Projecting the impact of strengthened tobacco control policy on disparities in US states with persistently high smoking rates.

Abstract

Introduction: Thirteen Southern and Midwestern states - termed 'Tobacco Nation' - have persistently higher smoking rates than other US states. Previous research indicates increased cigarette taxes and tobacco control expenditures (TCE) may mitigate this geographical cigarette smoking disparity. The current study simulates the impact of these policies on racial and socioeconomic tobacco-related disparities within Tobacco Nation.

Methods: Using ModelHealth^TM:Tobacco, we simulated 20-year changes in smoking and smoking-attributable (SA) outcomes by poverty status and race. We projected the impact of: 1) a 'tax-only scenario', increasing cigarette taxes by $1.50; and 2) a 'combined policy scenario', simultaneously increasing cigarette taxes by $1.50 and increasing state TCE to the Centers for Disease Control (CDC)-recommended level.

Results: Under the tax-only scenario, SA outcomes would be reduced for Tobacco Nation residents below 138% the federal poverty level (FPL) by about 4.3 the magnitude of those above 138% the FPL. Some SA outcomes would be reduced by about 10% more among Non-Hispanic (NH) Black residents than NH White residents. For all subgroups, the combined policy scenario would reduce SA outcomes by about eight times the magnitude of the tax-only scenario, even though the relative reduction in disparities by poverty status would be smaller (2.8 higher reductions for those below compared to above 138% the FPL).

Conclusions: The combined policy scenario, compared to the tax-only scenario, would reduce SA harms by a substantially larger magnitude. Both scenarios are projected to reduce socioeconomic disparities in tobacco harms but not all racial disparities in Tobacco Nation without greater prioritization of targeted policies.