Abstract
Background As cigarette smoking continues declining among youth and young adults, smoking rates among older Americans remain unchanged. Historically, cigarette and, more recently, e-cigarette tax policies influenced smoking behavior in younger smokers. Understanding how older smokers respond to tax changes can inform public health strategies.
Methods We assembled a quarterly panel of state cigarette and e-cigarette tax rates using the CDC STATE System Tobacco (2000–2024) and E-Cigarette Legislation databases (2015–2024), then merged these data to individual-level survey responses from the Behavioral Risk Factor Surveillance System (BRFSS). Our sample included all adults aged ≥65, but our main specification included adults with a history of smoking. We estimated two-way fixed-effects population-weighted linear probability regression models of current smoking and past-year quit attempts.
Results Among 3,117,382 adults, 50% had a history of smoking; from which 18% currently smoked. A one-dollar tax increase was associated with current smoking: cigarette tax = -0.61-percentage points (CI = -0.94,-0.28); e-cigarette tax = +0.19-percentage-points (CI = 0.14,0.24). There was no association between cigarette taxes and quit attempts. A one-dollar increase in e-cigarette tax was associated with reduced quit attempts (-0.17-percentage-points; CI = -28,-0.06). Approaching tax parity by one dollar was associated with increased current smoking by 0.23-percentage-points (CI = 0.16,0.29) and reduced quit attempts by -0.17-percentage-points (CI = -0.29,0.05).
Conclusions Older American smokers appear responsive to cigarette and e-cig tax changes. Policies increasing the relative cost of e-cigarettes may impede cessation and perpetuate smoking rates in older generations at the highest risk of smoking related harm.
Implications Many studies have investigated the impact of cigarette and e-cigarette tax changes on smoking behavior in youth or younger adults. This study adds new evidence quantifying how new cigarette and e-cigarette taxes change smoking behavior among older adults, a population yet to realize reductions in smoking despite higher risk of tobacco related harm. Analyzing large, population-based survey data, we show that older smokers change smoking behavior due to cigarette and e-cigarette taxes. Taxation of e-cig products may produce unintended harm among older smokers. Specifically, approaching tax parity may increase cigarette smoking and reduce quit attempts among older adults with a history of smoking.
Competing Interest Statement
The authors have declared no competing interest.
Funding Statement
Funding: none.
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Data Availability
Statement: Analytic data and code available at corresponding author’s publicly accessible repository [BLIND DURING PEER REVIEW].
