The impact of cigarette cost on pack sales per capita consumption in the United States.

OBJECTIVES: Evidence suggests that cigarette costs significantly impact tobacco use, yet the effect of state-level cost variations on cigarette sales per capita in the US remains uncertain. This study investigates how state-level cigarette costs affect pack sales per capita consumption.

STUDY DESIGN: This was an observational study of cigarette-pack sales per capita consumption in the United States.

METHODS: We used the tobacco tax burden data (1989-2019) and a two-way fixed-effects model to analyse how cigarette costs affect consumption. Our predictor variables were average cost per pack, state tax per pack, and combined federal and state tax as a percentage of the retail price. Additionally, we compared the percentage change in state cigarette taxes per pack for each state in five-year intervals, adjusting for inflation.

RESULTS: Regression analysis revealed that a 10% increase in the average cost per pack was related to a 9.59% decrease in per capita cigarette consumption (β_average cost = -0.959, P < 0.001). Similarly, a rise in state tax per pack and a higher tax as a proportion of the retail price per pack were related to a decline in consumption (β_ state tax = -0.176, P < 0.001), (β_retail price = -0.323, P < 0.001). States that raised cigarette taxes beyond the rate of inflation had a higher reduction in cigarette per capita sales than those maintaining stable tax rates.

CONCLUSIONS: Some states have not raised their cigarette taxes sufficiently to account for inflation. It appears that cigarette costs have significantly reduced cigarette consumption in the US.