The Effect of State-Funded Anti-Tobacco Expenditures on Youth Tobacco Use

Tobacco use is one of the major preventable causes of death in the world and causes nearly 6 million deaths per year even though there is a significant downward trend in tobacco use in the US. Current trends show that tobacco use will lead to more than 8 million deaths annually by the year 2030 (Centers for Disease Control and Prevention, 2018). While thousands of young people start smoking cigarettes every day, tobacco use by adolescent has declined substantially in the last 40 years. Among potential new smokers, the young are the most vulnerable. For the young, the adverse health effects are worse than adults because they smoke for more of their life. Already, over 3,200 people age 18 and younger smoke their first cigarette, and each day an estimated 2,100 adolescents who occasionally smoke become regular smokers. Almost 23 percent of high school students currently use tobacco products (Centers for Disease Control and Prevention, 2018). If smoking continues at the current rate among youth in the US, 5.6 million of today’s Americans younger than 18 will die early from a smoking-related illness.

Thus, all states in the US. have invested in large-scale comprehensive tobacco control programs for the entire population to prevent and reduce initiation of tobacco use and to promote quitting. Previous studies show that the longer that states invest in such programs, the greater the impact. After implementing a large-scale comprehensive tobacco control program, Massachusetts (Biener et al., 2000), Oregon (Pizacani et al., 1999), Arizona and Florida (Tauras et al., 2005) observe reductions in smoking. However, in contrast to the increasing number of state-specific studies, a few studies exist from the national-level analyses of the impact of investment tobacco control. Also, only few studies explore heterogeneous effects by age. If so, those studies mainly focus on the adult population. Hence, it is unclear whether or not these policies have different effects across each age group.

This paper attempts to fill in that gap by examining the causal impact of state-level per capita tobacco control expenditures on youth smoking prevalence in national-level to use data from the National Youth Tobacco Survey (NYTS). NYTS is a nationally representative sample of adolescents, which makes it ideal to evaluate the effect of tobacco control programs on the young. Thus, this study contributes to the existing research by showing if there exists a more effective way to implement state tobacco control policies. If current state tobacco programs do not influence or worsen adolescent smoking behavior, then the state or federal government should scale back these programs. Alternatively, if state tobacco programs do decrease smoking rates among adolescents, such policies should be expanded. Looking at heterogeneous responses from different population groups will help policymakers write legislation that accurately targets different population groups. This can prevent wasting limited resources in this country and enhance the overall health.