Who Smokes and Who Pays?

By Deedee Sun and Lindsey Reese

chart 1 recent trend

As smoking rates among Massachusetts citizens fell from 28 percent to 14 percent between 1986 to 2010, the cost of tobacco taxes has been borne more by a group least able to afford it.

According to research and polls, the poor and the less educated smoke at a higher rate than those with higher incomes and more schooling. As a result Massachusetts’ ever increasing tobacco tax has become increasingly regressive.

“You’re really asking people who are already at the lower end in terms of wealth to be shouldering an additional burden of taxes to fund projects that really should be funded by the government,” said Dr. Michael Siegel of Boston University’s School of Public Health.

A 2008 Gallup poll of more than 75,000 individuals across the nation found that smoking rates rise as income drops. Those at the bottom fifth of the income bracket are more than twice more likely to smoke than those in the top fifth.

Thirty-four percent of those making $6,000 to $11,999 per year said they smoke. That compares to 13 percent in the top two income brackets – those earning at least $90,000 per year.

Gallup researchers note the higher percentage of smokers in the lowest income bracket is skewed somewhat because of the high number of students that fall into the category.

The reasons why people in lower income brackets are more likely to be smokers is not well understood. Research has pointed to the stress of financial hardship or having a less “future-oriented” mentality.

According to a 2008 study published in the American Journal of Public Health titled, Being Poor and Coping with Stress: Health Behaviors and the Risk of Death: “Many individuals, especially amongst the working classes, cope with feelings of stress and anxiety by engaging in unhealthy but often pleasurable behaviors, including cigarette smoking.”

Another study from the Journal of Addictive Behaviors suggested that less educated people may have less understanding of the impact smoking has on their health “and might be less ‘future-oriented’ (that is, less sensitive to warnings about the long-term effects of unhealthy habits).”

Data from the Break Free Alliance, a non-profit program to reduce smoking among lower income groups, shows that in 2008 those with 9–11 years of education had a 35.7 percent smoking rate, while adults with an undergraduate or graduate degree had respective rates of 10.6 and 5.7 percent.

The Institute of Medicine, an arm of the National Academy of Sciences, says that the income and education gap among smokers could be closed by funding programs targeted to those specific groups.

But most states have been cutting back on allocation of tobacco tax revenues to such programs.

Massachusetts raised around $815 million in cigarette taxes and settlement payments from a nationwide tobacco lawsuit in the current fiscal year. The state spent $4.1 million on smoking cessation programs.

There is little doubt that raising the cost of cigarettes through tax increases is incentive itself for smokers to quit. When the cigarette tax increased $1 a pack in 2008, the number of packs purchased dropped from 278 million to 225 million.

“Kids are affected by price change because they have limited access to cash,” said Tami Gouveia, the director of Tobacco Free Massachusetts. “If something costs more they will stop and think twice about purchasing cigarettes when they could be putting two more songs on their iPods.”

But Siegel argues that more of that money should go to smoking cessation programs.

“We have a budget shortfall, but it’s not fair that smokers should be required to plug up the hole,” he said. “To tax one group to benefit another, it doesn’t make sense.”

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