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Opinion: Raise tobacco tax

By: REBEKAH HARTMAN, Mandan
It is time for North Dakota to raise the tobacco tax. I know firsthand that raising the price is an effective way to help people quit smoking.
I am personally affected by our state’s low rate of tobacco taxes as my husband is in a constant struggle to battle his addiction to tobacco. When we lived in Minnesota, the price of cigarettes was high enough that buying a pack forced him to stop and think about what — exactly — the money was going for and if there was a better way to spend the dollars. Now that we’re in North Dakota, where the cigarette prices are shockingly low, there is little pause when deciding to buy a pack.
I’m urging our state legislators to support the proposals before them to increase the state tobacco taxes. Our elected officials should seize the opportunity to increase taxes on all tobacco products as it would reduce smoking rates, support countless people who are desperately trying to break their addiction, and ultimately lower health care costs for all North Dakotans.
http://bismarcktribune.com/news/opinion/mailbag/raise-tobacco-tax/article_7d15ce12-df00-50f2-a0e2-47a0658cfa34.html

Proposed tobacco tax hike debated

By Nick Smith, Bismarck Tribune

Screen Shot 2015-02-08 at 5.28.04 PMHealth care officials gathered to voice support Tuesday for an increase to the state’s tobacco tax while business leaders lined up in defense of the status quo.

Nearly 50 people packed the Fort Totten Room for the hearing on House Bill 1421 before the House Finance and Taxation Committee.

HB1421 takes aim at North Dakota’s tax rate for tobacco. The state ranks 46th nationally in tobacco taxes at 44 cents per pack, ahead of Alabama, Georgia, Louisiana and Virginia.

HB1421 would raise the state’s cigarette tax to $1.54 per pack. It would also raise the excise tax on other tobacco products from 28 percent of the wholesale purchase price to 43.5 percent.

Similar legislation died in 2013, one of several previous unsuccessful legislative efforts to raise the tax since it was last increased in 1993.

“This bill is intended to stop young people from beginning to smoke. This is primarily for the health of North Dakota,” said Rep. Jon Nelson, R-Rugby, who estimated $103.5 million in new revenue would be generated during the 2015-17 biennium.

That figures does not include the $50 million per biennium the state’s general fund would still receive in tobacco taxes.

Sixty percent of new revenue would go toward health-related programs in the state’s Community Health Trust Fund. The rest would go to local communities for health-related programs.

Cost of prevention

Data from the Campaign for Tobacco-Free Kids says a cigarette tax of $2 per pack would prevent approximately 7,500 people younger than 18 to not smoke and prompt an estimated 8,000 adult smokers to kick the habit. The organization also claims this could result in $300 million in savings in future health care expenditures.

“With the retail sector of the state’s economy hitting on all cylinders, why would any legislator support throwing a wrench into the economic engine?” asked Mike Rud, president of the North Dakota Petroleum Marketers Association.

Data from the Centers for Disease Control and Prevention for 2012 shows that tobacco use isn’t a major problem in North Dakota, according to Rud, pointing out that North Dakota ranked 37th in adult smoking and 49th in smokeless tobacco use. Rud said among youth smokers North Dakota ranked 34th among 44 states reporting data.

“Contrary to what some may believe, North Dakota retailers don’t stand in the driveway or on the storeroom floor attempting to sell tobacco products,” Rud said. “We simply attempt to meet consumer demand. Don’t tie our hands.”

Dr. Eric Johnson, of Grand Forks, said North Dakota largely gets top marks from the American Lung Association’s annual state by state report card on tobacco control. Prices are the one area in which North Dakota gets a flunking grade, which Johnson called the main hole in the state’s tobacco cessation program.

Johnson also criticized the state for being 46th in tobacco taxes.

“If we were 46th in diabetes and obesity management, I don’t think we’d be happy with that,” Johnson said.

Paul Mutch, owner of Mutch Oil Company in Larimore, also voiced opposition to HB1421.

Mutch said, with national discussion on middle class needs and taxes, he found it odd the state would consider raising any taxes that would impact lower-income individuals most. CDC data puts 32 percent of North Dakotans earning less than $15,000 annually as smokers compared to 15.5 percent for those earning more than $50,000.

“I don’t believe raising taxes would result in any fewer smokers,” Mutch said. “Just more North Dakota residents with less money in their pockets for the things they really need.”

http://bismarcktribune.com/news/local/govt-and-politics/proposed-tobacco-tax-hike-debated/article_421fdf67-d289-5036-ae3c-a170e0e882a4.html

Pro-business lobby speaks out against ND tobacco tax bills

By Nick Smith / Bismarck Tribune

BISMARCK – Lawmakers attempting to raise the state’s tax on tobacco products for the first time in more than two decades acknowledge long odds as they face off with business groups that have successfully beaten back previous efforts.

One tobacco tax bill has been introduced in each chamber. The head of a state retail association says lawmakers’ efforts are misguided and would hurt businesses when the state is wrestling with a potentially tough budgeting effort due to slowing oil activity.

North Dakota ranks 46th nationally in tobacco taxes at 44 cents per pack, higher than Alabama, Georgia, Louisiana and Virginia. The price hasn’t been raised since 1993.

The two pieces of legislation aimed at tobacco taxes are House Bill 1421 and Senate Bill 2322.

HB1421 would raise the state’s cigarette tax to $1.54 per pack. It would also raise the excise tax on other tobacco products from 28 percent of the wholesale purchase price to 43.5 percent. The House Finance and Taxation Committee picks up the bill at 9:30 a.m. Tuesday.

SB2322 would raise the cigarette tax in the state to $2 per pack.

North Dakota Retail Association President Mike Rud is adamant in his opposition.

“This isn’t the time to tax any business in North Dakota,” Rud said. “The idea that a tax increase is going to help people not smoke, it doesn’t hold any water.”

HB1421 prime sponsor Rep. Jon Nelson, R-Rugby, disagreed.

“We’ll just present factual data that should support the fact that this will decrease the number of smokers,” Nelson said.

The recently unveiled legislation was touted along with data from the Campaign for Tobacco-Free Kids.

The organization’s data says a cigarette tax of $2 per pack would prevent an estimated 7,500 people younger than 18 to not smoke and prompt an estimated 8,000 adult smokers to kick the habit. The organization also claims this could result in $300 million in savings in future health care expenditures.

Long odds

Nelson admitted the tobacco tax bills face long odds: Similar legislation failed in 2013.

“We’re going to need a lot of help from our stakeholder groups to get over the hill,” Nelson said.

He said HB1421 would generate an estimated $103.5 million during the 2015-17 biennium. This doesn’t include the $50 million per biennium the state’s general fund would still receive in tobacco taxes.

“I think public sentiment is the main thing,” Nelson said. “We need the public to weigh in.”

Through HB1421, 60 percent of the new revenue would go toward health-related programs in the state’s Community Health Trust Fund, Nelson said. The rest would go to local communities for health-related programs.

Low smoking rates

Rud countered with 2012 data from the Centers for Disease control and prevention that shows tobacco use isn’t a major problem in North Dakota.

“North Dakota’s smoking rates are very low despite the state having some of the lowest tobacco taxes in the nation,” Rud said.

He said North Dakota in 2012 ranked 37th in adult smoking and 49th in smokeless tobacco use. Rud said among youth smokers, North Dakota ranked 34th among 44 states reporting data.

“Proponents of raising the state’s tobacco taxes would have us believe that low taxes are encouraging more tobacco use. But that contention isn’t supported by the data,” Rud said.

SB2322 prime sponsor Sen. Tim Mathern, D-Fargo, said the key target in tobacco tax legislation is youth.

“If we can keep them from smoking up to age 18, the odds of them ever smoking is close to zero,” Mathern said.

Mathern said North Dakotans have had smoke-free public places since June 2012. He said arguments against smoke-free public places were that it would negatively impact restaurants and bars.

“The scares that were around before … have proven not to be the case,” Mathern said.

He said retailers, such as gas stations, also have little to worry about.

“I would say to all these store owners: Do they want their children to smoke? Do they smoke? Consider the broader implications,” Mathern said.

Mathern said he believed the savings on health care to employees and having more healthy customers alive and able to come into their stores for other purchases would offset the losses in tobacco sales.

http://www.inforum.com/news/3670143-pro-business-lobby-speaks-out-against-nd-tobacco-tax-bills

Congress Should Back President Obama’s Tobacco Tax Plan – It Will Protect Kids, Save Lives and Cut Health Care Costs

Statement of Susan M. Liss, Executive Director, Campaign for Tobacco-Free Kids

WASHINGTON, DC – The Campaign for Tobacco-Free Kids strongly supports President Obama’s proposal to increase the federal tobacco tax, which is a proven way to prevent kids from smoking, save lives and reduce tobacco-related health care costs.

In his FY 2016 budget released today, President Obama urged Congress to increase the federal cigarette tax by 94 cents per pack and also increase taxes on other tobacco products. The tobacco tax changes would raise $95.1 billion in new revenue over 10 years.  The budget proposes to use these funds to pay for an extension of the Children’s Health Insurance program (CHIP) and fund early childhood education initiatives proposed by the President.

This proposal would do more to reduce tobacco use among kids than any other single action the federal government can take. It is also a fiscally responsible proposal that will help to reduce the huge financial burden that tobacco use imposes on governments, businesses and families.  A new CDC study issued in December found that smoking costs our nation about $170 billion a year in health care spending – far more than previously thought. More than 60 percent of these costs are paid by taxpayers through government programs such as Medicare and Medicaid.

Congress should embrace this proposal enthusiastically. It will save lives and money. And it will help millions of kids live longer, healthier lives free of tobacco addiction.

The evidence is clear that increasing the tobacco tax is one of the most effective ways to reduce smoking and other tobacco use, especially among kids. Economic research shows that every 10 percent increase in the price of cigarettes reduces youth smoking by about seven percent and overall cigarette consumption by three to five percent. We estimate that a 94-cent increase in the federal cigarette tax would:

·        Prevent 1.2 million kids from becoming smokers;

·        Prompt 2.6 million adult smokers to quit

·        Prevent 444,100 premature deaths as a result of these reductions in youth smoking

·        Save $51.9 billion in future health care costs.

Numerous public health and economic authorities have found that increasing the tobacco tax is effective at both reducing smoking and raising revenue. Last year’s Surgeon General’s report reaffirmed that. “Raising prices on cigarettes is one of the most effective tobacco control interventions,” the report concludes. “The evidence is sufficient to conclude that increases in the prices of tobacco products, including those resulting from excise tax increases, prevent initiation of tobacco use, promote cessation, and reduce the prevalence and intensity of tobacco use among youth and adults.”

The highly respected Congressional Budget Office has also concluded that increasing the federal tobacco tax would raise substantial new revenue, prompt millions of smokers to quit, save lives and reduce health care costs.

Furthermore, national and state polls consistently show strong public support for substantial increases in tobacco taxes, with most polls showing voters favoring tobacco tax increases by more than a two-to-one margin. Polls have found that large majorities of Democrats, Republicans and Independents and voters from a broad range of demographic and ethnic groups all support tobacco tax increases – as do significant numbers of smokers.

In short, a significant tobacco tax increase is a win-win-win for the country – a health win that will reduce tobacco use and save lives, a financial win that will reduce health care costs and raise revenue to fund an important initiative, and a win among voters.

The budget proposal also includes a measure that would ensure “full coverage of preventive health and tobacco cessation services for adults in traditional Medicaid.”  Tobacco cessation services have been proven to reduce smoking and are cost-effective. After Massachusetts implemented tobacco cessation coverage for all state Medicaid beneficiaries, smoking among the state’s Medicaid population declined by 26 percent and the state saved more than $3 for every $1 it spent to help beneficiaries quit smoking.

The need for Congress to act to increase tobacco taxes and expand cessation services is clear.  While our nation has made tremendous progress in reducing smoking, tobacco use remains the number one cause of preventable death in our country. Smoking annually kills 480,000 Americans – causing one in every five deaths.  Without urgent action, 5.6 million kids alive today will die prematurely from smoking-caused disease.

The President’s proposal represents exactly the kind of bold action needed to accelerate progress against tobacco and make the next generation tobacco-free.

LETTER: Tobacco tax can help smokers quit

By Rebekah Hartman

It’s time for North Dakota to raise the tobacco tax. I know firsthand that raising the price is an effective way to help people quit smoking.
I am personally affected by our state’s low rate of tobacco taxes, as my husband is in a constant struggle to battle his addiction to tobacco. When we lived in Minnesota, the price of cigarettes was high enough that buying a pack forced him to stop and think about what — exactly — the money was going for, and if there was a better way to spend the dollars.
Now that we’re in North Dakota, where the cigarette prices are shockingly low, there is little pause when deciding to buy a pack.
I’m urging our state legislators to support the proposals before them to increase the state tobacco taxes. Our elected officials should seize the opportunity to increase taxes on all tobacco products as it would reduce smoking rates, support countless people who are desperately trying to break their addiction and ultimately lower health care costs for all North Dakotans.
Rebekah Hartman, Mandan, N.D.
http://www.grandforksherald.com/opinion/letters/3668410-letter-tobacco-tax-can-help-smokers-quit

Cigarette Addiction Affects Men, Women's Brains Differently; Brain Scans Reveal Need For Tailored Treatment

By Samantha Olson, Medical Daily

Smoking is addictive and bad for the body in a laundry list of ways, but it hooks men and women differently. Researchers at Yale University studied the brains of men and women using positron emission tomography (PET) scans. Their intention was to measure the changing levels of dopamine, which control the brain’s pleasure and reward pathways, in men and women’s brains, and published their findings in the Journal of Neuroscience earlier this month.

Dopamine levels increase when addictive substances, such as the nicotine found in cigarettes, enter the body and flood the brain. For the first time, researchers have developed a way to watch the dopamine levels change while a person smokes. Researchers observed the dopamine levels of 16 addicted cigarettes smokers — eight men and eight women — with at least 17 years of smoking behind them.

Each participant was told to smoke one or two cigarettes whenever they wanted while under observation, and they weren’t allowed to use any nicotine patches or medications during the study. The study’s lead researcher Kelly Cosgrove, a radiology professor from Yale University, scanned each of their brains, and pieced each of the images together in order to create a sequence of brain movements.

Dopamine struck women harder and faster in one section of the brain called the dorsal putamen, while men had moderate to low activation in the same area. Men, on the other hand, had much faster and consistent activity in the ventral striatum, while women were only mildly affected. But what did all this mean?

“I think it confirms that strategies that focus on drug reward are likely to work better for men –- these would include the nicotine replacement strategies [like the patch],” Cosgrove, told the Huffington Post. “And for women it highlights that we need different and new medications — ones that target the reasons why women smoke, such as to relieve stress and manage mood.”

Women were more affected by the sensation of smoking, such as its taste and the smell of smoke, while men were more affected by the nicotine itself. Men are much more likely to use chewing tobacco because they don’t care about the cigarette or the activities smoking brings with it; they just want that nicotine. Women, on the other hand, may do better smoking a low-nicotine cigarette, so long as they have a cigarette in hand to take a drag and blow smoke from.

“If [women] are smoking more for the taste and sensory effects, then low-nicotine cigarettes might be an effective way to wean themselves off the regular cigarettes, whereas men might have more nicotine withdrawal and not really get much out of those [low-nicotine] cigarettes,” Kenneth Perkins, a psychiatric professor at the University of Pittsburgh who was not involved in the study, told HuffPost. “The possibility is that they might be a more effective way for women to quit than men, but that’s purely speculative at this point.”

Source: Cosgrove K. Journal of Neuroscience. 2014.

http://www.medicaldaily.com/cigarette-addiction-affects-men-womens-brains-differently-brain-scans-reveal-need-315628

The Post's View: Maryland’s cigarette tax is saving lives

By Editorial Board, The Washington Post

AMID AN electoral backlash against high taxes in Maryland, anti-smoking advocates have abandoned a campaign to raise the state-imposed levy on cigarettes. Politically, that makes perfect sense. As public-health policy, it is foolish.

A new study by Maryland’s Department of Health and Mental Hygiene shows that the state’s drop in teen smoking rates, already steep following three sharp tax increases since 1999 on a pack of cigarettes, has continued in the past few years.

The rate of cigarette smoking among underage youth in the state has fallen from 23 percent in 2000 to just 11 percent last year. Since 2008, when the per-pack levy was doubled, to $2, smoking among high school youth has fallen by about a third; according to the state study, for the first time, slightly more teenagers now smoke cigars than smoke cigarettes.

Adult smoking has also fallen by about a fifth since 2000. Smoking among both youth and adults in Maryland is considerably below the national average, which is about 16 percent for youth and 18 percent for adults.

No doubt, the anti-tax mood in Maryland was central to Republican Larry Hogan’s upset victory in November’s gubernatorial election. That sentiment notwithstanding, the smoking numbers are a strong argument for leaving in place the state’s relatively high levies on tobacco products, which are not just a revenue source but also a means of saving lives.

According to the state study, hospital admissions to treat tobacco-related cancers in Maryland have fallen by 11 percent from 2000 to 2011, saving more than $102 million in hospital charges in 2011 alone.

The state study also showed a strong link between youth smoking and other forms of substance abuse. Minors who smoked were three times more likely than non-smokers to have used alcohol in the past 30 days, five times more likely to have used marijuana, six times more likely to have used other illegal drugs, and nine times more likely to have used — or, more likely, abused — prescription drugs.

It’s no coincidence that states that have been loath to offend the tobacco or anti-tax lobbies by raising the tax on cigarettes have significantly higher smoking rates. As we’ve noted before, a case in point is Virginia, where the per-pack levy is among the lowest in the nation, the price of a pack of cigarettes is $2 lower than in Maryland and the smoking rate is much higher. For continuing to bow before the throne of King Tobacco, the Old Dominion will pay a price in the public health of its citizens.

As smoking rates nationally have fallen, the use of e-cigarettes among high school-age youth appears to be rising. That’s a worrying trend, given that e-cigarettes also contain nicotine, which is highly addictive, and could promote the use of cigarettes and other harmful substances.

You don’t have to be enamored of the nanny state to recognize that tobacco use, especially cigarette smoking, correlates directly with lung cancer and other diseases and is a major threat to public health. Nor is there any serious doubt that tax increases have played a critical role in cutting cigarette use, especially among price-sensitive teens.

If Mr. Hogan intends to cut taxes, as he has promised, the tobacco tax is one he’d be well advised to leave intact.

http://www.washingtonpost.com/opinions/marylands-cigarette-tax-is-saving-lives/2014/12/27/36f2818a-8573-11e4-9534-f79a23c40e6c_story.html

Tobacco tax: Move for $2 per pack gains momentum in CA

By Dr. Nicholas Leeper | Special to the Mercury News

The changing of the New Year brings about a fresh start. If you are one of the estimated 46.6 million Americans who smoke cigarettes, quitting the habit is likely being considered for a New Year’s resolution. Polls have shown that a vast majority of smokers would like to quit, and we at the American Heart Association are dedicated to giving smokers every edge we can to put their habit in the past. One such proven way to encourage quitting is a tobacco tax.

This is why we are joining with doctors, health care workers, taxpayers and other nonprofit health organizations to support a $2-per-package tax on the cost of tobacco.

The benefits to our state would be enormous and would more accurately account for the true cost of tobacco. Currently, California spends about $9 billion a year on tobacco-related medical care, with taxpayers footing about a third of that. In fact, in data compiled from the Centers for Disease Control, the true cost to society in California is $15 for every pack sold. Our current tobacco tax is 87 cents.

A tobacco tax is also a particularly effective way to prevent younger people from ever taking up the habit. A staggering 80 percent of smokers start before they are 18, while only one in 100 begin at age 26 or older. The Congressional Budget Office estimates that, based on previous research, a 10 percent increase in the cost of tobacco will result in a five to 15 percent decrease in youth tobacco usage. This compares to three to seven percent for adults.

Education about the ill effects of tobacco over the past several decades has been instrumental in lowering the rate of smoking in the United States. Toward that end, the tax would bolster proven youth prevention programs to deter smoking. A few years ago, it was estimated that even the $1 added tobacco tax then proposed in California would have prevented 200,000 children in California from becoming adult smokers.

Given that tobacco is a major contributor to coronary disease in our nation, we at the American Heart Association are always looking at effective policies that result in fewer smokers. The Congressional Budget Office estimates that if even a roughly $1 per package tax were to be instituted on cigarettes next year, there would be 2.6 million fewer adult smokers over the age of 18 by 2021. This would certainly be helpful in a nation where 443,000 people die from smoking-related diseases yearly, including 46,000 heart-related deaths attributed to secondhand smoke.

If these statistics just seem like numbers on a page, just think about the intangibles, such as the value added from having more years with a grandparent, or not watching a loved one suffer through the pain of emphysema, heart disease or cancer. These are things on which it’s impossible to place a monetary value, but with an estimated 100,000 California lives that will be saved in future years through a tobacco tax, they are nonetheless primary benefits.

So, in the New Year, if you need help to quit smoking, please visit our website, http://www.heart.org, for more information. And please join with us at http://www.savelivesca.com and support a $2-per-package tobacco tax next year. The life you save may be yours or a loved one’s.

Dr. Nicholas Leeper is Assistant Professor of Cardiovascular Surgery and Medicine at Stanford University Medical Center and president of the American Heart Association, Silicon Valley Division. He wrote this for this newspaper.

http://www.mercurynews.com/opinion/ci_27190645/tobacco-tax-move-2-per-pack-gains-momentum

Higher tobacco taxes save lives

By: Vincent DeMarco, Baltimore

A recent op-ed criticizing Maryland’s tobacco tax increases ignores the most important consequence of these measures: a dramatic decrease in tobacco use by teens that has saved thousands of young people from preventable tobacco-related deaths and serious illnesses (“Md. cigarette taxes have unintended consequences,” Dec. 18).

According to data compiled by the Campaign For Tobacco Free kids, within two years after the 2008 increase in the state cigarette tax, from $1 per pack to $2 per pack, there was a 29 percent drop in teen smoking in Maryland.

That translated into 15,000 fewer high school smokers (some of whom have become non-smoking young adults by now); more than 70,000 kids today who will not become adult smokers; more than 30,000 kids alive today who will avoid future premature smoking-related deaths; and more than $1.5 billion in long-term health care cost savings tp the state.

The Maryland Department of Health and Mental Hygiene recently released a study showing that between 2010 and 2013 there was an 18 percent drop in Maryland teens smoking cigars. This happened at a time when nationally there was no statistically significant change in teen cigar smoking.

This progress, which also resulted in saving thousands of Maryland youth from tobacco addiction and preventable death and illnesses, occurred in part because of the 2012 increase in the state tax on cigars, along with an effective public education campaign by the state health department.

Granted, there will always be some people who will seek to avoid the tobacco tax by going to other states or resorting to smuggling. But very seldom will this involve children, whose lives we are saving in record numbers.

And we know from experience that the drop in cigarette sales in Maryland far outweighed the increase in sales in neighboring states that didn’t increase their tobacco tax. And were are fully confident in Maryland Comptroller Peter Franchot’s ability to prevent and prosecute those who would try to illegally smuggle cigarettes into the state.

In addition to saving lives, tobacco tax increases are good for Maryland taxpayers because they both reduce the health-care cost for tobacco-related illnesses and help fund critical health care programs. The 2008 tobacco tax increase partially funded the expansion of health care to over 100,000 uninsured Marylanders.

Although the Maryland Taxpayers’ Association doesn’t seem to want Marylanders to have these benefits, many independent polls show the vast majority of Marylanders clearly understand these benefits and would strongly support further increases in the tobacco tax to save more lives and money for the state.

-The writer is president of the Maryland Citizens’ Health Initiative.

http://www.baltimoresun.com/news/opinion/bs-ed-tobacco-letter-20141222-story.html

Smoking Rates Continue to Decline

MMWR – MORBIDITY AND MORTALITY WEEKLY REPORT

The CDC recently updated its statistics about current cigarette smoking among adults. In its MMWR article of November 28, 2014, it tracked changes in smoking between 2005 and 2013. In general, the trends of previous years continued. Here are some of the results:

  • The proportion of U.S. adults who smoke declined from 20.9% to 17.8%, a 15% decline during that period. The 17.8% is a modern low in adult smoking prevalence.
  • The proportion of daily smokers declined from 16.9% to 13.7%, a 19% decline and another all time low.
  • Among daily smokers, the proportion who smoked at least one pack per day decreased from 52.1% to 36.4%, a 30% decline. And daily smokers now average 14.2 cigarettes, down from 16.7, a 15% decline.

Thus, there has been a decline in overall smokers, a slightly greater decline in daily smokers and in number of cigarettes smoked by daily smokers, and a major decline in the number of cigarettes consumed by daily smokers.

The profile of smokers is relatively unchanged:

  • Men (20.5%) are more likely to be smokers than women (15.3%)
  • Smoking prevalence is higher among adults aged 25-44 years (20.1%) and lowest among those over age 65 (8.8%)
  • Among ethnic groups, multiple race groups had the highest rates (26.8%), followed by American Indian/Native Alaskan (26.1%), Whites (19.4%), Blacks (18.3%), Hispanics (12.1%), and Asians (9.6%).
  • Smokers continue to be stratified by education level, often used as a marker for social class. Those without a high school diploma had smoking rates of 24.2%, followed by those with high school diplomas (22%), undergraduate college degrees (9.1%), and graduate degrees (5.6%). Those who obtained General Education Development (GED) certificates in lieu of high school graduation had the highest rates (41.4%). It is likely that many of these persons were incarcerated and thus also had medical conditions associated with high smoking rates, such as mental illness and substance use disorders.
  • Persons living below the federal poverty level had higher rates (29.2%) than those above that level (16.2%).
  • LGB adults were more likely to be smokers (26.6%) than straight adults (17.6%).

Thus, the trend of smoking to be concentrated among the less educated, the poor, and the LGB population continued. Not included in this report, but summarized previously by a special MMWR are recent data documenting the much higher rates among persons with behavioral health issues, the groups with the highest smoking rates in the entire population. Notably, those working in the health professions in the United States have some of the lowest smoking rates in the world, with some surveys showing that only 1% of physicians are smokers.

This new report should encourage us that progress, indeed, is happening. But, the slow rate of decline, in the face of all the evidence about the harms of smoking and the accumulating tobacco control policies such as taxes, clean indoor air laws, counter-marketing, and coverage for smoking cessation therapies, is sobering. As smokers increasingly resemble members of marginalized parts of the American community, the risk is that resources for tobacco control will be diverted to other causes. Yet, over 40 million people still smoke, including many of the most vulnerable of us. And close to 500,000 people die each year from smoking-associated illnesses. We need to capture better the sense of urgency buried in those statistics.

Finally, it is important to recognize two new potential threats to the health of the nation—electronic cigarettes and marijuana. Right now the rhetoric about the benefits and harms of these two commodities outstrips the evidence. We do know that the use of the e-cigarette is climbing, and it is highly likely that marijuana use is also increasing in the wake of state legalization efforts. We also know that because these commodities contain immense potential for profit, marketing efforts to promote usage are certain to increase. As we continue our efforts against the harm from using combustible tobacco, we need to track the use of these new potential threats, as well as to assemble evidence about what happens to those who use them.