One Size Fits All?

Background

To determine the relative impact of each of the three state-level tobacco control policies (cigarette taxation, tobacco control spending, and smoke-free air (SFA) laws) on adult smoking rate overall and separately for adult subgroups in the U.S.

Methods

We conducted a difference-in-differences analysis with generalized propensity scores. We merged state-level policies with the individual-level Behavioral Risk Factor Surveillance System in 1995–2009.

Results

State cigarette taxation is the only policy that significantly impacted smoking among the general adult population, with a one standard deviation increase in taxes (i.e., $0.68 in constant 2014 dollars) lowering the adult smoking rate by about a quarter of a percentage point. The taxation impact was consistent, regardless of the presence of, or interactions with, other policies. Taxation was also the only policy that significantly reduced smoking for some adult subgroups, including females, non-Hispanic Whites, adults aged 51 or older, and adults with more than a high school education. However, other adult subgroups responded to the other two types of policies, either by mediating the taxation effect or by reducing smoking independently. Specifically, tobacco control spending reduced smoking among young adults (ages 18–25 years) and Hispanics. SFA laws affected smoking among men, young adults, non-Hispanic Blacks, and Hispanics.

Conclusions

State cigarette taxation is the single most important policy for reducing smoking among the general adult population. However, adult subgroups' reactions to taxes are diverse and mediated by tobacco control spending and SFA laws.