Tobacco Use

V. Key Issues: Population Health >> E. Health Promotion >> Tobacco Use (last update: 11.18.15)

Key Questions

How Many People Smoke?

What are the Economic Consequences of Smoking?

  • Tobacco use in the U.S. adds $96 billion to health costs and imposes an additional $97 billion in non-health costs related to property losses, lost work productivity etc. (NIDA 2012).

What are the Health Consequences of Smoking?

Why Do Smokers Smoke?

  • Ert E, Yechiam E, Arshavsky O (2013) Smokers’ Decision Making: More than Mere Risk Taking. PLoS ONE 8(7): e68064. doi:10.1371/journal.pone.0068064. Studies show that smokers are at least as informed as nonsmokers about the risks of smoking — and possibly more informed. Some evidence suggests that smokers do take more risks than nonsmokers: they are more often involved in traffic accidents, less likely to wear seat belts and more likely to engage in risky sexual behavior. Women who smoke even have mammograms less frequently than their nonsmoking counterparts. But the reason is not because smokers have a greater tolerance for risk. An experimental analysis shows that smokers are more easily tempted by immediate high rewards compared to nonsmokers. Thus the salience of risky alternatives that produce large rewards most of the time can direct smokers to make bad choices even in an abstract situation such as the Iowa Gambling Task. These findings suggest that the risk taking behavior associated with smoking is not related to the mere pursuit of rewards but rather reflects a tendency to yield to immediate temptation. Smokers have poor self-control. See New York Times summary of this study.

Policy Options

Public Health Law ResearchAmericans for Nonsmokers’ Rights Foundation. ANRF has tracked, collected, and analyzed tobacco control laws around the country since the early 1980s, and the lists below represent only a small percentage of the data. Learn more about their comprehensive collection of state and local laws, covering: clean air, restrictions on youth access to tobacco, tobacco advertising and promotion restrictions, tobacco excise taxes, and conditional use permits

Clinical Policy


  • E-Cigarette Ban. 42 states have banned the sale of electronic cigarettes to minors (listed in Data Appendix).
    • Bans Promote Teen Cigarette Use. Using data from the National Survey on Drug Use and Health, a Yale study published 10.19.15 finds that state bans on e-cigarette sales to minors yield a 0.9 percentage point increase in rates of recent conventional cigarette use by 12 to 17 year olds, relative to states without these bans. “Conventional cigarette use has been falling somewhat steadily among this age group since the start of the 21st century. This paper shows that bans on e-cigarette sales to minors appear to have slowed this decline by about 70 percent in the states that implemented them,” said Abigail Friedman, assistant professor of public health and the study’s author. “In other words, as a result of these bans, more teenagers are using conventional cigarettes than otherwise would have done so.”

Excise Taxes

  • Congressional Budget OfficeRaising the Excise Tax on Cigarettes: Effects on Health and the Federal Budget  (June 13, 2012). This study uses a policy to discourage smoking as an example for estimating the overall impact on the federal budget of a policy intervention to improve health. Specifically, CBO analyzed the budgetary effects of a hypothetical increase of 50 cents per pack in the federal excise tax on cigarettes and small cigars (from $1.01 to $1.51 in fiscal year 2013, with the increase adjusted each year to keep pace with inflation and, in the long term, with the growth of people’s income).
  • Viscusi. Cigarette Taxation and the Social Consequences of SmokingThis paper assesses the appropriate cigarette tax needed to address potential market failures. There is no evidence of inadequate risk decisions by smokers regarding their own welfare. Detailed calculations of the financial externalities of smoking indicate that the financial savings from premature mortality in terms of lower nursing home costs and retirement pensions exceed the higher medical care and life insurance costs generated. The costs of environmental tobacco smoke are highly uncertain, but of potentially substantial magnitude. Even with recognition of these costs, current cigarette taxes exceed the magnitude of the estimated net externalities.

Raising Smoking Age to 21

Tobacco Settlement





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