The US will miss 5% smoking prevalence target by 2030 without more cigarette tax hikes

Most States Falling Behind Healthy People 2030 Goals

The United States is projected to miss its 5% smoking prevalence target by 2030, part of the national Healthy People 2030 initiative, unless cigarette taxes are significantly increased.

An analysis shows that only five states—Washington, Utah, Rhode Island, Massachusetts, and Maryland, along with the District of Columbia (DC)—are currently on track. The remaining 45 states will need to raise cigarette excise taxes annually—by as much as $1.37 per pack—to close the gap.

Tax Hikes: A Critical Yet Underused Strategy

To assess whether tax policy could help states reach this target, the researcher compared state smoking trends from 2011 to 2019 with the trajectory needed to reach 5% prevalence by 2030.

Key Findings:

• Current smoking prevalence ranges from ~7% in Utah to ~23% in West Virginia.

• Price-adjusted trends from 2011–2019 show little to no progress in some areas—0.00% in Hawaii and Montana.

• Desired annual trends for reaching the 5% target range from –0.23% in Utah to –1.97% in West Virginia.

These disparities informed projections on the required tax hikes, ranging from $0.02 to $1.37 per pack per year, when combined with other tobacco control measures.

Policy Inaction: A Missed Opportunity

Despite evidence supporting higher tobacco taxes as an effective deterrent, only 22 states increased cigarette excise taxes during 2011–2021. The author calls this a “severely underused measure” in the broader tobacco control arsenal.

Future Price Projections:

By 2030, the desired average price for a pack of cigarettes is projected to range from $6.13 to $18.40, depending on the state.

Equity Considerations: Supporting Vulnerable Communities

The analysis also highlights a potential downside: disadvantaged smokers may suffer unintended financial consequences from these tax hikes, especially those struggling to quit.

To mitigate these effects, the author recommends:

• Scaling up non-tax tobacco control programs in disadvantaged areas

• Harmonizing taxes and prices across state borders

• Monitoring tobacco industry interference

Takeaway

Without strategic, consistent increases in state cigarette excise taxes, the 5% smoking rate goal by 2030 is likely to remain unmet. For meaningful progress, tax policy must be paired with targeted cessation programs, especially for at-risk communities. BMJ