By Summer Sherburne Hawkins, Ph.D., M.S.
While seeing an adolescent smoking may be less common now than it was even a decade ago, the teenage years are a time of experimenting with risky behaviors. Everyone knows the long-term dangers of smoking, but adolescent brains are particularly susceptible to the nicotine buzz and social norms that surround them. By middle school 3% of students report smoking, increasing to 10% in 9th grade and nearly doubling to 19% by the time students graduate high school.
In public health we are concerned about adolescents’ lack of foresight – starting smoking as a teenager, especially as an early teen, increases the likelihood that it will turn into a lifelong habit. Preventing the uptake of smoking, therefore, is a better investment than waiting to treat smokers in adulthood.
3% of students report #smoking by middle school, 10% by 9 grade and 19% by high school graduation
While previous research has shown that youth are sensitive to the price of cigarettes, the landscape of tobacco control policies has changed considerably. Between 2005 and 2016, state cigarette taxes increased from $0.92 to $1.61 per pack and the number of states with 100% smoke-free restaurant legislation increased from 13 to 35 states and DC.
We sought to examine the impact of state cigarette taxes and smoke-free legislation on adolescent smoking overall as well as test whether there were differential policy effects across the teenage years. Changes in tobacco control policies across and within US states created a natural experiment, which we were able to evaluate using data on more than 717,000 adolescents from 43 states. In the Youth Risk Behavior Survey (YRBS), adolescents’ self-report on how many days they smoked cigarettes over the past month. We linked information on state cigarette taxes and smoke-free restaurant legislation to each adolescent based on the year the survey was completed.
Cigarette tax increases were associated with reductions in smoking among only the youngest adolescents
From 1999 through 2013, adolescent smoking decreased from 35% to 14%. We found that cigarette tax increases were associated with reductions in smoking among the youngest adolescents only, while the enactment of smoke-free legislation reduced smoking rates overall. According to the estimates from our sample, if cigarette taxes increase by $0.94 as proposed in the 2016 federal budget, smoking among 14-year-olds will decrease by 13% and smoking among 15-year-olds will decrease by 7%. If the remaining states implement smoke-free legislation, overall adolescent smoking will decrease by 9%. This begs the question, why are taxes not as effective at decreasing smoking among older teens? Unfortunately, the YRBS data cannot answer this question and we may need to ask youth themselves.
While our results further support policy efforts to increase cigarette taxes at the state and/or federal levels to reduce adolescent smoking, we need to find out whether there is a limit to tax increases. Future studies will help distinguish whether higher cigarette taxes continue to reduce smoking among younger adolescents or faced with higher prices, they are switching to cheaper tobacco products. Our findings also support the enactment of 100% smoke-free restaurants in the 15 states that are still without legislation as it will not only benefit adolescents but also reduce secondhand smoke exposure.
In the meantime, we will likely continue to see fewer adolescents using cigarettes, but what we need to find out is whether our policies are curbing smoking or they are encouraging the use of alternative tobacco products.
NOTE: This research was supported by the Eunice Kennedy Shriver National Institute of Child Health & Human Development of the National Institutes of Health (R00HD068506). The content of this posting is the responsibility of the author and does not necessarily represent the official views of National Institutes of Health.
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About the Author
Summer Sherburne Hawkins, Ph.D., M.S. is an Assistant Professor at Boston College in the School of Social Work. She received her Ph.D. in Epidemiology at University of London and was a Robert Wood Johnson Health and Society Scholar at the Harvard School of Public Health. Her research examines the impact of policies on health disparities in parents and children, particularly using methodology that integrates epidemiology and economics. More information can be found on her Boston College faculty website. Contact Summer Hawkins via email (firstname.lastname@example.org).
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