Cigarette Tax is Good Health Policy, Especially for Kentucky Babies and Youth

William D. Hacker, MD

• 23,200 more Kentucky youth who become smoke-free adults.
• Nearly 1,200 healthier newborns every year.
• $1 billion in long-term health care cost savings.

Isn’t that worth a dollar more?
Health advocates are calling for a $1 per pack increase in Kentucky’s state tax on cigarettes because it will reduce tobacco use, particularly among youth and pregnant women. Less smoking means healthier babies and youth and a significant reduction in the health care costs paid by taxpayers.

Raising Kentucky’s cigarette tax is good health policy and nearly seven in 10 Kentucky voters support it. Lawmakers don’t need to wait for a special tax reform session to start improving the health of Kentucky’s youngest residents. They can enact it right now and start reducing smoking on July 1.

Smoking and Youth
More than eight in 10 smokers started using tobacco before they turned 18. If we prevent Kentucky youth from smoking now, we’ll greatly reduce adult smoking over time. Youth are price-sensitive – when tobacco products cost more, fewer kids buy them. But right now, Kentucky has the 43rd lowest tobacco tax in the nation and one of the highest youth smoking rates.

In fact, Kentucky’s high school youth smoking rate is 14.3 percent. That’s 79 percent higher than the national average of 8 percent. Youth smoking is on a downward trend, but it’s not dropping nearly as quickly in Kentucky as elsewhere in the country.
And youth use of e-cigarettes, or vapes, is alarmingly high. In 2016, 14.1 percent of Kentucky high school students said they were e-smokers. The national rate is 11.3 percent, but that’s up from just 1.5 percent in 2011! More than 44 percent of Kentucky high schoolers and even 15 percent of middle schoolers have tried vaping. Research shows that youth who have tried e-cigarettes are more likely to be cigarette smokers later on. Moreover, teen tobacco users are more likely to use alcohol and illegal drugs.

Cigarettes are heavily associated with ADHD, PTSD, depression, and anxiety in teens. They are the most effective drug delivery device you can get, sending nicotine-laden smoke to the lungs where miles of tiny blood vessels absorb the toxin and carry it directly to the brain. The nicotine then kicks the brain into releasing a feel-good chemical called dopamine. Smoke just a few cigarettes or vapes and the brain starts needing more and more dopamine to feel good. Other behaviors that used to trigger dopamine release – social interaction, physical activity, and food – don’t work as well as they used to. This process happens even faster in teens’ brains, which are wired to take risks and push away from adult control. The result? An addiction that is difficult to break and frequently leads to illness, disease and premature death.

Smoking and Babies
It’s that strong addiction that is behind the high rate of smoking during pregnancy in Kentucky. About one in five women in Kentucky smoke cigarettes during pregnancy – that’s more than double the national rate. In four Kentucky counties, the rate exceeds 41 percent and in Lee County, nearly half of pregnant women smoke. Even in Fayette, Oldham and Jefferson Counties, where a lower proportion of women smoke during pregnancy than elsewhere in the Commonwealth, the rates exceed the national average of 10 percent.

Smoking during pregnancy affects the pregnancy itself, as well as the health of the baby. It can lead to miscarriage. It can damage the placenta, which is the source of food and oxygen for the baby during pregnancy. Smoking can cause babies to be born too early, too small, and with underdeveloped lungs. It can cause birth defects such as cleft lip or palate, and lead to Sudden Unexplained Infant Death Syndrome, commonly known as SIDS. And children born of moms who smoked during pregnancy and early childhood are much more likely to develop chronic diseases in adulthood.

Breaking the Addiction
Kentucky lawmakers have the most effective tool available for reducing smoking among youth and pregnant women. The experience of multiple other states shows that a significant price increase always reduces smoking. By the way, it always brings in more revenue as well. But we are not seeking this measure as tax policy. We support it because it will improve health in Kentucky as it has improved health in other states. Just think:
• 23,200 more Kentucky youth who become smoke-free adults.
• Nearly 1,200 healthier newborns every year.
• $1 billion in long-term health care cost savings.

Isn’t that worth a dollar more?
Dr. William Hacker, a Clay County native, formerly was Kentucky Public Health Commissioner.

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