised that these disruptions were associated with current or ex-smokers, but were very rare in non-smokers.”
Forty-six individuals who were undergoing dental treatment requiring tooth extraction consented to take part in the study, providing 70 teeth between them along with their medical and smoking histories.
Notably, the researchers found smoking damage in one of the teeth provided by a living donor which they estimated to have occurred between the ages of 22 and 41.
On checking the information provided, they found that the donor, who was aged 58 at the time of tooth extraction, was a smoker during that period. They had begun smoking when they were 28 years old and stopped at the age of 38.
Dr Schwalbe and Dr Valentina Perrone worked with Dr Sarah Inskip, UKRI Fellow at the University of Leicester’s School of Archaeology and Ancient History, to sample a further 18 teeth from archaeological remains dating from 1776-1890.
Evidence of the age, biological sex and date of death was available for 13 of the 18 teeth provided.
Some of the archaeological teeth bore clear evidence of smoking activity, displaying staining and even notches from pipe smoking.
Remarkably, cementum analysis of the archaeological samples revealed that the rings within the teeth of smokers who died in the 18th and 19th centuries displayed the same signs of disruption as those from living donors who were current or ex-smokers.
The findings could prove to be especially important for forensic science and historical studies in future, added Dr Schwalbe.
“This could help us learn more about people’s lifestyles in the past, especially in archaeological studies where patterns of tobacco use can reveal important cultural insights,” he said.
“The identification of 'smoking damage' in archaeological teeth opens up further avenues to understand how the long-term consumption of tobacco in populations has affected our health through time,” added Dr Inskip, who leads the Tobacco, Health and History Project which looks at the long-term consequences of tobacco use on health between 1600-1900.
“By looking at growth rings in the teeth, we can also estimate a person’s age when the tooth was removed, or when they died,” said Dr Schwalbe. “Together, this information could help identify unknown individuals – such as disaster victims or those buried in mass graves – and offer new tools for forensic and historical investigations.”
Cementochronology – the study of what is more formally known as acellular extrinsic fibre cementum (AEFC) – has been widely used to estimate age at death and conditions such as pregnancy or disease, but this is believed to be the first time it has been used to predict tobacco use.
Dr Valentina Perrone, who is now working as a Research Assistant at Leicester University, added: “We compared the cemental deposition of smokers, ex-smokers and non-smokers visually and statistically to identify irregularities that were potentially connected to smoking activity. We found that individuals with a history of smoking – whether as a current or former smoker – were significantly more likely to have disruption to their cementum than those who did not.
“Smoking is known to have a systemic impact on the body and numerous studies have highlighted the correlation between smoking, peridontitis and tooth loss. This study shows, for the first time, the biological record of smoking-related oral health damage within the dental structure.”
The paper, Reconstructing smoking history through dental cementum analysis – a preliminary investigation on modern and archaeological teeth is now published in PLOS One.
Journal
PLOS One
Subject of Research
Human tissue samples
Article Title
Reconstructing smoking history through dental cementum analysis – a preliminary investigation on modern and archaeological teeth
