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. 2025 Sep 1;117(9):1883-1890.
doi: 10.1093/jnci/djaf121.

Association of a major tobacco tax increase in California with increased smoking cessation

Shu-Hong Zhu  1   2 , Christopher M Anderson  2 , Yue-Lin Zhuang  2 , Hai-Yen Sung  3 , Anthony C Gamst  4
Affiliations

Association of a major tobacco tax increase in California with increased smoking cessation

Shu-Hong Zhu et al. J Natl Cancer Inst. .

Abstract

Background: In November 2016, California voters approved Proposition 56, increasing the cigarette tax by $2.00 per pack and nearly tripling spending on tobacco prevention. This study examined whether the initiative was associated with increased smoking cessation.

Methods: States in the United States were categorized into 3 groups: California, 18 other states (including the District of Columbia) that raised taxes, and 32 states that did not raise taxes. Tax and price increases, tobacco prevention spending per capita, 3-month smoking cessation rates using data from the Behavioral Risk Factor Surveillance System (N = 443 054), and the proportion of daily smoking were compared for 2014-2016 and 2017-2019 for these groups.

Results: California had the largest increases in cigarette price (30.8%) and tobacco prevention spending (271.9%), both adjusted for inflation. Other states that raised taxes experienced price increases of 6.3% on average. The 3-month smoking cessation rate in California increased from 11.5% in 2014-2016 to 14.2% in 2017-2019 (P = .005). Among other states that raised taxes in that timeframe, cessation rates did not change significantly, from 8.6% to 8.7% (P = .755). Among states that did not raise taxes, cessation rates declined significantly, from 9.5% to 9.0% (P = .026). California also had a significant reduction in the proportion of daily smokers among those who did not quit (from 60.4% to 56.4%, P = .012).

Conclusions: A major cigarette tax increase was associated with increased smoking cessation in California. Policies increasing tobacco taxes and re-investing new revenue in tobacco prevention can increase population cessation.

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Conflict of interest statement

S.Z., C.M.A., Y.Z., H.S., and A.C.G. report research grants and service contracts to their institutions from the Tobacco-Related Disease Research Program and the California Department of Public Health, funded in part with tax revenue from Proposition 56, outside the submitted work.

Figures

Figure 1.
Figure 1.
Smoking cessation rates among adult smokers for 3 groups of states in 2014-2016 and 2017-2019. States include the 50 US states and the District of Columbia. In grouping states, only tax increases from 2014 to 2019 were considered. Cessation rates based on data from the Behavioral Risk Factor Surveillance System, 2014-2019. Comparison between the 2 time periods for the 3 groups is as follows: California (n = 8698), difference = 2.6 percentage points, P = .005; 18 states with tax increase (n = 147 615), difference = 0.1 percentage points, P = .755; 32 states with no tax increase (n = 286 741), difference = −0.5 percentage points, P = .026.
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