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Copyright 1999 American Medical Association. All Rights Reserved. Applicable FARS/DFARS Restrictions Apply to Government Use.1999American Medical AssociationThis is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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In November 1996, residents of Oregon approved a ballot measure increasing the cigarette tax by 30 cents (to 68 cents per pack). The measure stipulated that 10% of the additional tax revenue be allocated to the Oregon Health Division (OHD) to develop and implement a tobacco-use prevention program. In 1997, OHD created Oregon's Tobacco Prevention and Education Program (TPEP), a comprehensive, community-based program modeled on the successful tobacco-use prevention programs in California and Massachusetts.1,2 To assess the effects of the tax increase and TPEP in Oregon, OHD evaluated data on the number of packs of cigarettes taxed before (1993-1996) and after (1997-1998) the ballot initiative and implementation of the program. Oregon's results also were compared with national data. This report summarizes the results of the analysis, which indicate that consumption of cigarettes in Oregon declined substantially after implementation of the excise tax and TPEP and exceeded the national rate of decline.
OHD obtained data on the sale of Oregon cigarette tax stamps from the Oregon Department of Revenue for 1993-1998. OHD also obtained data on the proportion of revenue received at the old and new rates after the tax change (February 1997) to calculate the number of packs sold each month. Per capita consumption was calculated by dividing the number of packs sold by the total population of Oregon each year.3
National comparison estimates were generated using data from the Tobacco Institute on state tax receipts for wholesale cigarette deliveries. Reliable figures were available through December 1997.4 Data from Oregon and the other three states (Arizona, California, and Massachusetts) with tobacco-use prevention programs funded through state initiatives were excluded from the comparison estimates. National per capita consumption was calculated by dividing the total number of packs sold by the total population in the remaining 46 states and the District of Columbia.5 Calculations for Oregon for 1996-1998 represent the 1 year before and the 2 years after the tax increase.
From 1993 to 1996, taxable per capita consumption of cigarettes increased 2.2% in Oregon and decreased 0.6% in the 46 remaining states and the District of Columbia. In Oregon, from 1996 to 1998, taxable per capita cigarette consumption declined 11.3% (from 92 packs to 82 packs). Despite a 2.7% increase in the state's population, 25 million fewer cigarette packs were sold in Oregon in 1998 than in 1996. In the United States during 1996-1997, per capita consumption declined 1.0% (from 93 packs to 92 packs).
B Pizacani, MPH, C Mosbaek, K Hedberg, MD, L Bley, PhD, M Stark, PhD, J Moore, PhD, D Fleming, MD, Oregon Health Div. Epidemiology Br, Office on Smoking and Health, National Center for Chronic Disease Prevention and Health Promotion, CDC.
Two years after the implementation of a ballot measure to increase the excise tax on tobacco and initiate TPEP, per capita consumption has declined 11.3% in Oregon, or the equivalent of 200 cigarettes (10 packs) per capita. Elements of the program include community-based tobacco-use prevention coalitions in every county; a statewide public awareness and education campaign; comprehensive school-based programs; tribal tobacco-use prevention programs; multicultural outreach and education; a quitters' help line providing smoking cessation support; and projects evaluating new approaches to prevent or reduce tobacco use. TPEP has an annual budget of $8.5 million, 93% of which is awarded in grants or contracts to external partners (e.g., county health departments, community-based agencies, tribal governments, and private-sector partners implementing the public awareness campaign).
Decreased consumption is probably a result of both the increase in the price of cigarettes and the tobacco-use prevention program. Price elasticity of demand, defined as the percentage change in demand for cigarettes resulting from a 1% change in price, is an estimated −0.4%.6 A 15.8% increase in the price of cigarettes (the amount of the price increase in Oregon, calculated in 1996 dollars) should result in a 6.3% decrease in cigarette consumption. The findings in this report are consistent with reports from other states with tobacco-use prevention programs and indicate that excise taxes in conjunction with prevention programs reduce cigarette consumption more than excise taxes alone.1,7
Other factors that could account for the decrease in cigarette consumption in Oregon probably did not contribute to the decline. Smuggling or cross-border sales probably are insignificant because a large proportion of Oregon's population resides in Portland, near Washington, where cigarette prices are higher. Increased sales on Indian reservations in the state probably would not contribute to the decline because cigarettes sold on reservations are taxed, and tribes are reimbursed only for tobacco taxes paid by tribal members. Another possibility is that the observed downward trend for Oregon may reflect national declines. Although reliable national data are not available for 1998, it is unlikely that the decrease in Oregon reflects secular trends. During 1990-1997, the annual rate of decline in consumption for all 50 states averaged only 1.4%.8
Oregon's decrease in cigarette consumption also appears to be resulting in decreases in smoking prevalence. Preliminary data from the Behavioral Risk Factor Surveillance System for 1996-1998 indicate that prevalence of current smoking among adults in Oregon declined 6.4%, representing 35,000 fewer smokers. The decline in cigarette consumption in Oregon, California, and Massachusetts indicates that an adequately funded, comprehensive tobacco-control program can quickly and substantially reduce tobacco use.
Decline in Cigarette Consumption Following Implementation of a Comprehensive Tobacco Prevention and Education Program—Oregon, 1996-1998. JAMA. 1999;281(16):1483–1484. doi:10.1001/jama.281.16.1483-JWR0428-3-1
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