Expert Commentary

Cigarette taxes and older adult smoking

2015 study in Health Economics that investigates the potential impact that raising cigarette taxes might have on tobacco use among older adults.


While the percentage of American adults who smoke cigarettes has dropped drastically since 1965, the number still is large – 42.1 million people in 2013, according to the U.S. Centers for Disease Control and Prevention. Smoking remains the leading cause of preventable death nationally, resulting in more than 480,000 deaths and nearly $170 billion in direct medical-care costs each year. High smoking rates are a main reason for America’s  relatively low life expectancy compared to other high-income countries. In recent years, the rise of e-cigarettes has given smoking renewed popularity even though their health effects remain largely unclear.

The health consequences of tobacco use fall disproportionately on the elderly, some of whom have spent much of their lives smoking. While long-term users cannot avoid the damage caused by many years of smoking, there are substantial benefits to quitting even at an advanced age. A 2000 report published in Age and Ageing suggests that smokers who stop after age 60 regain improved pulmonary and lung function. However, many older smokers are less likely to try quitting than younger ones. At the same time, studies indicate that health professionals are less likely to recommend that older smokers try to quit. Cessation programs do not often target older smokers specifically.

A team of researchers sought to determine whether older adults might change their smoking habits if cigarette prices increased. Their 2015 study published in Health Economics, “Cigarette Taxes and Older Adult Smoking: Evidence from the Health and Retirement Study,” relied on data collected through a longitudinal survey of older adults between 1992 and 2008. Researchers Johanna Maclean, Asia Kessler and Donald Kenkel — based at Temple University, the University of Nebraska and Cornell University, respectively — tested whether a $1 tax increase would prompt older adults to smoke fewer cigarettes per day. At the time of the study, the additional $1 represented a 131.6% increase in the cigarette tax.

The study’s key findings include:

  • The adults in the study sample had been smoking an average of 42.4 years and smoked an average of 16.9 cigarettes a day.
  • Smokers over age 50 cut back slightly in response to the $1 tax increase. They reduced the number of cigarettes smoked per day by 3.8%–5.2%.
  • Smokers older than 65 years reduced their daily cigarette usage 2.7%–8.5%.
  • The researchers found evidence indicating that women curb their smoking more in response to a tax increase than men. White smokers appeared to be more responsive to tax increases than non-white smokers.

The study suggests that older adults reduce their smoking only modestly when the cigarette tax is raised. Many older adult smokers likely would react to a tax increase by simply spending more of their income on cigarettes. The authors note that because older adults often live on fixed incomes, a tax increase could lead to reduced consumption of other goods or other unintended consequences. Offering smoking-cessation products at a reduced cost or offering financial incentives to stop smoking may be more effective ways to encourage older adults to change their smoking habits. The authors say these findings “shed new light on older adult smoker tax responsiveness and highlight the need for careful consideration of the full impacts of public health policy, particularly as the U.S.A. experiences demographic shifts in its population.”

Related research: A 2014 study in Frontiers in Aging Neuroscience, “Sex-Related and Tissue-Specific Effects of Tobacco Smoking on Brain Atrophy: Assessment in a Large Longitudinal Cohort of Healthy Elderly,” looks at the impact of tobacco use on brain aging. A 2015 study in Clinical Interventions in Aging, “Real-World Comparative Study of Behavioral Group Therapy Program vs. Education Program Implemented for Smoking Cessation in Community-Dwelling Elderly Smokers,” examines the effectiveness of group therapy in reducing smoking among the elderly.


Keywords: tobacco, cigarettes, health, older Americans, elderly, retirement, taxes, cessation, addiction

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