Public policy and smoking cessation among young adults in the United States
Introduction
Cigarette smoking is the single most preventable cause of death and disability in the United States (US), responsible for more than 400,000 premature deaths each year [1]. On average healthy male and female adults who smoke a pack or more of cigarettes each day live 7.1 and 4.1 fewer years, respectively, than their healthy counterparts who never smoked [2]. Notwithstanding the reduced life expectancy, smokers incur significantly higher lifetime medical expenditures than do neversmokers [3]. Despite the deleterious health effects of cigarette smoking, approximately 46.5 million adults in the United States aged 18 and over were current smokers in 2000, representing nearly one quarter (23.3%) of the total United States adult population [4].
According to the 1990 Surgeon General’s report, smoking cessation represents the single most important step that smokers can take to enhance the quality and length of their lives. Relatively small increases in smoking cessation have been found to yield substantial gains in quality-adjusted life-years among individuals aged 20–69 [5].
While the likely health benefits of smoking cessation are quite substantial, only 2.5% of smokers in the US quit smoking permanently each year [6]. The inability of smokers to quit is not due to a lack of desire, but rather, it is due in large part to the addictive properties of nicotine [7]. The Centers for Disease Control and Prevention estimated that more than two thirds of current smokers in the United States wanted to quit smoking completely in 1995 and just under half (45%) of everyday smokers quit smoking for at least 1 day during the preceding 12 months in an effort to stop stoking [8].
While unassisted smoking cessation is the most common approach used by smokers to quit, the existing medical literature suggests that pharmacotherapies such as nicotine replacement products and sustained release bupropion, physician advice, and non-physician counseling increase the likelihood of successful smoking cessation [9], [10], [11]. A substantial body of evidence from the discipline of economics suggests that cigarette prices are inversely related to smoking propensity and intensity.1 A preponderance of the studies concluded that the total price elasticity of adult cigarette demand falls in the range of −0.3 to −0.5 [12]. Consistent with economic theory, several studies have found adolescents and young adults to be substantially more responsive to cigarette prices than adults [13], [14], [15], [16], [17]. Studies based on survey data suggest that approximately half of the effect of price on cigarette demand is through its impact on smoking prevalence with the remainder of the effect on average smoking by smokers. While a significant number of studies have concluded that cigarette prices and smoking prevalence are inversely related, very few have been able to distinguish whether or not a decrease in prevalence, due to a price increase, is a result of decreased smoking initiation or increased smoking cessation. Several studies of adults and young adults have concluded that cigarette price increases have a positive impact on smokers’ decisions to quit smoking [18], [19], [20]. In addition, several studies have found a negative relationship between cigarette prices and adolescent smoking initiation [21], [22], [23].
This research adds to the very small body of evidence on the impact of cigarette prices on smoking cessation and distinguishes itself from previous studies by modeling multiple quit attempts of young adults. In addition, this research examines the impact of laws restricting smoking in private worksites and public places on young adult smoking cessation decisions. The public health findings from this research should be particularly important to many state policymakers who are contemplating the use of cigarette excise taxes to generate additional revenues in an attempt to compensate for fiscal shortages associated with the recent downturn in the economy.
Section snippets
Data
The empirical models that are estimated in this study employ panels formed from the nationally representative cross-sectional surveys of high school seniors conducted by the Institute for Social Research (ISR) at the University of Michigan. Each year since 1975, ISR has conducted a nationally representative random sample of between 15,000 and 19,000 high school seniors as part of a national research program titled Monitoring the Future: A Continuing Study of American Youth (MTF).
Methods
In the case of cigarette smoking, an individual can occupy one of two discrete states: smoking and non-smoking. As the costs of smoking increase, economic theory predicts that smokers would be more likely to move from the smoking state to the no-smoking state. Hazard modeling is the appropriate statistical technique to examine the structural determinants of the decision to make a transition from one discrete state to another. This paper employs a Cox regression to examine the impact economic
Results
Estimates from the cessation equations are presented in Table 2. Eight alternative models are estimated. The model presented in the first column (model 1) contains estimates from a specification which includes real average price, three dichotomous clean indoor air indicators reflecting state level restrictions on smoking in private worksites, restaurants, and any other public place, and a variety of socio-economic variables including: race, gender, income, type of community, marital status,
Discussion
The Balanced Budget Act of 1997 (Public Law 105-33, Section 9302) imposed a two-stage Federal excise tax increase on cigarettes. As part of the Balanced Budget Act of 1997, the Federal excise tax on a pack of 20 cigarettes increased by 10 cents on 1 January 2000. Two years later, the Federal excise tax on cigarettes increased an additional 5 cents per pack bringing the total Federal excise tax on cigarettes to 39 cents per pack.
In the wake of significant declines in revenues and large budget
Acknowledgements
Support for this research has been provided by the Robert Wood Johnson Foundation. I am indebted to Patrick O’Malley and Timothy J. Perry for providing the Monitoring the Future Data.
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