The Need For New Policy Approaches to Tobacco Cessation.

| April 15, 2013 | 0 Comments


Since the 1960’s, policy makers have been well aware of the public health crisis posed by tobacco consumption and have tried various approaches to tackle the problem. Contemporary policy approaches have been somewhat limited in that they have focused on two types of strategies, but there is reason to suspect that these strategies will lack impact with certain populations and can also lead to unintended consequences.

The first strategy can be described as being the dissemination and control of information. Evidence on the effectiveness of media campaigns, education programs, and health warnings is somewhat mixed, and the impact of these strategies is likely dependent on changing social norms and acceptability of tobacco consumption.[1,2] Marketing restrictions have been shown to be successful, especially in preventing children from initiating smoking, but because tobacco companies compete less with each other on spending advertising dollars, the policy may have actually led to historic tobacco industry profit and social welfare loss.[3]

The second strategy can be described as financial barriers to tobacco consumption. In the US, four states currently allow for health insurance rating, which is the practice of surcharging smokers, and under new rules in President Obama’s health care overhaul smokers across the country in the individual health insurance market could see their premiums increase up to 50% of the current cost in 2014. There is little evidence on the effectiveness of these surcharges, and groups including the American Cancer Society oppose them because many consumers are not even aware of the surcharge.[4] Perhaps the most “popular” approach used by policy makers are tobacco excise taxes. Tobacco has a relatively inelastic price elasticity of demand, and evidence shows that cigarette sales decline at least modestly with increases in the excise tax.[5] Some researchers though have noted that compensatory responses such as consumer substitution and purchases in lower-tax jurisdictions may occur.[6] Tobacco companies have even devised strategies to change the size of cigarettes to avoid the excise tax.[7] Perhaps the biggest concern with the levy of excise taxes though is that they are regressive, meaning they hit low-income individuals the hardest. When excise rates are increased, consumption decreases most among higher income individuals, and the potential benefit in terms of how the revenue is subsequently distributed is ambiguous.[8] One study found that some low-income smokers in New York may be spending up to 25% of their total income on cigarettes.[9]

The problem with these policy approaches is that they treat consumers as fully rational and infallible to behavioral bias, and they do little to address tobacco consumption as a behavior that results from addiction.  Tobacco has a particularly high dependency profile exceeding that of marijuana and alcohol, and is on par in severity with some Drug Class A substances such as cocaine and barbiturates.[10]  It is important to remember that most smokers would like to quit if they could. The Centers for Disease Control and Prevention estimates that in the United States approximately 70% to 80% of smokers want to quit if they could, and 52% of smokers have tried to quit smoking in 2010 alone.[12,13] Given the history of tobacco regulation efforts, is seems that policy makers must become more creative about approaches which considers the needs of a behavioral consumer, and should further consider strategies which reduce rather than increase disparity.


[1] Levy, D. T., Chaloupka, F., & Gitchell, J. (2004). The effects of tobacco control policies on smoking rates: a tobacco control scorecard. Journal of Public Health Management and Practice10(4), 338-353.

[2] Alamar, B., & Glantz, S. A. (2006). Effect of increased social unacceptability of cigarette smoking on reduction in cigarette consumption. Journal Information, 96(8).

[3] Farr, S. J., Horton Tremblay, C., & Tremblay, V. J. (2001). The welfare effect of advertising restrictions in the US cigarette industry. Review of Industrial Organization, 18(2), 147-160.

[4] Corlette. S (2012). New Federal Rating Rules. American Cancer Society retrieved 31 Jan 2013 from

[5] Gallet, C. A., & List, J. A. (2003). Cigarette demand: a meta‐analysis of elasticities. Health economics12(10), 821-835.

[6] Goel, R. K., & Nelson, M. A. (2012). Cigarette demand and effectiveness of US smoking control policies: state-level evidence for more than half a century.Empirical Economics42(3), 1079-1095.

[7] Government Accountability Office (2012). Large Disparities in Rates for Smoking Products Trigger Significant Market Shifts to Avoid Higher Taxes. GAO-12-475.

[8] Remler, D. K. (2004). Poor smokers, poor quitters, and cigarette tax regressivity. Journal Information94(2).

[9] Farrelly MC, Nonnemaker JM, Watson KA (2012) The Consequences of High Cigarette Excise Taxes for Low-Income Smokers. PLoS ONE 7(9): e43838. doi:10.1371/journal.pone.0043838

[10] Nutt, D., King, L. A., Saulsbury, W., & Blakemore, C. (2007). Development of a rational scale to assess the harm of drugs of potential misuse. The Lancet,369(9566), 1047-1053.

[12] Centers for Disease Control and Prevention (2011). Vital Signs: Current Cigarette Smoking Among Adults Aged ≥ 18 Years—United States, 2005–2010. Morbidity and Mortality Weekly Report 2011;60(33):1207–12

[13] Centers for Disease Control and Prevention. (2002). Cigarette smoking among adults—United States, 2002. Morbidity and Mortality Weekly Report, 51, 642–645.images

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