Association of a major tobacco tax increase in California with increased smoking cessation

Background In November 2016, California voters approved Proposition 56, increasing the cigarette tax by $2.00 per pack and nearly tripling spending on tobacco prevention. This study examined whether the initiative was associated with increased smoking cessation. Methods States in the United States were categorized into 3 groups: California, 18 other states (including the District of Columbia) that raised taxes, and 32 states that did not raise taxes. Tax and price increases, tobacco prevention spending per capita, 3-month smoking cessation rates using data from the Behavioral Risk Factor Surveillance System (N = 443 054), and the proportion of daily smoking were compared for 2014-2016 and 2017-2019 for these groups. Results California had the largest increases in cigarette price (30.8%) and tobacco prevention spending (271.9%), both adjusted for inflation. Other states that raised taxes experienced price increases of 6.3% on average. The 3-month smoking cessation rate in California increased from 11.5% in 2014-2016 to 14.2% in 2017-2019 (P = .005). Among other states that raised taxes in that timeframe, cessation rates did not change significantly, from 8.6% to 8.7% (P = .755). Among states that did not raise taxes, cessation rates declined significantly, from 9.5% to 9.0% (P = .026). California also had a significant reduction in the proportion of daily smokers among those who did not quit (from 60.4% to 56.4%, P = .012). Conclusions A major cigarette tax increase was associated with increased smoking cessation in California. Policies increasing tobacco taxes and re-investing new revenue in tobacco prevention can increase population cessation.