摘要：Objectives. We evaluated state-level characteristics associated with cigarette excise taxes before and after the Master Settlement Agreement (MSA). Methods. We gathered annual cigarette excise tax rates for all US states and the District of Columbia, between 1981 and 2011, and matched each state–year tax rate with economic, political, attitudinal, and demographic characteristics, creating a data set of 1581 observations. We used panel data regression techniques to assess relationships between key characteristics and state cigarette excise tax levels. Results. Cigarette excise tax rates grew at more than 6 times the rate of inflation between 1981 and 2011; growth varied by time period and region. We found strong negative associations between Republican Party control of state legislatures and governors’ offices and state cigarette tax rates. Tobacco production, citizens’ attitudes toward taxes and tobacco control, and cigarette tax rates in neighboring states were significantly associated with cigarette tax rates. We found no association between unemployment and tax rates. Conclusions. Future excise tax growth rate may depend more on the political leanings of state legislators, and the attitudes of the people they represent, than on economic circumstances. Smoking prevalence has declined in the past few decades, but recently, progress has stalled. 1,2 In 1997, nearly 1 in 4 adults, and more than 1 in 3 youths, smoked at least 1 cigarette in the previous month. Although by 2007 rates for both groups had dropped to about 20%, no declines have been observed since. 2,3 Without further progress, Healthy People 2020 goals for smoking among adults (12%) and youths (16%) will not be met. 4 Cigarette excise taxes are considered one of the most effective strategies for reducing smoking. 5,6 Higher cigarette prices are associated with decreased consumption, 7–9 and taxes are an effective tool for raising product price. 10 Furthermore, in almost half of all states, some portion of excise tax revenues fund tobacco control programs. 11 Although all states levy cigarette taxes, rates vary extensively. 12 In 2011, New York’s $4.35 tax rate was more than 25 times higher than Missouri’s $0.17 rate. 13 Geographic variation in taxes may promote regional disparities in smoking prevalence and encourage cross-border smuggling or online tobacco sales, limiting the public health impact and revenue generation capabilities of high taxes. 13–15 In 2007, the Institute of Medicine recommended that states with excise taxes below those in the top quintile raise their rates to match those in high-tax states. 6 Yet raising cigarette taxes, especially in low-tax states, has proven difficult. Between 2007 and 2011, only 43% of states in the bottom 4 quintiles raised taxes, whereas 91% of the highest-tax states increased their rates. 12 Little is known about what motivates recent changes in state excise tax levels. Tobacco control advocates have suggested that economic contractions may drive states to raise cigarette taxes to generate revenue, noting high numbers of tax hikes following national recessions. 16 Political scientists, however, argue that political factors and regional pressures may also be important policy predictors. 17–19 Nonelection years and neighboring tax initiatives, in addition to poor fiscal health, have been associated with diffusion of gasoline and income taxes. 18 Public support of tobacco control, as well as actions of local and neighboring governments, influence the uptake of indoor air and tobacco sales restriction policies. 20,21 The extent to which economic circumstances, state politics, constituency beliefs, or regional pressures influence state cigarette excise tax rates, however, remains unclear. Moreover, the key determinants of cigarette taxes can change over time, as public opinion evolves. The 1998 Master Settlement Agreement (MSA) with tobacco manufacturers generated new allocations of tobacco control revenue, some of which was used to fund social marketing campaigns about smoking and the tobacco industry (e.g., the “truth” campaign). One study did document some economic and political correlates of state cigarette tax rates, but relied on data through 2000, just as the impact of the MSA began. 22 In the years since the MSA, the public has increasingly identified smoking as hazardous, and the majority now supports some form of tobacco control legislation. 23 If these public sentiments influence beliefs about cigarette taxes, the political landscape in which tax decisions are made could be changing. Better understanding of which factors most strongly predict cigarette taxes could help tobacco control professionals target their advocacy. We used annual data from all 50 states between 1981 and 2011 to explore the magnitude of the associations between key economic, political, and regional characteristics and state cigarette excise tax levels, both before and after the MSA.
