Higher Cigarette Tax Might Help Some Smokers Quit

The 62-cent-per-pack federal tax increase on cigarettes recently signed into law by President Obama will push the nation's average cost of a pack of cigarettes to approximately $5 when it takes effect April 1. That, say FPs interviewed by AAFP News Now, may prompt some smokers to consider kicking the habit.

According to numbers provided by the Campaign for Tobacco-Free Kids, the increase means that smokers will pay between $2 and $3 in state and federal taxes for a pack of cigarettes in 14 states. They will pay $3 or more in taxes in 13 states and the District of Columbia. New York smokers will bear the highest tax burden, with a combined $3.76 in state and federal taxes for every pack. And those numbers don't include local cigarette taxes, such as the $1.50 per pack paid by New York City smokers.

Every 10 percent increase in the price of cigarettes reduces youth smoking by 7 percent and overall consumption by 4 percent, says the Campaign for Tobacco-Free Kids.

AAFP President Ted Epperly, M.D., of Boise, Idaho, said the combination of the increased taxes and the weak economy should cause many smokers to think about quitting.

"This is a wonderful opportunity for family physicians to engage their patients and tell them why they must stop," Epperly said. "Smoking is the most preventable health care problem in the world, and these taxes provide another reason to stop."

The tax increase coincides with the advent of a fourth year of funding for the AAFP's Ask and Act tobacco cessation program. The Smoking Cessation Leadership Center at the University of California, San Francisco, has provided more than $90,000 to support the program this year.

The Academy's Ask and Act program encourages family physicians to ask all patients about tobacco use and then act to help those who use tobacco quit. There's strong evidence that advice from a health care professional can more than double smoking cessation success rates.

"Every doctor during every visit with a patient who smokes should ask, 'Is this a good time to stop?'" said Epperly, adding that physicians don't need to be confrontational, but they should "chip away" at the patient's habit. "It doesn't have to be during the first visit. Let patients know you're there when they're ready to accept help."

Ask and Act recently updated its "Patient Stop Smoking Guide," which walks patients through the steps of quitting. Another new resource is a waiting room brochure that warns parents about the dangers of secondhand smoke. The program also is in the process of creating an online tobacco cessation training program for constituent chapter liaisons.

"There is a synergy with the Ask and Act tools for the patient and their families," Epperly said. "If we bring together individual counseling with the doctor, medication to stop and the support of the patient's loved ones, that combination can be very powerful."

"We know raising the price (of tobacco) is one of the best things you can do to reduce smoking," said Tom Houston, M.D., director of OhioHealth's Nicotine Dependence Program and clinical professor in the family medicine department at Ohio State University in Columbus.

Houston said doctors should personalize the antismoking message when counseling a patient. For example, he said a college-aged person might be alarmed by the possibility of smoking yellowing their teeth, but a 50-year-old construction worker might be more concerned about having an early heart attack, shortness of breath or impotence.

To tie in the tax increases, Houston suggested putting a sign in the reception room that says, "Cigarettes costing too much? Talk to us about how to stop smoking."

Houston, who is chairman of the AAFP's tobacco cessation advisory committee, said people also should be cautioned about the dangers of secondhand smoke.

"If you have a young patient with asthma, ear infections or upper respiratory infections that are caused or made worse by smoking, that patient's parents need to know that providing clean, smoke-free indoor air is one of the first steps they need to take, not only to protect their child's health, but for their own," he said. "And creating a smoke-free home is a great first step toward cessation."

Houston said parents also should know that one of the biggest predictors of teen smoking is whether a child's parents smoke.